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Psychotherapy can be an emotionally laden conversation, where both verbal and nonverbal interventions may impact the therapeutic process. Prior research has postulated mixed results regarding how clients emotionally react following a silence after the therapist is finished talking, potentially due to studying a limited range of silences with primarily qualitative and self‐report methodologies. A quantitative exploration may illuminate new findings. Utilising research and automatic data processing from the field of linguistics, we analysed the full range of silence lengths (0.2–24.01 s), and measures of emotional expression—vocally encoded arousal and emotional valence from the works spoken—of 84 audio recordings of Motivational Interviewing sessions. We hypothesised that both the level and the variance of client emotional expression would change as a function of silence length; however, due to the mixed results in the literature, the direction of emotional change was unclear. We conducted a multilevel linear regression to examine how the level of client emotional expression changed across silence length, and an ANOVA to examine the variability of client emotional expression across silence lengths. Results of both analyses indicated that as silence length increased, emotional expression largely remained the same. Broadly, we demonstrated a weak connection between silence length and emotional expression, indicating no persuasive evidence that silence leads to client emotional processing and expression. [ABSTRACT FROM AUTHOR]

Objective: The present study tested the efficacy of an unguided internet‐based Acceptance and Commitment Therapy (iACT) program for depression, and identified the psychological characteristics of participants who benefitted the most from the program. Method: Undergraduate students with mild to severe symptoms of depression were randomized to the iACT group (n = 95) or the waiting‐list group (WLC group; n = 87). Depressive symptoms and positive mental health were assessed at baseline (T0), at the end of the 6‐week program (T1), and at a 3‐month follow‐up (T2). Results: Compared with the WLC group, the iACT group showed significantly more improvement in depressive symptoms (d = 1.27) and positive mental health (d = 0.59), both at T1 and T2. Latent Profile Analysis identified three classes of participants: Sensitive‐to‐Relationship, Low‐Reactive‐Depression, and Endogenous‐Depression group. In general, the treatment was particularly suitable for the Sensitive‐to‐Relationship class. Conclusion: The iACT was effective in treating the depressive symptoms of undergraduates, especially suitable for the clients with high baseline depression, high externality, high resistance, and high sensitivity to relationships. [ABSTRACT FROM AUTHOR]

Objective: Both good therapeutic bond as well as extra-therapeutic social support seem to enhance treatment outcomes. Some features of the therapeutic bond are similar to experiences in extra-therapeutic relationships (e.g., feelings of trust or belongingness). Patients with a lack of social support might benefit particularly from a good therapeutic bond, because a well-formed bond can partly substitute relationship needs. This study replicates former research (main effects of bond and social support) and investigates the hypothesized interaction between both constructs. Method: Data from 1206 adult patients receiving cognitive-behavioral outpatient therapy were analyzed. Patients rated early therapeutic bond, their impairment, as well as their social support. Multilevel regression analyses were applied to test for main effects and interactions between bond and social support predicting therapy outcome post treatment. Results: Consistent with prior research, both therapeutic bond and social support predicted therapy outcome. Among patients with high social support, the impact of the therapeutic bond was minimal, while patients with low social support benefited most from a good therapeutic bond. Conclusions: Results suggest that both the therapeutic bond and social support play a role in therapy outcomes and that good therapeutic bond quality might be especially important if a patient lacks social support. [ABSTRACT FROM AUTHOR]

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between those clients in couple and family therapy who used the Systemic Therapy Inventory of Change (STIC) feedback system (ROM condition) versus those who were offered treatment without the use of STIC ("treatment as usual" or TAU condition). A sample of 328 adults seeking couple and family therapy in Norway was randomly assigned to ROM versus TAU conditions. Outcome measures were The Outcome Questionnaire–45 and The Revised Dyadic Adjustment Scale. The results demonstrated no significant differences in outcomes between the ROM and TAU. Possible explanations of this result related to design and implementation issues are discussed. [ABSTRACT FROM AUTHOR]

