Psychotherapy最新文献

{"title":"Struggling for resonance: Mediopassive interaction in a long-term treatment of severe personality disorder.","authors":"Christian Sell, Stefan Pfänder","doi":"10.1037/pst0000633","DOIUrl":"10.1037/pst0000633","url":null,"abstract":"<p><p>Although clinicians often report significant emotional challenges in psychotherapy for personality disorders, we still know relatively little about how these difficulties are enacted and reorganized in moment-to-moment patient-therapist interaction. We examine whether interactional resonance and mediopassive agency can help illuminate relational difficulties and change in a good-outcome long-term psychodynamic psychotherapy involving a patient with severe interpersonal pathology, chronic depressive symptoms, and somatic complaints. The patient met the diagnostic criteria for borderline and avoidant personality disorders, as well as depressive and somatic symptom disorders. For much of the treatment, the therapist described sessions as highly distressing. Over time, sessions were experienced as less distressing and more productive. We examined whether this shift could be accounted for by changes in how patient and therapist took up and developed each other's contributions in interaction. Following a preliminary screening of therapist reports, case notes, and session recordings, we selected 10 sessions for multimodal conversation analysis. Using exploratory conversation analysis, we specified analytic indicators for interactional resonance and then compared five high-distress sessions with five lower distress sessions. High-distress sessions showed lower interactional resonance, whereas lower distress sessions showed higher resonance. In lower distress sessions, patient and therapist more often engaged in mediopassive interactions-that is, they jointly participated in the stepwise construction of meaning across turns. Psychotherapy for severe interpersonal pathology may involve working with persistently low levels of interactional resonance that constrain spontaneous, collaborative meaning-making. The findings further suggest that a dyad's capacity for interactional resonance may increase over the course of long-term treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The revised American Psychological Association guidelines for clinical supervision: Rationale, revisions, and implications for practice and scholarship.","authors":"Catherine Grus, Carol Falender, Rodney Goodyear, Karen W Tao, Shiloh Jordan","doi":"10.1037/pst0000643","DOIUrl":"https://doi.org/10.1037/pst0000643","url":null,"abstract":"<p><p>Clinical supervision is foundational to the training of psychologists and protection of public welfare, yet concerns about its quality have persisted across decades of psychotherapy scholarship and practice. The American Psychological Association (2014, 2015) Guidelines for Clinical Supervision in Health Service Psychology provided the first comprehensive, competency-based framework for supervision practice in psychology. After a decade of its adoption, supervision research has advanced, and important additions to the original guidelines were introduced in 2025 to address these developments. This article describes the rationale for these revisions and articulates the changes across its six domains: supervisor competence (Domain A), multicultural orientation (Domain B), supervisory relationship (Domain C), teaching and learning strategies (Domain D), professional competence problems (Domain E), and ethical, legal, and regulatory considerations (Domain F). Revisions include the introduction of group supervision as a distinct supervisory competency, reframing of diversity competence as multicultural orientation, an expanded emphasis on the pedagogy of supervision, and new guidance on attending to the intersection of supervisee identities and professional competence concerns. Implications for practice, training, and future research are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward scalable detection of clinical reasoning in supervision: A machine learning feasibility study.","authors":"Kimberly D Becker, Ben Webster, Austin Seymour, Bruce F Chorpita","doi":"10.1037/pst0000638","DOIUrl":"https://doi.org/10.1037/pst0000638","url":null,"abstract":"<p><p>Clinical reasoning shapes every clinical decision but remains largely invisible in therapy. Supervision, where supervisors and therapists deliberate together through dialogue, is a natural context for studying clinical reasoning, yet such reasoning is difficult to measure at scale. This study examined whether machine learning could detect clinical reasoning in supervision transcripts. We analyzed 631 supervision transcripts from the Reaching Families trial, in which supervisor-therapist dyads discussed youth cases with treatment engagement challenges, coded by human raters across three categories: reasoning activities (e.g., considering, selecting, monitoring), content focus (problems or practices), and referent (youth or caregiver). We first compared a bag-of-words model (Complement Naïve