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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)
... Previous studies of the dynamic and iterative nature of interpersonal emotion regulation and empathic interactions focused primarily on regulator and target dyads (e.g. parent-child, romantic partners, therapist-client), with limited consideration of the other dimensions of these interactions 8,[68][69][70][71][72] . For instance, previous studies explored a person's characteristics in the setting of emotion regulation, such as a depressed regulator 73 , an intrusive mother 74 , a synchronised caregiver 69,75 , or changing targets 14 . ...
... anger, sadness, disgust, fear). Since adaptability is fundamental for fostering effective interpersonal emotion regulation in psychotherapy 70 , the ability to modify therapeutic strategies and interventions to tailor approaches that fit the unique context, emotional state and circumstances of each patient may lead to more effective and personalised care. ...
... Every case of parental neglect and maltreatment is unique and often the result of a complex mixture of multiple risk factors and child characteristics (Mulder et al., 2018;Ogle et al., 2022;Sidebotham et al., 2006;Stith et al., 2009). The best fit of client and family characteristics to treatment is a relevant factor that significantly contributes to the success of psychotherapy (Brakemeier & Herpertz, 2019;Fonagy et al., 2002;Norcross & Wampold, 2011, especially in child and youth welfare (Chambers & Potter, 2009;Chng et al., 2018;Holmes & McDermid, 2012;Lorenz et al., 2020). In other words, it is important to ensure that the bestfitting therapy is delivered to a particular child, adolescent, or family. ...
... Researchers examining individualized psychotherapy have gone beyond disorders and have emphasized the need for adapting evidence-based therapy to the patients' disorders and 4 | JOURNAL OF MARITAL AND FAMILY THERAPY characteristics to generate the best treatment outcome (Brakemeier & Herpertz, 2019;Norcross & Wampold, 2011. As a basis for this, it is necessary to consider as many biopsychosocial characteristics (e.g., information processing, temperament, coping strategies, cultural aspects, interpersonal aspects, such as family and peers, socioeconomical status, and environmental factors) as possible (Brakemeier & Herpertz, 2019). ...
Evidence‐based indication for targeted interventions is a central approach in the field of child welfare and psychotherapy. This study explored the characteristics of children and families referred to Multisystemic Therapy for Child Abuse and Neglect (MST‐CAN) in Switzerland and their associations with treatment outcomes. We sought to identify subgroups of children and families referred to MST‐CAN and understand their specific needs and alignment with the program. We identified five distinct subgroups of children: (a) those characterized by clinically significant “social withdrawal” and “anxiety/depression,” (b) with multiple clinically significant emotional and behavioral problems, (c) with predominantly externalizing problems, (d) with no pathological findings at all, with parents who were less stressed and had fewer mental health problems, and (e) with mainly internalizing problems and parents whose mental health problems deteriorated during treatment. Investigating the fit of children and families referred to treatment programs can enhance the understanding of their healthcare needs and enable more individualized interventions.
... Un tamaño del efecto de ,7 en las psicoterapias es equivalente a un NNT de 3, cuyo efecto indica que, de cada tres pacientes tratados con psicoterapia, uno alcanza sus objetivos. Para más información, véase Shearer-Underhill et al., 2011o Wampold 2001 Norcross & Wampold, 2011;Shearer-Underhill & Marker, 2010). Es decir, actualmente podemos asumir que a cada tres personas que buscan ayuda psicológica basada en evidencia, una mejorará, y que la TCC es el tratamiento con un mayor respaldo empírico para el 80% de los diagnósticos de trastorno mentales (David et al., 2018;Leichsenring & Steinert, 2017). ...
... Por este motivo, ante preguntas que inducen un planteamiento transversal de la psicoterapia, la respuesta habitual de los psicoterapeutas suele ser "depende del caso" (Callaghan, 2006;Norcross & Wampold, 2011). No obstante, tal contestación, sin estar contextualizada, no ofrece utilidad a los psicoterapeutas; el objetivo de la investigación de procesos de cambio es detectar variables responsables del éxito, pese a que los tratamientos sean individualizados. ...
Understanding clinical change remains a significant challenge in the study of psychotherapy success. To address this issue, recently, there has been a call for studies that bridge the gap between change processes research and psychotherapeutic outcomes . However, studies have highlighted the challenges in establishing this connection without being reliant on the limited pre-post strategy inherent in the Western biomedical model. Therefore, this doctoral thesis aims to overcome this limitation by preserving the individuality of participants and providing an analysis tailored to the interactive nature of the psychological phenomenon through a sequential microanalytic strategy within a behavioral-analytic framework.
