Psychotherapy最新文献

{"title":"Therapist trainee experience and client outcome: A within-person analysis of hours of experience, client order, initial client distress, and treatment length.","authors":"Saadet Zumbul, Dennis M Kivlighan","doi":"10.1037/pst0000612","DOIUrl":"10.1037/pst0000612","url":null,"abstract":"<p><p>Research does not consistently support the widely held assumption that therapist trainees' skills improve with supervised experience, leading to better client outcomes. The inconsistent findings are limited by methodological constraints. Measures of therapist trainee experience (e.g., training level, years since first client contact) fail to capture clinical experience accurately. Therefore, we operationalized therapist trainees' experience as the total hours of previous client contact under clinical supervision at the time of outcome assessment. We examined how therapist trainees' client contact hours (at the within-person level), client order, initial client distress, and treatment length are associated with client distress in the subsequent week. We used dynamic structural equation modeling to analyze longitudinal data with 1,125 outcome assessments from 192 clients and 45 doctoral-level therapist trainees, collected over 16 years. Therapists received weekly individual supervision and biweekly group supervision. Results indicated that at the within-person level, therapist trainee experience was modestly associated with reduced client distress, particularly for clients with higher initial distress. At the between-person level, therapist trainees' experience had a stronger impact on outcomes in shorter treatment lengths. Findings reveal the complexity of the therapist trainee experience-client outcome relationship and suggest that the effects of therapist trainee experience are contingent on other variables. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"48-61"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906564","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":"Barriers and facilitators in the implementation of routine outcome monitoring from the clinicians' perspective: A qualitative meta-analysis.","authors":"Klára Jonášová, Michal Čevelíček, Petr Doležal, Benjamin Aas, Tomáš Řiháček","doi":"10.1037/pst0000605","DOIUrl":"10.1037/pst0000605","url":null,"abstract":"<p><p>Routine outcome monitoring (ROM) has become an increasingly utilized tool in therapeutic practice that has the potential to improve therapy outcomes. This study aimed to synthesize the findings of existing qualitative studies investigating facilitators and barriers to clinicians' implementation of ROM in their practice. A systematic search of qualitative studies on clinicians' experience with the use of ROM in mental health services was conducted via APA PsycInfo, APA PsycArticles, Medline, Web of Science, and Scopus databases. Qualitative meta-analysis was used to synthesize the findings of the primary studies. Fifty-eight studies met the inclusion criteria. The analysis resulted in 22 metacategories organized into five clusters: (a) perceived clinical relevance, (b) institutional aspects, (c) practical aspects, (d) client variables, and (e) clinicians' personal reactions. The meta-analysis revealed that the implementation of ROM into clinicians' psychotherapy practice is influenced by many factors, including practical circumstances such as the work environment, the clientele, and the chosen ROM system. Clinicians' attitude to ROM, its perceived usefulness, and their openness to receiving feedback on their work are also important variables. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"33-47"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744042","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":"Tuning in: A mixed methods study evaluating clinician perceptions of measurement-based care training and their association with posttraining skills use.","authors":"Elizabeth A Penix-Smith, Kristina M Clarke-Walper, Katie L Nugent, Joshua E Wilk","doi":"10.1037/pst0000616","DOIUrl":"10.1037/pst0000616","url":null,"abstract":"<p><p>Understanding clinician perspectives and preferences is critical to advancing measurement-based care (MBC) training and implementation efforts. Yet, clinician perceptions of these and how they relate to MBC uptake are understudied. This mixed methods study aimed to evaluate clinicians' MBC training perceptions, posttraining MBC use, and predictors of MBC uptake. Clinicians in Department of Defense settings completed surveys immediately (N = 366) and 1 month (n = 88) posttraining. Most viewed MBC training as relevant (89.5%) and useful (81.8%); similarly, most were confident using symptom (87.9%) and alliance measures (89.3%) posttraining. Whereas 65.9% consistently used symptom measures posttraining, only 26.2% consistently used alliance measures, and about half did not regularly discuss those completed measures with clients. Using Bayesian logistic regression models, MBC use was linked with higher training relevance and usefulness ratings, reporting that training materials were understood and facilitated learning, and greater knowledge and confidence using MBC. Discipline and theoretical orientation were not significantly linked. Using reflexive thematic analysis, qualitative themes included clinician feedback about MBC, using symptom and alliance measures for MBC, training and presenter characteristics, and organizational considerations. Taken together, quantitative and