We now conduct most psychotherapy electronically, which combined with mental health apps (there are more than 10,000), internet guided therapies, precision mental health, natural language processing of therapy, electronic assisted deliberate practice of therapy skills, text messaging, and many other mental health software solutions, there is no turning back. To examine claims of superiority, my students and I undertook a meta-analytic examination of comparisons of psychotherapies intended to be therapeutic (Wampold et al., [9]). Over the years, as I and others have discussed psychotherapy innovations, we have been met with many who believe that psychotherapy must be delivered for 50 minutes a week, face-to-face in a clinic interview room, for a prolonged period; to improve a therapist learns from discussing cases and receiving supervision from a more experienced therapist. [Extracted from the article]

The fraternal birth order effect (FBOE) describes the phenomenon that homosexual men tend to have a greater number of older brothers than do heterosexual men. The FBOE is a marker for an innate, biological predisposition for androphilia in genotypic males. The FBOE has been studied since the 1930s and is the most consistent biodemographic correlate of sexual orientation in men. This study sought to determine whether the FBOE applies equally to all men who have sex with men (MSM), or disproportionately to MSM whose anal intercourse behavior is predominantly receptive (Bottoms). Participants included 243 North American adult MSM who responded to advertisements posted on a Web site and other electronic media associated with the GALA festival, a quadrennial gathering of gay and lesbian choruses. Each was asked whether his anal intercourse behavior during the preceding year was predominantly receptive, predominantly penetrative, or about equally receptive and penetrative. Those who indicated their behavior was predominantly receptive were coded "Bottoms"; all others were coded "Not-Bottoms." Participants were also surveyed as to their sibship composition. Bottoms had a significantly greater mean number of older brothers than did Not-Bottoms. There was no significant difference with respect to older or younger sisters or younger brothers. Further, the older sibling sex ratio (OSSR) for the Bottom cohort, but not for the Not-Bottom cohort, was significantly higher than the expected OSSR for the general male population (OSSR = No. older brothers/No. older sisters × 100; expected OSSR for general population = 106). Thus, late fraternal birth order was correlated with receptive anal-erotic behavior among MSM. [ABSTRACT FROM AUTHOR]

In this study, we introduce the journal issue devoted to evidence‐based responsiveness and frame it within the work of the third interdivisional APA Task Force on Evidence‐Based Relationships and Responsiveness. We summarize the meta‐analytic results and clinical practices on the adaptations of psychotherapy to multiple transdiagnostic characteristics of the patient, including attachment style, culture (race/ethnicity), gender identity, coping style, therapy preferences, reactance level, religion and spirituality, sexual orientation, and stages of change. We then discuss the clinical and research process of determining what works, and what does not work, for whom. The limitations of the Task Force's work are outlined and frequently asked questions are addressed. The article closes with the Task Force's formal conclusions and 28 recommendations and with some reflections on fitting psychotherapy to the individual client. [ABSTRACT FROM AUTHOR]

Some of the most important decisions that a researcher will make when conducting a meta-analysis are decisions about the search strategies and inclusion/exclusion criteria. Decisions regarding inclusion/exclusion criteria serve to define the scope of a meta-analysis and search strategy decisions can have a large impact on how well the results of a meta-analysis actually represent the existing body of literature. In this article, we provide descriptions and recommendations for performing searches and making inclusion/exclusion decisions. We also provide a review of 65 meta-analyses of psychotherapy versus pharmacotherapy in order to offer frequency data on the use of various search strategies and inclusion/exclusion decisions in the field. [ABSTRACT FROM AUTHOR]

The article presents a commentary to the article ''Fraternal Birth Order, Family Size, and Male Homosexuality.'' The author analyzes the meta-analysis of the fraternal birth order effect (FBOE) on sexual orientation. According to the author, effect is more prevalent among transgender androphilic males than among cisgender androphilic males. Additional topics discussed include the concept of volvivity, volvive behavior as female-typical trait, and statistical correlations between volvivity and androphilia.