This work aimed to identify sequential relational networks that reflect behavioral patterns of verbal interactions linked to successful psychotherapeutic interventions. To accomplish this, three empirical studies was conducted. The initial study entailed a methodological systematic review designed to identify the presence of such patterns within the existing literature. A total of 28 sequential microanalytic studies from diverse theoretical orientations were included, facilitating the development of a relational network composed of conditional probabilities related to psychotherapeutic verbal interactions. The second study compared nine cases treated by three therapists over the span of 10 years of psychotherapy. The third focused on examining therapeutic failure and abandonment, enabling a comparison between effectiveness, experience, and failure. Through the analysis of 80 intervention sessions, we identified different patterns of covariation associated with success and failure in psychotherapy. The results indicated the existence of conditional probabilities between the absence and presence of specific verbal events. Based on these findings, we developed a post hoc descriptive-functional guide aimed at potentially assisting novice psychotherapists and providing guidance for future research in the field of change processes and outcomes research.
... This finding underscores the importance of personalized healthcare and the need for interventions to be tailored based on the individual's distress level of severity (Kongerslev et al., 2015;Norcross & Wampold, 2011). Also, as the psychological intervention was focused on emotion regulation, it aligns with the literature highlighting the importance of tackling transdiagnostic factors such as affect regulation to improve psychological symptoms and disorders (Neacsiu et al., 2014;Sloan et al., 2017). ...
This randomized control study assessed the effectiveness of in-person and remote psychological support interventions in reducing post-traumatic stress symptoms in post-COVID-19 patients. Two hundred twenty-five patients were randomized to control, in-person, and remote intervention groups. The severity of post-traumatic stress and psychological symptoms was assessed at baseline, at six months, and at twelve months. Our results did not reveal a significant overall difference between the control and intervention groups. However, among patients with initial higher post-traumatic stress symptoms, a more significant decrease in distress was observed in the intervention group compared to the control group. No significant difference between in-person and remote interventions was found, suggesting both modalities are applicable. Secondary psychological symptoms (depression, anxiety, and sleep problems) also decreased in the high-distress subgroup following the intervention, but benefits were not maintained at twelve months. This study underlines the potential benefits of tailored psychological interventions in COVID-19 recovery, particularly for individuals with higher levels of distress. It also underscores the need for sustained ongoing psychological support and the utility of in-person and remote support modalities. Further studies should consider these findings when designing interventions to improve post-COVID-19 patient psychological health outcomes.
... However, clinical samples are very heterogeneous, especially under routine conditions, and even under research conditions it is expected that patients will respond differently to treatments (Cuijpers et al., 2024). Therefore, current research is increasingly focusing on the extent to which the effectiveness of different psychotherapies depends on certain patient characteristics ("What works for whom?"; Kramer et al., 2022;Norcross & Wampold, 2011Roth & Fonagy, 2006). To this end, various statistical approaches have been developed to estimate individual differences in treatment effects and to examine possible moderating baseline variables (e.g., Kaiser et al., 2022;Mayer et al., 2020). ...
This pragmatic study evaluates the long-term effectiveness of two forms of psychoanalytically oriented therapy, Psychodynamic Psychotherapy (PP) and Analytical Psychotherapy (AP), in routine care in Germany. Four hundred and twenty-eight patients diagnosed with various DSM-IV mental disorders were treated with PP or AP and provided annual self-reports of their mental health over a six-year period. Using propensity score methods and piecewise linear latent growth curve models, we identified distinct trajectories of change for the two treatments. In particular, symptom distress, personality dysfunction, interpersonal problems, and general life satisfaction improved substantially and persistently in both treatments, with PP showing faster initial improvements and AP maintaining gradual progress over time. AP showed greater long-term effectiveness, particularly for patients with more severe problems at baseline. These findings indicate the value of AP for complex cases. Future research should explore treatment mechanisms, cost-effectiveness, and implications for health policy.
... Navigating the increasingly complex and multifaceted social world necessitates the ability to apply knowledge acquired in interpersonal relationships and reflect on internal experiences, both one's own and those of others. To contribute to the open question of "what works for whom" (Norcross & Wampold, 2011;Roth & Fonagy, 2005), interventions aiming to improve psychological adjustment among adolescents with a history of ACEs should first rebuild trust in social cues to prioritize the enhancement of mentalized affectivity and equip adolescents with strategies to reduce uncertainty about their mentalizing abilities. In other words, aligned with recent clinical considerations and treatment goals (see Malberg et al., 2023), it seems crucial to start restoring disruptions in epistemic trust during adolescence, to enable teenagers not only to better develop higher-order mentalizing functions but also to navigate the complex system of social relationships more effectively. ...
