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The great psychotherapy debate: The evidence for what makes psychotherapy work: Second edition

Authors:
  • University of Wisconsin--Madison and Modum Bad, Norway

Abstract

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 research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specific ingredients of treatment. The new edition also includes a history of healing practices, medicine, and psychotherapy, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.
... ad esempio, molti studi hanno confrontato una specifica condizione di trattamento (ad esempio, una CBT manualizzata per i disturbi d'ansia) con una condizione clinica di controllo, per verificare se il cambiamento dei pazienti fosse legato realmente agli aspetti tecnici inerenti alla CBT o a fattori terapeutici 'aspecifici' caratteristici di ogni condizione di supporto psicologico: ci si può aspettare infatti che un paziente riporti un miglioramento soltanto per il fatto di potere parlare con un professionista che lo ascolti, o perché è sollevato dal poter ricevere le cure di qualcuno e superare il proprio stato di demoralizzazione? Tale condizione viene in genere equiparata al gruppo placebo nelle sperimentazioni farmacologiche (Wampold & imel, 2015). in realtà è molto difficile potere parlare di effetto placebo in ricerche di psicoterapia, soprattutto perché in una terapia, a differenza di quanto avviene in farmacologia, non tutti gli attori della sperimentazione (terapeuta, paziente, ricercatore) possono essere tenuti 'in cieco' circa ciò che il paziente sta ricevendo. ...
... Gli studi meta-analitici Nella prospettiva degli evidence-based treatments gli studi meta-analitici rappresentano il punto supremo di evidenza scientifica, in quanto riescono a fornire una stima dell'effetto terapeutico di un determinato trattamento, basandosi su tutti i risultati dei singoli studi pubblicati sul tema (Wampold & imel, 2015). Gli studi metanalitici si articolano in un lavoro di systematic review e di meta-analisi. ...
... a livello generale, le ricerche di tipo meta-analitico stanno comunque mostrando da più di trent'anni come la psicoterapia favorisca un cambiamento positivo nei pazienti, rispetto a gruppi di controllo composti da pazienti non sottoposti a trattamento (Wampold, 2001). a livello empirico, il celebre verdetto di Dodo ('Tutti hanno vinto e tutti meritano un premio') sembra riflettere l'evidenza che nessuna terapia si è mostrata significamene superiore ad altre nel trattamento di specifici disturbi (Wampold & imel, 2015). Tale equivalenza di efficacia terapeutica si è mantenuta anche quando ci si è riferiti al confronto tra terapie 'bona fide', caratterizzate cioè da indicatori chiari e riconosciuti nella comunità accademica e professionale, quali l'essere interventi rivolti alla cura di un paziente con un problema clinicamente rilevante; che si rifacciano ad un approccio terapeutico ben definito; possibilmente ad un manuale di trattamento; con un riferimento a processi psicologici definiti e descritti (Wampold, 2001). ...
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Questo articolo approfondisce il tema del rapporto tra ricerca in psicoterapia e pratica clinica. Nonostante gli avanzamenti nell’ambito della ricerca negli ultimi venti anni, permangono ancora diversi ostacoli nel processo di disseminazione di tale conoscenza. a tal fine, verranno messe in evidenza le differenze tra l’evidence-based research, volta a determinare quale trattamento terapeutico sia più efficace per i singoli disturbi psichiatrici e la practice-based research, che prova ad ottenere dei risultati più vicini alla pratica professionale quotidiana, focalizzandosi su aspetti come la relazione terapeutica, le caratteristiche del terapeuta e del paziente ed i fattori contestuali. È possibile costruire una pratica clinica che non sia sganciata dalle evidenze scientifiche su vari aspetti del lavoro terapeutico. infine, verrà evidenziato come le terapie psicodinamiche abbiano ottenuto varie prove di efficacia che le rendono comparabili a trattamenti di altri orientamenti, anche se la complessità dello studio della relazione terapeutica in tale setting richiede uno sforzo sempre maggiore per integrare ricerca quantitativa e qualitativa.
... This result questioned the very viability of the emerging profession of psychotherapy and the careers of those who would practice it. It would take a number of outcome studies to provide convincing evidence supporting the effectiveness of psychotherapy ( Wampold & Imel, 2015). What became clear that Eysenck's research methodology was not only questionable and limited, as was the case for some other published research in this era. ...
... If there remained any question of psychotherapy's effectiveness, it was firmly resolved during this era. For example, researchers established that psychotherapy was as effective as most medical treatments, including medication ( Wampold & Imel, 2015). Because of the proliferation of new therapies in the previous era, it was not surprising that much research now focused on the question: " Which approach is better?" ...
... In How and Why Are Some Therapists Better Than Others? and colleagues have synthesized the existing literature on therapist effects. Another book that well reflects this current era is the second edition of The Great Psychotherapy Debate ( Wampold & Imel, 2015). Major research developments since the first edition led to a major revision of Wampold's original contextual model of psychotherapy. ...
... The limitations of experimental designs such as Randomized Controlled Trials (RCTs) have been increasingly highlighted within the social sciences during the past few decades (e.g., Anjum et al., 2020;Carey & Stiles, 2016;Clarke et al., 2014;Deaton & Cartwright, 2018;Gillies, 2019;Krause & Lutz, 2009;Maxwell, 2004Maxwell, , 2021Russo & Williamson, 2007;Wampold & Imel, 2015). Yet, the very same designs seem to persistently hold their status as ideal for identifying causal relationships, as reflected in for example the American Psychological Association (APA) Policy Statement on Evidence-Based Practice (APA, 2005(APA, , 2006, which states that "RCTs and their logical equivalents (efficacy research) are the standard for drawing causal inferences about the effects of interventions" (APA, 2006, p. 274). ...
... Rather than documentation of specificity, numerous studies, meta-analyses, and reviews identified factors that cut across the specific treatment models. Factors such as the working alliance between the therapist and the client, motivation, expectations, and various other aspects of the treatment processes consistently explained more of the outcome variance than the theory-specific models or techniques themselves (e.g., Lambert, 2013;Laska et al., 2014;Wampold & Imel, 2015;Wampold & Owen, 2021). The expectations of demonstrable, specific effects of methods or techniques, cautiously tested by clinical experiments, overall were not met. ...
... Acknowledging the need for diversity may help making sense of seeming contra-intuitive empirical findings, such as overall scarce evidence of specific effects of particular methods and theory-specific interventions (e.g., Barkham & Lambert, 2021;Lambert, 2013;Wampold & Imel, 2015). How do techniques, theories and common factors (such as principles of change), the client and the therapist, operate together? ...
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Identifying causal relationships is at the heart of all scientific inquiry, and a means to evidence-based practices and to guide policymaking. However, being aware of the complexities of interactions and relationships, scientists and academics are cautious about claiming causality. Researchers applying methods that deviate from the experimental design generally abstain from causal claims, reserving them for designs that adhere to the evidential ideals of empiricism (e.g., RCTs), motivated by the Humean conceptions of causality. Accordingly, results from other designs are ascribed lower explanatory power and scientific status. We discuss the relevance of also other perspectives of causality, such as dispositionalism and the power perspectives of various realist approaches, which emphasize intrinsic properties and contextual variations, as well as an inferentialist/epistemic approach that advocates causal explanations in terms of inferences and linguistic interaction. The discussion will be illustrated by the current situation within psychotherapy research and the APA Policy Statement on Evidence-Based Practice. The distinction between difference-making and causal production will be proposed as a possible means to evaluate the relevance of designs. We conclude that clarifying causal relationships is an ongoing process that requires the use of various designs and methods and advocates a stance of evidential pluralism.
... One important ingredient of effective treatment is the therapeutic alliance, i.e., the agreement on therapeutic goals and on how to achieve those goals, and the development of a personal bond between the patient and psychotherapist (Bordin, 1979). Therapeutic alliance is a prominent common factor in psychotherapy (Wampold and Imel, 2015) and has proven to be a robust predictor of outcome in psychotherapy (Flückiger et al., 2018). Therapeutic alliance is also assumed to be an essential common factor in the treatment of suicidality (Michel and Jobes, 2011). ...
... Therapeutic alliance is an empirically robust common factor in psychotherapy (Wampold and Imel, 2015) and is assumed to be an essential change factor in the treatment of suicidality, too (Michel and Jobes, 2011). However, studies explicitly investigating the latter are sparse and reported inconsistent results. ...
... Second, our results were not controlled for differences between psychotherapists. This might have impacted our results, since various studies demonstrated that some psychotherapists show better outcomes than others, especially in naturalistic settings (Wampold and Imel, 2015). Effective psychotherapists are able to form stronger alliances across a range of patients (Del Re et al., 2012). ...
