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What Works for Whom: Tailoring Psychotherapy to the Person
Abstract
This article introduces the issue of the Journal of Clinical Psychology: In Session devoted to evidence-based means of adapting psychotherapy to the patient's (transdiagnostic) characteristics. Practitioners have long realized that treatment should be tailored to the individuality of the patient and the singularity of his or her context, but only recently has sufficient empirical research emerged to reliably guide practice. This article reviews the work of an interdivisional task force and its dual aims of identifying elements of effective therapy relationships (what works in general) and identifying effective methods of adapting treatment to the individual patient (what works in particular). The task force judged four patient characteristics (reactance/resistance, preferences, culture, religion/spirituality) to be demonstrably effective in adapting psychotherapy and another two (stages of change, coping style) as probably effective. Two more patient facets (expectations, attachment style) were related to psychotherapy outcome but possessed insufficient research as a means of adaptation. This special issue provides research-supported methods of individualizing psychotherapy to the person, in addition to his or her diagnosis.
Supplementary resource (1)
... Concerns regarding child and adolescent mental health have steadily been on the increase since the late 1990's. Understanding which treatments are effective, but also 'what works for whom' (Fonagy et al. 2015;Norcross & Wampold 2011;Fonagy 2010) can help better use limited resources and ensure patients are getting the best treatment at any one time. Hopefully preventing costly implications both financially and in terms of quality of life for individuals, their families, and society as a whole. ...
... As Kennedy and Midgely (2007) highlight, "the need for …process research has been consistently emphasised by leading figures in the field of child psychotherapy research" (p.8). Yet whilst there is now quite substantial evidence for the effectiveness of psychotherapy with adults (ibid), and the evidence base for work with children and adolescents is growing (Midgley et al. 2011;, little remains known about the mechanisms involved in effective treatments and what works best under what circumstances and for whom (Fonagy et al. 2015;Norcross & Wampold 2011;Fonagy 2010). We know, for example, that psychodynamic psychotherapy is an effective treatment for adolescent depression (Goodyer et al., 2017); and is equally effective as CBT and a brief psychosocial intervention (BPI). ...
... Emotional disorders specifically, cause significant disruption to an individual's ability to engage with learning, lead to social withdrawal, and consequently impact a young person's development and future (WHO, 2019). It is therefore imperative that treatments are not only effective in treating an episode of depression, but can guard against reoccurrence.With the rate of mental health concerns for children and adolescents continuing to rise, knowing what treatments are effective and 'what works for whom'(Fonagy et al. 2015;Norcross & Wampold 2011;Fonagy 2010), can help better utilise limited resources and ensure patients are receiving the most effective treatment; hopefully preventing costly long-term implications, both financially and in terms of quality of life for individuals, their ...
We now know that psychodynamic psychotherapy is an effective treatment for a range of mental health problems. Far less however is known about how it works. Whilst there has been much progress in this area in relation to adults, process research regarding children and adolescents has lagged behind. In recent years, there has been some effort to begin to redress this balance. This paper provides an overview of psychotherapy process-outcome studies with adolescents (aged 11-18 years) to date. Results suggest a combination of moderators and mediators impacting therapy process and outcome. These include: the therapeutic relationship; main attachment style at the start of treatment; length of treatment; and therapeutic technique. Themes appear interlinked, suggesting that different aspects of the therapy process cannot be separated, and instead the process is complex and nuanced. Review findings may be beneficial to therapists working with adolescent patients in thinking about the treatment setting, treatment length, and model fidelity.
... CBT on anxiety disorders), and the broader concept of EBP, which highlights the client's individual and sociocultural characteristics and a wide range of research (including controlled studies) that help the therapist best to work effectively (e.g., in psychological testing, case formulation, developing a therapeutic relationship, clinical decision making, use of interventions). EBP is a starting point for "what works for whom" (Norcross & Wampold, 2011), or for the adjustment of the therapy to clients' and therapists' characteristics and to the cultural and social context in which therapy takes place (Norcross & Lambert, 2019;Norcross & Wampold, 2019). ...
... pri psihološkem testiranju, formulaciji primera, razvijanju terapevtskega odnosa, kliničnem odločanju, uporabi intervencij). Gre za izhodišče, "kaj deluje za koga" (Roth in Fonagy, 1996Norcross in Wampold, 2011) ali prilagajanje terapije klientovim in terapevtovim značilnostim ter kulturno-družbenemu kontekstu, v katerem poteka terapija (Norcross, Beutler in Levant, 2006;Bertolino, 2018;Norcross in Lambert, 2019;Norcross in Wampold, 2019). ...
... Leta 2010 je prišlo do druge, ponovno izjemno uspešne in odmevne izdaje Srca in duše spremembe (Duncan in dr., 2010), ko se jim je kot urednik pridružil še Bruce Wampold 15 , ki se je v zadnjih petindvajsetih letih uveljavil kot eden ključnih akterjev v razvoju teorije skupnih dejavnikov in kontekstualnega modela (Wampold, 2001ab;Wampold, 2010;Wampold in dr., 2010;Wampold, Imel in Miller, 2009;Norcross in Wampold, 2011Wampold in Imel, 2015). Zdaj udarni četvorki in ne več trojki, kot pri prvi izdaji knjige, je v vlogi urednikov uspelo zbrati in povezati vse, kar je teorijo skupnih dejavnikov umestilo med empirično podprte teorije. ...
Potem ko sem v predhodnem članku opisal Dodova zgodnja leta, to je razvoj teorije skupnih dejavnikov od Rosenzweiga do Frankovega kontekstualnega modela, tokrat nadaljujem s pregledom Dodovih mladostniških in odraslih let, ki se raztezajo od prvih metaanalitičnih raziskav o učinkovitosti psihoterapije do Schiepkovega nelinearnega dinamičnega modela. Tretja faza raziskovanja psihoterapije (med letoma 1970 in 1983) je prinesla velike izboljšave raziskovalne metodologije, ki so omogočile kakovostnejše preučevanje terapevtskega odnosa in razvoj metaanaliz, ki so potrdile visoko splošno učinkovitost psihoterapije. Po eni strani so se intenzivirala prizadevanja za standardizacijo psihoterapevtskih intervencij, po drugi strani pa je Dodo spodbudil prizadevanja za integracijo psihoterapevtskih pristopov in razvoj transteoretičnih modelov. V četrti fazi (od leta 1984 do danes) je tako v psihoterapevtski znanosti kot tudi klinični praksi prišlo do paradigmatskih premikov, npr. do prehoda od empirično podprtih terapij k na izsledkih temelječi praksi in na praksi temelječih izsledkov ter do razcveta integrativnih in transdiagnostičnih pristopov. Razvoj različnih konceptualizacij skupnih dejavnikov in njihovo empirično potrjevanje je Dodu omogočilo vstop v odrasla leta, tako da je v okviru Wampoldovega kontekstualnega modela prispeval k preseganju dihotomije med terapevtskim odnosom in tehnikami. Schiepkov sinergetični nelinearni dinamični model pa omogoča vpogled v dinamiko interakcij med skupnimi in specifičnimi dejavniki. Psihoterapevtska znanost in klinična praksa sta od svojih začetkov do danes, tudi zahvaljujoč Dodovi pomoči, dosegli visoko stopnjo razvoja. Na osnovi obilja kliničnih in raziskovalnih izsledkov psihoterapevtom različnih pristopov ponuja možnost paradigmatskega preskoka v novo, bolj integrirano razumevanje psihoterapevtske stroke kot samostojnega poklica, v učinkovitejše in uspešnejše oblike klinične prakse in preventive ter v celovitejše, didaktično naprednejše oblike izobraževanja. Hkrati pa Dodo onkraj različnih psihoterapevtskih šol kot meta integrator ponuja vizijo širše integracije znanosti in prakse (model znanstvenika praktika), biološkega, psihološkega in socialnega, kvantitativne in kvalitativne metodologije, nomotetičnosti in idiografičnosti, teoretičnih razlag in kliničnega razumevanja, personalizirane medicine in psihoterapije ter medicinskega in kontekstualnega modela.
... On the basis of the preceding discussion, it is clear that there is strong evidence suggesting that effective prescribing requires an individualized approach to psychopharmacological treatment provision that acknowledges and explicitly addresses the role of the patient's subjective meaning and the patient-physician relational context, in addition to objective information utilized by the diagnosis/evidence-based symptom reduction model. The focus of effective prescribing thus shifts from utilizing evidence-based prescription algorithms for categorical DSM disorders to answering Gordon Paul's challenge 23 : "What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances?" (italics in the original). From this perspective, psychopharmacological decisions that optimally address the unique needs of a given patient within the existing doctor-patient relationship are made at the intersection of the objective, subjective, and intersubjective perspectives ( Fig. 1). ...
... Indeed, robust evidence demonstrates that different psychotherapeutic techniques have roughly equivalent effect sizes for a wide span of mental disorders, 1 and that specific patienttherapist effects have a greater impact than the choice of evidence-based techniques in outcome research. 52 These considerations prompted Norcross and Wampold 23 to look beyond the question of "what treatment works best for which disorder?" and focus on the common factors across all psychotherapeutic methods. This led to their conception of "evidencebased relationships," a revolutionary utilization of available evidence to provide complementary guidance on how to effectively tailor any given evidencebased treatment to each patient's unique experience. ...
The purpose of this review is to highlight the limitations of the traditional diagnosis/evidence-based symptom reduction paradigm and advocate for an individualized medicine approach that incorporates psychological and relational aspects of prescribing in addition to the objective patient presentation. Potential barriers, challenges, and proposed future directions for improving education in psychological and relational aspects of prescribing are discussed. Psychological aspects of prescribing, as recently spelled out in the field of psychodynamic psychopharmacology, are generally acknowledged as important, but they do not have a well-defined position in contemporary residency training throughout North America. While residents receive in-depth exposure to diverse aspects of what to prescribe in their psychopharmacological training, and they work with patients’ subjective and relational meaning and the quality of the therapeutic alliance in their psychotherapy rotations, an integrated approach to how to prescribe is generally lacking. Despite many legitimate challenges, the authors suggest that teaching an integrated approach that incorporates objective, subjective, and relational factors in the provision of psychopharmacology and utilizing evidence-based principles of individualized care should be prioritized in both residency training and the provision of psychiatric treatment as a whole.
