Bruce Wampold

University of Wisconsin--Madison and Modum Bad, Norway

Objective: Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia). Method: The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT super...

Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331 patients...

The second edition of The Great Psychotherapy Debate has been updated and revised to expand the presentation of the Contextual Model, which is derived from a scientific understanding of how humans heal in a social context and explains findings from a vast array of psychotherapies studies. This model provides a compelling alternative to traditional...

Objective: Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. Method: The present study examined changes in psychothera...

It has been argued that psychotherapy is a profession without any expertise (Shanteau, 1992). We examine the validity of this claim, reviewing the literature on expertise, clinical decision making, and psychotherapeutic outcome assessment, and find it a reasonable assessment. There is no demonstration of accuracy and skill that is associated with e...

The COVID-19 pandemic forced governments to implement a range of public health measures that disrupted the personal and professional lives of many, including an abrupt adoption of telemental health services. Using data from a nonprofit counseling practice, we tested whether telemental health services delivered during the pandemic were inferior to f...

The concept of alliance reflects the collaborative relationship between a clinician and a patient, defined as consisting of three elements: a) the agreement on the goals of treatment; b) the agreement on a task or series of tasks; c) the development of a bond. Although much of the theory and research on the alliance comes from the domain of psychot...

Background Patients with chronic depression (CD) typically have an early symptom onset, more psychiatric comorbidities, more treatment attempts, and more frequent and longer inpatient hospitalizations than patients with major depressive disorders. The main purpose of this study was to investigate the effectiveness of an intensive inpatient psychoth...

De therapeutische alliantie of werkrelatie heeft in de psychotherapie de status ‘gemeenschappelijke factor’ gekregen, vanwege het robuuste verband met de uitkomst van behandelingen. De opdracht voor ons werkveld is nu om een genuanceerder beeld te krijgen van de invloed van de alliantie op de mate waarin tijdens de therapie vooruitgang wordt geboek...

Meta-analyses have established the alliance as the most robust predictor of outcome in psychotherapy. A growing number of studies have evaluated potential threats to the conclusion that alliance is a causal factor in psychotherapy. One potential threat that has not been systematically examined is the possibility that the alliance-outcome associatio...

Previous research suggests that common relationship factors are composed of two overarching factors, "Confidence in the therapist" and "Confidence in the treatment." The aim of this naturalistic process-outcome study was to investigate the reciprocal relationships between these two constructs and patients' symptom level across treatment. The sample...

Psychotherapy can be an emotionally laden conversation, where both verbal and nonverbal interventions may impact the therapeutic process. Prior research has postulated mixed results regarding how clients emotionally react following a silence after the therapist is finished talking, potentially due to studying a limited range of silences with primar...

Objective: The aim of this naturalistic process study was to investigate the relationship between emotional clarity and tolerance of emotional distress and depressive symptoms over the course of short-term psychodynamic psychotherapy for chronically depressed patients. Method: Weekly self-reports of emotional clarity, tolerance of emotional dist...

Psychotherapy as it is implemented today, can be seen as the composition of unconnected groups of practitioners and scientists pursuing different theories. The idea of finding a common “umbrella” for all evidence-based treatments in the field of psychotherapy is gaining more interest. Based on this background, experts in clinical psychology from va...

Objective: This meta-analysis examined the relative efficacy of bona fide psychotherapy conditions in generalized anxiety disorder (GAD) from posttreatment to follow-up in adults. Methods: Omnibus tests of relative efficacy across bona fide psychotherapies for primary and secondary outcomes were conducted. Longitudinal multilevel subgroup analys...

Objective: The present study tested the efficacy of an unguided internet-based Acceptance and Commitment Therapy (iACT) program for depression, and identified the psychological characteristics of participants who benefitted the most from the program. Method: Undergraduate students with mild to severe symptoms of depression were randomized to the...

Patients seeking psychotherapy may progress through treatment in varying ways. Modeling multiple treatment trajectories through growth mixture modeling provides a comprehensive way of understanding a patient population. Multiple trajectories may additionally help researchers describe complexities within a patient population, such as those with seve...

Introduction This work builds on a small body of literature that explores core processes in psychotherapy, behavior change, and evidence-based alcohol or other drug (AOD) therapies. Here, this paper discusses two separate but dependent processes. The research team defines goal setting and goal monitoring as collaborative processes where clinicians...

Free access see above DOI: Estimating the reproducibility of psychotherapy effects is essential. This is particularly crucial for trials with large effects, as the inclusion of false-positive trials can lead to erroneous conclusions about treatment efficacy in research syntheses. We identified 184 papers, of which 30 referred to treatment outcomes...