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Background Therapeutic alliance is thought to be essential in the treatment of suicidality. Surprisingly, studies about the association between therapeutic alliance and change in suicide ideation over the course of treatment are sparse and reported inconsistent results. Furthermore, theoretically important moderators were rarely explored empirically. Methods We investigated the association between therapeutic alliance and change in suicide ideation (difference between intake and discharge), unadjusted and adjusted for potential confounding variables (diagnoses, sociodemographics etc.) in a sample of 351 inpatients treated in a psychiatric department specialized in crisis intervention and suicide prevention. We also explored if the association was moderated by suicide ideation at intake, history of suicide attempts, and borderline personality disorder (BPD). We ran sensitivity analyses for different diagnostic subgroups, history of suicide attempts, and a quantitative measure of BPD symptoms. Results We found a moderate association between therapeutic alliance and change in suicide ideation (r = 0.30, p < 0.01). This association remained robust after accounting for potentially confounding variables. Suicide ideation at intake, history of suicide attempts, and BPD were not statistically significant moderators. Sensitivity analyses led to similar results. Limitations Therapeutic alliance was assessed only at the end of treatment and causality cannot be inferred from our study method. Conclusions Therapeutic alliance was a robust correlate of improvement in suicide ideation among psychiatric inpatients at risk for suicide, independent from diagnostic groups and other patient characteristics. Our results support the crucial role of therapeutic alliance in the treatment of patients at risk for suicide.
... Doprowadziło to niektórych autorów do wniosku, że za podobne wyniki terapii odpowiadają raczej podobieństwa pomiędzy poszczególnymi odmianami interwencji, a nie różnice (np. Asay, Lambert, 2004;Wampold, Imel, 2015). Podobieństwa dotyczą charakterystyki klienta i środowiska, interakcji klient−terapeuta, przymierza terapeutycznego, oczekiwań klienta i terapeuty co do zmiany. ...
... 1), w którym zmiana kliniczna przedstawiana jest w odniesieniu do czynników relacyjnych; czynniki wspólne (budowanie relacji, kreowanie oczekiwań) integruje się tu z czynnikami szczególnymi (np. określone cele terapii i działania terapeutyczne) (Budge, Wampold, 2015;Wampold, Imel, 2015). ...
... Despite all our efforts to systematize, to manualize method, and to train application, psychotherapy also remains messy. Therapist individual differences have been shown to be a prevailing predictive factor (Wampold & Imel, 2015). Since Donald Kiesler's (1966) seminal critique, pursuits to uniformize the therapist continue and remain as elusive. ...
... We (J. C. M., C. F. E., and L. W. S.) originally based our definition of rupture on Ed Bordin's (1979) transtheoretical reformulation of the alliance construct as comprising the interdependent dimensions of purposeful collaborationagreement on the tasks and goals of treatment-and affective bond-mutual trust and respect-which laid the foundation for its consideration as an integrative variable or common factor (Wampold & Imel, 2015;Wolfe & Goldfried, 1988). Accordingly, rupture has been defined in general terms as • any disagreement on how the patient and therapist work together (e.g., on tasks, such as exploring thoughts and feelings, creating in-session exercises and between-session experiments) and to what end (e.g., goals, such as greater self-awareness, skill development, or decrease in symptom distress); and ...
... Clients play an important role in therapy and experience firsthand the impacts of the therapeutic process. In fact, scholars have suggested that client factors play a larger role in treatment success compared to other factors (Bohart andWade 2013, Fuertes andWilliams, 2017;Wampold and Imel 2015). Additionally, treatment success is associated with a stronger degree of treatment satisfaction, which is further related to specific client characteristics (Bucher et al. 2019;Eugster and Wampold 1996;Lipton and Stewart 1999;McCracken et al. 2002). ...
... The results highlight the role that specific client characteristics play in successful therapeutic outcomes. Through the lens of the CFT, of the factors that are viewed as influencing therapy success, client characteristics have been recognized as perhaps the most important (Bohart and Wade 2013;Fuertes and Williams, 2017;Wampold and Imel 2015). The results of this study suggest that the SBWA, a specific cultural characteristic of Black women, may interfere with the client's perceptions of the working alliance with the therapist, in turn, impeding clinical progress. ...
Article
The Strong Black Woman archetype (SBWA) describes a cultural pattern where Black women are expected to and present as physically and mentally strong, regardless of past and ongoing stressors. The SBWA has served the historical purpose of aiding survival for Black women throughout years of racial and gender oppression. However, the practice has also been associated with adverse mental health and with behaviors, such as self-silencing, that could impede therapeutic process. The purpose of this empirical study was to investigate the relationships between adherence to the SBWA and therapeutic outcomes (i.e., satisfaction with therapy, satisfaction with therapist, perceptions of one's global improvement in therapy) among Black women with childhood sexual abuse histories-a subpopulation at increased need for mental health treatment and who may be susceptible to high levels of adherence to the SBWA. Black adult female participants (N = 103) completed an online survey including a demographic questionnaire, an assessment of SBWA endorsement, and treatment outcomes from their current or most recent therapy experience. Three hierarchical linear regressions were conducted with SBWA as the independent variable and (i) satisfaction with therapist, (ii) satisfaction with therapy, and (iii) global improvement as the dependent variables. Consistent with our hypotheses, we found that SBWA inversely predicted satisfaction with therapy and the therapist. While the relationship between SBWA and global improvement was statistically significant, the finding was not practically significant. Still, our study findings suggest that higher levels of SBWA predict less favorable therapy outcomes. Future research directions and clinical implications are discussed.
... We experienced the shift from our secure epistemological position of the linear causality of the medical model to the unsecure epistemological position of circular causality, that is the shift from objectivistic certainty to the cybernetic (circular) "certainty in uncertainty" (Možina, 2010). We also reframed the medical model that we were used to with the "contextual model" (Wampold & Imel, 2015). Our medical professors taught us that we are objective observers of patients and that as experts we should know what to do with them. ...
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The "visible invisible" live supervision: The impact of the supervisor's participation on live supervision "Vidno nevidna" supervizija v živo: Vpliv supervizorjevega sodelovanja v superviziji v živo Abstract Live supervision (LS) is a special variety of (systemic) supervision which is not only efficient for providing quality supervision to the supervisees, but enables students/observers to experience directly live therapy and actively participate in many therapeutic processes during their practicum and internship. We present a qualitative analysis of 7 LS sessions after which 52 observers evaluated four dimensions of the supervisor's participation: 1. activity-passivity, 2. non-verbal-verbal participation, 3. the use of the therapeutic space, and 4. the co-creation of the atmosphere. It was possible to summarize the positive evaluations with the concept of the "visible and invi-sible" way of the supervisor's cooperation. On this basis, recommendations are given for the use of the constructivist, solution-focused and narrative model of LS, for the systematic evaluation of live supervision and for further research of the LS process in the future.
... 272); that is, ratings of the strength of the alliance do not differ significantly as a function of the therapist's theoretical orientation. More generally, effective therapists of all types share common traits, including the ability to engage in a warm, collaborative relationship, accurately assess clients' emotional states, and discuss the rationale for their treatment approach (Wampold & Imel, 2015). Arguably, then, therapists across multiple theoretical orientations share similar feelings about their dishonesty, believing it justified if it serves to maintain the therapeutic relationship. ...
Article
To examine whether and how therapy orientation is associated with psychotherapists’ perceived reasons for, feelings about, and regrets around their own dishonesty in therapy. A sample of 255 psychodynamic (n= 81), cognitive-behavior (n= 92), integrative (n= 64), and humanistic (n= 18) therapists who reported having been “less than completely honest” to a client provided open-text responses regarding this occurrence. A bricoleur approach was used to identify themes among responses, and Fisher’s exact test analyses were used to compare responses across theoretical orientations. The most frequent reason offered for instances of less than complete honesty was “treatment strategy” (i.e. it was deemed necessary for treatment). The most common feeling reported was discomfort, including anxiety. Most respondents reported that, in retrospect, they would not have handled the situation differently. Therapist orientation was not significantly associated to any pattern of responses to these questions. While therapist dishonesty is perceived as occurring primarily in the service of the client and tends to evoke similar reactions among therapists across theoretical orientations, most therapists report experiencing negative feelings after acting somewhat dishonestly. Training programs should encourage greater discussion about the potential benefits and consequences of therapeutic dishonesty, including instances of therapeutic tact.
... Therapist's performance in psychological interventions is a key factor to both research and clinical practice (Beutler et al., 2004;Dinger et al., 2008;Norcross & Lambert, 2011;Ricks, 1974). In fact, from a common factor's perspective, metanalysis conducted over the years found higher effect sizes for therapist than for therapy, showing up to 21% of effect size in natural clinical settings (Baldwin & Imel, 2013;Crits-Christoph et al., 1991;Johns et al., 2019;Wampold & Imel, 2015). Although there are controversies about the accuracy of common factors studies for these kind of outcome comparisons (e.g., Siev & Chambless, 2007), what studies on the specific common factor therapist effect show is that, regardless the therapeutic model or client's problematic, there are therapists who are systematically better than others (Johns et al., 2019;Miller et al., 2008). ...
