Research in Psychotherapy-Psychopathology Process and Outcome最新文献

{"title":"Examining the factor structure of the 40-item Defense Style Questionnaire among adults with depression: an individual participant data meta-analysis.","authors":"Frederik J Wienicke, William J Burk, Erkki Heinonen, Olavi Lindfors, Tommi Härkänen, Paul Knekt, Sampo Sarvasmaa, Luciano Dias de Mattos Souza, Karen Jansen, Ricardo Azevedo da Silva, Érico Nobre Dos Santos, Jack J M Dekker, Jaap Peen, Henricus L Van, John Christopher Perry, William M Van der Veld, Ednei Soares, Jan Spijker, Ellen Driessen","doi":"10.4081/ripppo.2026.887","DOIUrl":"10.4081/ripppo.2026.887","url":null,"abstract":"<p><p>The 40-item Defense Style Questionnaire (DSQ-40) is frequently used to measure defense mechanisms in adults with depression because of its brevity and efficient assessment. However, previous research has yielded inconsistent results concerning its factor structure, with one- (overall defensive functioning), three- (mature, neurotic, immature), and four- (mature, neurotic, immature, image-distorting) factor solutions being reported. Therefore, we examined the DSQ-40's latent structure across different samples. Using multigroup confirmatory factor analysis (CFA), we tested the one-, three-, and four-factor solutions using baseline data from three research projects of psychodynamic psychotherapy for depressed adults (N=667; mean age 33.9; standard deviation [SD]=9.3; 79.0% female). Configural invariance across samples was evaluated, and model fit was compared using multiple fit indices. Across samples, the three- and four-factor models outperformed the one-factor model, with the four-factor model providing the best relative fit; however, it fell short of conventional model fit thresholds. Separate CFAs found the four-factor model showing the best relative fit in two samples, and the three-factor model in one, but all models failed to meet acceptable fit criteria. Several defense mechanisms showed weak standardized loadings, high inter-factor correlations, and cross-loadings. These findings indicate that the DSQ-40 lacks a stable factor structure in adults with depression and raise important questions about the instrument's construct validity, suggesting that its subscale scores cannot be assumed to validly represent the theorized defense categorizations in this population. Further psychometric refinement and evaluation are needed to determine the DSQ-40's suitability for both clinical and research applications.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient experiences in receiving virtual psychotherapy: a qualitative study.","authors":"Giorgio A Tasca, Andie Storozuk, Victoria Klimkowski, Emily O'Connor, Stephanie Baker, Danielle Baldwin, Stephanie A Houle, Camille Garceau, John Sylvestre","doi":"10.4081/ripppo.2026.888","DOIUrl":"10.4081/ripppo.2026.888","url":null,"abstract":"<p><p>Virtually delivered psychotherapy is a widely adopted means of providing mental health interventions. There is little research on patients' perspectives on this mode of delivering therapy, and their perspectives are important given that patient factors predict a large proportion of mental health outcomes. This study explores patients' experiences with online psychotherapy to help inform best practices. Thirty-three patients who were currently receiving synchronous, virtually delivered psychotherapy were interviewed. The interview focused on patient experiences, both positive and negative, and their recommendations for improving virtually delivered therapy. Interviews were audio-recorded and transcribed. We used an inductive approach to thematic analysis in coding the transcripts. Audit trails and reflexive and independent coding ensured the trustworthiness and fidelity of the identified themes. Themes reflecting positive patient experiences included convenience, accessibility, and connection with the therapist. Themes of negative experiences included technology-related challenges, perceived disconnection due to not being physically present with a therapist, concerns about safety, and privacy issues. Patient characteristics and personal circumstances interacted with the online modality to affect their experiences. Patients recommended enhancing privacy and safety, utilizing online tools effectively, and encouraging therapists to be more deliberate in their non-verbal communication. For clinicians and researchers, this study outlines patients' perspectives on the aspects of virtual care that work effectively and those that could benefit from further improvement.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-session emotional experiencing in brief psychotherapy conducted by trainee psychologists: process, alliance, and the role of therapist persuasiveness.","authors":"Andreia Soares, Laura Ladislau, Ana Aleixo, João M Santos, Daniel Sousa","doi":"10.4081/ripppo.2026.891","DOIUrl":"10.4081/ripppo.2026.891","url":null,"abstract":"<p><p>Despite the recognition of emotional experiencing as a key change factor in psychotherapy, gaps remain regarding how clinical training influences this dimension, particularly in brief interventions conducted by trainees, and preliminary process data on this phenomenon in Portuguese clinical training contexts are scarce. This study examined emotional experiencing in brief psychotherapy conducted by trainee psychologists undergoing structured experiential training with deliberate practice, analyzing whether patients show a progressive increase in experiential depth across sessions, whether higher levels of emotional experiencing are associated with stronger therapeutic alliance and greater symptom reduction, and