Introduction: Adverse childhood experiences (ACEs) are
psychosocial factors acknowledged as significant contribu-
tors to health consequences later in adolescence, including
psychological maladjustment. The research suggests that, at a
transdiagnostic and transtheoretical level, working on restoring
epistemic trust (ET), mentalized affectivity (MA), and reflective
functioning (RF) in adolescents with ACEs assumes a central
role in the therapeutic process. However, there are still few
studies that attempted to investigate the specific role of these
sociocognitive factors in the detrimental positive association
between levels of experienced ACEs during childhood and
psychological maladjustment in nonclinical adolescents.
Methods: A community sample of 306 Italian cisgender
adolescents (61.4% assigned females at birth; age range
13–19 years old; Mage = 16.1, SD = 1.64) self‐reported ACEs
(Childhood Trauma Questionnaire‐Short Form), psychological
maladjustment (Strengths and Difficulties Questionnaire), ET
(Epistemic Trust, Mistrust and Credulity Questionnaire), MA
(Brief‐Mentalized Affectivity Scale for Adolescence), and RF
(Reflective Functioning Questionnaire). A multiple mediation
regression analysis has been performed to explore the
association between ACEs and psychological maladjustment
through the interaction with socio‐cognitive factors.
Results: ACEs are positive predictors of psychological
maladjustment later in adolescence. Regardless of gender
differences, epistemic mistrust and credulity, processing
and expressing emotions, and uncertainty about mental
states mediated this association, while epistemic trust,
identifying emotions, and certainty about mental states did
not configure as significant mediators.
Conclusion: Findings suggest that ET disruptions and
deficits in RF are risk factors, while MA is a protective
factor within the link between ACEs and psychological
maladjustment in adolescence. These links help to specify
the role of sociocognitive factors in the development of
mental problems in adolescents who have been exposed to
adverse experiences in childhood.
... In reality, the choice is often to continue with the same method or transfer the patient to another therapist. Norcross and Wampold (2011) recommend referring patients to a colleague when a therapist is unable to adapt their therapy to fit a particular patient. However, they do not mention how such referrals or changes of therapists should be undertaken, which is an important factor to consider as finding a therapist with the right combination of formal and interpersonal skills might be difficult (Iliakis et al., 2019). ...
Therapists’ outcome expectations influence the psychotherapy process and outcomes, but little is known about the factors influencing their development. This study explored therapists’ experiences with establishing outcome expectations for their patients. The participants were 35 therapists from a public mental health setting, who were interviewed in five different focus groups. Interviews were transcribed and analyzed using thematic analysis. Three themes and 10 subthemes were identified. In Theme 1 (understanding the problem), participants’ expectations were influenced by (a) their patients’ diagnoses and the diagnostic process, (b) their perceptions of the complexity of the presenting problem, (c) how stable the patients’ symptoms and situations were, and (d) whether they experienced familiarity with the patient or the patients’ situation. In Theme 2 (the patient’s openness to change), participants’ expectations were influenced by (a) the patient’s stated reason for seeking treatment, (b) the patient’s conceptualization of their problem/situation, and (c) their perception of the patient’s willingness to invest in the treatment. In Theme 3 (the fit between the therapist and patient), the participants discussed the factors that influenced whether they felt they were a good fit for working with an individual patient and how this perception of personal and professional fit influenced their expectations. We identify several ways that therapists’ situational factors and their recognition of the patient through their own past experiences can influence their expectations.
... Our effort reflects a broader movement away from specific treatment protocols and toward a deeper exploration of the principles and processes that underlie effective psychotherapy (Hofmann & Hayes, 2019). We hope that our investigation of the exposure process can inform more individually tailored psychotherapy approaches to effectively treat the broad range of individuals affected by traumatic stress (Norcross & Wampold, 2011). We are heartened by the commenters' reception of our contribution and look forward to continued dialogue with the aim of improving treatment for this important and deserving population. ...
We respond to commentaries by Brown (2024) and Najavits (2024) on our original work titled “To Expose or Not to Expose: A Comprehensive Perspective on Treatment for Posttraumatic Stress Disorder” (Rubenstein et al., 2024). Their work serves to augment the original argument that exposure is an important change factor in the amelioration of traumatic stress but should be viewed more broadly than traditional treatment paradigms suggest. We are grateful for this opportunity and aim to promote additional dialogue in the field about ways to improve upon existing models of trauma and its treatment.
... However, for González-Blanch and Carral-Fernández (2017), there are several different mechanisms that may produce similar results. Thus, beyond a particular theoretical approach, it is necessary to study how the techniques, the specific factors of a particular theory, and the common factors relate to each other (Norcross & Wampold, 2011). ...