... Between 2009 and 2011, the APA Division of Clinical Psychology and Division of Psychotherapy jointly sponsored a Task Force with the aim, in part, of identifying effective methods of adapting treatment to individual patients (Norcross & Wampold, 2011). This reflects a growing interest in "treatment matching," or personalized medicine (Norcross, 1991). ...
... Religion and spirituality were identified in the APA Interventional Task Force recommendations as one of the four client characteristics worthy of adapting therapeutic practice to (Norcross & Wampold, 2011). Spirituality was defined as a search for the sacred, while religion was thought to differ from spirituality in additionally encompassing rituals, prescribed behaviors and/or non-sacred goals such as group validation (Hill et al., 2000). ...
Objectives
Both mindful breathing and deep diaphragmatic breathing are used in the treatment of emotional disorders and can help people learn to modulate the body’s stress response. While both result in deep, slow breathing, the two approaches are quite different in their origins. We tested whether individual differences in spirituality might moderate their efficacy.Methods
Forty-eight undergraduates from the University of Pennsylvania completed baseline measures of spirituality as well as respiration rate, tidal volume and heart rate variability (HRV) at rest. Participants were then randomly assigned to a video that guided them through a mindful breathing exercise (which mentioned “a long tradition of meditation style exercises that have been used for literally thousands of years”) (N = 21) or a diaphragmatic breathing exercise (N = 27).ResultsBoth types of training resulted in lower respiration rate and higher tidal volume over baseline (all ts > 3.78, ps < 0.001), but only diaphragmatic breathing resulted in significant increases in HRV (t(26) = 6.29, p < 0.001). Spirituality moderated the impact, such that spiritual people benefited equally from both types of breathing training, but less spiritual people benefited more from diaphragmatic breathing than from mindful breathing (F(4,46) = 3.69, p = .06).Conclusions
These results suggest that spirituality may moderate the impact of mindfulness-based interventions (MBIs) in the American context. Discussion focuses analyzes how our results may reflect a misunderstanding of eastern wisdom traditions as they were characterized during colonial times.
... After all, where psychiatric patients differ enormously in severity, duration or symptoms of psychopathology and in risk of recurrence, treatments in daily care differ in used methods, assumed mechanisms and appointment frequency. Even within a specific diagnostic group, tailoring psychotherapeutic interventions specifically to the circumstances and characteristics of the patient can improve treatment outcomes (16,120,121). Depending on the context and goal of a ML model, one might want to adjust the probability cut-off for predicting non-improvement. We decided to use a probability cut-off of 50% for predicting non-improvement, because we did assume the cost of misspecification to be equal for the positive and negative class. ...
Objectives
Anxiety and mood disorders greatly affect the quality of life for individuals worldwide. A substantial proportion of patients do not sufficiently improve during evidence-based treatments in mental healthcare. It remains challenging to predict which patients will or will not benefit. Moreover, the limited research available on predictors of treatment outcomes comes from efficacy RCTs with strict selection criteria which may limit generalizability to a real-world context. The current study evaluates the performance of different machine learning (ML) models in predicting non-improvement in an observational sample of patients treated in routine specialized mental healthcare.Methods
In the current longitudinal exploratory prediction study diagnosis-related, sociodemographic, clinical and routinely collected patient-reported quantitative outcome measures were acquired during treatment as usual of 755 patients with a primary anxiety, depressive, obsessive compulsive or trauma-related disorder in a specialized outpatient mental healthcare center. ML algorithms were trained to predict non-response (< 0.5 standard deviation improvement) in symptomatic distress 6 months after baseline. Different models were trained, including models with and without early change scores in psychopathology and well-being and models with a trimmed set of predictor variables. Performance of trained models was evaluated in a hold-out sample (30%) as a proxy for unseen data.ResultsML models without early change scores performed poorly in predicting six-month non-response in the hold-out sample with Area Under the Curves (AUCs) < 0.63. Including early change scores slightly improved the models’ performance (AUC range: 0.68–0.73). Computationally-intensive ML models did not significantly outperform logistic regression (AUC: 0.69). Reduced prediction models performed similar to the full prediction models in both the models without (AUC: 0.58–0.62 vs. 0.58–0.63) and models with early change scores (AUC: 0.69–0.73 vs. 0.68–0.71). Across different ML algorithms, early change scores in psychopathology and well-being consistently emerged as important predictors for non-improvement.Conclusion
Accurately predicting treatment outcomes in a mental healthcare context remains challenging. While advanced ML algorithms offer flexibility, they showed limited additional value compared to traditional logistic regression in this study. The current study confirmed the importance of taking early change scores in both psychopathology and well-being into account for predicting longer-term outcomes in symptomatic distress.
... "My last therapist told me I was XYZ (diagnosis) and needed medication ( even though the therapist had no medical credentials)" and "S / he told me to (get divorced, leave my family, join AA)" are the most com mon things I hear from clients who have had negative therapy experiences. l know about clients' negative experiences in therapy because I ask (Norcross & Wampold, 2011)! And I continue to be amazed by the pseudo-expertise floating around the therapy community. ...
Dr. Frank Thomas is Professor of Counseling and Counselor Education at Texas Christian University in Fort Worth (Texas, US). He is also official Archivist for the Solution-Focused Brief Therapy Association. Frank and i have been friends and colleagues for nearly 25 years, co-presented at international conferences and writ ten book chapters and professional articles together. I endorsed his latest book, Solution-Focused Supervision: A resource-oriented approach to developing clinical expertise Springer), describing it as "THE most significant Solution-Focused book of the past 10 years." Frank is also an Associate Editor of JSFBT.
... parameter to be taken into account by participants in this study. Professionals seems to develop a less idealized view of Open Dialogue and to gain a more realistic view of what works for whom in psychotherapy (Norcross and Wampold, 2011). Participants report that the mentality and relationships among different members determine the quality and openness of the dialogue during network meetings. ...
Introduction
The present study is part of a large-scale original action-research project aiming to assess the introduction and implementation of the Open Dialogue approach within the clinical practice of an established multidisciplinary team in a Day Centre in Athens, Greece. More specifically, it aimed to explore the experiences of professionals within the process of implementation both in relation to their clinical practice and their professional identity.
Methods
Data collection employed a focus group, which was set up to explore professional reflections of the implementation and research processes since the introduction of the model. Thematic Analysis of transcripts revealed two main themes that correspond to the impact of Open Dialogue on professionals’ clinical practice and on team dynamics, respectively.
Results
Professionals identify several challenges in implementing OD, such as difficulties in linking theory to practice, containing uncertainty, and addressing cultural barriers to dialogical ways of working. Professionals further reflect on their own internal journey stemming from the implementation of Open Dialogue that has led them to greater openness and growth, personally and as a team.
Discussion
The role of mental health professionals is being acknowledged as being at the frontline of any meaningful psychiatric reform through the assimilation and promotion of humanistic paradigms aiming towards a change of culture in psychiatric care across different contexts. Despite variations in implementation across different contexts, the importance of consolidating and embracing Open Dialogue as a philosophical framework underpinning mental health care is being discussed.
... (2) Time sensitivity: the changes on the mechanism of change need to happen before the outcome is measured Since it has always been standard for therapists to tailor treatment to the individuality and singularity of their clients (Norcross & Wampold, 2011), individualising research designs might be an alternate solution that could contribute to their identification. ...
Decades of research could find no conclusive evidence that “mental disorders” exist as natural separated entities. Not only have epidemiological studies pointed out excessively high rates of comorbidity as well as short-term diagnostic instability, but the current nosology has also demonstrated its inability to clearly delimit “normal” from “abnormal”—or to use its vocabulary, “sane” from “sick”. As a result, the biomedical paradigm and its ensuing categorical classification have proven unfit to investigate, comprehend and accurately describe psychological distress. Since issues with the current categorical taxonomy considerably affect research and treatment development, it is paramount to move beyond categorical models and improve the conceptualisation, studying and classification of psychological distress. In this regard, Personality Disorders (PDs) provide a great opportunity since the very nature of the concept makes shortcomings of a categorical paradigm arguably even more salient: either someone’s personality is inherently ill (disordered) or it is healthy. Yet, research has demonstrated the superior validity of a dimensional approach where individual differences in personality are continuously distributed and do not consist of two discrete categories (ill vs. healthy). As a result, the field of PDs is taking a leading role in the integration of alternative approaches to provide fully accurate descriptions of people’s difficulties rather than forcing individuals into imprecise categories. In psychotherapy research, the field follows a similar rational and draws from the dimensional paradigm to focus on the individualisation of methods.
The aim of the present doctoral dissertation is to demonstrate the theoretical and methodological potential of said individualised and integrated approaches on the basis of three articles in the field of PDs. The first article illustrates how the individualisation of stimuli and the integration of the field of research in psychotherapy with neuroimaging can enhance our understanding of changes during psychotherapy for Borderline Personality Disorder (BPD). The second article presents the elaboration of a prototypical Plan Analysis of Narcissistic Personality Disorder (NPD) from individual case formulations and its implications for treatment. Finally, the third article is a study investigating the differences in emotional arousal between participants with a BPD and controls during an individualised experiential task focusing on self-criticism. The discussion reviews and analyses the findings of each article and addresses the limits as well as the broader theoretical and practical implications of their designs for psychotherapy research. The thesis concludes with a summary and thoughts of future directions of the field of PDs and mental health.