Objective:Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia).Method:The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT superiority: (a) effect size, power, and statistical significance, (b) focusing on disorder-specific symptom measures and ignoring other important indicators of psychological functioning, (c) problems inherent in classifying treatments provided in primary studies into classes of treatments, and (d) the inclusion of problematic trials, which biases the results, and the exclusion of trials that fail to find differences among treatments.Results:When these issues are examined, the effects demonstrating the superiority of CBT are small, nonsignificant for the most part, limited to targeted symptoms, or are due to flawed primary studies.Conclusion:Meta-analytic evidence for the superiority of CBT in the three meta-analysis are nonexistent or weak. [ABSTRACT FROM AUTHOR]

Introduction: Patients seeking psychotherapy often spend time on waitlist (WL), the effect of which is largely unknown. WL patients may forego alternative non-psychotherapeutic assistance and thus do more poorly than had they not been placed on a WL. The course of symptoms might also be influenced by use of antidepressant medication (ADM), an issue that remains unexplored in the literature. Objective: In a naturalistic setting, WL symptom change before inpatient psychotherapy (mean weeks of waiting = 22.6) was assessed in a sample (N = 313) of chronically depressed patients. Methods: Using the Beck Depression Inventory-II, patients' symptoms were tracked at assessment, when admitted to treatment (i.e., after WL), at posttreatment and 1-year follow-up. Multilevel growth curve analysis was used to examine waitlist change for the whole sample as well as for ADM users and nonmedicated patients. Results: Symptoms were reduced significantly from assessment to admittance (Cohen's d = 0.47). Symptoms reduced less for ADM users (d = 0.39) than for nonmedicated patients (d = 0.65). Conclusion: The findings indicate that chronically depressed patients experience a decrease in symptoms during WL, quite likely due to treatment expectations. We discuss whether less symptom improvement for ADM users could be attributed to iatrogenic comorbidity and a higher degree of demoralization in this group. [ABSTRACT FROM AUTHOR]

Background It is well-established that core clinician interpersonal behaviours are important when treating depression, but few studies have evaluated whether outcome is determined by clinicians׳ general behaviour rather than by the perception of the individual being treated. Methods In the NIMH TDCRP, 157 patients rated their clinician׳s genuineness, positive regard, empathy and unconditional regard during cognitive behavioural therapy, interpersonal therapy or clinical management with placebo. The association between averaged ratings for each of 27 clinicians and their patients׳ self- and observer-rated depression outcomes was evaluated, adjusting for the deviation of individual patient ratings from the average for their clinician and other potential confounders. Results Clinicians in the clinical management condition were rated on average as less genuine and less empathic than those in the psychotherapy conditions. Clinicians׳ average genuineness, positive regard and empathy were significantly associated with lower depression severity during treatment, but not with recovery from depression, after adjusting for the deviation of the individual patient׳s rating of their clinician from the average for that clinician, treatment condition and baseline depression severity. Clinician unconditional regard was not significantly associated with outcome. Limitations Using averaged ratings of clinician behaviour likely reduced statistical power. Conclusions Clinicians׳ ability to demonstrate genuineness, positive regard and empathy may represent a stable personal characteristic that influences the treatment of depression beyond the individual clinician–patient relationship or an individual patient׳s perception of their clinician. However, clinicians׳ ability to demonstrate these behaviours may be poorer when delivering an intervention without a specific rationale or treatment techniques. [ABSTRACT FROM AUTHOR]

Ubiquitous “sex tips” in popular media evidence an unquenchable public interest in learning how to experience “great sex,” and studies confirm that a great sexual relationship correlates to general relationship satisfaction, which in turn correlates to overall happiness. However, sexologists have paid scant attention to “optimal sexuality” and have focused instead on sexual dysfunction. While studies of optimal sexuality are few, we know enough to conclude that the paths to great sex depicted in popular media are largely dead ends. This article provides a framework for giving professional guidance to seekers of optimal sexuality. [ABSTRACT FROM AUTHOR]

The article discusses the difficulties in developing expertise in psychotherapy and proposes a model of outcome information usage as a means of developing expertise. The topics discussed include the definitions of expertise, barriers to achieving expertise, avoidance of hindsight bias during practice, and systematic use of client feedback for development of expertise.