The present study aimed to explore the relationship between changes in depressive symptoms and the capacity to mentalize over the course of a 3-month inpatient psychodynamic therapy in a sample of 56 patients with depression. Depressive symptoms and mentalizing were assessed weekly during treatment and at 1-year follow-up with the Beck Depression I...

Objective: Depression is typically seen as composed of several factors (i.e., cognitive, affective, somatic) which may be targeted by different interventions (i.e., pharmacotherapy, psychotherapy, or combination treatment). Successfully targeting these factors may contribute to improved treatment response in depression. A previous study identified...

This study aimed to examine if survivors of childhood abuse responded differently to couple and family therapy compared with patients without such experiences. The study included 36 couples and nine individuals (N = 81). Of these participants, 30.3% had disclosed being exposed to and/or physical or sexual abuse during childhood. All participants of...

When a patient presents to a health provider, the course of the disorder is composed of three effects: natural effects, specific effects, and contextual effects. Part of the contextual effect is due to the relationship between the healer and the patient. Social healing appears to be present in eusocial species and particularly well-developed in hum...

Objective: Prior research has established that common therapeutic relationship factors are potent predictors of change in psychotherapy, but such factors are typically studied one at a time and their underlying structure when studied simultaneously is not clear. We assembled empirically validated relationship factors (e.g., therapist empathy; patie...

Overview In the current work, we build upon a small body of literature that delineates cross-cutting factors, or processes, of evidence-based alcohol or other drug (AOD) therapies. Here, we discuss Psychoeducation. We define psychoeducation as a brief process of therapy focused on the communication of varied aspects of disease- and/or treatment-rel...

Objective: The relationship between the therapeutic alliance and outcome has been supported consistently over time. More recently, studies have examined therapist effects in the alliance-outcome relationship and came up with somewhat mixed findings. The purpose of this study was to replicate and extend previous meta-analytic work using a much larg...

Objective: Mental health disparities between racial/ethnic minorities (REM) and White individuals are well documented. These disparities extend into psychotherapy and have been observed among clients receiving care at university/college counseling centers. However, less is known about if campus RE composition affects outcomes from psychotherapy fo...

The therapeutic alliance has gained status as a common factor in psychotherapy due to its robust predictive relationship with outcome. The current challenge in our field is to gain a more nuanced understanding of alliance's impact on the progress of treatment over the course of therapy. In the current study, alliance was measured on 3 dimensions: (...

Research indicates combination of psychotherapy and antidepressant medication (ADM) provide cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi‐experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12‐week psychotherapeutic inpatient t...

Background: The factor structure of depression differs for different sub-samples. The purpose of this study was to explore the factor structure of Beck Depression Inventory-II in patients with chronic depression presenting for inpatient treatment. Methods: Using exploratory structural equation modeling (ESEM), we explored whether a two-factor so...

Objective In couple therapy clients often suffer from a blend of individual psychiatric symptoms as well as severe relational distress. However, research is inconclusive on whether relational change predicts symptom change or vice versa. Because answers to this question could have important clinical implications on what to focus on in couple therap...

Objective: Both good therapeutic bond as well as extra-therapeutic social support seem to enhance treatment outcomes. Some features of the therapeutic bond are similar to experiences in extra-therapeutic relationships (e.g., feelings of trust or belongingness). Patients with a lack of social support might benefit particularly from a good therapeuti...

Objective: To better understand the complexity of dyadic processes, such as the mechanisms of the working alliance, researchers recommend taking advantage of innovations in data analytic procedures when studying the interactions between therapists and patients that are associated with favorable therapeutic outcomes. Inspired by a recent line of all...

Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-se...

Overview This work builds on previous efforts to delineate cross-cutting factors of evidence-based therapies. In this report, we target a single therapeutic factor—skills training for addictive behavior change—and we operationalize this factor in a manner that will aid clinical training and quality control. Specifically, we identify principles, whi...

Aims The purpose of this review is to examine the replication attempts of psychotherapy clinical trials for depression and anxiety. We focus specifically on replications of trials that exhibit large differences between psychotherapies. The replicability of these trials is especially important for meta-analysis, where the inclusion of false-positive...

(Open access: https://www.karger.com/Article/FullText/507793) Deciding on the number of psychotherapy sessions to satisfactorily treat a patient is a vital clinical as well as economic issue in most mental health systems worldwide. Based on a systematic review, we identified 20 naturalistic samples across 8 countries (published between 2015-2019)....

The alliance is widely recognized as a robust predictor of posttreatment outcomes. However, there is a debate regarding whether the alliance is an epiphenomenon of intake characteristics and/or treatment processes occurring over the course of treatment. This meta-analysis aimed to synthesize the evidence on this issue. We identified 125 effect size...