Keywords: psychotherapy research, individualized methods, personality disorders, dimensional approaches
... En concreto con FAP, desde su origen se han hecho estudios de eficacia y efectividad (Kohlenberg et al., 2002;Macías et al., 2019;Maitland et al, 2016, entre nales, multicausales, enraizadas en el contexto verbal y social y en la biografía personal. Una alternativa que creemos más coherente con sus bases epistemológicas y ontológicas, que implicaría renunciar a artificios para encajar en las normas que le permitan jugar en la corriente científica y académica mainstream, y que le ofrece la posibilidad de alinearse con la crecientes corrientes críticas al modelo de salud mental dominante, desde donde se están ofreciendo alternativas de conceptualización y abordaje de los trastornos psicológicos mucho más cercanas y coherentes con los principios de FAP (Angus & McLeod, 2004;Elliott, et al, 2021;Fried, 2022;Hopfenbeck, 2015;Johnstone, 2018Johnstone, , 2022Johnstone & Boye, 2018;Moncrieff, 2018Moncrieff, , 2020Norcross & Lambert, 2019;Norcross, & Wampold, 2011a, 2011bRead, & Harper, 2022;Seikkula, 2011;Seikkula, & Arnkil, 2013;Timimi, 2014Timimi, , 2017Wampold & Imel, 2015). ...
La Psicoterapia Analítica Funcional (FAP) es una terapia contextual. Realiza un análisis funcional de la conducta del cliente dentro de la sesión clínica, aplicando contingencias de reforzamiento natural y el moldeamiento, y establece una equivalencia funcional entre el contexto clínico y la vida diaria del cliente. A pesar de los númerosos estudios que demuestran su eficacia para el tratamiento de trastornos psicológicos de muy diversa índole, su carácter eminentemente funcional e ideográfico, basándose en el estudio de casos clínicos de sujeto único, supone un claro inconveniente a la hora de adaptarse a los sistemas diagnósticos nosológicos y a los criterios de validez (el ensayo controlado aleatorizado y el metaanálisis) mayoritariamente aceptados por la comunidad científica. El presente trabajo expone el Modelo de Conexión Social como una alternativa a las limitaciones de FAP, reconociendo su utilidad clínica. Además, hace un análisis crítico de este modelo,señalando los riesgos de recurrir a términos de nivel medio (consciencia, coraje, amor, intimidad, etc.) y desviar el enfoque funcional e idiográfico característico de FAP.
... In contemporary psychotherapy, a consensus maintains the benefits of modifying treatment to meet the needs of the client, particularly the idiosyncrasies of their context (Norcross & Wampold, 2011b). Variations to standard treatment protocols were employed during recruitment, screening, assessment, and treatment to improve accommodation of the characteristics of Vietnamese Australian clients. ...
Equity is an important principle of health care in Australia, and redesigning health services to meet the needs of culturally marginalised groups has the potential to improve accessibility to psychotherapy. This paper describes the collaborative efforts of an ethno-specific service and a specialist treatment service to provide an evidence-informed intervention to treat Vietnamese Australian individuals experiencing gambling problems. Employing a clinical case audit tool and drawing on the evidence of 33 participants, the study identified which features of therapeutic practice had the most impact on retention and treatment completion. Moderate but influential adjustments to the delivery of a standard behavioural treatment program improved access, treatment adherence, and success for Vietnamese Australians experiencing gambling problems. These findings have significant implications for health care provision in a culturally diverse nation. Results highlight the importance of service adaptation to address under-utilisation and under-representation of psychotherapy services by culturally marginalised groups due to language and cultural barriers.
... In that sense, the authors support the increasing idea of tailoring psychotherapy to the person. 86 As the EFPI treatment is still in its pilot phase and as to avoid underpowered samples, we opted against a 2×2 design, and for the neglect of an EFPI once weekly condition. ...
Introduction
The effectiveness of psychotherapy in depression is subject of an ongoing debate. The mechanisms of change are still underexplored. Research tries to find influencing factors fostering the effect of psychotherapy. In that context, the dose–response relationship should receive more attention. Increasing the frequency from one to two sessions per week seems to be a promising start. Moreover, the concept of expectations and its influence in depression can be another auspicious approach. Dysfunctional expectations and the lack of their modification are central in symptom maintenance. Expectation focused psychological interventions (EFPI) have been investigated, primarily in the field of depression. The aim of this study is to compare cognitive behavioural therapy (CBT) once a week with an intensified version of CBT (two times a week) in depression as well as to include a third proof-of-principle intervention group receiving a condensed expectation focused CBT.
Methods and analysis
Participants are recruited through an outpatient clinic in Germany. A current major depressive episode, diagnosed via structured clinical interviews should present as the main diagnosis. The planned randomised-controlled trial will allow comparisons between the following treatment conditions: CBT (one session/week), condensed CBT (two sessions/week) and EFPI (two sessions/week). All treatment arms include a total dose of 24 sessions. Depression severity applies as the outcome variable (Beck Depression Inventory II, Montgomery Asberg Depression Rating Scale). A sample size of n=150 is intended.
Ethics and dissemination
The local ethics committee of the Department of Psychology, Philipps-University Marburg approved the study (reference number 2020-68 v). The final research article including the study results is intended to be published in international peer-reviewed journals.
Trial registration number
German Clinical Trials Registry (DRKS00023203).
... Lastly, as stated above, the latest developments in evidence-based practice suggest shifting attention from the efficacy of a treatment for a specific diagnosis to a more process-based approach, which necessarily leads to more SCHERB and KERMAN | 3 personalized treatments (J. C. Norcross & Wampold, 2011). Although we are still under the hegemony of the "protocol-for-syndrome" era, the picture is changing rapidly (Hoffman & Hayes, 2021). ...
Even in well-delivered treatments, a significant proportion of patients with severe diagnoses will not achieve sustained remission. For example, research demonstrates that in Bipolar II disorder, while psychological interventions combined with pharmacotherapy yield much better results than pharmacotherapy alone, relapse rates remain very high. In this article, we show the successful treatment of Mrs. C., who was diagnosed with Bipolar II disorder and fell into the non-responders. The treatment integrated a novel approach grounded on a cognitive-behavioral theory with a systemic perspective. The psychotherapist, the psychiatrist, and a family therapist composed the teamwork and delivered the treatment in three phases. In the first phase, the psychotherapist conjointly with the psychiatrist aimed at reducing symptoms. In the second phase, the psychotherapist and the family therapist addressed the dysfunctional relationship patterns that negatively reinforced emotional dysregulation. Finally, in the third phase, the aim was to consolidate the achievements, changes, and good outcomes.
... Such therapeutic programs or additional interventions should aim to improve feelings of low self-worth and lack of autonomy, as well as enhancing interpersonal skills by decreasing the tendency to engage in passive (aggressive) submission or dependent behavior. As suggested by other research [77], the knowledge generated by such studies may be used in developing Riel van et al. BMC Psychiatry (2023) 23:136 more effective, specifically tailored treatments for those patients with BED who fail to improve by the current evidence-based treatment programs. ...
Background
Binge eating disorder (BED), as the most prevalent eating disorder, is strongly related to obesity and other somatic and psychiatric morbidity. Despite evidence-based treatments a considerable number of BED patients fail to recover. There is preliminary evidence for the association between psychodynamic personality functioning and personality traits on treatment outcome. However, research is limited and results are still contradictory. Identifying variables associated with treatment outcome could improve treatment programs. The aim of the study was to explore whether personality functioning or personality traits are associated with Cognitive Behavioral Therapy (CBT) outcome in obese female patients with BED or subthreshold BED.
Methods
Eating disorder symptoms and clinical variables were assessed in 168 obese female patients with DSM-5 BED or subthreshold BED, referred to a 6-month outpatient CBT program in a pre-post measurement design. Personality functioning was assessed by the Developmental Profile Inventory (DPI), personality traits by the Temperament and Character Inventory (TCI). Treatment outcome was assessed by the Eating Disorder Examination-Questionnaire (EDE-Q) global score and self-reported binge eating frequency. According to the criteria of clinical significance, 140 treatment completers were categorized in four outcome groups (recovered, improved, unchanged, deteriorated).
Results
EDE-Q global scores, self-reported binge eating frequency and BMI significantly decreased during CBT, where 44.3% of patients showed clinically significant change in EDE-Q global score. Treatment outcome groups showed significant overall differences on the DPI Resistance and Dependence scales and the aggregated ‘neurotic’ scale. Significant overall differences were found between groups on TCI Harm avoidance, although post hoc t-tests were non-significant. Furthermore, multiple logistic regression analysis, controlling for mild to moderate depressive disorder and TCI harm avoidance showed that ‘neurotic’ personality functioning was a significant negative predictor of clinically significant change.
Conclusion
Maladaptive (‘neurotic’) personality functioning is significantly associated with a less favorable outcome after CBT in patients with binge eating. Moreover, ‘neurotic’ personality functioning is a predictor of clinically significant change. Assessment of personality functioning and personality traits could support indication for more specified or augmented care, tailored towards the patients’ individual strengths and vulnerabilities.
Trial registration
This study protocol was retrospectively evaluated and approved on 16-06-2022 by the Medical Ethical Review Committee (METC) of the Amsterdam Medical Centre (AMC). Reference number W22_219#22.271.
... Da je taka usmeritev (kot so jo tudi raziskovali in uveljavljali zagovorniki na klienta usmerjene terapije) učinkovita, so potrdile tudi sodobne raziskave psihoterapevtskega procesa in izida (npr. Wampold in Imel, 2015;Norcross in Lambert, 2019;Norcross in Wampold, 2011, 2019. ...