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Highly effective therapists are clinicians who systematically achieve excellent therapeutic outcomes. However, variables that could explain this performance still unknown. To identify these variables (i.e., definition, objective measurements; and the degree to which the independent variables measure what it claims) could help to know more about highly effective therapists’ performance. Therefore, a systematic review was conducted. Publications between 2000 and 2020 -from Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Scholar and ProQuest Research Library databases- were included. After analyzing 2784 empirical works, 31 studies have met the inclusion criteria. This systematic review allowed to identify, summarize, and define almost 50 variables that could predict therapists’ effects. The need to increase construct validity, to improve empirical designs, and to measure therapist-client interaction is discussed. Los terapeutas altamente eficaces son aquellos que logran sistemáticamente elevados niveles de éxito terapéutico. Sin embargo, aunque se contraste empíricamente dicha eficacia inter-terapeuta, todavía no se conocen cuáles son las conductas que explican este desempeño diferenciado. El objetivo de este trabajo es identificar las variables asociadas a estos terapeutas altamente eficaces, sus definiciones, los parámetros de medida de éxito y la precisión con la que se miden los constructos de interés. Para ello, se realizó una revisión sistemática (RS) con publicaciones entre los años 2000 y 2020 de las bases de datos Scopus, MEDLINE/PubMed, Web of Science, PsycInfo, Google Académico y ProQuest Research Library. Se seleccionaron 2784 artículos empíricos, de los cuales 31 cumplieron los criterios de inclusión. Los principales resultados muestran que hay casi 50 variables predictoras del efecto del terapeuta. Se resume y se define cada una de estas variables psicológicas, y se concluye que para lograr explicar el alto nivel de éxito inter-terapeuta es necesario incrementar la validez de constructo de las variables predictivas, adecuar el diseño de las investigaciones e incluir datos con respecto a la interacción entre el terapeuta y su cliente.
... 'Atheoretical amalgamation' has been a legitimate criticism of a common factors approach -that such an approach is nothing more than lists of nice, endlessly strung together features that lack theoretical anchor (cf. Wampold, 2015;Wampold & Imel, 2015). That very same criticism could legitimately be levelled at all that I have said thus far about psychoanalytic/psychodynamic supervision. ...
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I subsequently summarize the quintessentials of my talk, “Core Quintessentials of Psychoanalytic/Psychodynamic Supervisory Thought and Action: In Three Parts”, presented to the British Association for Psychoanalytic/Psychodynamic Supervision, 8 October 2022. I give focus to three ever fundamental, foundational areas: (a) the anchoring convictions that ground my supervisory perspective (the supervision foundation upon which I stand); (b¹) my search to identify the crucial commonalities that animate my own supervisory practice and perhaps bind us all together as supervisors (a common factors, common processes, common practices perspective); and (b²) my complementary effort to accordingly propose an explanatory framework within which those binding commonalities could be situated (the Contextual Psychoanalytic/Psychodynamic Supervision Relationship Model); and (c) my struggle to work at forever making culture an integral part of who I am, how I think, and how I act as a supervisor (striving to incorporate a multicultural orientation into my practice and bring the Cultural Third to life). I offer these personal sharings, my personal perspective (along with perspective-consistent references), in hopes of stimulating further reader reflection, dialogue, and conversation about these core matters of quintessential psychoanalytic/psychodynamic supervisory importance.
... La investigación ha confirmado, tal y como postuló Bowen (1991), que la diferenciación del self está asociada con la salud mental de las personas. Asimismo, diversos metaanálisis han concluido que la psicoterapia produce cambios significativos en la salud mental y el bienestar psicológico de los clientes, y que, además, no existen diferencias significativas entre los resultados obtenidos por cada modelo terapéutico (e.g., Wampold e Imel, 2015;Wampold et al., 2017). ...
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RESUMEN: Antecedentes: La diferenciación del self es la capacidad intrapsíquica de distinguir las emociones de las cogniciones, y la capacidad interpersonal de mantener vínculos significativos y ser autónomos. Objetivo: Analizar la relación entre la diferenciación y las habilidades sociales, y las diferencias en la diferenciación en función de la asistencia a psicoterapia en una muestra española. Método: La muestra está formada por 126sujetos españoles, 78 mujeres y 48 hombres, de entre 18 y 65 años, que contestaron un cuestionario sociodemográfico, la Escala de Diferenciación del Self y la Escala de Habilidades Sociales. Resultados: Se observaron relaciones entre la diferenciación y las habilidades sociales. Además, la fusión con los otros y el corte emocional predecían las habilidades sociales. Por otro lado, los sujetos que habían realizado una terapia anteriormente y aquellos que nunca habían acudido a terapia tenían unos niveles de diferenciación más altos que aquellos que acudían a terapia en el momento del estudio. Conclusiones: Existen asociaciones entre la diferenciación del self, las habilidades sociales y la asistencia a terapia. Se discuten los resultados y se sugieren futuras líneas de investigación- ABSTRACT: Background: Differentiation of self is the intrapsychic capacity to distinguish emotions from cognitions and the interpersonal capacity to maintain significant bonds and to be autonomous. Objetive: To analyze the relationship between differentiation and social skills, and the differences in differentiation according to therapy attendance in a Spanish sample. Method: The sample consisted of 126 Spanish subjects, 78 women and 48 men, aged between 18 and 65 years, who answered a sociodemographic questionnaire, the Differentiation of Self Scale and the Social Skills Scale. Results: Significant relationships between differentiation of self and social skills were observed. Furthermore, fusion with others and emotional cutoff predicted social skills. On the other hand, subjects who had previously undergone therapy and those who had never attended therapy had higher levels of differentiation than those who were attending therapy at the time of the study. Conclusion: There are associations between differentiation of self, social skills, and therapy attendance. Results are discussed and future lines of research are suggested.
... Recently, there has been growing interest in studying the embodied aspects of psychotherapy to investigate how they are related to the change process of psychotherapy and its outcome. Embodied aspects have been suggested as one of the common factors (1) shared among psychotherapy approaches that account for the effectiveness of the treatment (2,3). ...
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Research on embodied aspects of clinical encounters is growing, but discussion on the premises of including embodied variables in empirical research is scarce. Studies have repeatedly demonstrated that embodied aspects of psychotherapy interaction are vital in developing a therapeutic alliance, and these should be considered to better understand the change process in psychotherapy. However, the field is still debating which methods should be used and which features of the embodied aspects are relevant in the clinical context. The field lacks methodological consistency as well as a theoretical model. In the Relational Mind research project, we have studied the embodied aspects of interaction in the context of couple therapy for almost a decade and have gained experience with the positive and negative aspects of studying embodied variables in quantitative and qualitative studies. We have set out to develop the methodology (or procedures) for studying embodied variables in a multiperson setting, concentrating on interpersonal synchrony of sympathetic nervous system responses and movements, and we have strived to create methods for integrating information from different embodied modalities. In this narrative review, we share our experiences of the challenges and added value of studying embodied aspects in psychotherapy. The research field urgently needs an ongoing discussion of what researchers should take into consideration when studying the embodied aspects of interaction. We urge researchers to collaborate between research groups to jointly decide on the basic parameters of studies on the different embodied modalities of the research so that the individual researcher can become more aware of the impact the methodological choices have on their studies, results, and interpretations. We also see the use of embodied variables as having added value in the clinical work of psychotherapists, since it not only deepens our understanding about what is helpful in psychotherapy but will enable fine-tuning therapy processes to better suit clients who are verbally less fluent.
... Denne udvikling og anvendelse af evidensbaserede terapiformer har på den ene side medvirket til at bevise psykoterapiens berettigelse i forhold til alternativer (fx psykofarmaka), men har på den anden side bidraget til at øge den indbyrdes konkurrence mellem forskellige terapiformer. Det er naturligvis ønskvaerdigt at skabe bedre former for psykoterapi, men effekten af de specifikke nye ingredienser er naeppe så bemaerkelsesvaerdige, som de nye retninger sommetider reklamerer med (Wampold & Imel, 2015). Når der aktuelt kan identificeres mere end 500 terapiformer (Norcross, 2015), og ingen af disse har vist sig at vaere afgørende bedre end de andre (Lambert, 2013), kan man påpege, at denne bevaegelse fremmer adskillelse frem for forbedring og integration. ...
Article
Psykoterapi som disciplin og arbejdsfelt er i rivende udvikling i disse år, hvilket ses i forhold til efterspørgslen på psykologer, i mængden af psykoterapeutisk forskning og i måden, hvorpå psykologi praktiseres og udfoldes i det samfund, vi lever i. Udviklingen har skabt nye innovative behandlingsformer og terapeutiske ”produkter”, samtidig med at der også er forsøg på at samle disse til en samlet fortælling om psykoterapi. I dette nummer af Psyke & Logos gør vi status over tendenser i denne udvikling. Dette nummer af Psyke & Logos er dedikeret til Professor Esben Hougaard med tak for hans utrættelige engagement i psykoterapeutisk forskning og udvikling.
... Som modsvar kan det indvendes, at der generelt er mange indikationer på, at terapeuteffekten -dvs. den effekt, terapeuter har på klienters udbytte af terapi isoleret fra den behandlingsform, der anvendes, udgør en signifikant større del af variansen af terapiens effektivitet end behandlingsform (Wampold & Imel, 2015;Barkham, Lutz, Lamber, & Saxon, 2017). Man kan således undre sig over den vaegtning, dokumentation af bestemte behandlingsformers effekt i det hele taget tillaegges. ...