Bayes) and a transformer-based model (DistilBERT) to assess signal detectability. We then examined whether DistilBERT's performance varied by condition: a coordinated knowledge systems intervention, which structures supervisory dialogue around a specific reasoning cycle, versus a practice guidelines control, and benchmarked DistilBERT's agreement against human coders. DistilBERT outperformed Complement Naïve Bayes across all metrics, achieving moderate to substantial agreement with human ratings across code categories (κ > 0.58), though McNemar's tests indicated systematic underlabeling. Agreement was stronger for coordinated knowledge systems than practice guidelines transcripts. These findings support the feasibility of using machine learning to detect clinical reasoning in supervision transcripts, an early step toward scalable labeling methods that capture what reasoning was about and how it unfolded. With continued development, this approach could advance understanding of how supervisory reasoning relates to clinical practice and support data-informed feedback for supervisors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent trends and adaptations in trauma-informed psychoanalytic psychotherapies: A scoping review.","authors":"Carlos Pitillas, Emma Albarracín","doi":"10.1037/pst0000642","DOIUrl":"https://doi.org/10.1037/pst0000642","url":null,"abstract":"<p><p>A growing sensitivity has emerged within psychoanalytic theory and intervention to the specific conditions of complex posttraumatic pathology and its clinical challenges. Yet an articulated, encompassing view of the diverse proposals within this new sensitivity is still lacking. This article advances such articulation through a scoping review of psychoanalytic interventions focused on trauma and dissociation published over the past 15 years. Our analysis identifies five axes of trauma-sensitive psychoanalytic practice addressing vulnerability to dysregulation, limited symbolic access to traumatic material, structural dissociation, vulnerability to disorganization in contexts of intimacy, and enactments arising around dissociative collusions and dilemmas of recognition within the therapeutic dyad. Overall, the reviewed literature relocates interpretation within a temporally and clinically responsive framework, in which the timing and form of interpretive interventions are calibrated to the traumatized patient's regulatory, dissociative, and symbolic capacities. We conclude by outlining essential aspects of the therapeutic stance implied by these contributions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trust and respect declines and recoveries in psychotherapy: Clinical impact of relational feedback.","authors":"Mary Beth Connolly Gibbons, Nic Kodkany, Yaz Liow, Paul Crits-Christoph","doi":"10.1037/pst0000641","DOIUrl":"10.1037/pst0000641","url":null,"abstract":"<p><p>Measurement-based care, also referred to as routine outcome monitoring, has demonstrated modest benefits for psychotherapy outcomes, yet less is known about how feedback on specific relational processes may influence clinical course. The present study examined whether fluctuations in patient-reported trust and respect toward the therapist-conceptualized here as meaningful declines and subsequent recoveries in trust/respect, rather than direct measures of alliance ruptures and repairs-are associated with changes in functioning and whether providing therapists with feedback on these ratings alters these associations. Adult patients receiving treatment in U.S. community mental health settings were randomized for their therapist to receive symptom feedback alone or symptom plus trust/respect feedback. Meaningful declines in trust/respect were defined as within-patient decreases exceeding typical variability, and recoveries were defined as subsequent returns to predecline levels. Weekly functioning was assessed over 11 weeks using time-varying mixed-effects models. Of 233 randomized patients, 185 completed at least one postbaseline assessment, and 162 had postbaseline data sufficient for the current decline/recovery analyses. Meaningful declines in trust/respect across sessions that did not recover to previous levels were associated with lower within-person functioning in the symptom-only feedback condition but was attenuated in the trust/respect feedback condition. Recovery status was not differentially associated with functioning across conditions. These findings suggest that monitoring and providing feedback on patient perceptions of trust and respect may mitigate the impact of unresolved relational strain. Incorporating specific relational process indicators into measurement-based care/routine outcome monitoring may enhance its clinical utility. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between sessions: How challenging and satisfying moments shape therapists' inner worlds-A comparative interpretative phenomenological analysis study of novice and experienced therapists.","authors":"Yaren Okat, I Volkan Gülüm","doi":"10.1037/pst0000640","DOIUrl":"https://doi.org/10.1037/pst0000640","url":null,"abstract":"<p><p>The primary aim of this study was to provide an in-depth understanding of psychotherapists' experiences between sessions, following both challenging and satisfying sessions. A qualitative research design, interpretative phenomenological analysis, was employed. The study included seven novice and seven experienced psychotherapists. Semistructured interviews were conducted with all participants, and the data were analyzed according to interpretative phenomenological analysis guidelines. The findings are organized around two overarching domains: challenging and satisfying moments as experienced by novice and experienced therapists alike. Two superordinate themes emerged from the challenging moments: <i>challenging moments are also part of being a therapist</i>, and <i>the sessions ended, but the challenging moments did not let me go.</i> Similarly, two themes were identified for satisfying moments. <i>being satisfied is also a part of being a therapist</i>, and <i>sessions ended, but the satisfying moments stayed with me</i>. In both cases, challenging and satisfying moments were meaningful; however, they differed in affective tone, being experienced as either emotionally heavy or emotionally sustaining. These findings offer therapists a framework to better understand their intersession processes and provide actionable insights for supervision and self-care. These insights may help professional resilience and prevent burning out among practitioners. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonverbal coordination and affect regulation in play: Pathways to therapeutic change in Mentalization-Based Treatment for Children (MBT-C).","authors":"Sibel Halfon, Zeynep Çatay","doi":"10.1037/pst0000639","DOIUrl":"10.1037/pst0000639","url":null,"abstract":"<p><p>Nonverbal interventions are central to child psychotherapy and play a key role in enhancing in-session affect regulatory processes that may ultimately contribute to treatment outcomes; however, empirical evidence examining their role in therapeutic change remains limited. The present study investigated whether therapists' nonverbal coordination predicted treatment outcomes in Mentalization-Based Treatment for Children through improving children's in-session affect regulation in play. The sample comprised 95 children (<i>M</i>_age = 7.80 years, 37.9% girls) with internalizing and externalizing problems and their 16 therapists, who provided Mentalization-Based Treatment for Children within the context of a clinical trial. Two hundred forty-five therapy sessions from early, middle, and late phases of treatment were coded for therapists' nonverbal coordination and children's in-session affect regulation characteristics in play. Child outcomes included parent-reported emotion regulation and total problem levels assessed at baseline, midtreatment, and posttreatment. Multilevel mediation analyses indicated higher levels of therapists' nonverbal coordination significantly predicted better in-session affect regulation in play. In turn, in-session affect regulation in play predicted lower total problem levels and higher overall emotion regulation over the course of treatment. Indirect effects of nonverbal coordination on both outcomes via in-session affect regulation in play were significant, whereas direct effects were not, indicating that nonverbal coordination was associated with outcomes primarily through in-session affect regulation. Findings suggested that therapists' nonverbal coordination supports therapeutic change in Mentalization-Based Treatment for Children by enhancing children's affect regulatory capacities within play, which may facilitate broader improvements in emotional and behavioral functioning. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microprocesses predicting early emotional bond in videoconferencing and face-to-face psychotherapy.","authors":"Diego Fernández-Regueras, Ana Calero-Elvira, M Cristina Guerrero-Escagedo","doi":"10.1037/pst0000623","DOIUrl":"10.1037/pst0000623","url":null,"abstract":"<p><p>Research on microprocesses underlying alliance formation remains limited compared to outcome-based studies, particularly in videoconferencing psychotherapy (VCP). This study examined therapist and client interaction patterns predicting early emotional bond in VCP and face-to-face therapy. A total of 56 early therapy sessions from 28 therapist-client dyads were coded with the <i>Therapeutic Relationship Coding System,</i> yielding 35,715 behaviors. Alliance strength was determined through an extreme-groups design based on the Bond subscale of the <i>Working Alliance Inventory-Patient version</i>. Bayesian logistic regression models assessed whether therapist behaviors and therapist-client sequences predicted alliance and their interaction with modality (VCP and face-to-face). Empathy alone predicted weaker bond in VCP, whereas sequences where it was followed by clients' agreement predicted bond more strongly in VCP. Active listening followed by client agreement also predicted stronger bond only in VCP, while both behaviors followed by client disagreement predicted weaker bond across modalities. Joking and accurate recall of prior client information were particularly associated with strong bond in VCP, whereas early therapist disagreement predicted weaker bond across modalities. Findings indicate that precise, accurate, and context-sensitive verbal interactions are especially critical for fostering emotional bond in VCP, where nonverbal cues are limited. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"284-294"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance and commitment therapy for moral injury (ACT-MI) and present-centered therapy for moral injury (PCT-MI): Results from a randomized controlled pilot trial with war zone deployed veterans.","authors":"Lauren M Borges, Jacob K Farnsworth, Robyn D Walser, Kent D Drescher, Jeri E Forster, Lisa A Brenner, Jacob P S Johnson, Christin N Miller, Gabriel E Aharoni, Craig S Rosen, Jason A Nieuwsma, Joseph M Currier, Sean M Barnes","doi":"10.1037/pst0000632","DOIUrl":"10.1037/pst0000632","url":null,"abstract":"<p><p>Acceptance and commitment therapy for moral injury (ACT-MI) and present-centered therapy for moral injury (PCT-MI) were developed and piloted through the study. ACT-MI was created to improve psychosocial functioning among veterans experiencing moral injury. PCT-MI was developed as a transdiagnostic process-based moral injury intervention and an active comparison condition for a future ACT-MI efficacy trial. A randomized controlled pilot trial was conducted where 74 war zone-deployed veterans were randomized to ACT-MI or PCT-MI. Aims were to test the acceptability of ACT-MI and PCT-MI, evaluate study design feasibility, and determine candidate outcomes and sample size for a future efficacy trial. ACT-MI and PCT-MI are 15-session psychotherapies, including group (12 sessions) and individual case conceptualization (three sessions) sessions. ACT-MI was acceptable to veterans as evidenced by Client Satisfaction Questionnaire (CSQ) scores (<i>M</i> = 29.52, <i>SD</i> = 3.73, 95% CI [28.10, 30.94]). In qualitative interviews, ACT-MI was described as impacting psychosocial functioning and providing alternatives to suicidal behavior and substance use. PCT-MI was also acceptable to veterans (CSQ <i>M</i> = 26.41, <i>SD</i> = 5.07; 95% CI [24.40, 28.40]). Veterans reported PCT-MI contributed to social connection, understanding moral injury symptoms, and present moment problem solving. The study design was feasible to implement. The Outcome Questionnaire-45 was the candidate psychosocial functioning measure most sensitive to change (ACT-MI: <i>N</i> = 29, <i>M</i> = -17.45, <i>SD</i> = 19.33, 95% CI [-24.80, -10.10]; PCT-MI: <i>N</i> = 27, <i>M</i> = -5.89, <i>SD</i> = 15.29, 95% CI [-11.94, 0.16]). Next steps are described, including a full-scale efficacy trial to evaluate the impacts of the interventions on psychosocial functioning. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"352-365"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative meta-analysis on therapist responsiveness to dissociation: Introducing the dissociation-responsive therapy model.","authors":"Nicholas A Pierorazio, Heidi M Levitt","doi":"10.1037/pst0000626","DOIUrl":"10.1037/pst0000626","url":null,"abstract":"<p><p>Although it is common to encounter dissociative clients in the therapy room, little is known about how clinicians adapt therapy for these clients. The present study is a qualitative meta-analysis investigating how therapists are responsive to dissociation-that is, how they tailor therapy to meet dissociative clients' needs in and across sessions. We conducted a systematic search for qualitative studies on therapists' experiences working with clients who dissociate, yielding 16 eligible studies with at least 239 therapists represented across the studies. We used a critical-constructivist grounded theory method to build a hierarchy that represented patterns across studies, then generated clinical principles for practice through a hermeneutic analysis. Results indicated that therapists paradoxically honored dissociation as a coping mechanism while also promoting clients' agency over working through it. They gradually did so by (a) initially prioritizing alliance-building actions tailored to dissociation, (b) promoting clients' self-reliance in managing symptoms and safety, (c) repairing systemic harm by bearing witness to stigmatized forms of trauma and dissociation, and (d) strategically enhancing clients' capacity for accessing and experiencing emotion. By engaging in this developmental process, therapists sought to empower clients to heal from traumatic pain. This four-phase model may inform clinical decision making, training, and future research to improve treatment processes and outcomes for dissociative clients. Caution should be taken when applying these findings to child, non-Western, non-English language, and nonindividual psychotherapy settings. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"314-327"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}