Psihoterapija brez diagnoz in njen prispevek k družbeni pravičnosti: V spomin Grahamu Barnesu (1936-2020) 23 Psychotherapy without diagnoses and its contribution to social justice: In memoriam Graham Barnes (1936-2020) »Ljudje nas, psihoterapevte, vedno znova sprašujejo: 'Kakšne vrste terapevt si? Kakšen je tvoj pristop?' Vsi imamo različne stile, vendar smo sprejeli predpostavko, da moramo biti terapevti določene vrste, da moramo pripadati določenemu psihoterapevtskemu pristopu. Kakšna potrata virov, kakšna izguba človeških zmožnosti, da se moramo terapevti stlačiti v majhne škatle, na katerih so različne nalepke. Po dolgih letih študija psihoterapije moramo postati te ali one vrste terapevti, namesto da bi postali človeški terapevti! Terapevti, ki se v popolnosti odzivajo na vsakega klienta, ki vstopi skozi naša vrata.« (Graham Barnes, 2010a: 152) Povzetek V članku, napisanem v spomin Grahamu Barnesu, prikažem njegov projekt »refleksivne« oziroma »rekurzivne psihoterapije«, ki na krožen način obrača psihoterapijo k sebi in prevprašuje njene temeljne predpostavke. Z refleksivnim načinom mišljenja ne moremo izstopiti iz teorije, temveč lahko doživimo nekaj novega preko primerjalne epistemologije. To vključuje razvijanje teorije o teorijah in jezika o jeziku ter zavedanje, da je razlaga doživetja hkrati novo doživetje. Na podlagi lastne izkušnje učenja z Barnesom prikažem njegovo pojmovanje tragedije duševnega zdravja in psihoterapije ter njegovo prizadevanje za udejanjanje psihoterapije, ki ni osredotočena na teorijo in ki psihopatologije ne pojmuje kot odkritja temveč kot izum. Nadaljujem z osvetlitvijo treh konceptov-pravičnosti, ljubezni in modrosti-ki so po Barnesovem mnenju ključne sestavine psihoterapije kot pogovorne aktivnosti in načina prepričevanja, ki lahko prispeva k razvoju civilizacije in demokracije. Na primeru koncepta »slušne halucinacije« in vinjete iz klinične prakse prikažem, kako lahko refleksivna psihoterapija preokviri psihopatologijo, tako da prepreči patologizacijo, 1 Mag. Miran Možina, psihiater in psihoterapevt, SFU Ljubljana, miranmozina.slo@gmail.com 2 Članka ne posvečam le dragemu Grahamu, ki je umrl 9. avgusta 2020, temveč tudi svoji mami, ki je novembra 2020 odšla v šestindevetdesetem letu starosti: »Čeprav nisi prav dobro razumela moje življenjske poti, ki jo utira nekaj, kar je tudi meni nedoumljivo, in čeprav so se ti zdele čudne previsne steze, po katerih se poskuša vzpenjati moja misel, si me vedno, res vedno podpirala v moji nenasitni radovednosti, sli po učenju in potrebi po ustvarjalnem izražanju. Do konca svojih dni si dostojanstveno nosila svojo samoto, ki bi ti jo lahko pogosteje blažil z druženjem, a sem naju za to prikrajševal z vsakim tekstom, vključno s tem, ki sem ga pisal na račun prostih trenutkov.« 3 Članek je bil objavljen v Možina, M. (2020). Psihoterapija brez diagnoz in njen prispevek k družbeni pravičnosti: V spomin Grahamu Barnesu (1936-2020). Kairos-Slovenska revija za psihoterapijo, 14(3-4), 259-315.
... An extension of this question was posed by Gordon L. Paul: " What treatment, by whom, is most effective for this individual, with that specific problem, and under which set of circumstances?" ( Paul, 1967, p. 114). This extended question has become the basis for " tailoring 11 CORE CLInICAL COMPETEnCIES TODAY treatment" ( Norcross & Wampold, 2011), an initiative that continues into Era IV. ...
... One of the main goals of many clinicians and clinical researchers is to approach the question of what works for whom, in order to provide the best possible treatment for the individual patient. This has been a central question in psychotherapy research, addressed repeatedly since it was first mentioned by Gordon L. Paul in 1967(Hofmann & Hayes, 2019Kazdin, 2007;Norcross & Wampold, 2010). ...
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.
... It is widely discussed in the sexuality studies literature that sexuality is a fundamental part of the human experience (World Association for Sexual Health, 2014;World Health Organization, 2015). Religion, spirituality, and faith are components that many scholars including health researchers, also identify as integral to the human experience (Norcross & Wampold, 2011;Sulmasy, 2002). Researchers have noted in recent years that mental health clinicians should be better prepared to address clients' religious/spiritual needs (Marterella & Brock, 2008;Vieten et al., 2013;Williams-Reade et al., 2019;Xu, 2016). ...
... Individual patient factors may also account for a lack of difference between intervention types, as well as a need more effective and targeted techniques for reducing RNT. The optimum approach for reducing RNT may differ depending on the person or context (Norcross & Wampold, 2011), and multiple transdiagnostic mechanisms may be functioning and interacting simultaneously. For example, younger adolescents with less developed meta cognitive abilities may be more suited to basic CBT techniques which provide education on thinking patterns prior to commencing process based techniques to change these patterns. ...
Background
Depression and anxiety are prevalent in youth populations and typically emerge during adolescence. Repetitive negative thinking (RNT) is a putative transdiagnostic mechanism with consistent associations with depression and anxiety. Targeting transdiagnostic processes like RNT for youth depression and anxiety may offer more targeted, personalised and effective treatment.
Methods
A meta-analysis was conducted to examine the effect of psychological treatments on RNT, depression and anxiety symptoms in young people with depression or anxiety, and a meta-regression to examine relationships between outcomes.
Results
Twenty-eight randomised controlled trials examining 17 different psychological interventions were included. Effect sizes were small to moderate across all outcomes (Hedge's g depression = −0.47, CI −0.77 to −0.17; anxiety = −0.42, CI −0.65 to −0.20; RNT = −0.45, CI −0.67 to −0.23). RNT-focused and non-RNT focused approaches had comparable effects; however, those focusing on modifying the process of RNT had significantly larger effects on RNT than those focusing on modifying negative thought content. Meta-regression revealed a significant relationship between RNT and depression outcomes only across all intervention types and with both depression and anxiety for RNT focused interventions only.
Conclusion
Consistent with findings in adults, this review provides evidence that reducing RNT with psychological treatment is associated with improvements in depression and anxiety in youth. Targeting RNT specifically may not lead to better outcomes compared to general approaches; however, focusing on modifying the process of RNT may be more effective than targeting content. Further research is needed to determine causal pathways.
... Processes such as emotion regulation, emotional reactivity, mood states, and stress and coping are theorized as important mechanisms for the salutary effects of MBIs (Sauer et al., 2011), and are often successfully engaged in MBIs in addition to downstream outcomes such as anxiety and depression (Hoge et al., 2021). Participant and intervention-level attributes can moderate treatment response (Kazdin, 2007), and religiosity/spirituality (R/S) has been identified as one of four individual characteristics to be prioritized in personalizing therapeutic approaches (Norcross & Wampold, 2011), yet despite decades of research, it remains unclear how individuals' R/S might influence the effects of mindfulness on affective outcomes. ...
Unlabelled:
Mindfulness-based interventions (MBIs) are often promoted in the Western world as being "secular" in nature, despite the religious/spiritual (R/S) roots of mindfulness itself. Relevant individual characteristics such as R/S, however, have yet to be examined thoroughly in relation to treatment response. Using pre-post experimental designs, we examined the interaction of participant religiosity and different religious framings (Buddhist, secular, spiritual) of a brief MBI as determinants of affective responses to the MBI using regression in two online samples (Study 1: N=677; Study 2: N= 157). Aspects of religiosity (existential quest, scriptural literalism) had differential effects on affective responses to MBIs dependent on the framing of the condition. Participants' R/S, as well as the R/S attributes of an MBI, may impact affective responses to MBIs. Further research is needed to ascertain how, and to what extent, MBIs might be optimized in order to maximize benefits for participants with diverse religious and existential commitments.
Supplementary information:
The online version contains supplementary material available at 10.1007/s42761-022-00139-0.
... For example, one mourner who reports "often" engaging in Unhealthy Coping on item 3 might circle examples indicating frequent substance abuse, whereas another responding similarly to the same overall item might acknowledge significant self-destructive behavior or struggles with eating. Obviously, this greater level of detail could open doors to the closer evaluation of risk and the tailoring of clinical intervention to focus on clients' unique characteristics, which has been shown to improve therapeutic outcomes (Norcross & Wampold, 2011). Similarly, this straightforward encouragement to indicate particular examples of each item could promote more relevant therapeutic goal setting regarding other forms of functional impairment arising in the psychological, health or social domains. ...
Though most mourners are resilient, a minority of the bereaved experience disabling grief accompanied by clinically significant impairment in important areas of functioning. Although impairment measures exist, they have notable limitations in the context of bereavement. Therefore, the objective of this study was to develop and evaluate the Grief Impairment Scale (GIS), which was designed to identify the impact of grief on biopsychosocial functioning. The resulting 5-item scale, which was based on 363 adults who are struggling with grief, demonstrated solid reliability, factorial validity, and convergent and divergent validity with correlations with measures of impairment, prolonged grief, and psychological distress. The GIS also measures grief-related functioning equivalently across demographic groups and satisfactorily discriminates between persons with and without impairment using an optimized cut score of ≥ 9 (79% sensitivity and 74% specificity). These results provide preliminary support for the GIS as a flexible tool for clinical research and practice.
... It has been suggested that tailoring interventions to the patients' conditions may improve therapy outcomes (Norcross & Wampold, 2011). To that end, it is common practice to apply adapted CBT protocols for specific disorders (e.g., Cognitive Behavioral Analysis System of Psychotherapy, for treating chronic depression). ...
