Psychotherapy最新文献

{"title":"Alexithymia and treatment response for prolonged exposure therapy: An evaluation of outcomes and mechanisms.","authors":"Andrea Putica, Nicholas T Van Dam, Kim L Felmingham, Meaghan L O'Donnell","doi":"10.1037/pst0000512","DOIUrl":"10.1037/pst0000512","url":null,"abstract":"<p><p>Alexithymia is the inability to identify and recognize emotions. The present study examined the impact of alexithymia on prolonged exposure (PE) therapy. Participants (<i>n =</i> 68) with PTSD underwent 10 PE sessions. Alexithymia was assessed via the Toronto Alexithymia Scale (TAS-20) and the emotional clarity and awareness subscales of the Difficulties in Emotion Regulation Scale. Treatment outcomes were assessed via the PTSD checklist and Clinician-Administered PTSD Scale for the <i>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</i> at posttreatment and 6-month follow-up. Those with high alexithymia were more likely to endorse experiencing a full PTSD diagnosis immediately posttreatment, <i>χ</i>²(1) = 12.53, <i>p</i> = .002, and at 6-month follow-up, <i>χ</i>²(1) = 11.21, <i>p</i> = .004. Alexithymia was associated with delayed treatment effects on avoidance, with a significant reduction in symptomology observed from pre- to follow-up, <i>t</i>(51) = 4.52, <i>p</i> < .001, and not from pre- to posttreatment. Although both the low and high alexithymia groups showed significant changes in negative changes in thinking and mood, <i>F</i>(2, 14) = 9.18, <i>p</i> = .001, <i>d</i> = 1.57 and <i>F</i>(2, 50) = 13.86, <i>p</i> = .001, <i>d</i> = 1.49, respectively, the high alexithymia group exhibited a marginally lesser magnitude of treatment effect. Although those with significantly greater difficulties with emotional clarity were more likely to drop out of PE treatment, emotional clarity and awareness did not moderate treatment response. Our results confirm the efficacy of PE but also highlight that those with alexithymia show a delayed treatment response and may be at greater risk of pathology after treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"44-54"},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71426309","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":"Bridging the multicultural orientation framework with sexual and gender minority psychotherapy: A mixed studies systematic review.","authors":"Olivia Fischer, Daniel W Cox, Johanna M Mickelson, Kelly Lyons","doi":"10.1037/pst0000518","DOIUrl":"10.1037/pst0000518","url":null,"abstract":"<p><p>Sexual and gender minorities (SGM) experience higher rates of psychological distress and seek psychotherapy at higher rates compared to their heterosexual and cisgender counterparts. However, few therapists are trained on how to provide effective psychotherapy with SGM clients. The multicultural orientation (MCO) framework, which has been linked to improved therapeutic processes and outcomes, may be a valuable tool for working with SGM clients. The primary aim of this systematic review was to link the MCO framework to existing empirical psychotherapy research with SGM clients. A secondary aim was to examine how MCO constructs that we identified within the SGM literature have been associated with therapeutic processes and outcomes with SGM clients. A systematic search of five databases yielded 61 studies that were included in the review. Framework analysis was used to extract data and identify themes and subthemes related to MCO constructs from included studies. Results of the review demonstrate how the MCO framework can be used to conceptualize psychotherapy with SGM clients and-using the MCO framework-highlight potential beneficial and harmful therapist qualities and actions when working with SGM clients. Implications for future research and psychotherapy practice with SGM clients are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"1-30"},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425320","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":"Repairing alliance ruptures in psychodynamic psychotherapy with young people: The development of a rational-empirical model to support youth therapists.","authors":"Antonella Cirasola, Nick Midgley, J Christopher Muran, Catherine F Eubanks, Elaine Budreck Hunter, Peter Fonagy","doi":"10.1037/pst0000514","DOIUrl":"10.1037/pst0000514","url":null,"abstract":"<p><p>Alliance ruptures in youth psychotherapy can have a significant impact on treatment outcomes. However, there is currently limited guidance on how to effectively repair these ruptures with young people. This study aims to address this gap specifically in the context of psychodynamic psychotherapy with adolescents. The objectives of the study are (a) to understand the therapeutic interventions and attitudes that either