Article
Med afsæt i et kort rids af de forskellige betydninger af integrativ psykoterapi og de forskellige måder, hvorpå det kan praktiseres, er det gennemgående fokus i artiklen at undersøge novicers forudsætninger for at praktisere integrativ psykoterapi. Vordende psykologer tilegner sig på studiet et bredtkendskab til anvendte og almenpsykologiske discipliner. Dersom de i overgangen til psykoterapeutisk praksis afgrænser sig til én bestemt terapiform, vil det indebære, at man må sætte parentes om en betydelig del af den tilegnede viden fra studiet. Integrativ psykoterapi fremstår som et alternativ, der er karakteriseret af en åbenhed for at kombinere forskellige teorier, teknikker og behandlingsformer med henblik på at tilpasse behandlingen efter klientens idiosynkratiske behov. Artiklen opererer med en udvidet forståelse for, hvad der kan være genstand for integration, idet der argumenteres for, at forholdetmellem teori/praksis, nomotetisk/idiografisk viden, terapeutens personlighed og måder at agere på i terapien også indgår i integrative processer. Integration hos novicer skildres som en måde, hvorpå vedkommende kan udvikle sig som terapeut, frem for en bestemt måde at praktisere psykoterapi på. På den ene side indebærer integrativ psykoterapi en mulighed for at udvælge og blande teorier og interventioner, der synes at passe bedst i mødet med den enkelte klient for at forbedre terapien. På den anden side er der en risiko for, at terapien bliver usammenhængende, uoverskuelig og baseret på et ubevidst hensyn til egne behov, frem for hvad der tjener klienten bedst. Det konkluderes, at novicer kan arbejde integrativt i det omfang, de er i stand til at regulere den kompleksitet, integrative processer indebærer, ud fra deres kognitive og emotionelle kapacitet i terapisituation.
... De to dominerende metanarrativer inden for psy-videnskaberne er psykoanalysen og scientisme. Scientisme forstår vi her som naturvidenskabelig/ medicinsk tankegang, som inden for psykoterapiforskning kaldes "det medicinske paradigme" (Wampold & Imel, 2015) -af Adler og Adler (2007) kaldet "det psykomedicinske paradigme". Det er i høj grad disse metanarrativer, der dominerer den akademiske psykologi og også mainstream-psyvidenskaberne, når det drejer sig om selvskade (for en oversigt se Møhl, 2015;Rubaek, 2009). ...
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Based on the different professional backgrounds of the authors (anthropologist and psychologist), and taking postmodern ideas, exemplified by social constructionism and poststructuralismas a common epistemological starting point, self-injury is described as social suffering. The authors present the concepts of “idioms of distress” (Mark Nichter), “technologies of the self” (Michel Foucault) and “small acts of living” (Erving Goffman) and uses them as perspectives in a critical description of treatment culture based on a field study by Helen Gremillion. This critique is continued in a paragraph concerning the postmodern challenge in relation to self-injury. Finally, we outline some principles ofhow to work with people who self-injure in a postmodern therapeutic practice.
... In clinical psychology, expectations gained explicit relevance as the most important mechanism of the placebo effect (Imel et al., 2008;Wampold and Imel, 2015;Kirsch et al., 2016). As early as 1961, Jerome D. Frank postulated that psychotherapy works mainly by building positive expectations for improvement. ...
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Objectives Persistent dysfunctional expectations seem to be core features of mental disorders. The aim of this study was to develop a questionnaire that assesses mechanisms responsible for the consistency of dysfunctional expectations. Processes before (i.e., assimilation) and after (i.e., immunization) expectation-violating experiences have been considered. Design The Immunization Scale (IMS) is constructed and validated with the help of an explorative (EFA) and confirmatory factor analysis (CFA) in two conducted studies. Materials and methods For the first study, the initially formulated 75-item version was completed online by 230 (range 18–69) participants from a convenience sample. For the second study, 299 (range 18–62) participants completed the reduced scale at the first measurement point, 75 participants thereof also 1 month later. For validity and reliability analyses, participants in both studies provided demographic information, the Beck Depression Inventory (BDI-II), the Depressive Expectation Scale (DES), the Beck Anxiety Inventory (BAI), and the German version of the Acceptance and Action Questionnaire (FAH-II). Results The initial 75 items were reduced to 23 items. The EFA revealed three main factors, namely, negative expectations, assimilation, and cognitive immunization. The three-factor structure could be confirmed in study 2 by the CFA. Reliability measures showed an excellent internal consistency for the entire IMS. A very good test–retest reliability was found. Significant correlations resulted between the IMS and DES, BDI-II, BAI, and FAH-II, the highest for DES and FAH-II. Conclusion Psychometric properties of the IMS are promising. Future studies should verify the reliability and validity measures in other population samples. The IMS can be very useful in expectation research, especially in the examination of expectation-focused therapy.
... One of the most common concerns about internetbased interventions regards potential negative effects on, or total loss of, the therapeutic relationship (Rozental et al., 2014). Decades of psychotherapy research have consistently shown that relationship factors have a large influence on the outcome of psychotherapy (Norcross & Lambert, 2018;Wampold & Imel, 2015). A large amount of research points to the importance of the contribution of the therapist as a person and the value of the relationship between the patient and therapist to positive treatment outcomes (Heinonen & Nissen-Lie, 2020;Magnusson et al., 2018;Norcross & Lambert, 2018). ...
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Objective: To explore young people's perceptions of the relationship with the therapist in internet-based psychodynamic treatment for adolescent depression. Method: As a part of a randomized controlled trial, 18 adolescents aged 15-19 were interviewed after participating in treatment. Interviews followed a semi-structured interview schedule and were analyzed using thematic analysis. Results: The findings are reported around four main themes: "a meaningful and significant relationship with someone who cared", "a helping relationship with someone who guided and motivated me through therapy"; "a relationship made safer and more open by the fact that we didn't have to meet" and "a nonsignificant relationship with someone I didn't really know and who didn't know me". Conclusion: Even when contact is entirely text-based, it is possible to form a close and significant relationship with a therapist in internet-based psychodynamic treatment. Clinicians need to monitor the relationship and seek to repair ruptures when they emerge. Unlabelled: Trial registration: ISRCTN.org identifier: ISRCTN16206254..
... Although these classroom effects may appear small, the proportion of variability in group members' outcomes attributable to their classroom is sizeable compared to other sources of variability in students' SEL outcomes. Specifically, 6% explained variability in students' SEL outcomes is equivalent to a Cohen's d of .50, which is considered a medium effect (Wampold & Imel, 2015). Together, this evidence suggests that the Open Circle intervention may have the potential to meaningfully improve a range of relevant student and school outcomes and that the influence of the classroom dynamics on students' SEL outcomes is a sizeable effect. ...
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School improvement plans (SIPs) have become a central feature of schooling. Educational leaders experience tension between balancing compliance with accountability demands and continuous improvement, and neither of these lenses is centered in the social justice necessary for closing opportunity gaps. We propose a new rubric for assessing the extent to which SIPs focus on policy compliance, students, organizations, or community.
... Indeed, psychotherapy has been deemed effective for improving client functioning and in helping alleviate various symptomatology (cf. Wampold & Imel, 2015). There are a variety of reasons why there may be treatment failures in psychotherapy that may be observed at multiple levels: (a) the treatment in question (e.g. the choice of intervention for a given presenting concern), (b) the individuals involved (e.g. ...
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Despite the consistent positive outcome findings and psychotherapists’ best intentions in their efforts to help their clients, psychotherapy simply does not work in all cases. There are a variety of reasons why there may be treatment failures in psychotherapy that may be observed at multiple levels: (a) the treatment in question (e.g. the choice of intervention for a given presenting concern), (b) the individuals involved (e.g. therapist and client factors), and (c) the system in which the work of therapists is nested (e.g. the governance of the profession, jurisdictional laws, among others). The field has not fully developed adequate procedures and mechanisms for addressing treatment failures, which is at the core an ethical imperative. Although psychotherapy has made many strides over the last few decades to improve research rigour and to promote evidence-based practices, it is a profession that is continually growing. By embracing the opportunity to learn from therapeutic failures the profession will continue to refine its practices and ultimately better serve clients.
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The treatment of alcohol within a multicultural context is an understudied area with much still to be investigated in this complex arena. Much of what we do know about multicultural treatment comes from general behavioural healthcare, albeit limited in nature. This chapter firstly sets out within an international context some of what we know about disparities in treatment outcomes for those from diverse multicultural backgrounds. Having set the scene by exploring some of the issues faced in accessing and using behavioural healthcare treatment, this author details the current practices in treatment approaches across this area in general. As there is a paucity of literature focusing on alcohol use, this author provides a limited and highly specific narrative around alcohol treatment outcomes with minorities. However, much of this research is ethnocultural orientated and does not provide much by the way of practical use for the average professional in routine practice, where professionals work with individuals presenting with differential intersectional identities. Drawing on the multicultural competency framework, some benefits and limitations are discussed and the evidence-base assessed. In the next section of this chapter, this author presents four independent psychosocial interventions, two of which are multicultural specific, and two of which are general psychosocial interventions that can be adapted to work as multicultural interventions. The four interventions can be used as an alternative and/or to compliment the multicultural competency framework. The strength of these four interventions is in their applicability to a wide range of multicultural individuals, and thus, these are suitable for all professionals to use. Each of the four interventions is used to learn from individuals their important multicultural identities, values and beliefs as they relate to self and treatment approaches. It is this willingness to learn from the individuals who we work with that is at the heart of this chapter. Implications of the current state of our knowledge are outlined for professionals regarding specific versus a general multicultural approach. The penultimate section considers the role and needs of the family within a multicultural context as they relate to the individual and family during treatment. The final section of this chapter deals with some of the possible ethical considerations that professionals and systems of care will likely encounter in their multicultural endeavours. This author provides some recommendations to incorporate into systems and practice that will benefit those wishing to further their work practices with minorities.