The present study proposes an evaluation of the therapeutic process in relation to the following aspects: the therapist adherence, the items which are more and less characteristic in the treatment and the interaction structures, along the therapeutic process of two cases of couple therapy, one with significant positive clinical change and one with significant negative clinical change, in the couple's evaluation. This work used Integrative Behavioral Couple Therapy model, one of the approaches of the third wave therapies. The method was a study of contrasting cases. The similarities and differences between the cases were discussed, reaching the conclusion that there are aspects of the couple, the therapist, the therapeutic relationship and the context that may have contributed to the different outcomes.
... Findings also suggest that using immediate TSD can serve as a transdiagnostic strategy for people with various types of disorders who encounter emotional difficulties, as there is no significant interaction between group and immediate TSD. This is consistent with the growing trend in psychotherapy research toward emphasizing transdiagnostic processes associated with change (Norcross & Wampold, 2011. According to Norcross (2010), TSD is among the common factors, within the therapeutic relationship, that have been demonstrated to be associated with positive therapeutic outcomes, beyond the consideration of diagnosis. ...
Objective
Despite the clinical significance of emotional diversity, also known as emodiversity, there has been limited investigation into the therapeutic interventions that influence this construct. In the current study we examined the association between immediate therapist self‐disclosure (TSD) and emodiversity among two diagnostic groups who tend to experience emotional difficulties: people with schizophrenia and people with emotional disorders (i.e., depression and/or anxiety).
Method
The sample comprised 74 clients (37 diagnosed with schizophrenia and 37 with emotional disorders) treated by 45 therapists in a university clinic setting. Following each session, clients self‐reported their emotions, and therapists completed a measure of frequency and centrality of their immediate TSD during the session.
Results
Longitudinal multilevel models indicated that immediate TSD was positively associated with clients' global emodiversity, both at the within‐ and the between‐client levels, as well as with clients' negative emodiversity at the between‐client level. Moreover, clients with emotional disorders and clients with schizophrenia did not differ in the association between immediate TSD and emodiversity. In addition, across groups, clients treated by therapists who used more immediate TSD on average showed greater increases in global emodiversity during treatment.
Conclusions
immediate TSD is associated with clients' ability to experience rich and diverse emotional experiences across different disorders. The theoretical and clinical implications of these findings are discussed.
... Moreover, increased understanding of alliance processes is crucial in critical situations during the therapeutic interaction when the therapeutic work malfunctions as this could help guide interventions and therapeutic progress, and potentially prevent harmful effect and premature drop out (Cuijpers et al., 2019). Despite decades of research attempting to understand the complexity of the psychotherapeutic alliance (Norcross and Wampold, 2011), the processes that influence the quality of the alliance are still not well understood. Thus, knowledge in this area is inconclusive and calls for further attention to enrich our insight into what drives psychotherapeutic change (Koole and Tschacher, 2016;Kleinbub et al., 2020). ...
Introduction
The purpose of this systematic review is to expand our knowledge of the underlying mechanisms of the alliance in psychotherapy. This is done by examining the association between alliance rupture and repair processes and interpersonal coordination dynamics.
Method
A systematic review based on PRISMA guidelines was conducted, aimed at papers investigating the association between alliance rupture and repair episodes and different behavioral modalities (i.e., physiology, movement) in the psychotherapeutic interaction. Seventeen studies were included for full text-analysis.
Results
The results indicate that rupture and repair episodes were associated with interpersonal coordination dynamics. Different modalities (movement, heart rate, and vocalization) were found to serve as markers for alliance rupture and repair events. Facial expressions, physiological arousal, vocalization, and behavior were found to play important roles in the therapeutic interaction in relation to mutual emotion regulation, empathic response, safety, trust, and meaning-making.
Discussion
Limitations of this review are discussed, including the great methodological variation and selection bias observed in the reviewed studies. Recommendations for future research in this area are presented. Overall, interpersonal coordination dynamics was found to have the potential to help identify and manage alliance ruptures and foster repairs in the therapeutic interaction, which has high potential for future clinical work and training.
... Given the scarcity of research, there is a need for qualitative approaches to gain an understanding of clients' experiences when seeking counselling as well as for quantitative approaches to evaluate the potential protective effects of infertility counselling in systematic studies with comparison groups. Equivalent to the development in psychotherapy research, research paradigms in fertility counselling should focus on "What works for whom" [30] with regard to e.g. gender, sexual orientation, type of fertility disorder and individual needs and resources of the clients. ...
Purpose
This paper reports on the first evaluation of infertility counselling in Germany.
Methods
Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients.
Results
The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors’ expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects.
Conclusions
This piece of research suggests that the following issues need to be considered to improve infertility counselling.Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions
Better funding for counselling so that its uptake is not dependent upon the financial resources of clients
Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families
There is a need for more research and the development of counselling concepts.
