Psychotherapy Research最新文献

{"title":"The <i>SMD</i> =   .17 verdict-Comparative hypotheses, comparative trials and the real world.","authors":"Christoph Flückiger, Michael Barkham, Juan Martín Goméz Penedo","doi":"10.1080/10503307.2026.2732020","DOIUrl":"https://doi.org/10.1080/10503307.2026.2732020","url":null,"abstract":"<p><p>As in many areas of modern healthcare, major treatment breakthroughs are no longer easily achievable, even though optimism continues to fuel research. The real challenge is distinguishing random or trivial effects from small but meaningful ones. This is the central question of our umbrella review: What are the typical effect sizes generally expected when comparing two psychological therapies, and where might the boundary between random and meaningful effects lie in large studies? Our umbrella review focuses on the margins relevant to newer large-scale trials of over 1000 participants.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-3"},"PeriodicalIF":3.8,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformative pathways: shame and fear of compassion as potential mechanisms of change in psychotherapy.","authors":"Fanny Tufte Johansen, Ingvild Finsrud, Elisabeth Flo-Groeneboom, Ingvild Reppen Kvamme","doi":"10.1080/10503307.2026.2732028","DOIUrl":"https://doi.org/10.1080/10503307.2026.2732028","url":null,"abstract":"<p><strong>Objective: </strong>It has been hypothesized that shame and fear of receiving compassion from others are interrelated processes in psychotherapy. However, little is known about how these factors influence each other in a clinical setting. This study examined the relationships between shame, fear of receiving compassion from others, and symptom distress at a within-patient level throughout psychotherapy.</p><p><strong>Method: </strong>The transdiagnostic sample consisted of 1,134 inpatients at Modum Bad receiving psychological treatment. Weekly self-reports measured symptom distress, fear of receiving compassion, and shame. The Latent Curve Model with Structured Residuals was used to examine the relationships between the variables at a within-patient level throughout therapy.</p><p><strong>Results: </strong>At a within-patient level, reciprocal predictive relationships were found between shame and symptom distress, and between fear of receiving compassion and symptom distress. Shame also predicted fear of receiving compassion, but not vice versa. Sensitivity analyses supported the relationship between shame and symptom distress across treatment units but indicated greater variation in relationships involving fear of receiving compassion.</p><p><strong>Conclusion: </strong>The findings suggest that shame and fear of receiving compassion are dynamically involved in symptom change during psychotherapy. Shame appears particularly central, whereas the role of fear of receiving compassion may vary across treatment contexts.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT03503981.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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 to predict long-term treatment outcomes in psychotherapy for personality disorders.","authors":"Johanna W Van Den Eshof, Romy G Leferink, Henricus L Van, Rosa A Van Grieken, Arnoud Arntz, Henk R Cremers","doi":"10.1080/10503307.2026.2721657","DOIUrl":"https://doi.org/10.1080/10503307.2026.2721657","url":null,"abstract":"<p><p><b>Objective:</b> Evidence for predictors of long-term outcomes in personality disorder (PD) treatment remains limited. Machine learning (ML) shows promise in early prediction of treatment outcome to inform clinical practice. This study evaluates the performance of various ML algorithms and examines variables that predict long-term outcomes.<b>Method:</b> Personality functioning was assessed one-year post-treatment in 524 patients who received specialized outpatient psychotherapy for PD, using baseline predictors (demographic and clinical variables at intake) and post-treatment predictors (treatment and clinical variables at treatment end). Regularized linear regression methods were compared with more complex tree-based approaches using cross-validation. Predictive performance was assessed with Mean Absolute Error (MAE) between true and predicted scores.<b>Results:</b> Baseline-only predictors achieved an MAE of 0.40-0.44 (10-11% on a 0-4 scale range). Post-treatment predictors substantially reduced the MAE to 0.27-0.33 (7-8%). Only in the latter case did complex models perform slightly better. Predictors were anhedonia, self-esteem, and relational functioning.<b>Conclusion:</b> Baseline predictors alone provided limited prognostic value, while updating the model with post-treatment predictors improved performance, lending support for a forecasting approach to long-term outcome. In this tabular clinical dataset, complex models provided marginal improvements at best, making simpler models preferable for their interpretability.