{"title":"Comparing American and Chinese Primary School Students' Psychosocial Symptoms: Psychometric Network Analysis With Pediatric Symptom Checklist-17.","authors":"Ang Xia, Jin Liu, Tuo Liu, Junhao Pan, Ruyi Ding","doi":"10.1002/jclp.70049","DOIUrl":"https://doi.org/10.1002/jclp.70049","url":null,"abstract":"<p><p>This study aimed to compare the American and Chinese primary school students' psychosocial problems, utilizing the psychometric network analysis. American (n = 71, M<sub>age</sub> = 36.93 years, SD = 10.52 years, all females) and Chinese (n = 74, M<sub>age</sub> = 35.70 years, SD = 7.89 years, 85.92% females) primary school teachers were recruited to evaluate children's internalizing, externalizing, and attention problems using the Pediatric Symptom Checklist-17 (PSC-17). Each teacher evaluated 9 children in their classes. A total of 639 American students (M<sub>age</sub> = 8.88 years, SD = 2.02 years, 55.56% females) and 666 Chinese students (M<sub>age</sub> = 12.88 years, SD = 9.34 years, 57.96% females) were evaluated. Psychometric network analysis revealed distinct structures for American and Chinese children's psychosocial problems. In America, three distinct communities emerged, aligning with the theoretical constructs of the PSC-17. Conversely, while three communities were identified in China, three items assessing attention problems showed strong associations with those assessing internalizing problems, merging into the same community. The remaining two items assessing attention problems and the items assessing externalizing problems formed two other distinct communities. Moreover, in both cultures, the top three nodes with the highest centralities ('Distracted easily,' 'Blame others for his or her troubles,' and 'has trouble concentrating') are similar and all relate to externalizing and attention problems. However, the highest centralized node in the two cultures differed, with \"Distracted easily\" in America and \"Blames others for his or her troubles\" in China. In conclusion, the observed patterns in American and Chinese networks highlight the significant impact of culture on children's psychosocial issues. Although PSC-17 is a widely used screening tool in many languages, its application should be carefully considered in different cultural contexts, particularly when making cultural comparisons.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Felix Inchausti, Nancy V García-Poveda, Sheila Martínez de la Hidalga González de Betolaza, Iranzu Iñigo Morrás, Raffaele Popolo, Giancarlo Dimaggio
{"title":"Metacognitive Interpersonal Group Therapy for Adolescents With Emerging Personality Disorders: The Case of Nora.","authors":"Felix Inchausti, Nancy V García-Poveda, Sheila Martínez de la Hidalga González de Betolaza, Iranzu Iñigo Morrás, Raffaele Popolo, Giancarlo Dimaggio","doi":"10.1002/jclp.70050","DOIUrl":"https://doi.org/10.1002/jclp.70050","url":null,"abstract":"<p><p>An increasing number of adolescents attending child and adolescent mental health services present symptoms consistent with an emerging personality disorder (PD). Early identification and intervention are critical to preventing the devastating progression of symptoms, reducing the duration of untreated disorders, and supporting the recovery, development, and future quality of life of these individuals. The primary aim of this paper is to introduce a group therapy proposal designed for the entire spectrum of adolescent PDs: Metacognitive Interpersonal Group Therapy for Adolescents (MIT-GA). MIT-GA is a profoundly experiential interpersonal psychotherapy aimed at promoting the progressive growth of awareness and regulation of mental states, that is metacognition, and so alleviating symptoms and interpersonal problems. The paper first outlines the core principles of the treatment, its general structure, and session content. Next, it illustrates the therapeutic methodology through the case of Nora, a 16-year-old adolescent suffering from emerging, moderate PD with mixed features, primarily dependent and borderline. To evaluate the therapy's impact, quantitative and qualitative results are presented before and after the treatment, as well as 6 months post-therapy, focusing on symptomatology, interpersonal functioning, and overall functioning. Finally, the paper offers reflections on working with PDs, and discusses the advantages and challenges of MIT-GA.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allison E Bond, Taylor R Rodriguez, Kimberly Burke, Sultan Altikriti, Michael D Anestis
{"title":"Examining Demographic Characteristics of Firearm Owners Currently Engaged in Mental Health Treatment.","authors":"Allison E Bond, Taylor R Rodriguez, Kimberly Burke, Sultan Altikriti, Michael D Anestis","doi":"10.1002/jclp.70048","DOIUrl":"https://doi.org/10.1002/jclp.70048","url":null,"abstract":"<p><strong>Objective: </strong>Research on the demographic characteristics and mental health profiles of those with firearm access is scarce. To address this gap, the current study examined the demographic characteristics and use of mental health services among firearm owners in the United States.</p><p><strong>Methods: </strong>Using a sample of 3018 US adults with firearm access drawn from a nationally representative sample of adults (n = 8009), this study assessed the relationships between individual characteristics, engagement in therapy, and receiving prescribed psychiatric medication among respondents who have access to firearms.