Machine learning (ML) may help to predict successful psychotherapy outcomes and identify relevant predictors of success. So far, ML applications are scant in psychotherapy research and typically based on small samples or focused on specific diagnoses. In this study, we predict successful therapy outcomes with ML in a heterogeneous sample in routine outpatient care. We trained established ML models (decision trees and ensembles of them) with routinely collected clinical baseline information from n = 685 outpatients to predict a successful outcome of cognitive behavioral therapy. Treatment success was defined as clinically significant change (CSC) on the Brief-Symptom-Checklist (achieved by 326 patients; 48%). The best performing model (Gradient Boosting Machines) achieved a balanced accuracy of 69% (p < .001) on unseen validation data. Out of 383 variables, we identified 16 most important predictors, which still predict CSC with 67% balanced accuracy. Our study demonstrates that ML models built on data, typically available at the outset of therapy, can predict whether an individual will substantially benefit from the intervention. Some of the predictors were theoretically expected (e.g., level of functioning), but others need further validation (e.g., somatization). From a theoretical and practical perspective, ML is clearly an attractive addition to more established psychotherapy research methodology.
... 68 As stressed by Norcross and Wampold (2011), there is a strong need to identify variables that can help clinicians make informed decisions as to which treatment modalities may be more effective for their patients. 80 The present study contributes to this matter by being the first to examine the differential impact of attachment and CM in 2 treatment conditions for sexual difficulties. From a clinical standpoint, this research captures the importance of distal interpersonal factors in the treatment of sexual difficulties as they may influence the course of treatment. ...
Background
Although distal developmental factors, such as attachment and childhood maltreatment (CM), are associated with the occurrence, severity, and adjustment to provoked vestibulodynia (PVD)—the most prevalent form of vulvodynia—no studies to date have examined whether these variables are related to treatment efficacy in the context of PVD. Attachment and CM may act as moderating variables when examining different treatment modalities, whereby individuals with more insecure attachment orientations (anxiety/avoidance) or a history of CM may benefit less from treatments with higher interpersonal contexts, such as sex and couple therapy—a recommended treatment for PVD.
Aim
The present randomized clinical trial (RCT) examined attachment and CM as predictors and moderators of sexual satisfaction, distress, and function at post-treatment and 6-month follow-up while comparing 2 treatments for PVD: Topical lidocaine, and a novel cognitive behavioral couple therapy focused on women's pain and partners’ sexuality.
Methods
One hundred eight women with PVD were randomized to a 12-week treatment of either lidocaine or couple therapy. Women completed questionnaires at pretreatment, post-treatment, and at a 6-month follow-up.
Outcomes
(1) Global Measure of Sexual Satisfaction; (2) Female Sexual Distress Scale-Revised; (3) Female Sexual Function Index.
Results
Both attachment and CM were significant moderators of treatment outcomes. At either post-treatment or 6-month follow-up, in the couple therapy condition, women with greater attachment avoidance had poorer outcomes on sexual distress, satisfaction and function, whereas women with higher levels of CM had poorer outcomes on sexual satisfaction and sexual function, compared to women in the lidocaine condition.
Clinical Implications
Although these novel findings need further replication, they highlight the importance for clinicians to take into account distal factors, for instance, attachment and CM, when treating sexual difficulties such as PVD, as these variables may affect more interpersonal dimensions of treatment (eg, trust, compliance, etc.) and ultimately, treatment progress.
Strengths & Limitations
Using a rigorous RCT study design and statistical approach, this study is the first to examine attachment and CM as moderators in the treatment of sexual difficulties. It is however limited by the use of self-report measures, and further studies are necessary to validate the generalizability of current results to other sexual difficulties.
Conclusion
Findings support the role of interpersonal factors in the treatment of PVD and indicate that short-term psychological interventions, such as couple therapy, may be less beneficial for women with antecedents of CM and attachment insecurity.
V Charbonneau-Lefebvre, M-P Vaillancourt-Morel, NO Rosen, et al. Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia. J Sex Med 2021;XX:XXX–XXX.
... Understanding how individual characteristics interact to predict treatment adherence and outcome would help elucidate how different treatments can yield comparable results for different people. It would also allow researchers and health care practitioners to best tailor their treatment approach to their participants or patients, thereby optimizing treatment efficacy (Norcross & Wampold, 2011). ...
Background
An increasing number of studies have investigated the efficacy of Acceptance and Commitment Therapy (ACT) for the reduction of dysregulated eating behaviours such as binge eating and emotional eating. However, little is known about their short- and long-term efficacy and underlying mechanisms of change.
Objectives
To conduct a systematic effect size analysis to estimate the efficacy of ACT-based treatments on measures of dysregulated eating and of psychological flexibility, a theorized ACT mechanism of change.
Methods
Literature searches were conducted in PsycInfo, Medline, Web of Science, and ProQuest Dissertations. Within-group and between-group standardized mean differences were computed using Comprehensive Meta-Analysis Version 3. Additional subgroup and meta-regression analyses by study characteristics were conducted.
Results
A total of 20 publications (22 samples, n = 1269) were included. Pre-post and pre-follow-up effects suggest that ACT-based treatments are moderately effective in reducing dysregulated eating behaviours and increasing psychological flexibility. These effects were comparable for binge-eating and emotional eating outcomes and for face-to-face interventions, Web-based interventions, and interventions that used a self-help book. Longer treatments were associated with larger outcome effect sizes, and changes in psychological flexibility were not associated with changes in dysregulated eating outcomes. Small significant effects were found in favour of ACT when compared to inactive control groups. The only three studies that included active control groups and did not show significant differences in outcomes between ACT and other treatments.
Conclusion
Future studies should aim to compare ACT-based treatments to active treatments and to provide empirical evidence for the theoretical mediating role of psychological flexibility in reported changes in eating behaviour.
... In an attempt to identify crucial elements for effective therapy relationships, Norcross and Wampold (2011) noted the patient dimension religion/spirituality as one of 4 patient characteristics impacting effective methods. However, research (Mitchell & Baker, 2000) has shown client perception considers seeking help from mental health professionals as conflicting with their religious beliefs and a last resort. ...
Clients seeking sex therapy can bring into the clinical space a vibrant religious, spiritual and/or faith practice. Even those clients who do not consider themselves religious, often come to sex therapy with a prior relationship to a religion or with a higher power. While this relationship can be a source of strength, it may include a history of trauma, pain, and grief. This intersection of sexuality and faith can be a powerful clinical space; however, it is not without its challenges, specifically when shame, guilt and remorse are associated with the client’s sexual experiences. Mental health professionals skilled in sex therapy are ideally positioned to support these clients; however, they are rarely trained in incorporating client religious issues. This paper seeks to expand professional discourse on supporting clients at the intersection of sexual and faith well-being. First, we discuss why mental health clinicians focused on sex therapy need to incorporate a faith informed practice lens. Next, three case studies are presented to highlight the intersection of psychosexualtherapy and a client’s faith. The discussion section subsequently highlights preparation needed by mental health professionals and offers suggestions for better professional training in this specialty area. Finally, faith informed clinical interventions are presented.
... In addition, due to the pursuit of homogeneous groups, complex cases are usually excluded from RCTs. Another annoying observation was that most psychological treatments show only moderate effect sizes, often with a high degree of uncertainty, prompting the question: "What works for whom?" difficult to answer (Norcross and Wampold, 2011;Vlaeyen and Morley, 2005). ...
In recent decades, it has become clear that data collected at an individual level provides critical evidence that can be used to refine theories, improve treatment, and inform health care decisions. Recent developments in the field of single-case experimental design (SCED) have provided new opportunities to utilize data from a single person. After a brief historical background to why and how SCED recently remerged, this chapter provides a state-of-the art overview of key aspects of SCED methodology. It provides a description of the most frequently used SCEDs, including phase designs, multiple-baseline designs, changing criterion designs, and alternating treatment designs. The chapter then provides an overview of the methods that can be applied to analyze single-case data. Visual analysis and effect size metrics, as well as inferential statistics for single-case data are described and illustrated. The chapter subsequently discusses the role that standards play in the design of SCED research and research synthesis, including examples of existing guidelines. Finally, the chapter discusses some future directions that may help to move the field forward.
... Results of the current study indicate that modifications such as tailoring and integration may be perceived by practitioners as a normal part of implementation necessary to facilitate the best care (Borkovec and Sharpless, 2004;Moree and Davis, 2010), regardless of the modality of delivery (Norcross and Wampold, 2011). In turn, this normalization may increase frequency of this modification for VCD. ...
The implementation of evidence-based psychosocial interventions using video-conference delivery (VCD) has the potential to increase accessibility to effective treatments, although its use remains limited and understudied. This study employed a mixed methods approach in surveying mental health practitioners about their attitudes regarding VCD of interventions that are considered evidence-based (i.e., have been shown to improve targeted outcomes in rigorous research). One hundred and eleven practitioners were sampled from several national and regional U.S. practice organizations and were administered quantitative surveys about their use of and attitudes towards VCD of evidence-based interventions (EBI). We examined the relationship between practitioner-level technology access, experience, and training with technology fluency and acceptability of using VCD. Quantitative results indicated the most frequently used adaptation for VCD was Tailoring and that practitioner education predicted attitudes towards EBIs. A subset (n = 20) of respondents were then purposively selected for qualitative interviews to further investigate accessibility, appropriateness, and feasibility of delivering EBIs via video conference. A conventional content analysis revealed that VCD was appropriate and acceptable for EBIs; however, many practitioners also described barriers related to feasibility of implementation. The results of this study have important implications for telemental health dissemination efforts which seek to extend services to populations not served well by traditional, in-person mental health services.
... They often are delivered in groups (as this cost-effective), are delivered over multiple sessions, with content tending to come from (a combination of compatible) therapeutic paradigms. The content typically tends to be similar for all participants, despite the fact that personalising or tailoring interventions to individual needs might improve outcomes of interventions or improve the feasibility of its implementation (Norcross and Wampold, 2011). To improve tailoring, intervention developers often adjust the content of interventions to fit specific target populations such as students, older adults, or workforces (Waters, 2011;Shiralkar et al., 2013;Proyer et al., 2014;Robertson et al., 2015). ...