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-14"},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapist responsiveness to cultural contexts: A thematic analysis of CBT sessions in community care from a large-scale implementation effort.","authors":"Patty B Kuo, Halleh Hashtpari, Ya-Chi Tseng, Amber Calloway, Ana Decesare, Torrey A Creed","doi":"10.1080/10503307.2026.2732032","DOIUrl":"https://doi.org/10.1080/10503307.2026.2732032","url":null,"abstract":"<p><strong>Objectives: </strong>We examined how community mental health therapists learning CBT as part of a large-scale implementation effort navigated conversations about cultural identities in sessions with behavioral ratings of high and low therapeutic alliance.</p><p><strong>Methods: </strong>Using thematic analysis, we examined transcripts from 30 CBT community mental health sessions reflecting the highest and lowest alliance ratings from a set of 2,081 sessions.</p><p><strong>Results: </strong>Therapists engaged in conversations about cultural identities spanning three themes across high and low alliance sessions: going into cultural opportunities, missing cultural opportunities, and cultural missteps. While some therapists leveraged opportunities to deepen exploration of cultural contexts and centered cultural contexts within CBT interventions, others missed cultural opportunities, and implemented CBT interventions centering individual thoughts and behaviors with limited connection to cultural contexts. Some therapists made assumptions about client cultural contexts, reinforced client biases, or pathologized client cultural contexts.</p><p><strong>Conclusion: </strong>Our results highlight how missed cultural opportunities and cultural missteps in sessions among therapists learning CBT can occur when therapists are demonstrating strong rapport-building skills. Given global implementation efforts to expand CBT access, cultural responsiveness failures may be replicated at scale in underserved communities when training does not center multicultural orientation in exploration of thoughts, feelings, and behaviors.</p><p><strong>Clinical or methodological significance of this article: </strong>: this study provides important qualitative context about how therapists approach conversations surrounding cultural identities within CBT. Our results provide concrete examples of how therapists may deepen dialogue surrounding cultural contexts, or inadvertently invalidate client experiences.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-19"},"PeriodicalIF":3.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who benefits from electronic communications data in psychotherapy? Predictors of outcome and alliance in a pooled randomized trial database.","authors":"Mary Beth Connolly Gibbons, Peter P Zandi, Leslie Miller, Ipsit V Vahia, Robert Gallop, Rachel Y Chiu, Nic Kodkany, Yaz Liow, Paul Crits-Christoph","doi":"10.1080/10503307.2026.2734089","DOIUrl":"https://doi.org/10.1080/10503307.2026.2734089","url":null,"abstract":"<p><strong>Objective: </strong>Three recent pilot randomized clinical trials found no overall advantage of clinician dashboards containing information from patients' electronic communications over treatment-as-usual (TAU). The current pooled post-hoc study examined patient characteristics and electronic-communication measures as exploratory moderators of depressive-symptom outcomes and predictors of therapeutic alliance, with the goal of generating hypotheses for future trials.</p><p><strong>Methods: </strong>Outcome measures were the Patient Health Questionnaire-8 (PHQ-8) and Working Alliance Inventory (WAI). Using pooled data across the three studies (<i>N</i> = 289 with PHQ-8 slopes; <i>N</i> = 301 in the full baseline database), regression analyses tested demographic, functioning, electronic-communication activity, and language variables, controlling for study membership.</p><p><strong>Results: </strong>Gender and Black racial identity showed interactions with treatment in predicting PHQ-8 slopes, although the Black racial identity finding was based on only seven intervention patients and requires caution. Number of electronic-communication platforms also interacted with treatment: high-platform users had relatively poor outcomes in TAU but improved comparably to low-platform users in the intervention. Greater first-person singular pronoun use was associated with stronger therapeutic alliance (partial <i>r</i> = .39).</p><p><strong>Conclusion: </strong>These exploratory findings identify candidate moderators and process markers for a prospective study. Future trials should directly assess patient preference for incorporating electronic communications, standardize and measure clinician dashboard engagement, and replicate candidate moderators before clinical recommendations are made.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT04011540.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT03712267.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT03925038.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-15"},"PeriodicalIF":3.