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In questo articolo l’autore tende a mostrare come possa funzionare l’integrazione tra ricerca clinica e ricerca empirica secondo il modello della perturbazione reciproca tra i dati e le osservazioni prodotte da due distinti sistemi di conoscenza. Viene messa in evidenza come esista un forte influenzamento della ricerca clinica sulle ipotesi che vengono testate negli studi empirici e il potenziale effetto dei dati empirici sulla chiarificazione e messa a fuoco di questioni fondamentali per la pratica clinica e la riuscita dei trattamenti. Da qui il potenziamento di ‘buone pratiche’ rispetto ad errori e importanti disconoscimenti dei fattori che determinano l’esito delle terapie. Conseguentemente l’interesse si orienta sui percorsi formativi nella prospettiva di favorire un approccio in cui l’attenzione del clinico in formazione si equilibra tra ‘punti di ancoraggio’ osservabili, mutuati dalla ricerca, approfondimenti intuitivi e quei pattern descrittivi derivati dalla esperienza clinica che arricchiscono la letteratura psicoanalitica.
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At present, an understanding of psychic suffering marked by the biomedical model predominates, which also permeates the approach from clinical psychology and determines the expectations of patients. Expectations are one of the least studied variables of therapeutic change, despite being included among the common factors and their importance being confirmed in different studies. This research seeks to describe the expectations of the population assessed in the clinical psychology service in a Mental Health Center. Expectations are assessed quantitatively using the MPEQ questionnaire and qualitatively using an ad hoc questionnaire. The results reflect that most patients have the expectation that therapists will help them through techniques to reduce their symptoms and have disproportionately high expectations regarding the results of psychotherapy, which in accordance with the biomedical and rational-scientific predominant conception in this area
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This chapter argues for ensuring that psychotherapy research reflects the diverse values of the stakeholders surrounding it, by suggesting a dialectical reasoning and listening approach to guide initial discussion in a research project. This is guided by a pluralistic view of reality and psychotherapy research methods and a philosophical pragmatism that guides the linking of stakeholder values and research tactics. The authors reflect over some of critiques of DP and on recommendations for psychotherapy research that may help the field produce a richer, more multifaceted, and socially relevant set of findings regarding counseling and psychotherapy’s processes and outcomes.
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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 psychotherapy, the concept is applicable to any practice involving a person seeking help and a socially sanctioned healer. An extensive research evidence suggests that the alliance (typically measured at the third or fourth session) is a robust predictor of the outcomes of various forms of psychotherapy, even when prior symptom improvement and other factors are considered. Both the clinician and the patient bring to the therapy situation different capacities to form an alliance. Factors concerning the patient include, among others, the diagnosis, attachment history and style, motivation, and needs for affiliation. However, the benefits of the alliance have been found to be mostly due to the therapist's contribution, in particular his/her facilitative interpersonal skills, including verbal fluency, communication of hope and positive expectations, persuasiveness, emotional expression; warmth, acceptance and understanding; empathy, and alliance rupture‐repair responsiveness. Placebo studies have allowed to experimentally manipulate aspects of the relationship between a therapist and a patient in non‐psychotherapy contexts. In these settings, two components of the relationship have emerged: an emotional one (involving being cared for and understood by the clinician) and a cognitive one (including the belief in the competence of the therapist to select and administer an effective treatment). Here we propose a model that describes three pathways through which the alliance creates benefits, named CARE (caring, attentive, real and empathic), EXPECTANCY, and SPECIFIC. Although research and clinical attention have mostly focused on the alliance between a clinician and a patient in face‐to‐face interactions, there is preliminary evidence concerning the alliance between patients and other clinic staff, systems of care, or the program in Internet‐mediated services. These new research areas clearly require further development.
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Although studies have shown that client feedback can improve treatment outcome, little is known about which factors might possibly moderate the effects of such feedback. The present study investigated potential therapist variables that might influence whether frequent client feedback is effective, including the Big Five personality traits, internal/external feedback propensity, and self‐efficacy. Data from two previous studies, a quasi‐experimental study and a randomized controlled trial, were combined. The sample consisted of 38 therapists and 843 clients (55.4% females, mean age = 42.05 years, SD = 11.75) from an outpatient mental health institution. The control condition consisted of cognitive‐behavioural therapies combined with low frequency monitoring of clients’ symptoms. In the experimental condition, high‐intensity (i.e., frequent) client feedback as an add‐on to treatment as usual was provided. Outcomes were measured as adjusted post‐treatment symptom severity on the Symptom Checklist‐90 and drop out from treatment. The final model of the multi‐level analyses showed that therapists with higher levels of self‐efficacy had poorer treatment outcomes, but when high‐intensity client feedback was provided, their effectiveness improved. Furthermore, higher self‐efficacy was associated with a higher estimation of therapists’ own effectiveness, but therapists’ self‐assessment of effectiveness was not correlated with their actual effectiveness. The results of this study might indicate that therapists with high levels of self‐efficacy benefit from client feedback because it can correct their biases. However, for therapists with low self‐efficacy client feedback might be less beneficial, possibly because it can make them more insecure. These hypotheses need to be investigated in future research.
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The introduction chapter describes the scope and purpose of this book and summarizes key topics regarding online therapy. We explain that the book addresses most of the main approaches and schools of psychotherapy that are prevalent in the therapeutic field nowadays. Thus, in addition to exploring how each of them adjust to online therapy, we also have created a collection of the most practiced therapeutic approaches nowadays. Beyond the theories, we describe why flexibility and creativity are among the main factors that contribute to the success of online therapy. Also discussed briefly are skills and training required for the successful provision of online therapy. The introduction also presents the current research about online therapeutic alliance, elements influencing the therapeutic alliance such as the setting and rupture and repair, and the outcome of online therapy. We show that there is enough evidence that online therapy is beneficial no less than in-person. We address the question whether it is suitable for everyone, and summarize how the factors that unify all psychodynamic approaches can be applied online.
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A growing body of cross-cultural survey research shows high percentages of clinicians report using placebos in clinical settings. One motivation for clinicians using placebos is to help patients by capitalising on the placebo effect’s reported health benefits. This is not surprising, given that placebo studies are burgeoning, with increasing calls by researchers to ethically harness placebo effects among patients. These calls propose placebos/placebo effects offer clinically significant benefits to patients. In this paper, we argue many findings in this highly cited and ‘hot’ field have not been independently replicated. Evaluating the ethicality of placebo use in clinical practice involves first understanding whether placebos are efficacious clinically. Therefore, it is crucial to consider placebo research in the context of the replication crisis and what can be learnt to advance evidence-based knowledge of placebos/placebo effects and their clinical relevance (or lack thereof). In doing so, our goal in this paper is to motivate both increased awareness of replication issues and to help pave the way for advances in scientific research in the field of placebo studies to better inform ethical evidence-based practice. We argue that, only by developing a rigorous evidence base can we better understand how, if at all, placebos/placebo effects can be harnessed ethically in clinical settings.
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Background: Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group is scarce. We assessed for the first time the efficacy and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT). Methods: 24 youths (mean age 19.08 years) participated in three face-to-face workshops and six email-guided self-help sessions, followed by four e-mail guided follow up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design). Results: The number of weekly LOC episodes decreased during both the waiting-time and the active treatment period and remained more or less on the same level during the subsequent 12-months follow-up. Abstainer rates, depressive symptoms, eating disorder pathology and appearance-based rejection sensitivity all improved from pretreatment to posttreatment and typically further improved during follow-up. Body weight in contrast remained more or less constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12 months follow-up. Conclusions: This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish interventions targeted at reducing body weight change while at the same time holding dropout rates low. Trial registration: The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018)
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This chapter describes why the biomedical model is inadequate and even unethical while proposing different models of research for PTSD and trauma including biopsychosocial and epidemiological models, the latter from an ecosocial lens emphasizing public health approaches. These research models permit the inclusion of intersecting social factors into the medical diagnoses as an integral part of the traumatic impact. They underscore the bidirectionality of the event and its impact on humans in their natural environment. It calls for new training of health care workers to be integrated with biological, psychological and social factors that may underlie treatment of victims and those who cause violence, although much of the latter research still needs to be done. Acceptance of sophisticated correlational statistics will need to be considered as acceptable methodology along with carefully analyzed qualitative studies while moving away from the standard RCT models measuring effect-sizes that are ill-suited to clarify the intersectional conditions. This does not mean all our knowledge gathered to understand cause and effect in trauma treatment should be discarded. Rather, the approach to understanding trauma will need both a broadened approach in some areas and narrowly defined targeted subgroups in other areas based on our data. The arguments presented here demonstrated the need for this new research approach by illustrating how the intersectionalities were missed using a biomedical model in discussing the impact from two traumatic events that involve PTSD; child abuse and terrorism. Without effective treatment, child abuse can and often does give rise to other intrafamily trauma and community disruption through terrorism.