Replicating or distilling information from psychological interventions reported in the scientific literature is hindered by inadequate reporting, despite the existence of various methodologies to guide study reporting and intervention development. This article provides an in-depth explanation of the scientific development process for a mental health intervention, and by doing so illustrates how intervention development methodologies can be used to improve development reporting standards of interventions. Intervention development was guided by the Intervention Mapping approach and the Theoretical Domains Framework. It relied on an extensive literature review, input from a multi-disciplinary group of stakeholders and the learnings from projects on similar psychological interventions. The developed programme, called the “Be Well Plan”, focuses on self-exploration to determine key motivators, resources and challenges to improve mental health outcomes. The programme contains an online assessment to build awareness about one’s mental health status. In combination with the exploration of different evidence-based mental health activities from various therapeutic backgrounds, the programme teaches individuals to create a personalised mental health and wellbeing plan. The use of best-practice intervention development frameworks and evidence-based behavioural change techniques aims to ensure optimal intervention impact, while reporting on the development process provides researchers and other stakeholders with an ability to scientifically interrogate and replicate similar psychological interventions.
... With psychosocial interventions for mental health moving away from the "one-size-fits-all" model (Norcross and Wampold, 2011), future research into MM could explore different moderators for its efficacy, including age, diagnoses, duration/phase of illness, duration and format of intervention, and training received by instructors. ...
Mindfulness meditation (MM) and its alignment with the mind-body perspective of health in Chinese cultures indicate its potential to benefit Chinese patients with psychosis. This is the first systematic review and meta-analysis to address the following questions: (1) Does MM improve clinical, well-being, and third-wave outcomes (i.e., mindfulness, acceptance, and compassion levels) among Chinese patients with psychosis? (2) What are the patient- and/or intervention-specific factors that moderate the efficacy of MM? (3) Are improvements on third-wave outcomes associated with improvements on clinical and well-being outcomes? (4) What are the mechanisms underlying the effects of MM? Evidence synthesized from 23 relevant articles (20 studies) involving 1749 patients showed that (1) MM improved a wide range of patients' outcomes, most consistently and sustainably for insight, rehospitalization duration, recovery rate, and social functioning; (2) age and duration of illness, but not the cumulated intervention hours, moderated the overall efficacy of MM; (3) post-MM improvements on mindfulness and on clinical and well-being outcomes were related, and (4) the effects of MM on patients' outcomes may be driven by its ability to promote positive changes in personal growth and enhance one's coping with the illness and its symptoms. Our data showed preliminary support for the benefits of MM in Chinese patients with psychosis. However, results should be considered in light of the varying quality of included studies and their heterogeneity in multiple aspects. Further research is needed to deduce the sustainability of MM's effects, its active ingredients, underlying mechanisms, and additional moderators of its efficacy.
... Conversely, if a psychological professional conducted PTG and disclosed this to a patient, trust could be reduced and, whilst this might cause a rupture repair and constitute a valuable opportunity for growth in the therapeutic relationship (Safran et al., 2011), it might also harm the therapeutic relationship. This is crucial given extensive evidence that the therapeutic relationship makes significant and consistent contributions towards therapy outcome, explaining at least as much of the variance in outcome as the therapeutic model used (Norcross & Wampold, 2011). Even if a therapist decided against disclosing PTG, they would nonetheless have acquired knowledge that impacts their own experience of the therapeutic relationship and their capacity to be authentic. ...
Background
“Patient-Targeted Googling” (PTG) refers to a healthcare professional using the Internet to discover information about a patient. The present review explores PTG by psychological therapists. The review focused on the prevalence of PTG, how often consent is sought from the patient, and the motivations for and consequences of PTG.
Method
A narrative literature review of published PTG studies was undertaken. Potentially eligible studies were identified by searching PsycINFO, PsycARTICLES, Psychology and Behavioural Sciences Collection, and MEDLINE. Results were screened for suitability for inclusion in the sample (n = 9). All studies were appraised for quality using a structured tool developed for this review.
Results
PTG prevalence rates ranged from 20% to 98%, with rates of non-consent ranging from 60% to 84%. Motivations for PTG included curiosity, to gather new information and to verify existing information. Consequences of PTG included enhancing the therapist's sense of safety and causing harm to the therapeutic relationship.
Discussion
Current literature on PTG is limited and focussed largely in the United States. This review revealed no published PTG studies including UK-based psychological therapists, as well as issues in defining and operationalising PTG. Further research is needed to understand the prevalence of PTG by UK-based psychological therapists, as well as the motivations behind, and consequences of, PTG. This evidence base will inform the development of PTG professional guidelines and training, neither of which currently exist for therapists practising in the UK. Both would be timely given the increasing move of the therapeutic frame to the online environment due to the COVID-19 pandemic.
... These average improvement rates, which are highly similar across different therapeutic approaches (Luborsky et al., 2002), can conceal the underlying diversity within treatment groups. For example, although a number of people improve substantially over the course of the therapy, others improve only mildly, do not improve, or even deteriorate (Norcross & Wampold, 2011). In other words, there are always some participants who do not benefit from the therapy (i.e., exhibit no symptomatic improvement or deteriorate). ...
Analysis of single cases represents an essential strategy for developing our
understanding of paradoxical outcome and illusory mental health. Based on
findings from both practice-based and randomized controlled outcome studies,
35-40% of clients fail to improve over the course of psychotherapy.
We examined the prevalence of failure cases in the Single Case Archive, a
database that includes more than 3000 psychotherapy case studies from a
variety of ISI-ranked journals. We found that only 4% of these studies describe
any form of failure in treatment.
Thematic analysis of the titles and abstracts of failure case studies revealed that
the majority did not focus on investigating the nature or meaning of failure but
were primarily interested in other theoretical and practical matters. We propose
a number of explanations for this apparent publication bias in case study
research and discuss implications for further research.
... Though our work is exploratory and the sample size unfortunately small, if the results are supported by further studies, the implications are profound. In therapy research it is recognised that not all patients automatically benefit from a given type of therapy; treatment response is regulated by various factors due to both patient and therapist (Norcross and Wampold, 2011). High DES scores, for example, could indicate that patients suffer from trauma related symptoms rather than ADHD and thus might benefit less from NFB training. ...
Neurofeedback for attention deficit/hyperactivity disorder (ADHD) has long been studied as an alternative to medication, promising non-invasive treatment with minimal side-effects and sustained outcome. However, debate continues over the efficacy of neurofeedback, partly because existing evidence for efficacy is mixed and often non-specific, with unclear relationships between prognostic variables, patient performance when learning to self-regulate, and treatment outcomes. We report an extensive analysis on the understudied area of neurofeedback learning. Our data comes from a randomised controlled clinical trial in adults with ADHD (registered trial ISRCTN13915109; N = 23; 13:10 female:male; age 25–57). Patients were treated with either theta-beta ratio or sensorimotor-rhythm regimes for 40 one-hour sessions. We classify 11 learners vs 12 non-learners by the significance of random slopes in a linear mixed growth-curve model. We then analyse the predictors, outcomes, and processes of learners vs non-learners, using these groups as mutual controls. Significant predictive relationships were found in anxiety disorder (GAD), dissociative experience (DES), and behavioural inhibition (BIS) scores obtained during screening. Low DES, but high GAD and BIS, predicted positive learning. Patterns of behavioural outcomes from Test Of Variables of Attention, and symptoms from adult ADHD Self-Report Scale, suggested that learning itself is not required for positive outcomes. Finally, the learning process was analysed using structural-equations modelling with continuous-time data, estimating the short-term and sustained impact of each session on learning. A key finding is that our results support the conceptualisation of neurofeedback learning as skill acquisition, and not merely operant conditioning as originally proposed in the literature.
... Our overall goal is to not only discuss the statistical importance of negative clustering effects, but to show how negative effects should be interpreted. We will argue why clinical practitioners and psychotherapy researchers (and all others who are interested in knowing what works when for whom; Norcross & Wampold, 2011;Tasca et al., 2015) are -in factinterested in interpreting negative clustering effects. Finally, the specific features of BCSM are discussed, including its strengths and limitations. ...
The multilevel model (MLM) is the popular approach to describe dependences of hierarchically clustered observations. A main feature is the capability to estimate (cluster-specific) random effect parameters, while their distribution describes the variation across clusters. However, the MLM can only model positive associations among clustered observations, and it is not suitable for small sample sizes. The limitation of the MLM becomes apparent when estimation methods produce negative estimates for random effect variances, which can be seen as an indication that observations are negatively correlated. A gentle introduction to Bayesian Covariance Structure Modelling (BCSM) is given, which makes it possible to model also negatively correlated observations. The BCSM does not model dependences through random (cluster-specific) effects, but through a covariance matrix. We show that this makes the BCSM particularly useful for small data samples. We draw specific attention to detect effects of a personalized intervention. The effect of a personalized treatment can differ across individuals, and this can lead to negative associations among measurements of individuals who are treated by the same therapist. It is shown that the BCSM enables the modeling of negative associations among clustered measurements and aids in the interpretation of negative clustering effects. Through a simulation study and by analysis of a real data example, we discuss the suitability of the BCSM for small data sets and for exploring effects of individualized treatments, specifically when (standard) MLM software produces negative or zero variance estimates.
Background:
Dementia is a syndrome of acquired cognitive impairment which is severe enough to interfere with independent living. Over the course of the illness, people with dementia also experience changes in emotions, behaviour and social relationships. According to Alzheimer's Disease International, dementia affects approximately 55 million people worldwide. The latest NICE guideline for dementia highlights the value of diverse treatment options for the different stages and symptoms of dementia, including non-pharmacological treatments. Relevant literature also argues for the value of interventions that acknowledge the complexity of the condition and address the person as a whole, including their physical, emotional, social and cognitive processes. A growing literature highlights the capacity of the arts and has embodied practices to address this complexity. Dance movement therapy (DMT) is an embodied psychological intervention that can address complexity and thus may be useful for people with dementia, but its effectiveness remains unclear.
Objectives:
To assess the effects of dance movement therapy on behavioural, social, cognitive and emotional symptoms of people with dementia in comparison to no treatment, standard care or any other treatment. Also, to compare different forms of dance movement therapy (e.g. Laban-based dance movement therapy, Chacian dance movement therapy or Authentic Movement) SEARCH METHODS: We searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register of the International Clinical Trials Registry Portal until 8 December 2022.