</p><p><strong>Results: </strong>Among those with firearm access, being younger, female, having higher education, and a history of suicidal ideation were associated with engagement in therapy and receiving psychiatric medication. Additionally, being nonwhite and employed were associated with lower odds of receiving medication. The findings highlight the need to better identify high-risk subgroups (e.g., nonwhite, older, and less educated) with firearm access who do not engage with mental health services.</p><p><strong>Conclusion: </strong>It is hypothesized that extending mental health services and suicide prevention strategies to those who traditionally underutilize these services despite an elevated risk of self-harm can help reduce self-injury and potentially reduce firearm-related suicides among these populations.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Negative Emotion Regulation Self-Efficacy Moderates the Association Between PTSD Symptom Severity and Suicidal Thoughts and Behaviors in a Trauma-Exposed Community Sample of Adults.","authors":"Kayla E Hall, Matthew T Tull, Kim L Gratz","doi":"10.1002/jclp.70046","DOIUrl":"https://doi.org/10.1002/jclp.70046","url":null,"abstract":"<p><p>Individuals who experience symptoms of post-traumatic stress disorder (PTSD) are more likely to experience suicidal thoughts and behaviors (STB). However, additional research is needed to clarify for whom the relationship between PTSD symptoms and STB is the strongest. Considering that both PTSD and STB are characterized by difficulties with emotion regulation, one construct worth exploring in this regard is emotion regulation self-efficacy (ERSE), or one's beliefs in their ability to regulate negative emotions. Thus, the current study sought to explore the role of ERSE in the association between PTSD symptoms and STB. Using Amazon's Mechanical Turk, participants (N = 227; M<sub>age</sub> = 39.91, 65.2% assigned female sex at birth) completed self-report measures of PTSD symptoms, ERSE, and STB. Controlling for depression, results revealed a significant interaction between PTSD and ERSE in relation to STB. Simple slopes analyses revealed a significant positive association between PTSD symptom severity and STB among individuals with low or moderate, but not high, self-efficacy for managing negative emotions. Results highlight the relevance of ERSE in understanding STB among individuals experiencing PTSD symptoms.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Loving in Secret, Grieving in Silence: Emotion-Focused Therapy With the Other Woman After an Affair in a Japanese Cultural Context.","authors":"Shigeru Iwakabe","doi":"10.1002/jclp.70045","DOIUrl":"https://doi.org/10.1002/jclp.70045","url":null,"abstract":"<p><p>Although extensive literature exists on supporting couples after an affair, there is a notable lack of clinical focus on working with the other woman-a figure often viewed as a moral transgressor and subjected to social stigma. Despite this marginalization, her experience is frequently marked by secrecy, emotional ambivalence, and a mix of profound pleasure, guilt, and shame. This paper presents a case study of individual therapy with a Japanese woman in her late 30 s, struggling with the unresolved emotional aftermath of a 5-year affair that had ended more than 7 years earlier. Early sessions revealed significant unfinished emotional business with her ex-boyfriend, who left her shortly after his wife gave birth, a relationship she had entered unaware of his marital status. The therapy focused on helping the client process the complex emotional residue of this relationship, which had affected nearly every aspect of her life. Drawing on an affect-focused integrative approach that combined Emotion-Focused Therapy (EFT) and Accelerated Experiential Dynamic Psychotherapy (AEDP), the therapist supported the client in processing both the pleasurable and painful aspects of the affair. These had remained unspoken due to the absence of a safe space for expression. Within the safety of the therapeutic relationship, she was able to articulate long-suppressed needs, reclaim her sense of self-worth, and regain agency. The case also explores the cultural and gendered dimensions of infidelity within the Japanese context and reflects on implications for affect-focused clinical practice with clients experiencing stigma or struggling with morally complex personal issues.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan Van Patten, Erica Cotton, Lawrence Chan, Hamada Altalib, Krista Tocco, Tyler E Gaston, Leslie P Grayson, Amber Martin, Samantha Fry, Adam Goodman, Jane B Allendorfer, Andrew Blum, Jerzy P Szaflarski, W Curt LaFrance