... Finally, the current study's inclusion of multiple interventions that represented the different elements of Woebot is in line with a movement in psychotherapy outcome research that calls for a focus on studying the mechanisms that help people in therapy, rather than solely focusing on outcomes such as symptom reduction (Norcross & Wampold, 2011;Wachtel, 2010). While this study's findings emphasize the importance of retaining a clear distinction between BITs and mental health treatment, it does suggest that journaling might be particularly indicated for individuals experiencing depressive symptoms, and that the conversational nature of a chatbot can be beneficial for both depression and anxiety. ...
... Finalmente, la integración multinivel tiene un lugar muy importante, pues las problemáticas objeto de la intervención clínica siempre son consideradas como emergentes de la interacción de múltiples planos de la existencia de los seres humanos, en cada uno de los cuales pueden plantearse distintos objetivos clínicos según sea la necesidad de la persona (Norcross & Wampold, 2010). ...
La contemporaneidad ha transformado la cosmovisión en las últimas décadas. El neoliberalismo, la relativización de la verdad y la caída de los grandes metarrelatos generan sujetos proteiformes, individualistas, insatisfechos e inestables. La pandemia potenció estas características, generando problemas de salud mental complejos en su abordaje psicoterapéutico, por su novedad. Fenómenos como la diversidad identitaria, los síntomas médicamente inexplicables o los problemas asociados a la virtualidad, retan a los psicoterapeutas. Una atención clínica pertinente, contextualizada y efectiva, requiere alternativas conceptuales e intervencionistas adecuadas a la época y a las subjetividades emergentes de ella, y exige actualizar los modelos de formulación de casos en psicoterapia Se describe un modelo de formulación de caso en psicoterapia integrativa, adecuado al contexto contemporáneo, abierto a la pluralidad teórico/técnica y pertinente para las necesidades psicoterapéuticas actuales.
... The move towards Evidence-Based Practice has raised some concerns about whether paradigms grounded in randomized controlled trials are suitable for addressing some of the core concerns of the discipline (Aigen, 2015). More generally, outcomes research in psychological therapy faces the challenge of understanding individual differences in what factors contribute to effective interventions-"what works for whom?" (Norcross & Wampold, 2011). This question implies equifinality in therapeutic outcomes; fsQCA could help therapy researchers to embrace the complexity of individual differences in treatment response and develop interventions more precisely targeted to clinical needs. ...
Preserved engagement with music in Alzheimer's disease (AD) is noteworthy given that such persons lack interest and engagement in the activities of daily life. Because music engagement is associated with increased well-being, illuminating personal attributes that facilitate music engagement is an important step towards utilizing music as a therapeutic tool. Here, we use Fuzzy Set Qualitative Comparative Analysis, a systematic approach to case study series analysis, to explore the role of personal attributes such as musical semantic memories, music perceptual abilities, and overall cognitive status in facilitating music engagement in 15 individuals with a diagnosis of probable AD. Nine different solution terms revealed many different pathways to preserved music engagement in AD. Solutions demonstrated the equifinality of music engagement and the usefulness of the qualitative comparative analysis approach. This article is meant to provide both concrete evidence for the role of different person attributes in music engagement in AD and an illustration of the application of qualitative comparative analysis. We discuss our results using the Comprehensive Process Model as a framework and provide suggestions on how to incorporate qualitative comparative analysis in the research workflow.
... Third, in line with recent advancements in psychotherapy research, we aim to adopt a patient-specific, or "tailored, " approach, exploring "what works for whom, " as described by Peter Fonagy: indeed, the PsyCARE will provide findings to identify the therapeutic elements associated with patients' improvement and determine which patients may benefit the most from the bonus sessions and specific psychotherapeutic techniques adopted [67,68]. For example, we will consider between-subjects variability on the longitudinal trajectories of psychological symptoms accounting for different diagnostic presentations and controlling for the therapists' different theoretical frameworks. ...
Background
The prevalence of anxiety and depression disorders is surging worldwide, prompting a pressing demand for psychological interventions, especially in less severe cases. Responding to this need, the Italian government implemented the “Psychological Bonus” (PB) policy, allotting 25 million euros for mental health support. This policy entitles individuals to a minimum of four to twelve psychological sessions. In collaboration with the National Board of Italian Psychologists, our study assesses this policy’s effectiveness. Indeed, the PsyCARE study aims to examine the utilization of the Psychological Bonus, evaluate its impact on adult and adolescent participants’ psychological well-being through pre- and post-intervention assessments and six-month follow-up, and conduct a longitudinal cost-effectiveness analysis of this policy. A secondary aim is to investigate the influence of these interventions on transdiagnostic factors, including emotion regulation and epistemic trust.