Selection criteria:
We included randomised controlled trials (RCTs) that included people with dementia, of any age and in any setting. The DMT intervention had to be delivered by a dance movement therapy practitioner who (i) had received formal training (ii) was a dance movement therapist in training or (iii) was otherwise recognised as a dance movement therapist in the country in which the study was conducted.
Data collection and analysis:
Two review authors independently assessed studies for inclusion, extracted data and evaluated methodological quality. We expressed effect estimates using the mean difference (MD) between intervention groups and presented associated confidence intervals (CIs). We used GRADE methods to rate our certainty in the results.
Main results:
We found only one study eligible for inclusion in this review. This was a 3-arm parallel-group RCT conducted in Hong Kong involving 204 adults with mild neurocognitive disorder or dementia. The study examined the effects of short-term (12 weeks) group DMT in comparison with exercise and a waiting-list control group immediately post-intervention and three and nine months later. We found that, at the end of the intervention, DMT may result in little to no difference in neuropsychiatric symptoms assessed with the 12-item Neuropsychiatric Inventory when compared with waiting list (MD 0.3, 95% CI -0.96 to 1.56; low-certainty evidence) or exercise (MD -0.30, 95% CI -1.83 to 1.23; low-certainty evidence). Nor was there any evidence of effects at later time points. Cognitive functioning was assessed with a variety of instruments and there were no statistically significant between-group differences (low-certainty evidence). When compared to exercise or waiting list, DMT may result in little to no difference in cognitive function immediately after the intervention or at follow-up. In comparison to waiting list, DMT may result in a slight reduction in depression assessed with the 4-item Geriatric Depression Scale at the end of therapy (MD -0.60, 95% CI -0.96 to -0.24; low-certainty evidence). This slight positive effect of DMT on depression scores was sustained at three and nine months after the completion of the intervention. DMT may also reduce depression slightly in comparison with exercise at the end of therapy (MD -0.40, 95% CI -0.76 to -0.04, low-certainty evidence), an effect also sustained at three and nine months. Our fourth primary outcome, quality of life, was not assessed in the included study. There were data for two of our secondary outcomes, social and occupational functioning and dropouts (which we used as a proxy for acceptability), but in both cases the evidence was of very low certainty and hence our confidence in the results was very low. For all outcomes, we considered the certainty of the evidence in relation to our review objectives to be low or very low in GRADE terms due to indirectness (because not all participants in the included study had a diagnosis of dementia) and imprecision.
Authors' conclusions:
This review included one RCT with a low risk of bias. Due to the low certainty of the evidence, the true effects of DMT as an intervention for dementia may be substantially different from those found. More RCTs are needed to determine with any confidence whether DMT has beneficial effects on dementia.
Enmarcada en la orientación humanista-existencial, y con más de ochenta años de historia, la psicoterapia centrada en la persona continúa siendo uno de los principales sistemas de intervención psicológica. Las ideas de su principal creador, Carl R. Rogers, han sido claves en el desarrollo de la investigación y el ejercicio de la psicoterapia tal y como la conocemos en la actualidad, tanto dentro como fuera de las fronteras de la orientación. Tras una introducción a la teoría psicopatológica y psicoterapéutica que subyace al sistema, este artículo se centra tanto en los nuevos desarrollos dentro de la teoría rogeriana como en la investigación llevada a cabo hasta el momento sobre ella. Revisando algunos de los debates centrales en el ámbito, desde la perspectiva del siglo XXI, el artículo concluye con una reflexión sobre la situación actual del sistema.
Background:
The question 'what works for whom' is essential to mental health research, as matching individuals to the treatment best suited to their needs has the potential to maximize the effectiveness of existing approaches. Digitally administered single-session interventions (SSIs) are effective means of reducing depressive symptoms in adolescence, with potential for rapid, large-scale implementation. However, little is known about which SSIs work best for different adolescents.
Objective:
We created and tested a treatment selection algorithm for use with two SSIs targeting depression in high-symptom adolescents from across the United States.
Methods:
Using data from a large-scale RCT comparing two evidence-based SSIs (N = 996; ClinicalTrials.gov: NCT04634903), we utilized a Personalized Advantage Index approach to create and evaluate a treatment-matching algorithm for these interventions. The two interventions were Project Personality (PP; N = 482), an intervention teaching that traits and symptoms are malleable (a 'growth mindset'), and the Action Brings Change Project (ABC; N = 514), a behavioral activation intervention.
Results:
Results indicated no significant difference in 3-month depression outcomes between participants assigned to their matched intervention and those assigned to their nonmatched intervention. The relationship between predicted response to intervention (RTI) and observed RTI was weak for both interventions (r = .39 for PP, r = .24 for ABC). Moreover, the correlation between a participants' predicted RTI for PP and their predicted RTI for ABC was very high (r = .79).
Conclusions:
The utility of treatment selection approaches for SSIs targeting adolescent depression appears limited. Results suggest that both (a) predicting RTI for SSIs is relatively challenging, and (b) the factors that predict RTI for SSIs are similar regardless of the content of the intervention. Given their overall effectiveness and their low-intensity, low-cost nature, increasing youths' access to both digital SSIs may carry more public health utility than additional treatment-matching efforts.
Objective:
This study examined the relationships between patient-therapist similarity and therapy outcome. We aimed to explore whether patient-therapist match in personality and attachment styles leads to a better therapy outcome.
Method:
We collected data from 77 patient-therapist dyads in short-term dynamic therapy. Patients' and therapists' personality traits (Big-5 Inventory) and attachment styles (ECR) were assessed prior to beginning therapy. Outcome was measured on the OQ-45.
Results:
When patients and therapists scored either high or low on neuroticism and conscientiousness we found a decrease in symptoms from beginning to end of therapy. When patients' and therapists' combined scores were either high or low on attachment anxiety, we found an increase in symptoms.
Conclusion:
Match or mismatch on personality and attachment style in therapy dyads contributes to therapy outcome.
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.
Item response theory was used to study the psychometric properties of the Client Meaningful Experiences Scale (CMES). In a sample of 306 adult counseling clients, we examined the dimensional structure of the scale, item-fit, and person-fit statistics. Implications of these findings for counselors, counselors-in-training, and counseling researchers were discussed.
Both empirical data and genetic counselors' clinical experience suggest that patients differ in the extent to which they benefit from genetic counseling (GC). Understanding the origins of these differences could help adapt services to ensure that all patients benefit fully, and potentially inform triage. Although patient personality dimensions and coping styles have been shown to influence outcomes of other psychological interventions, they have remained largely unexplored in relation to GC outcomes. We conducted an exploratory, descriptive study to assess relationships between patient personality dimensions, coping styles, and outcomes of GC. We recruited patients from a psychiatric genetics clinic who had – in the prior 7 years ‐ completed the GC Outcomes Scale (GCOS, a measure of empowerment) immediately prior to, and approximately one month after their appointment, and asked them to complete validated measures of personality and coping style. Interactions between each personality dimension or coping style and GCOS score were assessed using mixed‐effects linear regression models. Among the 169 participants, GCOS score increased by an average of 16.48 points (SD = 12.59). Though extraversion, conscientiousness, neuroticism, and all three coping styles significantly predicted GCOS score (p < 0.02), there was no relationship between these variables and time. For example, though a high score on conscientiousness predicted higher GCOS scores, it did not predict greater change in GCOS – people with higher scores on this dimension of personality had higher GCOS scores both pre‐ and post‐ GC. These preliminary data suggest that genetic counseling may increase empowerment regardless of personality dimensions and coping styles.
In der existenzanalytischen Diagnostik fokussiert phänomenologisch das, was die PatientInnen subjektiv bewegt. Dies wird durch die Klärung der Voraussetzungen für ganzheitliche Existenz (Grundmotivationen) und der Begegnungsfähigkeit mit sich und der Welt (Personale Existenzanalyse) abgeglichen. Damit wird das Phänomen hinsichtlich des Störungswertes (Behandlungsbedürftigkeit), der Störungsursache (Anthropologie, existenzielles Milieu), der Prognose (Therapieerwartung, mögliche Hindernisse) erfasst und die Erkenntnisse werden mit einer optimalen und ethisch vertretbaren Behandlung abgestimmt.
Objective: The Cooper-Norcross Inventory of Preferences (C-NIP) is a new and promising tool for measuring clients’ preferences regarding psychotherapy. However, the psychometric evaluation of this measure is scarce in general and completely missing for the Czech adaptation of the measure. This study aimed to test the Czech version of the C-NIP factor structure, test its measurement invariance, and establish cut points. Methods: N = 772 adults answered the C-NIP in an online survey. Confirmatory and exploratory factor analyses were used to test the factor structure and assess the C-NIP measurement invariance between men and women and across several levels of psychotherapy experience. Results: The original four-factor model was not supported. Instead, a five-factor model was suggested that fit the data adequately and was strictly invariant with respect to gender and levels of experience with psychotherapy. Conclusions: The Czech C-NIP can be considered a valid and reliable measure of clients’ preferences regarding psychotherapy. The replication of the new factor model is needed.
Estimating individual treatment effects (ITEs) is crucial to personalized psychotherapy. It depends on identifying all covariates that interact with treatment, a challenging task considering the many patient characteristics hypothesized to influence treatment outcome. The goal of this study was to compare different covariate-selection strategies and their consequences on estimating ITEs. A Monte Carlo simulation was conducted to compare stepwise regression with and without cross-validation and shrinkage methods. The study was designed to mimic the setting of psychotherapy studies. No single covariate-selection strategy dominated all others across all factor-level combinations and on all performance measures. The least absolute shrinkage and selection operator showed the most accurate out-of-sample predictions, identified the highest number of true treatment-covariate interactions, and estimated ITEs with the highest precision across the most conditions. Domain backward stepwise regression and backward stepwise regression using Bayesian information criterion were least biased in estimating variance of ITEs across the most conditions.