qualitative findings highlight a gap in using alliance measures for MBC in applied settings. This study is the first to document a link between training perceptions and MBC uptake, underscoring the need to integrate frontline clinician perspectives in MBC efforts. Quantitative and qualitative findings indicate key topics that may be important to consider to facilitate MBC training and implementation efforts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":"63 1","pages":"91-103"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326839","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":"Beyond the treatment manual: Examining factors influencing Black client engagement in psychotherapy.","authors":"Miracle R Potter, Fatou Gaye, Tyler B Rice, Anika Sigel, Victoria K Swaine, Brandon King, Thomas E Joiner, Ericka M Lewis","doi":"10.1037/pst0000617","DOIUrl":"https://doi.org/10.1037/pst0000617","url":null,"abstract":"<p><p>Despite the benefits of psychotherapy to improve mental health outcomes, therapy remains significantly underutilized among Black Americans. Yet, once therapy is initiated, Black clients experience mental health outcomes comparable to those in the general population, underscoring potential barriers to engagement. To address this gap, our qualitative study explored factors that contribute to client engagement throughout the therapeutic process, including core therapeutic skills related to therapist qualities, provider-client alliances, and nontherapeutic factors that shape the client experience. Using a qualitative hermeneutic phenomenological approach, semistructured qualitative interviews were conducted with past and current Black clients at a university-based training clinic about their experiences engaging in therapy. Data were analyzed through thematic analysis, and a codebook was developed to adequately capture patterns in perspectives across the interviews. Major themes, including therapist acknowledgment of cultural identity and perceived therapeutic collaboration, were emphasized as being integral in promoting engagement. Additionally, participants discussed factors that contributed to positive treatment experiences, including flexible procedures and accommodating clinic staff. These findings suggest that cultural acknowledgment, therapeutic collaboration, and a supportive clinic environment are essential to increasing Black clients' utilization of therapeutic services. Understanding the factors that increase accessibility and engagement for Black clients can lead to improved treatment outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290791","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":"Examining two pedagogical methods on attitudes toward religiousness within mental health and social justice in an undergraduate course.","authors":"Craig A Warlick, Calista A Spears","doi":"10.1037/pst0000613","DOIUrl":"10.1037/pst0000613","url":null,"abstract":"<p><p>Integrating spirituality and religiousness (S/R) into mental health (MH) treatment aligns with our ethics codes and professional guidelines, and it can promote therapeutic outcomes. There is emerging evidence among samples of professional clinicians and graduate students that the Spirituality Competency Training in MH curriculum (SCT-MH; Pearce et al., 2019) may address the dearth of training in this intersection. However, SCT-MH needs to be assessed among undergraduates to support vocational development and those who pursue graduate school or bachelor-level mental health work. In this exploratory pedagogical study, we used a series of repeated measures analyses of variance to assess undergraduate students' (<i>N</i> = 39) attitudes toward a revised version of the Attitudes subscale of the S/R integration into MH Scale (Oxhandler & Parrish, 2016), the Social Justice Scale (SJS; Torres-Harding et al., 2012), and single-item scales focused on pursuing MH-focused work postdegree across teaching-as-usual and SCT-MH curricula. During teaching-as-usual, there were no significant increases in attitude scores regarding S/R integration (<i>p</i> = .25) or SJS (<i>p</i> = .4). However, there were significant increases in attitudes toward S/R integration (<i>p</i> < .001) and SJS during the SCT-MH curriculum (<i>p</i> < .001). In neither arm did interest single-item scores on pursuing MH graduate school (<i>p</i> = .68) or vocationally (<i>p</i> = .05) increase. While not causal, these increases during SCT-MH regarding attitudes toward S/R MH integration and social justice attitudes and behaviors are noteworthy. Further extension using vocational assessment, longitudinal and experimental designs, and diverse multisite samples are needed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012132","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":"Is employment status associated with baseline symptoms, engagement, and outcomes in naturalistic psychotherapy? Evaluation in a large community mental health agency.","authors":"Zishan Jiwani, Qiang Xie, John J Curtin, Kevin M Riordan, Robbie Babins-Wagner, Derek Caperton, Mindi N Thompson, Simon B Goldberg","doi":"10.1037/pst0000597","DOIUrl":"10.1037/pst0000597","url":null,"abstract":"<p><p>Employment status, an essential socioeconomic factor, may be an important driver of disparities in mental health and access to treatment. However, prior research has been inconclusive and utilized broad employment categories. The present study investigated the associations between various types