Article
Objective Text-based communication is becoming an increasingly salient feature of the psychotherapeutic landscape. Yet little is known about the factors distinguishing high- and low-quality therapeutic conversations taking place over this modality. Prior research on therapist effects has outlined several common factors associated with better clinical outcomes. But these common factors can only be researched in the context of text-based communication if they can be measured. Accordingly, we developed and validated a new behavioral task and coding system: the Facilitative Interpersonal Skills Performance Task for Text (FIS-T) to measure therapists’ messaging quality across eight dimensions of facilitative interpersonal skill. Methods 1150 survey-takers rated the interpersonal dynamics and response difficulty of the FIS-T Task’s text-based stimuli. The FIS-T was then administered to 64 therapists. Results The FIS-T stimuli displayed similar interpersonal dynamics to those elicited by the original FIS task, demonstrated a similar range of difficulties to those of the video-based stimuli of the original FIS Task, and showed high inter-rater reliability. Conclusions The text-based FIS-T Task demonstrates high reliability and convergent validity with the original FIS Task, making it appropriate for use in assessing the common factors in text-based therapy. Future directions in the quality assessment of internet-delivered psychotherapies are discussed.
Article
With a lack of experimental designs in psychotherapy/counselling process research, evidence is limited regarding which therapeutic style is helpful for which patient and the role of expectations. Therefore, the aim of this experimental study was to manipulate the therapeutic style and clients' expectations towards psychological counselling and investigate their effects on counselling outcome. Eighty healthy participants (74% female, Mage = 31.2 years, SDage = 12.21) received a single counselling session focussing on interpersonal conflicts. We defined two therapeutic styles (relationship‐focussed vs. problem‐focussed) based on the interpersonal circumplex, and participants were led to believe they would receive one of the two styles. In the actual counselling session, they received either the expected or the contrary, resulting in a 2 x 2 design. Primary outcome rated by participants was subjective impairment caused by the conflict 2 weeks after the session; secondary outcomes were satisfaction with the session and perceived working alliance. The successful implementation of the proposed therapeutic styles was confirmed by adherence ratings (U = 25.50, p < 0.001) and ratings of counsellors’ behaviour in the circumplex model (p < 0.001) for the friendly and hostile dimensions. Impairment was significantly reduced 2 weeks after the counselling session, but this effect was dependent on neither the therapeutic style, clients' expectations, nor their interaction. The study provides the first evidence that a single counselling session appears to be effective in alleviating impairment caused by an interpersonal conflict, independent of the counselling style and client expectations. The novel experimental design provides a basis for further process research in psychological counselling and psychotherapy.
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Introduction According to Control-Mastery Theory (CMT)—a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy—patients come to therapy with an unconscious plan to disprove their pathogenic beliefs and achieve adaptive goals. One of the primary ways patients work to disconfirm their pathogenic beliefs is by testing them within the therapeutic relationship. Objectives: The present study aimed to replicate and expand the results of previous studies suggesting that therapists’ responses that disconfirmed patient’s pathogenic beliefs were predictive of patients’ within-session progress. Moreover, we wanted to investigate whether these interventions correlated with the therapeutic alliance. Methods: Transcriptions of 81 sessions from five brief psychodynamic psychotherapies were assessed by 11 independent raters. For each case, the patient’s plan was formulated and tests identified, the accuracy of the therapist’s responses to these tests was rated, and the impact of the therapist’s interventions on the patient’s subsequent communications and their relationship with the therapeutic alliance was measured. Results: The results supported the central hypothesis of the CMT that when the therapist’s interventions passed the patient’s tests, the patient showed signs of improvement. Moreover, the ability of the therapist to pass the patient’s tests correlated with the therapeutic alliance. Conclusions: The clinical implications and the limitations of these findings are discussed, together with the relevance of a good case formulation for clinicians’ optimal responsiveness.
Article
There is an increasing need for practitioners to be responsive to multicultural identities in clinical practice. Although the multicultural competency framework has been around for a number of decades, its overall utility and generalisability has not being consistently established. The book chapter approach to learning about multicultural engagement is rather limited, not least because it is impossible to learn about the vast identities of the different cultures that the average practitioner will work with in routine practice. In response to this gap in the literature, the current paper proposes an integrative model of multicultural responsiveness that brings together trans-theoretical practices from the extant literature. In doing so, this paper provides a model of multicultural practice that seeks to learn about the client’s complex multicultural identity during the assessment phase, during therapy, and by monitoring the process and outcome of care. A case vignette is provided demonstrating the application and utility of this model.
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A network approach has been offering an alternative to the conception of psychological disorders as underlying disease. The network assumption views psychological disorders as networks of symptoms of causal interaction. Network analysis offers a unique view of an individual's system, obtained from data rather than categorization. It allows moving toward specific interventions for specific symptom relationships rather than a protocol approach. In order to provide a current overview of the network approach studies and to present the possible implications for clinical practice, a narrative review of the literature was conducted using the Scopus and PubMed databases. Studies sought to build symptom networks through cross-sectional and time-series data collection methods, allowing analysis of the symptom's centrality in the inter/intra-individual network, enabling a specific intervention for each patient. Research suggests that changing the connectivity of symptoms and delaying the re-stabilization of an individual's network after a disturbance leads to changing from a healthy to a pathological-stable-state. Monitoring the network dynamics could predict relapse, permitting early intervention in the central symptoms. In conclusion, networks can provide information about the specific psychological mechanisms underlying the development of psychological disorders. However, research is in its infancy, and a consensus on the analysis model is necessary. It is also necessary to consider what types of variables should be included in psychopathological networks.
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Zusammenfassung Der Artikel geht der gesellschaftsrelevanten Frage nach, welche Versorgungskonzepte und Qualitätssicherungsmaßnahmen erforderlich sind, um der Psychotherapie als Behandlung einen versorgungsrelevanten Stellenwert in der österreichischen Gesundheitsversorgung einzuräumen. Er geht auf soziologische Ursachen für den Anstieg psychischer Krankheiten sowie auf Fakten zum Bedarf, auf Prävalenzzahlen, Versorgungsdaten und -mittel ein und beschreibt, wie die Entwicklung einer Nationalen Strategie Psychische Gesundheit helfen kann, die flächendeckende Versorgung mit Psychotherapie zu verbessern. Der Artikel beruht auf den Erkenntnissen der Autorinnen aus der Tagung 2020 „VersorgungsNOTwendigkeit – Versorgung in der NOT“ – veranstaltet von der Koordinationsstelle Psychotherapieforschung an der Gesundheit Österreich GmbH – und der vertieften Auseinandersetzung zum Thema Psychotherapieversorgung bzw. Versorgungsnot: In Fokusgruppen bzw. im Fachbeirat der Koordinationsstelle wurden die Fragen der Psychotherapieversorgung diskutiert sowie eine Literaturanalyse und vertiefende exemplarische explorative Interviews zum Thema durchgeführt. Der Artikel bietet erste Ergebnisse dieser Analysen, Recherchen, Reflexionen und die Schlussfolgerungen der Autorinnen.
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Objective: Psychotherapy studies have revealed that therapist characteristics are responsible for 5% to 9% of outcome variance. The therapist-facilitative interpersonal skills (FIS) have been shown to predict both alliance and outcomes, indicating that higher FIS therapists are more effective than lower FIS therapists. The current study focused on the development and validation of the FIS-client version (FIS-C) instrument, aimed at collecting the clients' perspectives on relevant therapist characteristics. Method: The clinical outcomes in routine evaluation-outcome measures, the session rating scale, and the FIS questionnaire-client version were filled out by psychotherapy clients. Exploratory, confirmatory factor, and test-retest analysis were conducted. Results: Results indicate robust psychometric characteristics, in terms of validity (factorial, convergent, discriminant, and nomological), reliability, and sensitivity. Conclusion: The validation of the FIS-C represents an important contribution to clinical research and practice, namely to the field of client feedback and therapist expertise.
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Based on an integrative review of the relevant literature in and on person‐centred and experiential (PCE) therapy, this study identifies and discusses the findings of 13 articles on the delivery of individual video counselling and psychotherapy. Six overarching themes were identified: the discrepancy of the experiences of clients and practitioners; the possibility of good‐quality PCE therapy (psychotherapy and/or counselling); “doing” PCE therapy online; “being” online; the role of technology; and implications for training and practice. It is suggested that all these have implications for ongoing practice and education/training, and need to be considered by practitioners, educators/trainers, and professional bodies.
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Miljøbehandling er viktig for pasienter i psykisk helsevern. For å redusere uheldig variasjon i behandlingen ønsker Blakstad sykehus å konkretisere hva miljøbehandling er. HOVEDBUDSKAP Flere pasienter rapporterer om krenkelser, avmakt og uønsket variasjon i behandlingstilbudet. Blakstad sykehus har derfor startet et større prosjekt for å utvikle en felles tilnærming til hva miljøbehandling er og hvordan det utføres. Tilnærmingen bygger på tydelig verdiforankring og kunnskapsbasert metode.