Objective Cross-sectional data show elevated levels of circulating cytokines in psychiatric patients. The literature is divided concerning anti-inflammatory drugs’ ability to relieve symptoms, questioning a causal link between inflammatory pathways and psychiatric conditions. We hypothesized that the development of circulating cytokine levels is re...

Work functioning has significance for the individual and society but has rarely been used as an outcome measure for psychotherapy. Work‐related factors such as work satisfaction and working hours impact personal and relational life. More than half of those on sick leave suffer from social problems such as family‐related distress or mental health is...

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between t...

This replication study examined the change over time and the relationship between depressive symptoms and dyadic adjustment during residential couple therapy and at one- and three-year follow-up. Mixed models were used in the analyses, and a disaggregation procedure was applied to examine the results on a between-person as well as on a within-perso...

Why the concept of distinct psychotherapeutic approaches is indispensable - and why the tool box concept of psychotherapy cannot workBackground: In Germany, the official psychotherapy guidelines are oriented towards the model of distinct psychotherapeutic approaches. Within the German health care system this also applies to the training in psychoth...

Background: The combination of eating disorder (ED) and the experience of childhood trauma leads to significant impairment and suffering. To improve treatment, it is critically important to study treatment effects, and the mechanism of these effects. The overall aim of the current project is to; (1) build knowledge on how to best treat patients wit...

In recent years, McNamara, and associates Hambrick and Oswald, conducted and published studies which purportedly showed deliberate practice exerts less powerful main effects than presented and popularized in the press, public discourse, and professional circles. Their central aim seemed to be one of correcting a particular misperception, as they su...

In recent years, Macnamara, and associates Hambrick and Oswald, conducted and published studies which purportedly showed deliberate practice (hereafter, DP) exerts less powerful main effects than believed and popularized in the press, public discourse and professional circles. Their central purpose seemed to be one of correcting a misperception, as...

Objective: Background regarding a recent debate between Cuijpers et al. (2019a, b) and the authors (Munder et al. 2019) about the efficacy of psychotherapy for depression is given. Method: A main reason for the discrepancy in Cuijpers et al.'s and our conclusions is discussed. Results: In our view the discrepancy is due, among other things, to a bl...

This chapter introduces the second volume of Psychotherapy Relationships That Work and frames its work within the Interdivisional APA Task Force on Evidence-Based Relationships and Responsiveness. The book presents clinical examples, original meta-analyses, diversity considerations, training implications, and research-infused practice recommendatio...

The alliance continues to be one of the most investigated variables related to success in psychotherapy. In this chapter, the authors define and illustrate the alliance (also conceptualized as therapeutic alliance or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients for face-to-face...

The chapter concludes the third edition of the book by summarizing what works and what does not in psychotherapy responsiveness and treatment adaptations. The authors present the Task Force conclusions and 28 recommendations for training, practice, research, and policy. The authors conclude that adapting psychotherapy in ways reviewed in this book...

Different forms of psychotherapy are effective for cluster C personality disorders, but we know less about what in-session processes promote change. Contrasting successful and unsuccessful cases may elucidate processes that facilitate or impede outcome and offer suggestions for clinical practice and future research. In this exploratory outcome–proc...

Psychotherapy Relationships That Work is the definitive, evidence-based book on the psychotherapy relationship: what works in general (Volume 1) and what works for particular patients (Volume 2). Each chapter presents definitions, clinical examples, landmark studies, comprehensive meta-analyses, diversity considerations, and training implications a...

The therapeutic relationship and responsiveness/treatment adaptations rightfully occupy a prominent, evidence-based place in any guidelines for the psychological treatment of trauma. In this light, we critique the misguided efforts of the American Psychological Association's (APA, 2017) Clinical Practice Guideline on Posttraumatic Stress Disorder i...

This chapter presents the theoretical framework and research evidence of the contextual model, which integrates common factors and specific ingredients in psychotherapy. In working with clients, the specific ingredients and common factors of various therapy approaches are not mutually exclusive but work together to make psychotherapy effective. The...

In this special section of the Journal of Psychotherapy Integration a variety of treatments for PTSD, including prolonged exposure, EMDR, interpersonal therapy, memory specific training, schema therapy, and narrative-emotion process therapy, were described. In this comment, two issues were discussed (a) psychotherapy integration, and (b) mechanisms...

Little is known about the mechanisms through which routine outcome monitoring (ROM) influences psychotherapy outcomes. In this secondary analysis of data from a randomized clinical trial (Brattland et al., 2018), we investigated whether the working alliance mediated the effect of the Partners for Change Outcome Monitoring System (PCOMS), a ROM syst...