of employment status and baseline symptomology, psychotherapy engagement, and psychotherapy outcomes. We examined 27,258 patients (<i>M</i>age = 32.54; 62.9% female; 75.8% White) who attended 115,936 psychotherapy sessions at a Canadian mental health agency between January 2014 and July 2022. Employment status was categorized into nine distinct groups (e.g., full-time, part-time, unemployed and looking for work, unemployed not looking for work, and retirement). Multilevel models examined the association between employment status and baseline symptoms, psychotherapy engagement (e.g., total sessions, early termination), and outcomes (e.g., symptom change). Patients who were unemployed (both looking for and not looking for work) reported higher baseline symptoms and increased odds of suicide concern compared to patients with full-time employment. Contrary to our preregistered hypotheses, patients who were unemployed attended more sessions and showed no significant differences in symptom change or trajectory of change compared to those employed full-time. Retirement was linked to lower baseline symptomology, and both retirement and full-time student status were associated with slower trajectories of change relative to full-time employment. Findings suggest that unemployment is associated with worse baseline mental health but does not hinder psychotherapy engagement and effectiveness. Ensuring accessibility of psychotherapy for unemployed individuals is crucial, given their heightened risk of psychological distress. (PsycInfo Database Record (c) 2025 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"495-508"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776059","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":"Parsing the within- and between-therapist positive regard-outcome association in cognitive-behavioral therapy for generalized anxiety disorder.","authors":"Anuj H P Mehta, Michael J Constantino, Alice E Coyne, Averi N Gaines, Henny A Westra, Martin M Antony","doi":"10.1037/pst0000606","DOIUrl":"10.1037/pst0000606","url":null,"abstract":"<p><p>Positive regard (PR)-rated from multiple perspectives across diverse psychotherapies-correlates positively with patient improvement. Yet, existing research has generally not parsed this total correlation into its within- and between-therapist components, which limits its interpretability. Thus, the present study explored (a) the association between positive regard and outcome at both the within- and between-therapist levels, (b) whether between-therapist differences in positive regard moderated the within-therapist positive regard-outcome association, and (c) whether treatment condition (cognitive-behavioral therapy [CBT] vs. CBT that integrated client-centered principles) moderated either level of the positive regard-outcome association. Adults with generalized anxiety disorder were randomly assigned to CBT alone (<i>n</i> = 49) or CBT integrated with motivational interviewing (MI-CBT; <i>n</i> = 52) to responsively address patient resistance (Westra et al., 2016). Ten therapists treated patients in CBT only, and nine distinct therapists treated patients in MI-CBT only. Patients rated therapist-offered positive regard repeatedly across 15 sessions and their worry and general distress outcomes at baseline and posttreatment. Multilevel structural equation modeling revealed a significant association between patients' experience of higher early treatment positive regard and lower posttreatment worry and general distress at the within-therapist level. There was no between-therapist association for either outcome. Additionally, neither between-therapist positive regard nor treatment condition moderated the within-therapist effect of positive regard on either outcome. Results underscore the value of therapists working to foster their patients' felt regard irrespective of the treatment they use or the general ability they have in cultivating this relational experience. (PsycInfo Database Record (c) 2025 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"474-485"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258886","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":"Black clients' perceptions of therapists' cultural comfort, alliance, and outcome and the discussion of anti-Black racism in psychotherapy.","authors":"Theodore T Bartholomew, Emma Smith, Andrés E Pérez-Rojas, Krista A Robbins, Eileen E Joy, Mukasa Mubirumusoke","doi":"10.1037/pst0000598","DOIUrl":"10.1037/pst0000598","url":null,"abstract":"<p><p>Prior scholarship has helped demonstrate therapists' perceptions of the value of discussing anti-Black racism with Black clients in a manner that espouses cultural comfort or the ability to be at ease when discussing lived experiences related to clients' culture during treatment. Better understanding cultural comfort, an aspect of multicultural orientation, when discussing anti-Black racism with Black clients could help clarify paths by which psychotherapy does not perpetuate harm reflected in the dehumanization of such racism. However, Black clients' perspectives are missing in the literature. As such, we collected data from 153 Black participants with recent therapy experiences. They were asked about discussing anti-Black racism during therapy, satisfaction/helpfulness of these conversations, and items related to initiation and frequency of such discussions. Participants also completed measures of cultural comfort, working alliance, and perceived