facilitate or hinder the resolution of alliance ruptures and (b) to develop a model for repairing these ruptures within this particular treatment approach. To accomplish this, a task analysis of a previously developed rational model of resolving alliance ruptures was conducted using 16 sessions from short-term psychodynamic psychotherapy with depressed adolescents. The analysis supported some stages of the hypothesized rational model while revealing the need for revisions. As a result, the study developed a rational-empirical model that includes flexible strategies that therapists can use to repair alliance ruptures. This model emphasizes the significance of a collaborative, open, and empathetic approach to resolving ruptures. In contrast, rigid, defensive, or invalidating therapist attitudes can hinder the resolution process. The evidence-based model developed from the study can provide valuable guidance to psychodynamic psychotherapists working with young people, offering insights on how to approach ruptures and employ effective strategies to promote their resolution. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"68-81"},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92156176","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":"Automating the assessment of multicultural orientation through machine learning and natural language processing.","authors":"Simon B Goldberg, Michael Tanana, Shaakira Haywood Stewart, Camille Y Williams, Christina S Soma, David C Atkins, Zac E Imel, Jesse Owen","doi":"10.1037/pst0000519","DOIUrl":"10.1037/pst0000519","url":null,"abstract":"<p><p>Recent scholarship has highlighted the value of therapists adopting a multicultural orientation (MCO) within psychotherapy. A newly developed performance-based measure of MCO capacities exists (MCO-performance task [MCO-PT]) in which therapists respond to video-based vignettes of clients sharing culturally relevant information in therapy. The MCO-PT provides scores related to the three aspects of MCO: cultural humility (i.e., adoption of a nonsuperior and other-oriented stance toward clients), cultural opportunities (i.e., seizing or making moments in session to ask about clients' cultural identities), and cultural comfort (i.e., therapists' comfort in cultural conversations). Although a promising measure, the MCO-PT relies on labor-intensive human coding. The present study evaluated the ability to automate the scoring of the MCO-PT transcripts using modern machine learning and natural language processing methods. We included a sample of 100 participants (<i>n</i> = 613 MCO-PT responses). Results indicated that machine learning models were able to achieve near-human reliability on the average across all domains (Spearman's ρ = .75, <i>p</i> < .0001) and opportunity (ρ = .81, <i>p</i> < .0001). Performance was less robust for cultural humility (ρ = .46, <i>p</i> < .001) and was poorest for cultural comfort (ρ = .41, <i>p</i> < .001). This suggests that we may be on the cusp of being able to develop machine learning-based training paradigms that could allow therapists opportunities for feedback and deliberate practice of some key therapist behaviors, including aspects of MCO. (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651585","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":"Supplemental Material for Bridging the Multicultural Orientation Framework With Sexual and Gender Minority Psychotherapy: A Mixed Studies Systematic Review","authors":"","doi":"10.1037/pst0000518.supp","DOIUrl":"https://doi.org/10.1037/pst0000518.supp","url":null,"abstract":"","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":"46 2","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139386622","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":"Asian international psychotherapist's experiences of client's microaggression in therapy.","authors":"Kun Wang, Christopher Anders, Yu Chak Sunny Ho, Yunkyoung Loh Garrison, D Martin Kivlighan","doi":"10.1037/pst0000502","DOIUrl":"10.1037/pst0000502","url":null,"abstract":"<p><p>Much of the multicultural counseling literature focuses on how White or U.S.