Introduction: Suicide is a leading cause of death. One challenge to prevention efforts is the wide phenomenological heterogeneity in suicidal urges, thoughts, and behaviors across individuals at risk. Despite this heterogeneity, most suicide research estimates group-level effects by averaging across people as if they were the same, preventing detection of person-specific factors that may modulate risk and be key to effective prevention. The goal of the present study is to illustrate the idiographic (i.e., person-specific) approach and highlight its utility for suicide research. Methods: We implemented a case series approach using three cases from a subset of psychiatrically hospitalized adolescents who provided intensive longitudinal data on daily urges and coping behavior after discharge following a suicide attempt. For illustration, person-specific, bidirectional links between suicidal urges and coping behavior were modeled across a series of cases using a vector autoregression approach. Results: The relationship between suicidal urges and coping differed across the three individuals, who were presented to exhibit the range of this variability in the presence/absence and magnitude of effects.
Conclusions
Individuals who report similar suicidal risk levels likely respond in individualized ways to suicidal urges (e.g., use different coping strategies), necessitating personalized assessment and treatment. We discuss implications for future suicide research.
This paper is a synopsis of scientific research on treatment effectiveness of ten varying approaches to psychotherapy. Different types of psychotherapy justify their existence by the basic assumption that therapeutic change is effectuated by specific concepts, attitudes and interventional techniques. In comparative psychotherapy research, for many years, studies have quantified outcome differences (see e.g. Lambert, 2013), and only very few have closely examined the process of treatment. The study reported here was part of a larger multi-center naturalistic process-outcome study (pre-post-follow-up, see e.g. von Wyl et al., 2013; Crameri et al., 2015; Tschuschke et al., 2015), named PAP-S, which included 362 patients from 81 therapists. The synopsis includes methods as well as results and discussion.
Formal psychotherapy in Ghana is gaining momentum. Concerns about the over-reliance on Western theories bring the suitability of associated clinical interventions into question for Ghanaian, non-Western clients. We interviewed 27 clinical practitioners (including clinical, counseling, and health psychologists) practicing in an urban setting to explore cultural challenges they faced and to identify cultural adaptations they made in their practice. Our participants reported navigating cultural barriers to therapy such as potential clients seeing therapy as an unfamiliar resource, resistance due to mental illness stigma, linguistic barriers, and hierarchical and age norms associated with help-seeking. Our sample identified attention to the following as routine in clinical practice: charismatic Christian and African cos- mological worldviews, cultural expectations of helping and interdependence, and family involvement in “individual” therapy sessions. The findings have implications for future psychotherapy practice and training in Ghana and similar Low and Middle Income Country (LMIC) contexts, as well as for clinical work with African immigrants.
The focus of this chapter is supervising professionals who have double mandates when combining help and social control. The Norwegian Child Protection Service (CPS) operates with a two-part mandate as described, but the issue is transferable to several professions and businesses. The double mandate can be ethically and professionally challenging: After some time where professionals are helping the family, the conclusion can be not good enough parenting, and the children are moved to an institution or in foster care. This often is experienced by the families as betrayals. Information that professionals helping families accomplishes can be held against the parents and used as information for the court, where they decide if children should live in foster care or institutions for a long time, or adoption of the child. Central themes in supervision of professionals at CPS are handling resistance by being transparent, support the development of intrinsic motivation (may be developed by the use of externalizing the problem and Motivational Interviewing), and creating strong and often long-lasting working alliances. Supervisors often are the “hands” that holds the professionals when they feel being on the top of the circle and feels mastery, as well as comforting when they feel like being on the bottom of the circle. In the same way, professionals should be the hands for parents, and parents should be supported to be the hands for their children.
In intensive transactional analysis psychotherapy (ITAP), intensity is obtained with both technical expedients and the relational manner with the patient. In ITAP, the therapist modulates pressure and support commensurately to the patients' ego strength. In the present article, we contrast two clinical cases of young adults in which ego strength produced different therapy outcomes and processes. We present excerpts of the psychotherapy process that illustrates technical aspects of ITAP as well as the therapist's attitude that we describe as holding. We show quantitative therapy outcomes consisting of effects size values of changes in Clinical Outcome in Routine Evaluation-Outcome Measure scores in baseline, treatment, and follow-up phases and qualitative outcome evaluated with the Change Interview at the end of the therapy. In the patient with high ego strength, we observed a rapid improvement and a complete recovery at the end of the therapy, whereas the results of the patient with low ego strength were less consistent (more fluctuations in Clinical Outcome in Routine Evaluation-Outcome Measure scores including deterioration but good qualitative outcome). We conclude that quantitative and qualitative outcome data, together with process observations, are required to have a complete picture of therapy effectiveness. Moreover, we conclude that qualitative ego strength is not a limitation for the use of expressive therapy such as ITAP, but rather, it is an important variable that should be considered to dose confrontations and support.
the history of theoretical developments in psychoanalysis can be understood as a series of successive reactions to Freudian drive theory / discuss traditional Freudian drive theory, followed by a section on its ego psychological extensions / present object relations theory, interpersonal theory, . . . self psychology, and a sampling of other recent developments (by Mahler, Kernberg, and Weiss and Sampson)
these models of therapeutic action focus mainly on psychoanalysis and, by extension and modification, to psychoanalytic psychotherapy (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Much about this third edition of A Guide to Treatments That Work remains as it was in the first and second editions. Like its predecessors, this edition offers detailed evaluative reviews of current research on empirically supported treatments, written in most instances by clinical psychologists and psychiatrists who are major contributors to that literature. Similarly, the standards by which the authors were asked to evaluate the methodological rigor of the research on treatments have also remained the same. As before, they provide information on the quality of the research on treatment efficacy and effectiveness that is reviewed.
In 2009, the American Psychological Association Division of Psychotherapy along with the Division of Clinical Psychology commissioned a second task force on evidence-based therapy relationships to update the research base and clinical practices on the psychotherapist-patient relationship. This chapter begins by tracing the purpose and processes of the interdivisional Task Force. It explicates the need for identifying evidence-based elements of the therapy relationship and means of matching or adapting treatment to the individual. In a tentative way, it offers two models to account for psychotherapy outcome as a function of various therapeutic factors (e.g., patient, relationship, technique). The latter part of the chapter features the limitations of the Task Force's work and responds to frequently asked questions.
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005
Reviews the book, What works for whom? A critical review of psychotherapy research by Anthony Roth and Peter Fonagy (see record 1996-98691-000). This book presents a comprehensive review of the status of psychotherapy research. The authors look at the evidence dealing with both efficacy and effectiveness of psychotherapy for the more common DSM-IV disorders. All of the chapters are geared toward the goal of providing the practitioner with a list of treatments for which there is empirical support. The reviewer notes that the amount of information covered in this text is extensive and provides sufficient evidence for the efficacy of psychotherapy for many of the diagnostic categories. Despite an overemphasis on cognitive/behavioral treatments, the authors do present the best of the research in psychodynamic therapy. The reviewer recommends this volume to both to researchers and practitioners. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It is impossible in a mere chapter to discuss all of the achievements of the thousands of studies and decades of psychotherapy research that are now part of our history. As a consequence, I shall focus on those achievements that exerted the greatest relevance to practice and training. This focus is consistent with the major goals of psychotherapy research as an applied clinical science, namely, protecting and promoting the welfare of the client by identifying the principles and procedures that enhance positive outcomes. The research achievements are divided into two major categories: (a) those that have been attained directly in response to the goals of research and (b) those that are conceptual and methodological by-products of the research itself. Such a classification allows us to see how successful we have been in answering many of the questions we have asked and, at the same time, to examine the fortunate consequences of undertaking research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced.
This article introduces the special issue of Psychotherapy devoted to evidence-based therapy relationship elements and traces the work of the interdivisional task force that supported it. The dual aims of the task force are to identify elements of effective therapy relationships (what works in general) and to identify effective methods of adapting or tailoring treatment to the individual patient (what works in particular). The authors review the structure of the subsequent articles in the issue and the multiple meta-analyses examining the association of a particular relationship element to psychotherapy outcome. The centrality of the therapy relationship, its interdependence with treatment methods, and potential limitations of the task force work are all highlighted. The immediate purpose of the journal issue is to summarize the best available research and clinical practices on numerous elements of the therapy relationship, but the underlying purpose is to repair some of the damage incurred by the culture wars in psychotherapy and to promote rapprochement between the science and practice communities.
REVIEWS THE CURRENT STATUS OF PSYCHOTHERAPEUTIC RESEARCH, CONCLUDING THAT THE GREATEST NEED IS FOR OUTCOME STUDIES. THE MAJOR VARIABLES AND DOMAINS INVOLVED IN PSYCHOTHERAPY ARE DELINEATED TO SHOW WHERE ERRORS HAVE OCCURRED IN PAST INVESTIGATIONS, AND TO SERVE AS A BASIS FOR DETERMINING THE DEGREE OF CONTROL NECESSARY TO ANSWER THE VARIED QUESTIONS CONCERNING THE PRACTICE OF PSYCHOTHERAPY. STRATEGIC CHOICES FOR ACCUMULATING KNOWLEDGE ARE SUGGESTED IN TERMS OF THE SELECTION OF VARIABLES, CRITERIA, AND ADEQUATE RESEARCH DESIGNS FOR A GIVEN LEVEL OF EMPIRICAL KNOWLEDGE. CONTRARY TO MANY CURRENT VIEWS, THE PRESENT METHODOLOGY OF SCIENTIFIC PSYCHOLOGY IS FELT TO BE ADEQUATE FOR EVALUATING PSYCHOTHERAPY; HOWEVER, THE VALUE OF DIFFERENT RESEARCH APPROACHES FROM CASE STUDIES TO FACTORIAL DESIGNS MUST BE RECOGNIZED AND USED STRATEGICALLY. (2 P. REF.)
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- Nathan