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everyday sexisms in therapy: Microaggressions towards members of sexual minorities, gender minorities, and women within psychotherapeutic dyads.","authors":"Franziska Hausmann, Marei Klose, Ruth Lefin, Juliane Sachschal, Alexander L Gerlach, Timo Slotta","doi":"10.1080/10503307.2026.2730414","DOIUrl":"https://doi.org/10.1080/10503307.2026.2730414","url":null,"abstract":"<p><strong>Objective: </strong>Microaggressions are a common phenomenon affecting minoritized individuals across a wide range of contexts. Their well-known cumulative detrimental effect on mental health raises questions not only in regard to etiological, but also health services research. Initial evidence suggests that microaggressions within psychotherapeutic contexts might harm both process and outcome variables within specific (e.g., racialized) samples. Still, it is unclear whether this is primarily a problem of specific patient groups or rather a generalizable pattern of structural oppression.</p><p><strong>Method: </strong>The present work investigates parallels and differences in the experience and management of therapeutic microaggressions towards women, sexual, and gender minorities via client self-report (<i>N</i> = 707).</p><p><strong>Results: </strong>Across all three samples, a majority of participants reported microaggressions directed at them by their therapists. These experiences were associated with both a weaker working alliance and less perceived improvement from therapy. The effects were attenuated whenever microaggressions were subsequently addressed.</p><p><strong>Conclusion: </strong>Microaggressions should be understood as a structural phenomenon probably affecting most minoritized individuals, even within psychotherapies usually considered to be safer-spaces. To protect patients from their harmful effects, therapists should not only strive to minimize the occurrence of microaggressions, but also establish their collaborative management.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-inferiority margins for trials need to be meaningful: commentary on Flückiger et al. (2026).","authors":"Jan R Boehnke, Beatriz Goulão","doi":"10.1080/10503307.2026.2721641","DOIUrl":"https://doi.org/10.1080/10503307.2026.2721641","url":null,"abstract":"<p><p>Flückiger and colleagues discussed in their recent umbrella meta-analysis the use of non-inferiority margins for randomized controlled trials comparing bona fide psychological treatments. The review raises important points to increase the diversity of trial designs used in psychotherapy research and, together with the invited comments, provides a springboard for future methodological and standards development in the field. In our Commentary we focus on two questions: Firstly, we challenge whether the derived effect size can be used as a non-inferiority margin for the planning of future trials; and secondly, we highlight the importance of the contribution of other sources of information for the determination of target differences, and in particular that of including public and patient voices.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-3"},"PeriodicalIF":3.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment dose and reliable change in trauma-focused therapy for comorbid PTSD and MDD.","authors":"Alexander C Kline, Laura D Crocker, Nicholas P Otis, Juan Diego Vera, Hayley C Myers, Lisa H Glassman, W Michael Hunt, Kristen H Walter","doi":"10.1080/10503307.2026.2724950","DOIUrl":"https://doi.org/10.1080/10503307.2026.2724950","url":null,"abstract":"<p><strong>Objective: </strong>Major depressive disorder (MDD) commonly co-occurs with posttraumatic stress disorder (PTSD) and increases risk for reduced response to evidence-based PTSD treatment, yet little is known regarding the dose-outcome link for this comorbidity.</p><p><strong>Method: </strong>The relationship between attendance and reliable change was examined among 88 service members with comorbid PTSD/MDD receiving cognitive processing therapy (CPT) or CPT with behavioral activation (BA + CPT) in a clinical trial. Survival analyses calculated reliable change likelihood during treatment for PTSD, MDD, and both, and explored between-treatment differences.</p><p><strong>Results: </strong>Among participants reporting reliable change, median attendance equaled the full treatment protocol. Reliable change likelihood was higher when completing treatment versus adequate dose. A log-rank test comparing Kaplan-Meier curves between treatments was statistically significant for reliable change in both disorders (χ²(1) = 4.46, <i>p</i> = .03), but not PTSD (χ²(1) = 3.06, <i>p</i> = .08) or MDD (χ²(1) = 1.86, <i>p</i> = .17) alone. Cox proportional hazards regression indicated reliable change for both disorders was less likely in BA + CPT (hazard rate = 0.52, 95% confidence interval: 0.28, 0.97, <i>p</i> = .04).</p><p><strong>Conclusion: </strong>Results highlight differences in symptom change timing between a standard and integrated treatment and suggest strong adherence (i.e., completing protocol) is critical for this comorbidity.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT02874131..