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Courtney Benjamin Wolk, Rebecca E Stewart, Ricardo Eiraldi, Peter Cronholm, Eduardo Salas, David S Mandell
Children obtain more mental health services through schools than through any other system. In urban, low-resource schools, mental health care often is provided by teams of contracted community mental health workers. Implementation of intended services may struggle in the context of challenges related to team functioning. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an efficacious approach for improving team functioning in health care. In collaboration with stakeholders, we adapted TeamSTEPPS for school mental health teams and pilot-tested it in 3 schools participating in an ongoing implementation of cognitive-behavioral therapy...
November 29, 2018: Psychotherapy
D Martin Kivlighan, Yi-Jiun Lin, Karen P Egan, Theodore Pickett, Simon B Goldberg
Accurate estimations of progress in psychotherapy are necessary for therapists to identify clients at risk of deterioration and potentially reduce premature terminations. This need has resulted in a large body of literature examining the rate and trajectory of change in psychotherapy; however, few studies have tested these dose-response relationships outside of global measures of mental health. Moreover, there is a paucity of research examining the relationship between progress in treatment, treatment length, and premature termination...
November 26, 2018: Psychotherapy
Soo Jeong Youn, Sarah E Valentine, Kaylie A Patrick, Molly Baldwin, Anisha Chablani-Medley, Yesenia Aguilar Silvan, Derri L Shtasel, Luana Marques
The science-practice gap in the treatment of mental health is most pronounced in community settings, where clients with the highest needs often receive their care. Implementation science and community-based participatory research strategies aim to effectively address this gap by establishing partnerships that focus on scientifically rigorous, as well as clinically and socially relevant, research. Despite significant benefits, the community-based participatory research implementation framework has a unique set of challenges...
November 26, 2018: Psychotherapy
Soo Jeong Youn, Henry Xiao, Andrew A McAleavey, Brett E Scofield, Tyler R Pedersen, Louis G Castonguay, Jeffrey A Hayes, Benjamin D Locke
Conducted in naturalistic settings, practice-oriented research (POR) is aimed at building stronger connections between the science and practice of psychotherapy. Promoting the principles of POR, this article has 2 aims: (a) presenting the results of a survey assessing the interests of members of a large practice research network in topics that could guide future research conducted as part of clinical routine, and (b) describing difficulties in implementing a study in line with such interests. Despite the significant interest in and perceived clinical significance of two relationship constructs (alliance and countertransference), there were unique obstacles faced in their empirical investigation within an already operationally functional practice research network...
November 26, 2018: Psychotherapy
Clara E Hill, Kathryn V Kline, Seini O'Connor, Katherine Morales, Xu Li, Dennis M Kivlighan, Justin Hillman
We investigated the antecedents, occurrences, and consequences of 183 silence events in the first 5 and last 5 sessions of a 73-session case of successful psychodynamic psychotherapy. Silences generally occurred within client speaking turns, such that the client often paused to reflect while speaking. In the last 5 sessions, as compared with the first 5 sessions, the client was more collaborative before and after silences, silences were shorter, the therapist was more connectional during silences (e.g., shared emotion and meaning with client), and the client was more emotional after silences...
November 26, 2018: Psychotherapy
Shannon Sauer-Zavala, Amantia A Ametaj, Julianne G Wilner, Kate H Bentley, Santiago Marquez, Kaylie A Patrick, Billie Starks, Derri Shtasel, Luana Marques
Homeless individuals experience higher rates of mental illness than the general population, though this group is less likely to receive evidence-based psychological treatment for these difficulties. One explanation for this science-to-service gap may be that most empirically supported interventions are designed to address a single disorder, which may not map on to the substantial comorbidity present in safety-net samples, and create a high training burden for often underresourced clinicians who must learn multiple protocols to address the needs of their patients...