Ubiquitous “sex tips” in popular media evidence an unquenchable public interest in learning how to experience “great sex,” and studies confirm that a great sexual relationship correlates to general relationship satisfaction, which in turn correlates to overall happiness. While studies of great sex or “optimal sexuality” are few, enough is known to conclude that the paths to great sex depicted in popular media are largely dead ends. This lesson plan will help educators (a) dispel inaccurate information about optimal sexuality disseminated in the popular media and (b) inform students about the components of optimal sexuality. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to examine the relative efficacy of evidence-based treatments (EBTs) versus treatment-as-usual (TAU) in routine care for anxiety and depression in adults. Method: A computerized search of studies that directly compared an EBT with a TAU was conducted. Meta-analytic methods were used to estimate effectiveness of EBTs relative to TAU and to model how various confounding variables impacted the results of this comparative research. Results: A total of 14 studies were included in the final meta-analysis. There was significant heterogeneity in the TAU conditions, which ranged from unknown and/or minimal mental health treatment to psychotherapeutic interventions provided by trained professionals. Although the effect for EBT vs. TAU was significantly greater than zero, the effect for EBT vs. TAUs that were psychotherapeutic interventions was not statistically different from zero. Conclusions: Heterogeneity of TAU conditions in this meta-analysis highlight the importance of clarifying the research questions being asked when investigating and drawing conclusions from EBT–TAU comparisons. Researchers need to clarify if they are comparing an EBT to psychotherapeutic services in routine care or to minimal mental health services. Extant research on EBT versus TAU reveals that there is insufficient evidence to recommend the transportation of EBTs for anxiety and depression to routine care, particularly when the routine care involves psychotherapeutic services. [Copyright &y& Elsevier]

This article introduces the issue of the Journal of Clinical Psychology: In Session devoted to evidence-based means of adapting psychotherapy to the patient's (transdiagnostic) characteristics. Practitioners have long realized that treatment should be tailored to the individuality of the patient and the singularity of his or her context, but only recently has sufficient empirical research emerged to reliably guide practice. This article reviews the work of an interdivisional task force and its dual aims of identifying elements of effective therapy relationships (what works in general) and identifying effective methods of adapting treatment to the individual patient (what works in particular). The task force judged four patient characteristics (reactance/resistance, preferences, culture, religion/spirituality) to be demonstrably effective in adapting psychotherapy and another two (stages of change, coping style) as probably effective. Two more patient facets (expectations, attachment style) were related to psychotherapy outcome but possessed insufficient research as a means of adaptation. This special issue provides research-supported methods of individualizing psychotherapy to the person, in addition to his or her diagnosis. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:127-132, 2011. [ABSTRACT FROM AUTHOR]

Abstract: Many researchers accept that trauma-focused treatments are superior to non-trauma focused treatments for Post-Traumatic Stress Disorder (PTSD). However, Benish, Imel, and Wampold (2008) recently published a meta-analysis of clinical trials directly comparing ‘bona fide’ PTSD treatments that failed to reject the null hypothesis that PTSD treatments are similarly effective. They concluded that the results of previous meta-analysis may have been influenced by several confounds, including the use of control treatments, to make conclusions about the relative efficacy of specific PTSD treatments. Ehlers et al. (2010) claim that the selection procedures of the Benish et al. meta-analysis were biased and cite results from individual studies and previous meta-analyses that suggest trauma-focused psychological treatments are superior to non-trauma focused treatments. We first offer a review and justification of the coding criteria and procedure used in Benish et al. In addition, we discuss the appropriateness of utilizing treatments designed to control for non-specifics or common factors such as ‘supportive therapy’ for determining the relative efficacy of specific PTSD treatments. Finally, we note several additional confounds, such as therapist effects, allegiance, and alteration of legitimate protocols, in PTSD research and describe conceptual problems involved in the classification scheme used to determine the “trauma focus” of interventions, which lead to inappropriate conclusions about what works in the treatment of PTSD. [ABSTRACT FROM AUTHOR]

The article presents the author's view on the relevance of randomized controlled trials (RCTs) in clinical practice. The author explores on the process involved in the application of RCT and its effects on people with psychological disorders. He suggests that RCT is designed to control the individual differences. The author also explores on some clinical trials where randomization approach was treated systematically.