</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-14"},"PeriodicalIF":3.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative evaluation of LLM-generated and clinician-written psychotherapy session summaries.","authors":"Liran Keren, Ayal Klein, Yael Bar-Shachar, Maria Liakata, Dana Atzil-Slonim","doi":"10.1080/10503307.2026.2729093","DOIUrl":"https://doi.org/10.1080/10503307.2026.2729093","url":null,"abstract":"<p><strong>Objective: </strong>Psychotherapy session summaries are crucial to the continuity of care, supervision, and treatment planning; however, they are time-consuming and contribute to the documentation burden. Large language models (LLMs) may help streamline this workflow, but their adequacy must be established. We evaluated whether state-of-the-art LLMs can generate clinically meaningful summaries comparable to those of human clinicians.</p><p><strong>Method: </strong>We compared 1,008 segment-level summaries (504 clinician-written and 504 LLM-generated) drawn from 108 five-minute segments across 36 sessions. The summaries adhered to a structured template capturing core therapeutic components. The LLM summaries were generated using a multi-step prompting pipeline. Blinded-to-source judges evaluated the summaries on factual consistency, salient meaning preservation, and clinical value.</p><p><strong>Results: </strong>Clinicians-written summaries were rated higher overall than LLM-generated summaries across the evaluation dimensions. Component-level analyses revealed exceptions: the LLM was superior in preserving central themes, and no differences were found regarding the clinical value of the therapeutic relationship and intrapersonal functioning. Overall, both sources were rated favorably.</p><p><strong>Conclusion: </strong>LLMs can produce clinically usable session summaries, but they do not fully capture the clinical subtleties or depth reflected in clinician-written summaries. These findings support clinician-supervised human-AI workflows where LLMs generate drafts that are reviewed and verified, rather than replacing clinicians.</p><p><strong>Clinical or methodological significance of this article: </strong>While producing high-quality session summaries is clinically vital, its time-intensive nature creates a substantial documentation burden that emerging generative AI technologies could potentially alleviate. This study introduces a clinically informed, multi-step prompting pipeline and provides the first direct comparison of LLM-generated and clinician-written summaries across core therapeutic components using the transtheoretical MIND framework. The findings demonstrate that while LLMs capture structured session content, they do not yet match clinicians' nuanced understanding, supporting a collaborative \"draft-and-review\" paradigm where AI assists rather than replaces clinical reflection and judgment.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-14"},"PeriodicalIF":3.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated sentiment analysis in psychotherapy: Convergence with human-coded affective behavior and dyadic associations with early therapeutic alliance.","authors":"Yunzhi Zheng, Paul R Peluso","doi":"10.1080/10503307.2026.2724951","DOIUrl":"https://doi.org/10.1080/10503307.2026.2724951","url":null,"abstract":"<p><strong>Objective: </strong>Emotional sentiment expressed during sessions is important in understanding psychotherapy processes and outcomes. Although human coding is typically considered the gold standard for assessing emotions, it is resource-intensive and difficult to scale. Automated sentiment analyses offer promising alternatives, yet little is known about (1) their convergence with human-coded affective behavior at the turn-level rather than session averages, (2) whether the association between automated sentiment and human-coded affect differs by the speaker (therapist vs. client), and (3) automated sentiment indicators' dyadic associations with early therapeutic alliance.</p><p><strong>Method: </strong>Using 108 individual early therapy sessions, trained coders coded affective behavior in sessions to generate turn-level positive, negative, and neutral affect scores. Additionally, to automatically quantify sentiment in transcripts at scale, we used a dictionary-based method (LIWC) and a natural language processing-based model (XLM-T).</p><p><strong>Results: </strong>Automated models showed nearly no convergence with human affect coding at the turn-level but limited convergence at the session level. Associations between automated sentiment and human-coded affect for negativity were stronger in clients' than therapists' turns. Automated sentiment was dyadically associated with therapist- and client-reported early alliance.</p><p><strong>Conclusion: </strong>Automated sentiment may provide a scalable additional source of information for understanding the therapeutic process and therapeutic relationships.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":" ","pages":"1-14"},"PeriodicalIF":3.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}