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Objective: This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliably symptom increase pre-to-post treatment. Method: An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre-post outcome evaluation of self-reported depression symptoms and qualitative analysis of patients’ interviews. In a Randomized Controlled Study on the treatment of Major Depression, three patients showing reliable increase in symptom severity on the BDI-II pre-to-post therapy were selected. An interpretative phenomenological analysis (IPA) was performed on individual interviews conducted pre-, peri- and post-treatment. Results: Cross-case outcome experiences were: (1) enduring complaints, experienced as uncontrollable; (2) non-internalized insights and unanswered questions; and (3) enduring (mild to severe) interpersonal difficulties. Within-case idiosyncratic differences revealed that the statistical classification of “deterioration” not necessarily corresponds to a “deteriorated experience”, nor univocally indicates unwanted therapy effects. Our findings point at the influences of the patient’s (lack of) agency in the process, a discrepancy between patients’ expectations and the therapy offer, the therapeutic relationship, interpersonal difficulties and contextual influences. Conclusion: The meaning of symptomatic deterioration should be interpreted within a patient’s idiosyncratic context. The multi-faceted nature of deterioration requires further research to rely on multiple perspectives and mixed methods.
Article
Our practice-based research programme has devoted itself to the study of how psychotherapy works for over 30 years. It has focused on how to negotiate the therapeutic alliance: more specifically, on rupture resolution as a critical change process in psychotherapy. Rupture refers to moments in which the patient and therapist experience a disagreement in the tasks and goals of treatment, a deterioration in their emotional bond or a breakdown in the intersubjective negotiation of their needs. Resolution (or repair) refers to the dyadic process that patient and therapist engage in to restore the alliance and to effect a new or corrective emotional experience. Our research has not only sought to provide further definition to this process but has striven to define and evaluate training for psychotherapists to be better able to identify ruptures and resolve them. We will provide some review of the evidence-based change process literature and the cognitive, emotion and social sciences that have informed our programme, concluding with a brief introduction to our research on clinical practice.
Article
Study aims: The article aims at reiterating the importance of a biopsychosocial approach to mental health, taking stock of the critiques that have been raised and moving forward throughout a reconsideration of the theoretical background of systems thinking and emphasizing the relevance of the concept of thick description for the promotion of an adequate reflection on methodology and case formulation. Literature review: It is our opinion that the biopsychosocial approach is still a powerful framework for making sense of the growing data collected in the different fields related to mental health and for designing proper treatment plans. A crucial challenge for mental health is that of surpassing the dichotomies and ideological disputes that still contaminate the field with detrimental effects on the advancement of knowledge and on the integration and continuity of different kind of interventions. Conclusions: The time is ripe for building bridges among neuroscience, humanities and social sciences, and this can only happen within the umbrella of a biopsychosocial perspective reinstated into its systems thinking background.
Article
Objective: To investigate clients' perceptions of changes in their therapists' provision of positive regard (PR) following their transition from in-person therapy to teletherapy.Method A total of 2,118 clients, predominantly White, female, heterosexual, and in their mid-20s, who had been working with their therapist for an average of 20 months in-person and five months in teletherapy completed a Perceptions of Psychotherapy Process Scale (POPPS). This 42-item measure investigated, at a single time-point, the extent to which participants believed that specific therapist-related behaviors, statements, or attitudes changed since shifting to teletherapy. Results: An exploratory factor analysis revealed, among other factors, a factor comprised of six items related to therapist-provided PR (e.g., "my therapist makes me feel cared about"). Clients' scores on this factor indicated a marginal but significant increase in therapists' provision of PR over teletherapy; these scores also significantly predicted scores on a factor reflecting clients' engagement in teletherapy. Conclusions: Despite the challenges of an abrupt shift to teletherapy, clients perceive their therapists as communicating PR to the same or even slightly higher degrees as compared to in-person therapy pre-pandemic; therapists and clients have seemingly adapted to the new demands of technology to preserve important elements of the therapeutic relationship.
Chapter
The second edition of the essential guide for reproductive professionals is now available in a Clinical Guide and a Case Studies Guide, presenting the most current knowledge on counseling diverse patients amidst rapidly advancing modern technology. Follow an in-depth presentation of clinical concepts in this Clinical Guide for a foundational understanding of the medical and psychosocial experience of fertility treatment. Explore the areas of reproductive psychology, therapeutic approaches, assessment and preparation in assisted reproduction, addressing the needs of diverse populations, and clinical practice issues. Featuring new topics such as transgender ART, recurrent pregnancy loss, post-partum adjustment, and the pregnant therapist. Then in Case Studies, discover the accessible, real-world experiences and perspectives as leading international practitioners share their stories applying clinical concepts to treatment practice. An essential aid for medical and mental health professionals, this comprehensive guide allows clinicians to develop and refine the skills required to address the increasingly complex psychosocial needs of fertility patients.
Article
To understand the process by which evidence-based practices (EBPs) move from identification as effective through research establishing empirically validated effects, to being routinely adopted to bring about meaningful impact, we examined the selection/adaptation process within a well-established consultation model, COMPASS, applying two frameworks—the Evidence-Based Practice in Psychology (EBPP) Framework and the Consolidated Framework for Implementation Research (CFIR). The EBPP Framework proposes the equal importance of the EBP, student/family and school/teacher factors in decision-making. CFIR highlights greater understanding of the iterative decision-making process and elucidates how an EBP moves from being selected, adapted, and used. Descriptive analysis of COMPASS intervention plans revealed that five EBPs were selected on average and specific EBPs were based on goal domain. Social goals used the widest variety of EBPs and demonstrated the greatest number of intercorrelations with other EBPs. Goal attainment outcomes were similar across goal domains.
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Hailed by one reviewer as "the bible of the integration movement," the inaugural edition of Handbook of Psychotherapy Integration was the first compilation of the early integrative approaches to therapy. Since its publication psychotherapy integration has grown into a mature, empirically supported, and international movement, and the current edition provides a comprehensive review of what has been done. Reflecting the considerable advances in the field since the previous edition's release in 2005, this third edition of Handbook of Psychotherapy Integration continues to be the state-of-the-art description of psychotherapy integration and its clinical practices by some of its most distinguished proponents. Six chapters new to this edition describe growing areas of psychotherapy research and practice: common factors therapy, principle-based integration, integrative psychotherapy with children, mixing psychotherapy and self-help, integrating research and practice, and international themes. The latter two of these constitute contemporary thrusts in the integration movement: blending research and practice, and recognizing its international nature. Also closely examined are the concepts, history, training, research, global themes, and future of psychotherapy integration. Each chapter includes a new section on cultural considerations, and an emphasis is placed throughout the volume on outcome research. Charting the remarkable evolution of psychotherapy integration itself, the third edition of this Handbook will continue to prove invaluable to practitioners, researchers, and students alike.
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This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.
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In meta-analysis format the effectiveness of Beck's cognitive therapy for depression was reviewed. Twenty-eight studies were identified that used a common outcome measure of depression, and comparisons of cognitive therapy with other therapeutic modalities were made. The results document a greater degree of change for cognitive therapy compared with a waiting list or no-treatment control, pharmacotherapy, behavior therapy, and other psychotherapies. The degree of change associated with cognitive therapy was not significantly related to the length of therapy or the proportion of women in the studies, and although it was related to the age of the clientele, a lack of adequate representativeness of various age groups renders these results equivocal. Implications for further outcome and process studies in cognitive therapy are discussed.
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The two-volume third edition of this book identifies effective elements of therapy relationships (what works in general) as well as effective methods of tailoring or adapting therapy to the individual patient (what works in particular). Each chapter features a specific therapist behavior (e.g., alliance, empathy, support, collecting feedback) that demonstrably improves treatment outcomes or a nondiagnostic patient characteristic (e.g., reactance, preferences, culture, attachment style) by which to effectively tailor psychotherapy. Each chapter presents operational definitions, clinical examples, comprehensive meta-analyses, moderator analyses, and research-supported therapeutic practices. New chapters in this book deal with the alliance with children and adolescents, the alliance in couples and family therapy, and collecting real-time feedback from clients; more ways to tailor treatment; and adapting treatments to patient preferences, culture, attachment style, and religion/spirituality.
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Interpersonal psychotherapy began as a time-limited, manualized psychotherapy for patients with major depressive disorder.
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Prior research indicates that therapist effects can be sizeable in substance-abuse treatment. Therapist differences were examined within a multisite (N = 1726) randomized trial of three psychosocial treatments for alcohol problems: twelve-step facilitation (TSF), cognitive-behavioral skills training (CBT), and motivational enhancement therapy (MET). Therapists (N = 80) were nested within treatments, selected and trained for expertise in a specific approach. This report describes: (1) differences in therapist characteristics across the three treatments; (2) the magnitude of therapist effects within each treatment; and (3) exploratory analyses of therapist attributes associated with successful outcomes. Therapist characteristics differed between TSF and the other two conditions. Significant therapist effects were found in client satisfaction and outcomes, even after covarying for effects of treatment sites and client baseline characteristics. Specific therapist attributes were predictive of client outcomes. Outlier therapists whose caseloads showed unusually poor outcomes accounted for most of the observed effects.
Book
The Patient’s Brain describes and explains recent advances within neuroscience that enable us to describe and discuss the biological mechanisms that underlie the doctor-patient relationship, how this new scientific knowledge can be put to great practical use, and the doctor-patient relationship can be subdivided into at least four steps: feeling sick, seeking relief, meeting the therapist, and receiving therapy.