outcome. Perceived therapist cultural comfort did not significantly vary if anti-Black racism was discussed, and discussing anti-Black racism did not moderate the relationship between cultural comfort and working alliance or cultural comfort and outcome. Satisfaction and helpfulness positively correlated with cultural comfort. Cultural comfort scores also varied by who initiated these conversations and their frequency. We contextualize these findings in a need for greater nuance with respect to examining discussions of racism in psychotherapy and consider our findings with respect to broaching literature. (PsycInfo Database Record (c) 2025 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"529-536"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966487","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":"Therapist personality factors as predictors of between-therapist effectiveness differences.","authors":"Michael J Constantino, Averi N Gaines, Alice E Coyne, Henricus L Van, Anuj H P Mehta, Jaap Peen, Frank J Don, Jack J M Dekker, Ellen Driessen","doi":"10.1037/pst0000591","DOIUrl":"10.1037/pst0000591","url":null,"abstract":"<p><p>Abundant research across various treatments indicates that therapists can differ in their general, caseload-level effectiveness. However, relatively little is known about therapist factors that predict such \"performance\" variability. Moreover, most of the limited existing work on this topic has relied on demographic and professional convenience variables, which have demonstrated low predictive power. Thus, it is possible that therapist effectiveness differences would be better explained by personality characteristics that are inescapably present in a clinician's work. Addressing this question, the present preregistered study preliminarily explored whether more versus less effective therapists possess more adaptive personality traits among the \"big five,\" defense style maturity, and psychological mindedness. Data were derived from a randomized clinical trial comparing the efficacy of 16 sessions of cognitive behavioral therapy and psychodynamic therapy for depression (Driessen et al., 2013). Effective sample participants were 142 adult outpatients treated by 32 therapists nested within the treatment condition. Therapists completed multiple personality measures, and patients' depression and global distress symptoms were assessed (via self-report or observer ratings) at baseline and posttreatment. Despite there being significant between-therapist effectiveness differences (on their average patient's posttreatment outcome), multilevel models revealed no significant associations between personality characteristics and such differences on any outcome. It may be that therapists' overall effectiveness has more to do with their transferable actions <i>in the room</i> versus traits they bring into their work. Alternatively, certain traits may predict between-therapist effects but only in specific treatment, patient, and/or cultural contexts that differ from the ones herein. (PsycInfo Database Record (c) 2025 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"509-517"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761147","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":"Applying a theory of change approach to evaluating evidence for circle of security interventions: A systematic review.","authors":"Erinn Hawkins, Brittnee Byron, Anna Huber, Nicole Perry, Catherine McMahon, Neil W Boris","doi":"10.1037/pst0000592","DOIUrl":"10.1037/pst0000592","url":null,"abstract":"<p><p>Circle of Security (COS) interventions aim to improve parent-child relationships. Preliminary evidence of the effectiveness of COS interventions has been positive, but recent studies suggest mixed results that may be due to a lack of differentiation between different versions of COS interventions. This systematic review used a theory of change/program logic approach to summarize the evidence for COS interventions and to explore the conditions under which each protocol was most effective. A comprehensive systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies administering a verified COS intervention protocol with parents/caregivers of children aged 0-8 years. Studies were coded for study design, protocol type, sample characteristics, treatment fidelity, dose, risk of bias, and type of outcome. Nineteen eligible studies were included; seven were randomized controlled trials. Studies of the higher dose protocols (i.e., COS-Intensive, COS-Intensive-Revised Hybrid, COS-Perinatal Protocol) showed promising results across primary and secondary parent outcomes, longer term relationship and child outcomes, and clinical samples. Results showed mixed evidence for the efficacy of the more scalable COS-Parenting. Reviewing studies according to the theory of change/program logic suggested three sources of variability in COS-Parenting studies compared to the higher dose COS interventions that could impact outcome: treatment dose/strategies, sample type, and treatment fidelity. Differential effectiveness of COS interventions tested in seven randomized controlled trials, two nonrandomized controlled trials, and 10 single-arm trials suggests that different COS variants may be better suited to different target populations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"445-456"},"PeriodicalIF":3.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675568","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}