{"title":"Neurobehavioral Therapy Is Associated With Improvements in Social Functioning in Patients With Functional Seizures and Traumatic Brain Injury.","authors":"Ryan Van Patten, Erica Cotton, Lawrence Chan, Hamada Altalib, Krista Tocco, Tyler E Gaston, Leslie P Grayson, Amber Martin, Samantha Fry, Adam Goodman, Jane B Allendorfer, Andrew Blum, Jerzy P Szaflarski, W Curt LaFrance","doi":"10.1002/jclp.70047","DOIUrl":"https://doi.org/10.1002/jclp.70047","url":null,"abstract":"<p><strong>Objective: </strong>Functional (nonepileptic) seizures (FS) frequently co-occurs with traumatic brain injury (TBI) and reduces social functioning. In the current study, we aimed to identify whether psychotherapy is associated with changes in social functioning in TBI + FS.</p><p><strong>Methods: </strong>Participants were 96 adults with TBI, 48 of whom had FS and 48 of whom did not. Both TBI cohorts received standard medical care (SMC), and the TBI + FS group received adjunctive 12-session neurobehavioral therapy (NBT) for seizures. Neuropsychiatric evaluations measured sociodemographics, mental health, cognition, medications, social functioning, and quality of life, with a subset of items completed at 8- and 12-month post-enrollment follow ups. Social functioning was assessed with a quality of life scale.</p><p><strong>Results: </strong>Baseline seizure worry was the most reliable correlate of baseline social functioning (r = 0.52; p < 0.001; multivariable linear regression: β = 0.42, t = 2.80, p = 0.04) in the TBI + FS cohort. A 2-time (treatment baseline to endpoint) × 2-group (TBI + FS vs. TBI comparison) mixed ANOVA showed improved QOLIE-31 Social Functioning in the SMC + NBT-treated TBI + FS cohort but not for SMC TBI-only participants, F(1, 94) = 17.62, p < 0.001, partial η<sup>2</sup> = 0.16. NBT was associated with improved social activities and leisure time, reduced social limitations, and increased work status. None of the baseline clinical variables predicted pre-post change in social functioning in TBI + FS participants.</p><p><strong>Conclusion and implications for practice: </strong>Seizure worry appears to be an important component of social functioning in patients with FS and TBI and could be a worthwhile target of intervention. Our results suggest that multimodal NBT may be associated with improvements in aspects of social functioning for these patients. Those with TBI who were treated with SMC (no NBT) displayed no symptomatic or social benefit. This study highlights the importance of assessing and considering treatments for social functioning in FS.</p><p><strong>Trial registration: </strong>Data in this secondary analysis came from ClinicalTrials. gov: NCT03441867.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Ballesio, Andrea Zagaria, Valeria Fiori, Mariacarolina Vacca, Caterina Lombardo
{"title":"Adverse Childhood Experiences, Insomnia, and Depressive Symptoms in Later Life: Moderation Effect of Loneliness but Not Hair Cortisol.","authors":"Andrea Ballesio, Andrea Zagaria, Valeria Fiori, Mariacarolina Vacca, Caterina Lombardo","doi":"10.1002/jclp.70041","DOIUrl":"https://doi.org/10.1002/jclp.70041","url":null,"abstract":"<p><strong>Objectives: </strong>Adverse childhood experiences (ACEs) are established risk factors for developing depression in adulthood, although the mechanisms of this association are yet to be fully elucidated. In this study, we tested whether insomnia (i.e., difficulties in sleep onset and maintenance) can mediate the association between ACEs and adult depressive symptoms, and whether loneliness and hair cortisol, reflecting hypothalamic-pituitary-adrenal axis activity, can act as moderators.</p><p><strong>Methods: </strong>We analyzed data of 1593 participants (64.7% female) aged 65.25 ± 8.15 from the English Longitudinal Study of Ageing (ELSA) across three waves of data collection. ACEs were retrospectively assessed in 2008-2009 (wave 4), insomnia symptoms, loneliness, and hair cortisol in 2012-2013 (wave 6), while depressive symptoms were assessed in 2014-2015 (wave 7).</p><p><strong>Results: </strong>After accounting for health-related confounders and baseline values, conditional process analysis showed that insomnia symptoms exerted a mediating role between ACEs (ACEs total, parental bonding, and household dysfunction) and depressive symptoms, with a stronger effect in lonely older adults. Hair cortisol did not moderate the association between ACEs and insomnia symptoms.</p><p><strong>Conclusion: </strong>Results are consistent with the view of insomnia as a mechanism linking ACEs to depressive symptoms later in life. Elderly experience of loneliness may further increase the mediatory role of insomnia between ACEs and depression.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Provencio, Maria F Rodríguez-Muñoz, Katina Kovacheva, María Dolores López-Salmerón, Ana Fonseca, Cristina Soto-Balbuena, Elvira Macayo-Sánchez
{"title":"Psychological Vulnerability to Perinatal Depression: A Longitudinal Mediation Model.","authors":"Maria Provencio, Maria F Rodríguez-Muñoz, Katina Kovacheva, María Dolores López-Salmerón, Ana Fonseca, Cristina Soto-Balbuena, Elvira Macayo-Sánchez","doi":"10.1002/jclp.70044","DOIUrl":"https://doi.org/10.1002/jclp.70044","url":null,"abstract":"<p><p>Perinatal depression (PD) is a significant mental health concern affecting women during pregnancy (antenatal depression, AD) and postpartum (postpartum depression, PPD). The association between AD and PPD is well established, with AD serving as a risk factor for PPD. Additionally, a history of depression and neuroticism have been identified as key vulnerability factors. However, the role of neuroticism remains controversial in the scientific literature, with some studies suggesting it is a stable predictor of depression, while others propose it may exhibit fluctuations in response to life events, altering its mediating role in PD. We aim to explore the role of psychological vulnerability (history of depression and neuroticism) and AD, as