November 26, 2018: Psychotherapy
Jennifer M Oswald, James F Boswell, Melanie Smith, Heather Thompson-Brenner, Gayle Brooks
Residential treatment involves a number of treatment components and modalities, and treatment staff come from diverse training backgrounds. These complexities present unique challenges for the implementation of standardized programming, training, and routine assessment to support practice and research aims. Implementation science highlights the critical role of clinician attitudes in successful adoption and sustainability. This article describes an ongoing real-world quality improvement effort to implement transdiagnostic evidence-based interventions for primary eating disorders, as well as routine data collection, in a residential eating disorder treatment center...
November 15, 2018: Psychotherapy
J Christopher Fowler, Alok Madan, B Christopher Frueh, Major Bradshaw, James Flack, Benjamin Weinstein
In today's world of smart-device monitoring systems, clinicians may be lulled into the assumption that we can download software to monitor our patients' psychological and behavioral functioning with little or no effort or follow-up. This belief is as erroneous as it is tempting; in fact, implementing effective and efficient systems for utilizing patient-reported outcomes (PROs) in daily practice and research takes a virtual village of stakeholders, clinicians, developers, analysts, and clinical researchers...
November 15, 2018: Psychotherapy
Rebecca Drill, Robert Drinkwater, Julian Ernst, Annabel Gill, Patrick Hunnicutt, Shannon McIntyre, Carrie M Potter, Hannah Richardson, Jack Beinashowitz
This article reports on our experiences conducting naturalistic research as clinician-researchers in a training setting within a public safety-net hospital. The naturalistic, practice-based context has presented various challenges to the research process, including the following: supporting research with limited finances, establishing continuity of research personnel, designating time for research within an intensive clinical training program, responding to difficulties obtaining data, seeking consultation for advanced data analysis, organizing the writing process, and determining order of authorship...
November 8, 2018: Psychotherapy
Alice E Coyne, Michael J Constantino, Henny A Westra, Martin M Antony
In a randomized trial for generalized anxiety disorder, cognitive-behavioral therapy (CBT) and CBT integrated with motivational interviewing (MI) promoted comparable worry reduction at posttreatment, whereas MI-CBT outperformed CBT over 12-month follow-up (Westra, Constantino, & Antony, 2016). Secondary analyses revealed competing mediators of the long-term treatment effect: MI-CBT related to lower patient resistance to the treatment, which promoted lower follow-up worry, whereas CBT related to greater increases in patient friendly submissiveness (FS), or compliance, which also promoted lower follow-up worry (that suppressed an even greater long-term advantage of MI-CBT)...
November 8, 2018: Psychotherapy
Michael J Lambert, Jason L Whipple, Maria Kleinstäuber
This systematic review and meta-analysis examines the impact of measuring, monitoring, and feeding back information on client progress to clinicians while they deliver psychotherapy. It considers the effects of the 2 most frequently studied routine outcome monitoring (ROM) practices: The Partners for Change Outcome Management System and the Outcome Questionnaire System. Like other ROM practices, they typify attempts to enhance routine care by assisting psychotherapists in recognizing problematic treatment response and increasing collaboration between therapist and client to overcome poor treatment response...
December 2018: Psychotherapy
Catherine F Eubanks, J Christopher Muran, Jeremy D Safran
A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. We present the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, and the impact of rupture resolution training on outcome, we conducted two meta-analyses. In the first meta-analysis, we examined 11 studies (1,314 patients) that examined the relation between rupture repair episodes and patient treatment outcomes...
December 2018: Psychotherapy
Jeffrey A Hayes, Charles J Gelso, Simon Goldberg, Dennis Martin Kivlighan
In this article, we review the history and definition of countertransference, as well as empirical research on countertransference, its management, and the relation of both with psychotherapy outcome. Three meta-analyses are presented, as well as studies that illustrate findings from the meta-analyses. The first meta-analysis indicated that countertransference reactions are related inversely and modestly to psychotherapy outcomes (r = -.16, p = .02, 95% CI [-.30, -.03], d = -0.33, k = 14 studies, N = 973). A second meta-analysis supported the notion that countertransference management factors attenuate countertransference reactions (r = -...
