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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
Majse Lind, Carsten René Jørgensen, Torben Heinskou, Sebastian Simonsen, Rikke Bøye, Dorthe Kirkegaard Thomsen
Patients with borderline personality disorder (BPD) display disturbances in self and other understanding, which is also evident when they narrate events from their own and significant others' lives. In a recent study, we found that patients described both their own and their parents' life stories as more negative and with fewer themes of agency and communion fulfillment. Hence, we examined whether 12 months of psychotherapy would change how patients described their own and their parents' life stories. At baseline, 30 BPD patients and 30 matched control participants described and answered questions about their personal and their parents' life stories...
August 16, 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
Robert Elliott, Arthur C Bohart, Jeanne C Watson, David Murphy
Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes...
December 2018: Psychotherapy
Gary M Burlingame, Debra Theobald McClendon, Chongming Yang
Cohesion is the most popular of the relationship constructs in the group therapy literature. This article reviews common definitions of cohesion, the most frequently studied measures, and a measure that may clarify group relations using two latent factors (quality and structure) to explain common variance among frequently used group relationship instruments. We present the results of a meta-analysis examining the relation between group cohesion and treatment outcome in 55 studies. Results indicate that the weighted aggregate correlation between cohesion and treatment outcome was statistically significant, r = ...
December 2018: Psychotherapy
Georgiana Shick Tryon, Sarah E Birch, Jay Verkuilen
This article provides meta-analyses of the relation between goal consensus and collaboration and individual psychotherapy outcome using studies published in English between 1978 and June 2017. Inclusion criteria involved (a) a measure of psychotherapy outcome, (b) a measure of goal consensus and/or collaboration, (c) a group design, (d) adult patients (aged 18 years or older), and (e) a reported effect or statistic that could be converted to an effect size. For the 54 studies (N = 7,278) of goal consensus and outcome, the result was r = ...
December 2018: Psychotherapy
Myrna L Friedlander, Valentín Escudero, Marianne J Welmers-van de Poll, Laurie Heatherington
This article reviews meta-analytic evidence for the alliance-outcome relation in couple and family therapy (CFT), with implications for clinical practice. We begin by describing the unique features of CFT alliances and their measurement, followed by two case descriptions. We explain that due to the systemic context of CFT, each patient's personal alliance with the therapist affects and is affected by other family members' levels of collaboration. Because family members often seek help when they are in conflict with one another, "split" alliances are common, as are problematic within-system alliances, defined as the degree to which family members agree on the nature of their problems and value participating in therapy together to achieve shared goals...
December 2018: Psychotherapy
Marc S Karver, Alessandro S De Nadai, Maureen Monahan, Stephen R Shirk
In the youth treatment literature, the alliance has been defined and measured as a consensual or collaborative bond. In this article, we review varied definitions of the alliance, enumerate its frequent measures, and present clinical examples. We provide a meta-analytic review on the relation between the therapeutic alliance and treatment outcome in child and adolescent psychotherapy. In particular, this review only includes prospective studies of youth therapy that used an explicit measure of alliance. The meta-analysis of 28 studies revealed a weighted random effect size of r = ...
December 2018: Psychotherapy
John C Norcross, Michael J Lambert
This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome...
December 2018: Psychotherapy
Christoph Flückiger, A C Del Re, Bruce E Wampold, Adam O Horvath
The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators...
December 2018: Psychotherapy
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