transdiagnostic risks factors contributing on PPD in a longitudinal sample of 229 women. Self-report questionnaires were administered during pregnancy and postpartum. Results indicate that a history of depression had an indirect effect on PPD, mediated by both neuroticism and AD. Given the uncertainties regarding the stability of neuroticism, further longitudinal research is needed to clarify its mediating role in perinatal depression. These findings underscore the importance of early identification of vulnerability factors, particularly a history of depression, to prevent AD and subsequent PPD. Screening for psychological vulnerability is essential in clinical practice. Early identification of psychological vulnerability may help reduce the risk of postpartum depression. Screening for these factors during pregnancy could help identify women with high levels of neuroticism, who may benefit from brief, evidence-based psychological interventions, such as mindfulness-based cognitive therapy. Implementing targeted preventive strategies may enhance maternal mental health.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deliberate Practice in Psychotherapy Supervision: A Promising Paradigm for Enhancing Clinical Effectiveness Even if We Still Have Puzzles to Solve.","authors":"Helene Amundsen Nissen-Lie","doi":"10.1002/jclp.70043","DOIUrl":"https://doi.org/10.1002/jclp.70043","url":null,"abstract":"<p><p>The current paper is a commentary of the four papers (Brand et al.; Husby, Sacks, and Rosén) on deliberate practice (DP) as applied to psychotherapy supervision across therapeutic methods and contexts, published in this virtual issue of the Journal of Clinical Psychology: In Session. The commentary starts by situating the efforts of DP into the broader context of psychotherapy research and therapist effects (TEs), before providing a brief summary of each paper. All the papers point to the fact that traditional supervision often misses opportunities to practice specific clinical skills and the promotion of translation of reflection into action. They each give hands on and engaging cases of supervisory practices. Still, there are some critical questions that warrant attention which concern some of the assumptions that DP supervision is based on, which are discussed here. These are: (1) Are client outcomes enhanced as a result of DP supervision?; (2) Is it true that declarative knowledge does not translate into procedural knowledge?; (3) Does DP supervision put too much emphasis on the supervisor's ability to know what needs to be changed? and (4) Is it possible to apply the principles of DP to a dyadic enterprise such as psychotherapy? While clinical supervision based on DP principles is promising, there are issues to be solved, and we should proceed with sobriety with regard to how much DP may enhance the training of psychotherapists and clinical practice.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ulrike Maaß, Michael Witthöft, Yvonne Marie Junga, Daniela Hahn, Florian Weck
{"title":"Relationships Among Patients' Interpersonal Behaviors in Sessions, Therapist Competence, and the Therapeutic Alliance in Cognitive Behavior Therapy: A Cross-Lagged Panel Analysis.","authors":"Ulrike Maaß, Michael Witthöft, Yvonne Marie Junga, Daniela Hahn, Florian Weck","doi":"10.1002/jclp.70040","DOIUrl":"https://doi.org/10.1002/jclp.70040","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the reciprocal relationships between patient interpersonal behavior (IB), therapist competence, and the alliance within- and between-persons.</p><p><strong>Methods: </strong>A secondary analysis was conducted of a randomized controlled trial with 67 cognitive behavior therapists and 114 patients with depression. The therapists evaluated their patients' IB, and they both judged the alliance. Pre- and post-treatment, the patients indicated their general levels of interpersonal problems. Every fourth session, independent raters judged the patients' IB and therapists' competence. Random-intercept cross-lagged panel analyses were calculated.</p><p><strong>Results: </strong>First, intraindividual deviations in patient IB were associated with deviations in therapist competence or the alliance (within-person); and patients with generally more positive IB experienced not only better alliances but also more competent therapists (between-person). Second, the perspective of the evaluating person and the time interval were decisive, as significant cross-lagged effects between patients' IB in one session and the alliance in subsequent sessions (and vice versa) only occurred from the therapist perspective, but not when the patient perspective was considered. Third, patients with more interpersonal problems before treatment did not show more negative IB, nor did they experience poorer alliances or less competent therapists.</p><p><strong>Conclusion: </strong>The study supports the idea that patient IB is as an important part of both therapeutic competence and the alliance. However, therapists and raters may be prone to evaluation bias, interpreting negative patient IB as a sign of poor alliance or competence (and vice versa). Finally, the extent of interpersonal problems before treatment does not substantially influence the three process variables.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov/study/NCT02479594.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}