December 2018: Psychotherapy
Michael J Constantino, Alice E Coyne, James F Boswell, Brittany R Iles, Andreea Vîslă
Patients' perception of treatment credibility represents their belief about a treatment's personal logicality, suitability, and efficaciousness. Although long considered an important common factor bearing on clinical outcome, there have been no systematic reviews of the credibility-outcome association. The present study represents a meta-analysis of the association between patients' credibility perception and their posttreatment outcomes. To be included, articles published through August, 2017 had to (a) include a clinical sample, (b) include a therapist-delivered treatment of at least 3 sessions, (c) include a measure of patients' own early treatment credibility perception, (d) include at least 1 posttreatment mental health outcome not explicitly referenced as a follow-up occasion, and (e) report a statistical test of the credibility-outcome association...
December 2018: Psychotherapy
Michael J Constantino, Andreea Vîslă, Alice E Coyne, James F Boswell
Patients' outcome expectation (OE) represents their belief about the mental health consequences of participating in psychotherapy. A previous meta-analysis of 46 independent samples receiving the treatment of at least 3 sessions revealed a significant association between more optimistic baseline, or early treatment, OE and more adaptive posttreatment outcomes (weighted r = .12 or d = .24; Constantino, Glass, Arnkoff, Ametrano, & Smith, 2011). The present study represents an update to that meta-analysis...
December 2018: Psychotherapy
Paul R Peluso, Robert R Freund
Although emotion has long been considered important to psychotherapeutic process, empirical assessment of its impact has emerged only recently. The present study applied two meta-analyses to explore the association between therapist expression of emotion and psychotherapy outcome, and client expression of emotion and psychotherapy outcome. Overall, 66 studies (13 for the therapist meta-analysis and 43 for the client meta-analysis) were included. A significant medium effect size was found between the therapist's emotional expression and outcomes (d = 0...
December 2018: Psychotherapy
Clara E Hill, Sarah Knox, Kristen G Pinto-Coelho
We review definitions and provide case examples of therapist self-disclosure (TSD) and immediacy (Im). We then present a qualitative meta-analysis of 21 studies that examined the subsequent process following TSD and Im in psychotherapy (excluding analogue and correlational studies). Across the 21 studies, the most frequent subsequent processes were enhanced therapy relationship, improved client mental health functioning, gains in insight, and overall helpfulness, suggesting that most often TSD and Im were followed by positive and beneficial therapeutic processes...
December 2018: Psychotherapy
Charles J Gelso, Dennis M Kivlighan, Rayna D Markin
Although writing about the real relationship has existed from the beginnings of the "talking cure," it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable...
December 2018: Psychotherapy
Gregory G Kolden, Chia-Chiang Wang, Sara B Austin, Yunling Chang, Marjorie H Klein
Congruence or genuineness is a relationship element with an extensive and important history within psychotherapy. Congruence is an aspect of the therapy relationship with two facets, one intrapersonal and one interpersonal. Mindful genuineness, personal awareness, and authenticity characterize the intrapersonal element. The capacity to respectfully and transparently give voice to ones' experience to another person characterizes the interpersonal component. Although most fully developed in the person-centered tradition, congruence is highly valued in many theoretical orientations...
December 2018: Psychotherapy
Barry A Farber, Jessica Y Suzuki, David A Lynch
This article meta-analytically reviews the research on the association between therapist positive regard (PR) and treatment outcome. The history of the construct of unconditional PR in client-centered theory and the efforts to clearly operationalize and measure this construct are reviewed. Several clinical examples are presented. The updated meta-analysis, which features expanded inclusion criteria and a larger number of studies (k = 64) than previous analyses, yielded a small positive association between PR and treatment outcome, g = ...
December 2018: Psychotherapy
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