Methods
The study involves licensed psychotherapists and their patients, both adults and adolescents, benefiting from the Psychological Bonus. Data collection is underway and set to conclude in December 2023. Psychotherapists will provide diagnostic information and assess patient functioning. In addition, patients will be evaluated on mental health aspects such as clinical symptoms, emotion regulation, epistemic trust, and quality of life. We will employ linear mixed-effects models to analyze the outcomes, accounting for both fixed and random effects to capture the hierarchical structure of the data.
Discussion
We anticipate the study’s findings will highlight reduced psychological distress and improved quality of life for participants and demonstrate the Psychological Bonus policy’s cost-effectiveness. The study will gather data on the role of specific versus nonspecific therapeutic factors in psychotherapy while adopting a patient-tailored approach to identify effective therapeutic elements and examine transdiagnostic factors. Overall, this study’s findings will guide future measures within the Italian healthcare system, fostering a psychological health culture and providing valuable insights to the broader public.
Study registration
https://osf.io/6zk2j
... 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.
Results
ML 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.
Given the high co-occurrence of social anxiety in autism, no reviews to date have explored how cognitive and behavioural mechanisms identified to maintain social anxiety in non-autistic individuals may operate in autistic individuals. This systematic review evaluated: (1) empirical evidence underlying the Clark and Wells (1995) Cognitive Model of Social Anxiety in autistic individuals; (2) how vulnerability factors identified from autism literature (beyond core autistic traits) may be associated with social anxiety beyond the cognitive model. Published peer-reviewed English articles until 27th November 2023 were retrieved from PubMed, EMBASE, Ovid MEDLINE and PsycINFO. Quality appraisal and risk of bias were assessed using The Standard Quality Assessment Criteria for Evaluating Primary Research papers from a Variety of Fields tool. 47 articles met full inclusion criteria and included autistic individuals (with clinical diagnosis), a measure of social anxiety, and a mechanism outlined by either (or both) research questions. The majority of the 3340 participants across studies were male without intellectual disability, White/Caucasian, with 7 studies reporting an average age above 30 years old. Most studies used only self-report measures that may have inflated associations observed between social anxiety and mechanisms. All studies employed cross-sectional design, and no causality inferences could be drawn. Methodological issues around potential construct overlaps between social anxiety and autistic traits are highlighted. Overall, there is evidence in support of the as reported by Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model, as greater fear of negative evaluation from others, use of safety behaviours and somatic symptoms, and peer victimisation were associated with greater social anxiety. The review contributes evidence in support of autism specific contextual, predisposing/antecedent and maintenance factors of social anxiety beyond the original Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model. Given the potential for considerable heterogeneity for each highlighted process at an individual level across autistic individuals, clinicians can broaden formulation conversations with autistic clients to understand how autism related factors may influence the development and maintenance of social anxiety symptoms when applying and adapting the Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model.
Psychologists want to know what works in therapy, what specific factor benefits the individual, and how to the quality of therapy outcomes. According to this aim, empirically supported treatments were developed in 2005 and "Evidence-Based Practice" was put forward. Routine Outcome Measure (ROM) is a feedback system rooted in Evidence-Based Practice. The aim of the current study is to provide information about the ROM method by making a scoping review. EKUAL, PubMed and Scopus databases were scanned. As a result of the screening, 44 studies in the mental health literature that provided information about ROM were included in the study. The findings obtained from 44 studies were evaluated under 6 main headings: Stages of ROM, advantages
of ROM, disadvantages of ROM and obstacles to its use, efficacy of ROM, digitalization of ROM and suggestions
for the development of ROM. It can be said that ROM is a promising method in terms of improving the quality of therapies. It is expected that studies on ROM and regular use of ROM in therapies will increase in the future. (Psikologlar psikoterapide neyin işe yaradığını, birey için spesifik olarak neyin fayda ettiğini, psikoterapi çıktılarının
kalitesini nasıl arttıracağını bilmek istemektedir. Bu bağlamda 2005 yılında ampirik destekli tedaviler geliştirilerek
“Kanıta Dayalı Uygulama (KDU)” öne sürülmüştür. Rutin Sonuç İzlemi (RSİ), KDU’yu temel alan bir geri bildirim
sistemidir. Mevcut çalışmanın amacı kapsam derlemesi aracılığıyla RSİ yöntemi hakkında bilgilendirme sunmaktır. EKUAL, PubMed ve Scopus veri tabanlarında tarama yapılmıştır. Taramanın sonucunda ruh sağlığı alan yazınında yer alan ve RSİ hakkında bilgi veren 44 araştırma çalışmaya dahil edilmiştir. 44 çalışmadan elde edilen bulgular RSİ’nin aşamaları, RSİ’nin avantajları, RSİ’nin dezavantajları ve kullanımına dair engeller, RSİ’nin
etkinliği, RSİ’nin dijitalleşmesi ve RSİ’nin geliştirilmesine dair öneriler olmak üzere 6 ana başlık altında değerlendirilmiştir. RSİ’nin psikoterapilerin kalitesinin arttırılması bakımından umut verici bir yöntem olduğu söylenebilir. Gelecekte RSİ’ye dair çalışmaların ve psikoterapilerde düzenli RSİ kullanımının artması
beklenmektedir.)