whether therapists' persuasiveness predicts patients' emotional experiencing at different session moments. A quantitative repeated measures design was adopted with 5 trainee psychologists and 15 adult patients in a university clinic. Four sessions per patient were analyzed by three independent researchers using standardized measures: the Outcome Questionnaire-45 (OQ-45), the Working Alliance Inventory - Short Revised (WAI-SR), the Experiencing Scale (EXP), and the Therapist Persuasiveness Rating Scale (TPRS). Mixed linear models were then applied to assess longitudinal changes and relationships among variables. A significant reduction in psychological distress and an increase in therapeutic alliance indices, particularly in the tasks and bond dimensions, were observed. No significant changes were found in the depth of emotional experiencing, nor robust associations of this variable with symptom improvement or alliance, except for a marginal negative relationship between goal consensus and modal emotional experiencing. These findings suggest a stability of emotional experiencing in brief intervention contexts, highlighting the central role of collaborative processes in clinical change.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing relational competence in psychotherapy training: a qualitative study of trainees' perspectives.","authors":"Giovanna Trimoldi, Marco Sambin, Pietro Spataro, Giulia Gagliardini, Irene Messina","doi":"10.4081/ripppo.2026.890","DOIUrl":"10.4081/ripppo.2026.890","url":null,"abstract":"<p><p>Relational competence is a key determinant of psychotherapy outcomes, yet its development during training remains insufficiently understood. The present study adopts a qualitative, trainee-centered approach to examine how psychotherapy trainees conceptualize relational competences, evaluate their strengths and limitations, and identify the experiences most influential in their development. Forty-nine trainees from a four-year psychotherapy training program completed a structured interview, and data were analyzed using inductive qualitative content analysis. Findings revealed four main themes: i) the conceptualization of relational competence as a foundational and multidimensional component of clinical practice; ii) a predominantly external, patient-driven locus of validation for perceived strengths; iii) the context-dependent and relationally situated nature of perceived limitations; and iv) the central role of experiential learning contexts in fostering relational development. Overall, relational competence emerged as a dynamic and developmental construct, shaped by the integration of personal dispositions, experiential learning, and evolving professional identity. These findings highlight the need for training models that more effectively integrate experiential and reflective components while supporting the development of more internalized standards of professional competence.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between overall defensive functioning and the Personality Assessment Inventory borderline and treatment outcome scales.","authors":"Laura A Richardson, John H Porcerelli, Michelle Stein, Brynn DeLorenzo, Christina Massey, Emma Lindquist, Sarah McNamee, Mark Blais","doi":"10.4081/ripppo.2025.883","DOIUrl":"10.4081/ripppo.2025.883","url":null,"abstract":"<p><p>Mature defense mechanisms support patients' engagement in psychotherapy. The Overall Defensive Functioning (ODF) scale of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Defensive Functioning Scale (DFS) is a measure of the maturity of patients' defenses. Immature defenses (e.g., splitting) and poor emotion regulation are hallmarks of borderline personality organization, and both can interfere with positive treatment engagement. We predicted that ODF would significantly and negatively correlate with the Personality Assessment Inventory Borderline (PAI-BOR) scales, PAI Treatment Rejection (PAI-RXR) scale, and the PAI Treatment Process Index (PAI-TPI). To our knowledge, no studies have examined the relationship between ODF scores, as measured by the DFS rating of Thematic Apperception Test (TAT) narratives, and defense levels, PAI-BOR Full Scale (PAI-BOR-FS), PAI-RXR, and PAI-TPI scales. The sample included 73 outpatients from an academic hospital. Patients were administered the PAI and a TAT protocol. Two psychologists independently rated 40 TAT protocols with the observer-rated DFS for reliability. Healthy defenses showed significant negative correlations with PAI-BOR-FS (r=-.27), PAI-BOR Negative Relationships (PAI-BOR-N) (r=-.38), and PAI-RXR (r=.30). The pathological defenses had positive correlations with four of the five PAI-BOR scales and the PAI-TPI. There were significant correlations between ODF and the treatment related scales, PAIRXR (r=.37, p<.01) and PAI-TPI (r=-.32, p<.01). ODF significantly and negatively correlated with the PAI BOR-FS (r=-.36, p<.01) and its subscales, Affective Instability (r=-.35, p<.01) and Negative Relationships (r=-.39, p<.01). High and low ODF groups had significant and meaningful differences on all seven PAI scales. Overall, these findings provide support for the construct validity and clinical utility of the DFS defense levels (healthy, neurotic, and pathological) and the global ODF.