-born therapists can work effectively with clients of color. However, with the increasing number of racial minority and international therapists and trainees, there is a need to expand the multicultural counseling literature to acknowledge and center the experiences of therapists and trainees of color, particularly the experiences of Asian international therapists. Specifically, a greater understanding and guidelines are needed regarding how Asian international therapists handle clients' xenophobia, racism, and microaggressions in therapy. This qualitative study interviewed 11 licensed practicing Asian international psychotherapists within the United States about their experiences of client-initiated microaggressions in therapy. Consensual qualitative research was used to analyze interview data. Results indicated four domains pertaining to Asian international psychotherapists' experiences in therapy: xenophobia, microaggression, impact, and strategy. Participants reported complex negative impacts of xenophobia and microaggressions on their well-being as well as the therapeutic relationship and treatment outcomes. Additionally, participants identified the difficulty and complexity of addressing client-initiated microaggressions in session. Implications for training and practice as well as suggestions for future research are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"442-454"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10050974","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":"Using machine learning algorithms to predict the effects of change processes in psychotherapy: Toward process-level treatment personalization.","authors":"Juan Martín Gómez Penedo, Julian Rubel, Manuel Meglio, Leo Bornhauser, Tobias Krieger, Anna Babl, Roberto Muiños, Andrés Roussos, Jaime Delgadillo, Christoph Flückiger, Thomas Berger, Wolfgang Lutz, Martin Grosse Holtforth","doi":"10.1037/pst0000507","DOIUrl":"10.1037/pst0000507","url":null,"abstract":"<p><p>This study aimed to develop and test algorithms to determine the individual relevance of two psychotherapeutic change processes (i.e., mastery and clarification) for outcome prediction. We measured process and outcome variables in a naturalistic outpatient sample treated with an integrative treatment for a variety of diagnoses (<i>n</i> = 608) during the first 10 sessions. We estimated individual within-patient effects of each therapist-evaluated process of change on patient-evaluated subsequent outcomes on a session-by-session basis. Using patients' baseline characteristics, we trained machine learning algorithms on a randomly selected subsample (<i>n</i> = 407) to predict the effects of patients' process variables on outcome. We subsequently tested the predictive capacity of the best algorithm for each process on a holdout subsample (<i>n</i> = 201). We found significant within-patient effects of therapist perceived mastery and clarification on subsequent outcome. In the holdout subsample, the best-performing algorithms resulted in significant but small-to-medium correlations between the predicted and observed relevance of therapist perceived mastery (<i>r</i> = .18) and clarification (<i>r</i> = .16). Using the algorithms to create criteria for individual recommendations, in the holdout sample, we identified patients for whom mastery (14%) or clarification (18%) were indicated. In the mastery-indicated group, a greater focus on mastery was moderately associated with better outcome (<i>r</i> = .33, <i>d</i> = .70), while in the clarification-indicated group, the focus was not related to outcome (<i>r</i> = -.05, <i>d</i> = .10). Results support the feasibility of performing individual predictions regarding mastery process relevance that can be useful for therapist feedback and treatment recommendations. However, results will need to be replicated with prospective experimental designs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"536-547"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41127262","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":"Are changes in joviality associated with cognitive behavioral treatment outcomes? Examining an emerging treatment target.","authors":"Daniella Spencer-Laitt, Laura J Long, Lauren S Woodard, Brittany A Jaso, Nicole D Cardona, Saige R Fong, Todd J Farchione","doi":"10.1037/pst0000498","DOIUrl":"10.1037/pst0000498","url":null,"abstract":"<p><p>The present study expands on the growing body of research on the effects of cognitive behavioral therapy (CBT) on positive affect. More specifically, we explore how CBT may promote increases in the Joviality subscale of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X), a measure of self-rated affect that captures positive emotions, including joy and excitement, and how change in joviality may be associated with concurrent symptom change. We utilized data from a randomized equivalence trial comparing the efficacy of the unified protocol (UP) for transdiagnostic treatment of emotional disorders, a transdiagnostic CBT, against various well-established single disorder protocols (SDP) and waitlist control. First, we generated affect profiles for patients receiving CBT (either UP or SDP) or waitlist control, based on their baseline and posttreatment positive affect (PA) and negative affect (NA), compared with a clinical reference sample. We found that the affect profile for most