Despite widespread scientific and popular interest in mindfulness-based interventions, questions regarding the empirical status of these treatments remain. We sought to examine the efficacy of mindfulness-based interventions for clinical populations on disorder-specific symptoms. To address the question of relative efficacy, we coded the strength o...

In 2014, Macnamara, Hambrick, and Oswald published a meta-analysis of studies questioning the strength of the association between deliberate practice and performance. In this brief report, the correlation reported by Macnamara et al. (2014) is placed in the context of other well-known associations. Additionally, a re-analysis of the studies include...

Monitoring outcome and progress is important to inform clinical decisions during treatment. We discuss why tracking change is insufficient for this purpose. [originally published at https://societyforpsychotherapy.org/did-i-make-a-difference-with-my-client/]

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than...

Die zweite Auflage des Titels „The Great Psychotherapy Debate“ von Bruce E. Wampold und Zac E. Imel liegt nun in der deutschsprachigen Adaption von Christoph Flückiger vor. Das Buch gibt einen umfassenden Überblick über die psychologische Therapieforschung, ihre Geschichte und über die verschiedenen Ansätze, die zur Untersuchung der Wirksamkeit ver...

In this study, we introduce the journal issue devoted to evidence‐based responsiveness and frame it within the work of the third interdivisional APA Task Force on Evidence‐Based Relationships and Responsiveness. We summarize the meta‐analytic results and clinical practices on the adaptations of psychotherapy to multiple transdiagnostic characterist...

Background: A reciprocal relationship between activated innate immune system and changes in mood and behavior has been established. There is still a paucity of knowledge on how the immune system responds during psychiatric treatment. We aimed to explore circulating cytokines and assess psychiatric symptom severity scores during 12 weeks of inpatien...

This study investigated the effects of the Partners for Change Outcome Management System (PCOMS) in adult outpatient treatment at a hospital-based mental health clinic. It also investigated whether the effects differed with the timing of the treatment within a 4-year implementation period, with clients’ initial distress levels, and between therapis...

Aims The aim of this study was to reanalyse the data from Cuijpers et al. 's (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al ., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evid...

We present a classification of five distinct types of clinical difference to monitor in clinical practice, and use this classification to describe major limitations in current systems for routine outcome monitoring (ROM). We find that, by design, ROM systems deliver less than what their supporting evidence suggests—they fail to identify treatment r...

Background: Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching int...

Open access: http://psycnet.apa.org/fulltext/2018-23951-001.pdf Abstract: The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance or working alliance) and then...

Free download: https://doi.org/10.1080/10503307.2018.1430390 (copy&past) Psychotherapy researchers have had a long-standing interest in developing and applying meta-analytic methods.This Special Section aims to provide a synopsis of lasting evidence-based considerations and challenges present in psychotherapy meta-analyses and psychological interve...

Response to placebos has been documented experimentally for many medical disorders and had been verified in laboratory studies. However, the mechanisms that produce the response to placebos are not well identified, although it appears that the relationship between the medical practitioner and the patient plays an important role. Humans and other eu...

One explanation for differences in treatment effectiveness for targeted symptoms is that more-effective treatments are more focused on patients’ problems than are less-effective treatments. This conjecture was examined meta-analytically. Comparisons of two treatments of adults with anxiety disorders were included. Effect sizes for targeted symptoms...

Some of the most important decisions that a researcher will make when conducting a meta-analysis are decisions about the search strategies and inclusion/exclusion criteria. Decisions regarding inclusion/exclusion criteria serve to define the scope of a meta-analysis and search strategy decisions can have a large impact on how well the results of a...

Background Depression, anxiety, excessive alcohol use and trauma history are associated with elevated levels of pro-inflammatory cytokines. Few have investigated cytokines prospectively during psychiatric treatment. We aimed to explore predictors of change in cytokine levels during treatment. Methods Serum blood samples and psychometric scores were...

Despite widespread scientific and popular interest in mindfulness-based interventions, questions regarding the empirical status of these treatments remain. We sought to examine the efficacy of mindfulness-based interventions for clinical populations on disorder-specific symptoms. To address the question of relative efficacy, we coded the strength o...

Few studies have compared the effects of Metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) for comorbid anxiety disorders. In the current study we compared CBT and MCT for heterogeneous anxiety disorders in a residential setting. Ninety patients with a primary diagnosis of Post Traumatic Stress Disorder, Social Phobia or Panic diso...

Psychotherapists have long questioned what mediating processes are linked to outcome of psychotherapy. Few studies examining this question have assessed within-person changes in the process outcome relationship over time. The present study examined changes in cognition and metacognition over the course of therapy using a dataset from a randomized c...