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of defense mechanisms on the longitudinal development of interpersonal problems during outpatient therapy.","authors":"Jonas Schmitt, Matthias Volz, Cord Benecke","doi":"10.4081/ripppo.2025.878","DOIUrl":"10.4081/ripppo.2025.878","url":null,"abstract":"<p><p>This longitudinal observational study investigates the relationship between patients' defense mechanisms before outpatient therapy and their interpersonal problems during early treatment, exploring how specific defense mechanisms are associated with interpersonal problems, a clinically relevant factor for therapy planning. Participants (N=286) from a German outpatient sample completed baseline assessments prior to their first therapy session, including self-report measures of defense styles (Defense Style Questionnaire [DSQ]), emotion regulation (Difficulties in Emotion Regulation Scale - Short Form [DERS-SF]), structural integration (Operationalized Psychodynamic Diagnosis - Structure Questionnaire Short Version [OPD-SQS]), and interpersonal problems (Inventory of Interpersonal Problems [IIP-32]). Follow-up assessments were conducted at approximately 6 and 12 months. Linear mixed models were used to examine longitudinal changes in interpersonal problems and their association with baseline defense styles and defense mechanisms, adjusting for age, sex, therapy duration, structural integration, and emotion regulation difficulties. Particularly, the intermediate (neurotic) defense style was associated with higher levels of interpersonal problems across timepoints. However, defense styles did not significantly predict changes in interpersonal problems over time. In contrast, a more nuanced analysis at the level of defense mechanisms revealed that projection, undoing, and reaction formation were associated with greater interpersonal difficulties, while anticipation was associated with fewer difficulties. Projection showed a robust interaction with time, indicating its relevance for predicting individual change trajectories. These findings suggest that individual defense mechanisms provide added predictive value over aggregated defense styles when assessing interpersonal functioning in early outpatient therapy. From a clinical perspective, the differentiated assessment of specific defenses may improve treatment planning in psychodynamic therapy, although further research is warranted.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional burnout in therapists working with LGBTQ+ patients: associations with defenses and reflective functioning.","authors":"Gianluca Cruciani, Jacopo Tracchegiani, Maria Quintigliano, Selene Mezzalira, Cristiano Scandurra, Nicola Carone","doi":"10.4081/ripppo.2025.880","DOIUrl":"10.4081/ripppo.2025.880","url":null,"abstract":"<p><p>This cross-sectional, questionnaire-based study examined the role of psychological (i.e., defenses and reflective functioning) and contextual variables (i.e., LGBTQ+ identity, clinical experience, and LGBTQ+-specific training) in contributing to professional burnout among 51 Italian psychologists and psychotherapists (mean age 40.12, standard deviation [SD]=9.86) working with LGBTQ+ patients. Preliminary correlational analyses showed that mature defenses were negatively associated with emotional exhaustion and depersonalization, and positively with personal accomplishment. Conversely, immature defenses correlated positively with emotional exhaustion and depersonalization, and negatively with personal accomplishment. Neurotic defenses were linked specifically to reduced personal accomplishment. Lower certainty about mental states - an indicator of diminished reflective functioning - was also associated with higher burnout. In line with the study's main hypothesis, regression analyses revealed that lower overall defensive functioning (ODF), reduced certainty about mental states, and fewer years of clinical experience significantly predicted higher burnout levels. These findings underscore the importance of both intrapsychic resources and professional development in protecting therapists from burnout. Adaptive defenses and strong reflective functioning appear particularly protective in LGBTQ+ clinical contexts, where therapists often encounter emotionally complex, identity-related challenges. Therapists who can mentalize effectively and regulate internal responses through mature defenses may be better equipped to sustain therapeutic engagement and mitigate emotional exhaustion. These results suggest that clinical training and supervision should prioritize the enhancement of reflective capacity and adaptive defenses. Supporting these intrapsychic skills may be key to promoting therapist well-being and ensuring affirming, competent care for LGBTQ+ patients.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical applications of the Defense Mechanisms Rating Scale-Self-Report-30: a systematic review of the first five years.","authors":"Gabriella Martino, Orlando Silvestro, Emanuele M Merlo, Carmelo M Vicario, Alessandro Meduri, Gianluca Lo Coco","doi":"10.4081/ripppo.2025.881","DOIUrl":"10.4081/ripppo.2025.881","url":null,"abstract":"<p><p>Defense mechanisms are automatic psychological processes that regulate emotional conflicts and modulate adaptation to internal and external stressors. As implicit components of emotion regulation, they play a transdiagnostic role across psychological and physical domains of health. Among the available instruments, the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30) directly operationalizes the hierarchical model of defenses, widely considered the gold standard framework for their empirical assessment. This systematic review aimed to synthesize findings from all studies that had employed the DMRS-SR-30 to date, summarizing its psychometric properties, domains of application, and clinical implications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across PubMed, Scopus, and Web of Science databases. Eligible studies were full-text peer-reviewed articles written in