This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depression provided in a natural setting by benchmarking the clinical outcomes in a managed care environment against effect size estimates observed in published clinical trials. Overall results suggest that effect size estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effectiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as compared to the benchmarks. Because the nature of the treatments delivered in the managed care environment were unknown, it was not possible to make conclusions about treatments. However, while replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to treatments delivered in clinical trials appear unjustified. [ABSTRACT FROM AUTHOR]

A meta-analysis was conducted to determine whether differences in efficacy exist among treatment approaches applied to youth. Included were all studies published between 1980 and 2005 involving participants 18 years of age or younger with diagnoses of depression, anxiety, conduct disorder, and attention-deficit/hyperactivity disorder that contained direct comparisons among two or more treatment methods intended to be therapeutic. Effect sizes were found to vary significantly, providing some evidence that differences in efficacy exist among treatments for these disorders in youth. However, the upper bound of the true difference in effects among treatments was small. Furthermore, researcher allegiance was found to be strongly associated with the difference in effect sizes so that when allegiance was controlled there was no evidence of any differences among treatments. [ABSTRACT FROM AUTHOR]

Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331 patients seen by 80 therapists (therapist average caseload was 4.1). Patients rated both the alliance and outcome and all models adjusted for baseline psychological functioning. The results indicated that therapist variability in the alliance predicted outcome, whereas patient variability in the alliance was unrelated to outcome. Reasons why therapist variability as opposed to patient variability predicted outcome are discussed. Clinical implications include therapists monitoring their contribution to the alliance, clinics providing feedback to therapists about their alliances, and therapists receiving training to develop and maintain strong alliances. [ABSTRACT FROM AUTHOR]

Although it is well established that psychotherapy is remarkably effective, the change process in psychotherapy is not well understood. Psychotherapy is compared with medicine and cultural healing practices to argue that critical aspects of psychotherapy involve human processes that are used in religious, spiritual, and cultural healing practices. A model of psychotherapy is presented that stipulates various aspects that involve uniquely human characteristics. Central to this model is patient acquisition of an adaptive explanation of his or her difficulties. Finally, the research evidence for this model is presented. [ABSTRACT FROM AUTHOR]

Increasingly, longitudinal multilevel models are being used to investigate change in psychotherapy. An issue related to these methods concerns how measurement error is modeled; one proposed model anchors patient trajectories on the initial observation, thereby assuming that the initial observation contains no error. Wampold and Bolt (2006) claimed that anchoring overestimates patient variability and consequently underestimates therapist effects. In this study, a simulation study was conducted to test this conjecture, and it was found that anchoring yields estimates of patient variability that are substantially higher than the actual variability and, therefore, therapist effects are underestimated. [ABSTRACT FROM AUTHOR]

In 2005, in an article reviewing the evidence related to the placebo effect that was derived from clinical trials in medicine and psychotherapy, B. E. Wampold, T. Minami, S. C. Tierney, T. W. Baskin, and K. S. Bhati re-analyzed studies contained in A. Hróbjartsson and P. C. Gøtzsche's (2001) meta-analysis of trials that contained placebo and no-treatment conditions. Whereas Hróbjartsson and Gøtzsche (2001) concluded that the placebo effect was weak at best, Wampold et al. (2005) concluded that it was “robust.” Hróbjartsson and Gøtzsche (this issue) challenged Wampold et al.'s (2005) conclusion, claiming essentially that the results of clinical trials containing placebo and no-treatment conditions are not sufficient to claim that the placebo effect exists to any substantial degree. In this article, it is shown that when properly interpreted by considering theory, method, context, and related research, the results of clinical trials support the existence of a placebo effect. In short, the placebo effect appears in those instances where it is expected. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 379–390, 2007. [ABSTRACT FROM AUTHOR]

This study estimates pretreatment-posttreatment effect size benchmarks for the treatment of major depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice. Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity-low specificity measures. These benchmarks were further refined for 3 conditions: treatment completers, intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects of outcome measure reactivity and specificity on the pretreatment-posttreatment effect sizes. The authors provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical settings. [ABSTRACT FROM AUTHOR]