Psychologists want to know what works in therapy, what specific factor benefits the individual, and how to improve the quality of therapy outcomes. According to this aim, empirically supported treatments were developed in 2005 and "Evidence-Based Practice" was put forward. Routine Outcome Measure (ROM) is a feedback system which rooted in Evidence-Based Practice. The aim of the current study is to provide information about the ROM method by making a scoping review. EKUAL, PubMed and Scopus databases were scanned. As a result of the screening, 44 studies in the mental health literature that provided information about ROM were included in the study. The findings obtained from 44 studies were evaluated under 6 main headings: Stages of ROM, advantages of ROM, disadvantages of ROM and obstacles to its use, efficacy of ROM, digitalization of ROM and suggestions for the development of ROM. It can be said that ROM is a promising method in terms of improving the quality of therapies. It is expected that studies on ROM and regular use of ROM in therapies will increase in the future
Literature and knowledge of empirically supported treatments (ESTs) in inpatient psychiatric settings for youth are limited. This chapter provides a review of ESTs for youth inpatient psychiatric settings; discusses recommendations for adaptation, implementation, and personalization of ESTs; and describes an example of implementation, evaluation, and sustainability of an EST in this context.
Objective
The efficacy of psychological interventions for bipolar disorder (BD) is well established, but much remains unknown about how change occurs. The primary objective of this exploratory study was to audit what is known about active components and mechanisms of action of psychological interventions for BD.
Method
We conducted a systematic review (PROSPERO CRD42022323276). Two independent reviewers screened references from four databases and extracted data from eligible studies.
Results
We included four component studies, six studies with mediation analyses and 26 studies presenting subjective experiences of how psychological interventions bring change. Ten mediators were examined across six studies, with only one putative mediator, medication adherence, tested in more than one study. Some initial support for mediation of varied outcomes by control over thoughts, positive non‐verbal behaviour, self‐esteem, post‐trauma growth and medication adherence. Some preliminary support was found in two components, human support and IPT. Studies exploring participant experiences of therapeutic change enumerated a range of potential active components, mechanisms of action and contextual factors potentially warranting investigation in future research. However, the evidence base for active components and mechanisms of action in psychological interventions for BD is unsatisfactory. Findings were inconsistent, studies homogenous with significant methodological limitations and statistical approaches failed to meet quality criteria.
Conclusions
Preliminary identification of potential components and mechanisms via qualitative analyses and the insights emerging from this review will inform future research aimed at investigating how psychological interventions work in BD.
Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German master's program. Eligible participants were students in the master’s program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students’ knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.
Objectives
To compare idiographic change during two formats of guided self‐help (GSH); cognitive‐behavioural therapy guided self‐help (CBT‐GSH) and cognitive analytic therapy guided self‐help (CAT‐GSH).
Design
Qualitative inductive thematic analysis.
Methods
Semi‐structured interviews with N = 17 participants with a reliable change outcome on the GAD‐7 after completing GSH for anxiety. Changes were categorised and themes extracted.
Results
No differences between CAT‐GSH and CBT‐GSH were found regarding types of change reported. The five overarching themes found were personal qualities of success, enlightenment through understanding, specific tools and techniques, changes to relationships and tailoring support. Four themes maximally differentiated between the two different types of GSH; CAT‐GSH enabled relational insight and change whilst CBT‐GSH enabled better understanding of anxiety, new coping techniques and supportive relationships.
Conclusions
Both common and model‐specific factors contribute to patient change during GSH. Whilst all forms of GSH are grounded in the psychoeducational approach, separate theoretical foundations and associated methods facilitate different types of ideographic change.
Anxiety disorders are the most common mental health problem, and cognitive-behavioral therapy is one of the most widely used, evidence-based treatments. While several mobile apps for anxiety that integrate cognitive-behavioral therapy (CBT) techniques exist, major challenges remain concerning uptake and engagement. Personalization is one strategy that can be used to improve client engagement, and integrating therapist input is one mechanism for such personalization. This study aims to understand therapist practices and identify new possibilities for delivering intervention content between face-to-face CBT therapy sessions. It comprised semi-structured interviews, followed by a series of ideation activities, and thematic analysis of the data. The results showed the central role of clients in shaping the content of therapy sessions, their challenges with homework practice, and therapists’ diverse practices. Analysis of the ideation activities elaborated the potential role of therapists in the personalization of apps for anxiety. We conclude with takeaways for designers of personalized mental health mobile applications.