English employing the DMRS-SR-30. Risk of bias was assessed according to study design using an established quality appraisal tool. Twenty-six studies met the inclusion criteria. The main domains of application were medical conditions, mental health and psychopathology, personality, and stress-related adjustment. Across these research areas, mature defenses were consistently associated with adaptive functioning and resilience, whereas immature and neurotic defenses predicted higher psychological distress, maladjustment, and psychopathology. The findings from the validation studies demonstrated that the scale exhibited robust reliability, construct validity, and clinical sensitivity. The DMRS-SR-30 provides a valid, efficient, and clinically meaningful method to assess the full hierarchy of defense mechanisms through a self-report tool. Its overall defensive functioning (ODF) index may offer an integrative measure of adaptive capacity that can complement standard psychodiagnostic and medical evaluations. Incorporating the assessment of defensive functioning can enhance the holistic understanding of patients, improve compliance with treatment, and promote person-centered care within mind-body health contexts.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change and sustained recovery in defense mechanisms and depression in a pilot study of antidepressant medications plus up to 18 months of psychotherapy for recurrent major depression.","authors":"John Christopher Perry, Claire J Starrs, Trent Semeniuk, Elisabeth Banon, Ruta Westreich","doi":"10.4081/ripppo.2025.885","DOIUrl":"10.4081/ripppo.2025.885","url":null,"abstract":"<p><p>Treatment studies of major depression commonly focus on symptoms rather than changes in psychological risk factors. This pilot study examines the relationship between changes in eight defenses specifically related to depression, called depressive defenses, and depressive symptoms. Thirty adults with acute, recurrent major depression were given antidepressant medications (ADM) and randomized to up to 18 months of either cognitive behavioral therapy (CBT), dynamic, or supportive psychotherapy and followed for 4.5 years. Defenses were assessed using the observer-rated Defense Mechanism Rating Scales (DMRS) at intake and 18 months. The Hamilton Rating Scale for Depression-17 item version (HRSD-17) and the Beck Depression Inventory-2nd version (BDI-II) assessed depression periodically. Depressive symptoms decreased significantly on both the HRSD-17 (effect size [ES]=-1.03) and BDI (ES=-1.90). Overall defensive functioning (ODF) increased significantly (ES=.85), improving in 76% of participants. Similarly, the mean proportion of depressive defenses decreased significantly by termination (ES=-.62), although the overall mean remained above that generally seen in healthy adults. Twenty-four percent of participants attained this threshold at termination. After controlling for initial levels, at termination depressive defenses correlated significantly with HRSD-17 (rs=.44, p=.02), and BDI (rs=.33, p=.095). Although causal relationships were not established, depressive defenses were consistently related to changes in depressive symptoms, suggesting that they are promising mediators of treatment effects for major depression. Clinically, defenses are readily identifiable and can serve as important foci in treatment. Finally, levels of depressive defenses that exceed healthy norms may reflect a continuing level of risk for current or future depressive symptoms or episodes.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It takes two to tango: a qualitative meta-synthesis on processes of psychotherapy dropout from the Single Case Archive.","authors":"Liza Notaerts, Melissa De Smet, Martin Finn, Kimberly Van Nieuwenhove, Vicky Hennissen, Reitske Meganck","doi":"10.4081/ripppo.2025.876","DOIUrl":"10.4081/ripppo.2025.876","url":null,"abstract":"<p><p>Premature termination of psychotherapy is a challenging reality for both research and practice. This study aimed to contribute to a more comprehensive understanding of psychotherapy dropout by aggregating and synthesizing findings across dropout cases. A qualitative meta-synthesis was conducted on case studies from the Single Case Archive (SCA), a representative sample of published, peer-reviewed single-case psychotherapy studies. This meta-synthesis aggregated and synthesized the 11 case studies in the SCA published in English that described dropout substantively. The meta-synthesis identified 7 themes that influenced dropout: misattunement, inert therapeutic relationships, unmanaged therapist responses, unmanaged therapist interventions, rigid protocol adherence, readiness for change, and repeating interpersonal dynamics. These themes were arranged into the interrelated patient, therapist, and interactional clusters. The findings of the meta-synthesis were comprehensively represented by the metaphor of tango dancing, in which both partners co-create the dynamic that produces a (un)successful dance. One additional theme not fitting this structure includes instances in which dropout was a positive act on the part of the patient. The meta-synthesis revealed the complex and multifarious nature of psychotherapy dropout, a phenomenon that requires a sufficiently multifaceted conceptual framework for adequate comprehension. It was found that patients, therapists, and their dynamic interaction must be incorporated to account for the complex processes underlying psychotherapy dropout.</p>","PeriodicalId":44262,"journal":{"name":"Research in Psychotherapy-Psychopathology Process and Outcome","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}