patients receiving CBT shifted from high NA/low PA to low NA/high PA. Further, participants receiving CBT were more likely than individuals in the waitlist control to achieve this outcome. We then examined the PANAS-X Joviality subscale, which has been subject to very limited previous research. Change in joviality was associated with improvement in symptoms of both anxiety (<i>B</i> = -0.81, <i>p</i> = .00) and depression (<i>B</i> = -0.94, <i>p</i> = .00). Joviality increased more rapidly in individuals with more severe anxiety but not severe depression. We discuss the possible clinical implications of these preliminary results, including the role of treatment innovations incorporating a focus on increasing positive affect, particularly the emotions associated with joviality, while simultaneously decreasing negative affect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"477-487"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10843828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9991710","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":"I see you as recognizing me; therefore, I trust you: Operationalizing epistemic trust in psychotherapy.","authors":"Shimrit Fisher, Peter Fonagy, Hadas Wiseman, Sigal Zilcha-Mano","doi":"10.1037/pst0000501","DOIUrl":"10.1037/pst0000501","url":null,"abstract":"<p><p>Epistemic trust (ET) is one's ability to trust others and relies on the information they convey as being relevant and generalizable. This concept has received considerable theoretical and clinical attention, suggesting it is a promising factor in effective psychotherapy, possibly consisting of three elements: sharing, we-mode, and learning. However, for it to be used in clinical practice and research, it is imperative to (a) enhance our clinical understanding of how ET may manifest in the context of treatment and (b) understand how the process of change may occur in the course of treatment. The present study aims to identify patients' trait-like ET characteristics upon initiating treatment and explore the possible state-like changes in ET characteristics throughout treatment. Taking a discovery-oriented approach, we examined how therapists can identify a patient's level of ET at the beginning of treatment. We also examined how, within a treatment for individuals with poor pretreatment ET, the therapist and patient work interactively to bring about a positive change in ET. Identifying the process in which the therapist implements techniques in response to the patient's reactions may enable the active mechanism to be isolated and promote the first formulation of the way changes in ET occur in sequence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"560-572"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152530","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":"Dynamic relations between mentalization techniques and therapeutic alliance in psychodynamic child therapy: An evidence-based case study.","authors":"Dilara Güvenç, Sibel Halfon","doi":"10.1037/pst0000505","DOIUrl":"10.1037/pst0000505","url":null,"abstract":"<p><p>Therapeutic alliance and mentalization are common factors inherent to all effective treatments. Mentalization-based interventions have the potential to create a safe relationship, which makes further mentalizing interventions possible. However, to date, no study has examined the bidirectional relationship between these variables in child psychotherapy. In an evidence-based case study design, psychodynamic therapy processes of two Turkish children (age: 9 and 10 years) who presented with social withdrawal problems were compared. All their sessions (34 sessions from Case No. 1 and 31 from Case No. 2) were coded using the Therapy Process Observational Coding System-Alliance Scale and Mentalization-Based Treatment for Children Adherence Scale. Outcome scales pertaining to symptoms, attachment, and mentalization were administered at baseline and at termination. Time-series Granger Causality tests revealed that in the case with clinically significant outcome, mentalization techniques predicted therapeutic alliance in the subsequent sessions, which predicted the use of further mentalization interventions. However, this relationship was not supported in the case with no significant improvement. Selected sessions were clinically analyzed with verbatim session vignettes. Our findings indicate that mentalization techniques in child therapy are closely related to the therapeutic relationship. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p>","PeriodicalId":20910,"journal":{"name":"Psychotherapy","volume":" ","pages":"548-559"},"PeriodicalIF":2.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49681709","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}