Artificial intelligence (AI)-enabled chatbots are increasingly being used to help people manage their mental health. Chatbots for mental health and particularly 'wellness' applications currently exist in a regulatory 'gray area'. Indeed, most generative AI-powered wellness apps will not be reviewed by health regulators. However, recent findings suggest that users of these apps sometimes use them to share mental health problems and even to seek support during crises, and that the apps sometimes respond in a manner that increases the risk of harm to the user, a challenge that the current US regulatory structure is not well equipped to address. In this Perspective, we discuss the regulatory landscape and potential health risks of AI-enabled wellness apps. Although we focus on the United States, there are similar challenges for regulators across the globe. We discuss the problems that arise when AI-based wellness apps cross into medical territory and the implications for app developers and regulatory bodies, and we outline outstanding priorities for the field.
This chapter explores the revolutionary potential of new immersive technologies in the practice of psychotherapy and their role in increasing the accessibility and inclusivity of mental health services. It discusses how immersive technologies provide a safe and personalised environment for the treatment of a wide range of psychological disorders, opening up new perspectives for more effective and welcoming therapy. However, it also examines the challenges associated with the technology gap and highlights the need for targeted strategies to ensure equitable access to such tools. Finally, it highlights the importance of fully exploiting the potential of new immersive technologies to promote more inclusive and accessible psychotherapy for all.
Background
Behavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment.
Methods
375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients’ random effects.
Results
Both group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT).
Discussion
Both modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.
Trauma-focused psychotherapies, in particular prolonged exposure (PE) therapy, have been recognized as the “gold standard” for the treatment of posttraumatic stress disorder (PTSD). But effectiveness and implementation data show that a large proportion of patients who undergo exposure therapy retain their PTSD diagnosis, and implementation studies have shown low engagement and high dropout rates. Meanwhile, non-trauma-focused therapies have shown promise in treating PTSD. In this review, we aim to answer the question of whether exposure is necessary to treat PTSD by integrating clinical and research literature from multiple perspectives. We review the roots of exposure therapy in both psychodynamic and behavioral paradigms and their proposed mechanisms. We then review non-trauma-focused treatments and their proposed mechanisms. We conclude that the specific form of exposure required by PE is not necessary for symptom remission. Finally, common psychotherapy factors may facilitate patient self-directed exposure outside of the therapy context. These findings should alter the direction of clinical research to identify the therapy processes that most effectively promote the processing of trauma memories. With respect to clinical practice, shared decision-making should allow for increased patient autonomy in choosing either trauma-focused or non-trauma-focused treatments.
The Melbourne Study of Psychoanalytic Psychotherapy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychotherapy in a low‐cost, private‐sector community clinic. A first in Australia, this 8‐year demonstration project allowed naturalistic study of the impact and process of intensive, long‐term, time‐limited psychoanalytic psychotherapy delivered to self‐referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE‐AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance . This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psychotherapy, with Adoption of the full 2‐year treatment program being 60%. Improvements in mental health and life functioning provided quantitative evidence of Effectiveness for those completing the 2‐year treatment program, with Maintenance at 8‐month follow‐up. Patient age, gender and personality characteristics did not modify these improvements. In‐depth qualitative exploration of patient and psychotherapist perspectives regarding the psychotherapy is reported in the second paper highlighting expectations, experience and benefits of the psychotherapy. The third companion paper presents the qualitative findings concerning factors experienced as facilitating or challenging therapeutic progress. Each of the three related papers amplifies understandings of how low‐cost, long‐term but time‐limited psychoanalytic psychotherapy can be implemented in the community with adults otherwise unable to afford such treatment, and discusses lessons learned.
We used structural equation modeling to test client meaningful experiences in counseling and the therapeutic working alliance (TWA) as predictors of affective distress, controlling for clients’ age, gender, race and ethnicity, and length of counseling relationship. In a sample of 306 adult clients engaging in counseling, we a found statistically significant relationship between client meaningful experiences in counseling and the TWA ( r = 0.80, p < 0.001). There was a significant and negative direct effect from client meaningful experiences in counseling to affective distress ( β = −0.45, p < 0.001). However, we did not find a significant direct effect of the TWA on affective distress ( β = −0.00, p = 0.97). Implications for counselors, supervisors, and counselor educators are discussed.
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.
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)
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.)
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)
Bergin and Garfield's handbook of psychotherapy and behavior change
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psychotherapy and behavior change (5th ed.). New York: Wiley.
American Psychological Association Task Force on Evidence-Based Practice
American Psychological Association Task Force on Evidence-Based Practice. (2006). Evidence-based
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- Nathan