Data for completer and intent-to-treat samples from the two psychotherapy conditions of the National Institute of Mental Health Treatment of Depression Collaborative Research Program were analyzed to estimate the proportion of variability in outcomes resulting from therapists. Therapists, who were nested within treatments, were considered a random factor in multilevel analyses. These analyses, which modeled therapist variability in several different ways, indicated that about 8% of the variance in outcomes was attributable to therapists, whereas 0% was due to the particular treatment delivered. When therapist effects were appropriately modeled, previously detected differences in efficacy between the two psychotherapy conditions for more severely depressed patients disappeared, as predicted by methodological considerations. Daten von vollständigen Stichproben mit einer Behandlungsabsicht, von den beiden Psychotherapiebedingungen des gemeinsamen Forschungsprogramms des Nationalen Instituts für psychische Gesundheit zur Behandlung von Depression, wurden analysiert, um den Anteil der Variabilität im Ergebnis zu schätzen, der auf Therapeuteneinfluss beruht. Die Therapeuten, innerhalb ihrer Behandlungen vernetzt, wurden als Zufallsfaktor in Multiebenen-Analysen betrachtet. Diese Analysen, die Therapeutenvariabilität, auf verschiedene Art modelliert, gab zu erkennen, dass ca. 8 Prozent der Varianz im Therapieergebnis den Therapeuten zuzuschreiben war, während 0% auf die spezifische Behandlung zurückzuführen war. Wenn die Therapeuteneffekte in geeigneter Weise modelliert wurden, verschwanden, wie durch methodische Überlegungen vorhergesagt, die früher gefundenen Effektivitätsunterschiede zwischen den beiden Psychotherapiebedingungen für schwerer depressive Patienten. Les données pour les échantillons de patients avec intention de se soigner et qui ont terminé le traitement et pour les deux conditions du Programme Collaboratif sur la Dépression de l'Institut National de Santé Mentale (NIMH) ont été analysées pour estimer la proportion de variabilité des résultats provenant des thérapeutes. Les thérapeutes, qui étaient emboîtés avec les traitements, ont été considérés comme un facteur aléatoire dans des analyses multi-niveaux. Ces analyses, qui modélisent la variabilité du thérapeute de plusieurs manière différentes, indiquent que 8% environ de la variance des résultats est attribuable aux thérapeutes, alors que 0% est attribuable au traitement particulier délivré. Lorsque les thérapeutes sont modélisés de manière appropriée, les différences détectées précédemment entre les deux conditions thérapeutiques pour les patients les plus sévèrement déprimés disparaissent, comme prédit par des considérations méthodologiques. Se analizó la variabilidad de los resultados debidos al terapeuta en muestras de tratamientos completados y prospectivos ( completer and intent-to-treat samples ) de las dos psicoterapias para el tratamiento de la depresión del Programa de investigación colaborativa del Instituto Nacional de Salud Mental. Se consideró que los terapistas, ubicados en los tratamientos ( nested within treatments ), eran un factor para randomizar en análisis multinivel ( multilevel analyses ). Estos análisis, que configuran la variabilidad del terapeuta en diferentes formas, indicaron que aproximadamente el 8% de la varianza en los resultados es atribuible a los terapeutas, mientras que no hay varianza debida al tratamiento particular administrado. Como se predijo por consideraciones metodológicas, cuando los efectos del terapeuta fueron modelizados apropiadamente, desaparecieron las diferencias en eficacia previamente detectadas entre las dos psicoterapias para pacientes más severamente deprimidos. Foram analisados dados de amostras que completaram o tratamento e que iniciaram tratamento das duas condições psicoterapêuticas do Programa Colaborativo de Investigação do Tratamento da Depressão do Instituto Nacional de Saúde Mental dos EUA para determinar a proporção da variabilidade de resultados terapêuticos resultante dos terapeutas. Os terapeutas, que no desenho forneciam apenas um tipo de tratamento, foram considerados como um factor aleatório nas análises de múltiplos níveis. Estas análises, reflectem a variabilidade dos terapeutas de diversas formas, que modelaram cerca de 8% da variância dos resultados terapêuticos era atribuível aos terapeutas, enquanto que 0% se devia ao tratamento específico prestado. Quando os efeitos dos terapeutas estavam adequadamente adaptados, desapareciam as diferenças modeladas anteriormente na eficácia entre as duas condições psicoterapêuticas para os pacientes mais deprimidos, tal como o prediziam os pressupostos metodológicas. I dati per i campioni più trattati e da trattare con le due condizioni psicoterapeutiche dell'Istituto Nazionale di Trattamento della Salute Mentale del programma di ricerca in equipe sulla depressione sono stati analizzati al fine di valutare la proporzione di variabilità negli esiti che risultano dai terapeuti. I terapeuti che erano inseriti nei trattamenti sono stati considerati un fattore casuale nelle analisi multilivello. Queste analisi, che hanno modellato la variabilità del terapeuta in parecchi modi diversi, hanno indicato che circa l'8% della varianza degli esiti era attribuibile ai terapeuti, mentre lo 0% era dovuto al particolare trattamento somministrato. Quando gli effetti dei terapeuti erano appropriatamente modellati, le differenze nell'efficacia precedentemente rilevate tra le due condizioni psicoterapeutiche per i pazienti più severamente depressi scomparvero, come predetto dalle considerazioni metodologiche. [ABSTRACT FROM AUTHOR]