Book
This therapist guide of prolonged exposure (PE) treatment is accompanied by the patient workbook, Reclaiming Your Life from a Traumatic Experience. The treatment and manuals are designed for use by a therapist who is familiar with cognitive behavioral therapy (CBT) and who has undergone an intensive training workshop for prolonged exposure by experts in this therapy. The therapist guide instructs therapists to implement this brief CBT program that targets individuals who are diagnosed with posttraumatic stress disorder (PTSD) or who manifest PTSD symptoms that cause distress and/or dysfunction following various types of trauma. The overall aim of the treatment is to help trauma survivors emotionally process their traumatic experiences to diminish or eliminate PTSD and other trauma-related symptoms. The term prolonged exposure (PE) reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which patients are helped to confront safe but anxiety-evoking situations to overcome their unrealistic, excessive fear and anxiety. At the same time, PE has emerged from the adaption and extension of Emotional Processing Theory (EPT) to PTSD, which emphasizes the central role of successfully processing the traumatic memory in the amelioration of PTSD symptoms. Throughout this guide, the authors highlight that emotional processing is the mechanism underlying successful reduction of PTSD symptoms.
Article
Objective: Redesigning the fragmented U.S. mental health care system requires knowing how service sectors share responsibility for individuals' mental health needs. Method: Twelve-month DSM-IV mental disorders and their severity were assessed in respondents ages 15-54 from the National Comorbidity Survey (NCS) in 1990-1992 (N=5,388) and the NCS Replication in 2001-2003 (N=4,319). Six profiles involving potentially multiple service sectors were defined, including those in which pharmacotherapy plus psychotherapy (psychiatry profile, general medical with other mental health specialty profile), single modalities (general medical only profile, other mental health specialty only profile), or neither modality (human services only profile, complementary/ alternative medicine only profile) could potentially have been received. The use of profiles was compared between surveys. Results: The general medical only profile experienced the largest proportional increase (153%) between surveys and is now the most common profile. The psychiatry profile also increased (29%), as did the general medical with other mental health specialty profile (72%). The other mental health specialty only (-73%), the complementary/alternative medicine only (-132%), and the human services only (-137%) profiles all decreased in use. The elderly, women, minorities, the less educated, and rural dwellers were less likely to use profiles capable of delivering pharmacotherapies and/or psychotherapies. Conclusions: How service sectors share responsibility for peoples' mental health care is changing, with more care falling to general medical providers rather than specialists. Efforts are required to ensure that people who would benefit have access to the necessary treatment modalities.
Article
Sixteen therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant-observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways.
Article
Manipulation checks should be used in psychotherapy trials to confirm that therapists followed the treatment manuals and performed the therapy competently. This article is a review of some strategies that have been used to document treatment integrity; also, their limitations are discussed here. Recommendations for improving these checks are presented. Specific guidelines are offered regarding when and how to assess both therapist adherence to treatment protocols and competence.
Article
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Article
This study used a benchmarking strategy to evaluate the effectiveness of community psychotherapy for depressed youth relative to evidence-based treatment in clinical trials. Symptom trajectories of depressed youth treated in community mental health centers (CMHCs) were compared with trajectories of youth treated with cognitive-behavioral therapy (CBT) in clinical trials. Overall, outcomes of CMHC youth more closely resembled those of control condition youth than youth treated with CBT. Within the CMHC sample, ethnic minority status and low therapy dose were related to worse outcomes. However, when outcomes for Caucasian youth and youth receiving longer term services were examined, the CMHC sample still performed more poorly than youth treated with CBT. The findings support the value of developing, testing, and exporting effective therapies for depressed youth to community clinic settings.
Article
Eye movement desensitization and reprocessing (EMDR), a controversial treatment suggested for posttraumatic stress disorder (PTSD) and other conditions, was evaluated in a meta-analysis of 34 studies that examined EMDR with a variety of populations and measures. Process and outcome measures were examined separately, and EMDR showed an effect on both when compared with no treatment and with therapies not using exposure to anxiety-provoking stimuli and in pre-post EMDR comparisons. However, no significant effect was found when EMDR was compared with other exposure techniques. No incremental effect of eye movements was noted when EMDR was compared with the same procedure without them. R. J. DeRubeis and P. Crits-Christoph (1998) noted that EMDR is a potentially effective treatment for noncombat PTSD, but studies that examined such patient groups did not give clear support to this. In sum, EMDR appears to be no more effective than other exposure techniques, and evidence suggests that the eye movements integral to the treatment, and to its name, are unnecessary.
Article
Consumer Reports (1995, November) published an article which concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features of these two methods can be combined into a more ideal method that will best provide empirical validation of psychotherapy.
Article
No study has reported on the comparative effectiveness of blinding procedures for psychotherapy and pharmacotherapy conditions in treatment efficacy studies or the potential impact of failure to maintain a psychotherapy blind. In a randomized clinical trial, we found, from the perspective of clinical evaluators who were unaware of the patient's treatment assignment, procedures intended to protect the psychotherapy blind were only modestly effective but comparable to standard procedures used to maintain pharmacotherapy blinds. Second, accuracy of guessing each form of treatment (psychotherapy or pharmacotherapy) was not independent of the other. Third, findings suggested the importance of maintaining both psychotherapy and pharmacotherapy blinds, as subjective ratings of treatment outcome were significantly different depending on whether the clinical evaluator had correctly guessed the patients' true treatment condition.
Article
In a controlled clinical trial, 57 Ss meeting DSM—III—R criteria for generalized anxiety disorder, and fulfilling an additional severity criterion, were randomly allocated to cognitive behavior therapy (CBT), behavior therapy (BT), or a waiting-list control group. Individual treatment lasted 4—12 sessions; independent assessments were made before treatment, after treatment, and 6 months later, and additional follow-up data were collected after an interval of approximately 18 months. Results show a clear advantage for CBT over BT. A consistent pattern of change favoring CBT was evident in measures of anxiety, depression, and cognition. Ss were lost from the BT group, but there was no attrition from the CBT group. Treatment integrity was double-checked in England and in Holland, and special efforts were made to reduce error variance. Possible explanations for the superiority of CBT are discussed.
Article
In recent empirical trials testing causal mediational models of cognitive therapy for depression, researchers have found comparable change in cognition regardless of intervention, leading some to reject any mediational role for cognition. Such an interpretation is premature because alternative models exist that allow potential mediators to exhibit nonspecific change across diverse interventions yet still play a causal mediational role in one or all of those interventions. A failure to distinguish between the mediator's role as a consequence of the manipulation and its role as a potential cause of the dependent outcome is seen as contributory to this premature rejection. We suggest strategies that can facilitate the testing of causal mediational models.
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Countertransference and the Therapist's Inner Experience explores the inner world of the psychotherapist and its influences on the relationship between psychotherapist and patient. This relationship is a major element determining the success of psychotherapy, in addition to determining how and to what extent psychotherapy works with each individual patient. Authors Charles J. Gelso and Jeffrey A. Hayes present the history and current status of countertransference, offer a theoretically integrative conception, and focus on how psychotherapists can manage countertransference in a way that benefits the therapeutic process.
Article
What makes us human? Why do people think, feel, and act as they do? What is the essence of human nature? What is the basic relationship between the individual and society? These questions have fascinated people for centuries. Now, at last, there is a solid basis for answering them, in the form of the accumulated efforts and studies by thousands of psychology researchers. We no longer have to rely on navel-gazing and speculation to understand why people are the way they are; we can instead turn to solid, objective findings. This book not only summarizes what we know about people; it also offers a coherent, easy-to-understand though radical, explanation. Turning conventional wisdom on its head, the author argues that culture shaped human evolution. Contrary to theories that depict the individual's relation to society as one of victimization, endless malleability, or just a square peg in a round hole, he proposes that the individual human being is designed by nature to be part of society. Moreover, he argues that we need to briefly set aside the endless study of cultural differences to look at what most cultures have in common; because that holds the key to human nature. Culture is in our genes, although cultural differences may not be. This core theme is further developed by a tour through the main dimensions of human psychology. What do people want? How do people think? How do emotions operate? How do people behave? And how do they interact with each other? The answers are often surprising, and along the way, the author explains how human desire, thought, feeling, and action are connected.
Article
One of the most widespread words in medicine is the placebo and placebo effect, although it is not always clear what it means exactly. Recent progress in biomedical research has allowed a better clarification of the placebo effect. This is an active psychobiological phenomenon which takes place in the patient's brain and that is capable of influencing both the course of a disease and the response to a therapy. The psychosocial context around the patient is crucial to placebo effects, for example the doctor's words and attitudes, and this may have a profound impact on the patient's brain which, in turn, may affect several physiological functions of the body. This book emphasizes that there is not a single placebo effect but many. The book critically reviews them in different medical conditions, such as pain, neurological disorders, psychiatric and behavioural disorders, immune and endocrine systems, cardiovascular and respiratory systems, gastrointestinal and genitourinary disorders, as well as some special conditions, such as oncology, surgery, sports medicine, and acupuncture.
Article
This article is a republication of a classic paper in which Rosenzweig introduced the concept of common factors in psychotherapy. This seminal idea-which refers to the finding that all forms of psychotherapy seem to share, to some degree, a small number of effective change ingredients-remains highly influential in psychotherapy integration today. Rosenzweig reviewed the data presented by then current forms of psychotherapy and argued that the theories that describe the change principles in each psychotherapy are inadequate to capture those deeper common factors.