The article discusses methods to make therapist effects disappear. It states that therapist effects can be made to disappear by the construction of models with inappropriate assumption and the performance of different analytic operations, such as removing outliers. It looks into the various analytic actions used to diminish therapist effects.

To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in' which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists. [ABSTRACT FROM AUTHOR]

The logic of the randomized double-blind placebo control group design is presented, and problems with using the design in psychotherapy are discussed. Placebo effects are estimated by examining clinical trials in medicine and psychotherapy. In medicine, a recent meta-analysis of clinical trials with treatment, placebo, and no treatment arms was conducted (Hróbjartsson & Gøtzsche, 2001), and it was concluded that placebos have small or no effects. A re-analysis of those studies, presented here, shows that when disorders are amenable to placebos and the design is adequate to detect the effects, the placebo effect is robust and approaches the treatment effect. For psychological disorders, particularly depression, it has been shown that pill placebos are nearly as effective as active medications whereas psychotherapies are more effective than psychological placebos. However, it is shown that when properly designed, psychological placebos are as effective as accepted psychotherapies. © 2005 Wiley Periodicals, Inc. J Clin Psychol 61: 835–854, 2005. [ABSTRACT FROM AUTHOR]

Issues related to establishing specificity in psychotherapy are discussed. It is suggested that the null hypothesis that the specific ingredients are responsible for the benefits of psychotherapy should not be rejected unless the evidence is sufficiently inconsistent with the null hypothesis. However, generally or for specific disorders, the uniform efficacy of psychotherapeutic treatments with adults does not provide any evidence that the null hypothesis is false. As well, the relationship of the alliance and outcomes does not provide any evidence against the null and indeed provides evidence for a common-factor model of psychotherapy with adults. Additional evidence that is contrary to a specificity hypothesis is summarized. [ABSTRACT FROM AUTHOR]

Evidence-based practice and empirically supported treatment movements are potent forces that affect the practice of psychology today and have the potential to mandate the types of treatments psychologists conduct. The histories of these movements reveal that certain aspects of therapy valued by psychologists have been ignored. It is shown that the evidence-based movements (a) overemphasize treatments and treatment differences and (b) ignore aspects of psychotherapy that have been shown to be related to outcome, such as variation among psychologists, the relationship, and other common factors. It is important that psychologists understand the development of these movements so that they can be critical consumers of research and can effectively influence the future course of events. [ABSTRACT FROM AUTHOR]

The purpose of this study was (a) to determine whether the relationship between male gender role conflict variables and mental health generalizes to women and (b) to investigate other aspects of social gender roles and mental health. An adaptation of the Gender Role Conflict Scale (J. M. O'Neil, B. J. Helms, R. K. Gable, L. David, & L. S. Wrightsman, 1986) and measures of depression and anxiety were administered to male and female college students. Men showed more restricted emotionality, more restricted affection, greater appropriate and inappropriate success, and more restricted affection, particularly for other men; there were no gender differences related to the conflict between work and family. However, for the most part these variables were related to depression and anxiety in similar ways in men and women. The major predictor of depression and anxiety for men and women was conflict between work and family. [ABSTRACT FROM AUTHOR]

Background: Cognitive therapy (CT) for depression has been found to be efficacious for the treatment of depression. In comparison to other psychotherapies, CT has been shown to be approximately equal to behavior therapies, but sometimes superior to ‘other therapies.’ The latter comparison is problematic given that ‘other therapies’ contain bona fide treatments as well as treatments without therapeutic rationale for depression. Method: A meta-analysis was conducted for studies that compared CT to ‘other therapies’ in an earlier meta-analysis, except that in this meta-analysis ‘other therapies’ were classified as bona fide and non-bona fide. Results: The benefits of CT were found to be approximately equal to the benefits of bona fide non-CT and behavioral treatments, but superior to non-bona fide treatments. Conclusions: The results of this study fail to support the superiority of CT for depression. On the contrary, these results support the conclusion that all bona fide psychological treatments for depression are equally efficacious. [Copyright &y& Elsevier]

Addresses issues raised by K. Chwalisz (2001) and S. Maltzman (2001) regarding H. Ahn and B.E. Wampold's (2001) study on psychotherapy by clarifying various aspects of the medical model and its alternative. Review of the medical model of psychotherapy; Analysis of fallacies that occur when one is rejecting the medical model.

Presents a meta-analysis of psychotherapy component studies to determine the degree to which these studies produce evidence supporting the specificity of psychological treatments. Homogenous effect sizes; Lack of relationship between specific ingredients of psychological treatments and the beneficial outcomes of counseling and psychotherapy.

Investigates the preferences of Social (S) and Investigative (I) people for performing S and I tasks with either S or I people or alone. Consistency with the prediction of the preferences of S types than those of I types; Preference for Social tasks performed alone; Unconfirmed hypothesis that task would be the most important for I people.

Provides information on the special section on Innovative Quantitative Research Models where C.M. Fox, J.A. Jones and others presented statistical methods relating to Rasch modeling, social network analysis and latent variable structural equation modeling for experimental research in counseling psychology. Issues in which the methods addressed; Information on the structural equation modeling.

Examines social skills and social environments produced by people classified according to Holland types, namely realistic, investigative, artistic, social, enterprising and conventional. Emotional expressivity; Emotional sensitivity; Social expressivity; Emotional control; Social sensitivity; Social control.

Examines ethnic minorities' perceptions of and preferences for ethnically similar counselors over European American counselors. Influence of participants' cultural affiliation; Effects of counselors' attitudes, values and skills to preference.

Reexamines the merits of choice and judgment methodologies as presented in the study `Mexican Americans' Initial Preferences for Counselors: The Role of Ethnic Factors,' by Lopez, Lopez, and Fong. Limitations of simple choice methodology; Portrayal of Mexican Americans as basing their preferences on ethnic schemata.

Details a study that investigated sex-typed and androgynous subjects' preferences for male and female counselors of varying levels of effectiveness. How subjects were classified as either sex-typed or androgynous; Use of the Bem Sex-Role Inventory; Study methods and results; More.

Reports on a study which used sequential analysis to examine within-session interactional behavior in four brief-therapy cases. Coding of message units along the dimensions of power and involvement; Working or therapeutic alliances; Power and involvement in theories of social interactions; Method; Results.

Presents the reply to a study on the uniform efficacy of bona fide psychotherapies. Who the study was done by; Whether criticisms of the study were justified; Listing of alternative hypotheses for use in psychotherapy.

Presents a study which was done to test the Dodo bird conjecture, as it relates to psychotherapies. Outcome of clinical trials on the efficacy of psychotherapy; Results of the study.

Investigates the impact of differential use of five cognitive-behavioral strategies in adjustment to bereavement. Administration of assessment measures for variables to 164 widows whose husbands died 5 to 11 months prior; Analysis of measures results; Discussion.

Identifies systematic differences between therapists and patients in the process components that predict evaluation of psychotherapy sessions. Development of the Comprehensive Scale of Psychotherapy Session Constructs; Prediction of therapist session evaluation by therapist expertness; Relation of patient progress in predicting therapist and patient evaluation.