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Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as 'moderate', and 40 were rated as 'weak' in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes., (© 2024 John Wiley & Sons Ltd.)

Pathogenic beliefs are maladaptive cognitive schema that may obstruct a person's ability to achieve meaningful goals in their life. This study sought to revise a previously existing measure of pathogenic beliefs (the Pathogenic Beliefs Scale) by improving the quality of items and separating the ratings of the presence of a pathogenic belief from the distress associated with it. In Study 1 ( n  = 272), we used item-response theory to identify 21 items from an initial pool of 44 items. In Study 2 ( n  = 422), we tested the items from Study 1 using confirmatory factor analysis. Study 3 used the combined samples from Study 1 and Study 2 (total n  = 528) to compare the revised measure to the Experiences in Close Relationships and the Measure of Parental Style. Results indicate that the revised 21-item PBS has good reliability and convergent validity with related measures, consistent with previous studies of the longer version of the PBS. The 21-item revised PBS is included as supplemental material, and freely available to clinicians and researchers.

Objective: The COVID-19 outbreak has led to an increase in posttraumatic stress symptoms (PTSSs; Prout et al., 2020) for some individuals, whereas others appeared to be more resilient. It remains relatively unclear what characterizes these potentially different response trajectories ( Chen & Bonanno, 2020). This study sought to (a) assess individuals' PTSS levels at the start of the pandemic and at two subsequent timepoints 3 and 6 months later, (b) identify different trajectories of PTSSs over time, and (c) describe which individual characteristics influenced the likelihood of each of these different trajectories to occur., Method: A community sample ( n = 317) responded to an online survey during the first weeks of the pandemic, 3 and 6 months later., Results: Among those who reported acute levels of PTSSs, latent class growth analyses identified three different resilience trajectories-resilient (low baseline PTSSs and a slight decrease over time), chronic (severe PTSSs at baseline and no change over time), and recovered (severe PTSSs at baseline but a sharp improvement over time). Baseline childhood adversity, depression, anxiety, defensive functioning, and somatization predicted trajectories. Demographics (age, gender, preexisting chronic illness) and COVID-related factors (knowing someone diagnosed with or who died of COVID-19) were unrelated to trajectories., Conclusions: Results suggest that although high PTSS levels decreased over time on average, heterogenous change trajectories can be identified based on baseline psychological characteristics. This implies that mental health, including past and present experiences, as well as adaptational mechanisms may shape individuals' experiences with pandemic-related ongoing stress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Research into defensive functioning in psychotherapy has thus far focused on patients' defense use. However, also the defensive functioning of therapists might be significant because of its potential in promoting changes in the patient's overall defensive functioning by sharing their higher-level understanding of a given situation and letting the patient have the opportunity to learn how to cope more successfully. This exploratory case study is the first to examine therapist's defense mechanisms and their relationship to changes in the patient's defensive functioning evaluated at different times throughout psychoanalytic treatment. We assessed the use of defense mechanisms with the Defense Mechanisms Rating Scales in 20 sessions collected at three phases (early, middle and late) of the psychoanalytic treatment. For each session, we identified therapist's and patient's defenses, defense levels and overall defensive functioning, with particular attention to the sequence of consecutively activated defenses within the therapeutic dyad. Results showed that the patient's defensive functioning tended to gradually improve over the course of the treatment, with a slight decrease at the end. Therapists' overall defensive functioning remained stable throughout the treatment with values in the range of high-neurotic and mature defenses. Assessment of the dyadic interaction between therapist and patient's use of defenses showed that within-session, the patient tended to use the same individual defenses that the therapist used, which was especially pronounced in the initial phases of the treatment. Towards the end of the treatment, once there was a stable shared knowledge, the patient started to explore using new, higher-level defenses on her own, independent from what defenses the therapist used. Our findings emphasized the analyst's role in encouraging the development of more effective ways of coping in the patient, confirming previous theoretical and empirical research regarding the improvement of patient's defensive functioning in psychotherapy. The alterations in these coping strategies, also called high-adaptive defenses, as part of the therapist-patient interaction demonstrate the importance of studying defenses as an excellent process-based outcome measure. The measurement of the degree to which the analyst models and illustrates these superior coping methods to the patient is a prime vehicle for supporting internalization of these skills by the patient.

Objectives: Real relationship (RR) refers to a genuine human relationship between client and therapist, that has been found to be positively related to treatment outcome, and to predict unique variance in outcome over and above the working alliance. However, thus far, the measurement of RR has been limited to self-report. We aimed to develop an observer-rated version of the RR measure (RR-O) to assess RR in therapy sessions., Methods: We adapted items from the self-report measures to an observer rated measure, which was reviewed by RR experts. The final 24-item RR-O was rated in 540 session transcripts from 27 psychoanalytic treatments that already had existing process and outcome scores., Results: The RR-O showed good internal consistency and good interrater reliability. In hierarchical EFA, items clustered into a general RR factor, and client realism, client genuineness, therapist genuineness, and therapist realism group factors. In addition, the RR-O was positively related to another RR measure and to the therapeutic alliance., Conclusion: The RR-O shows initial reliability and validity as an observer-rated measure of the RR to be used in post-hoc psychotherapy research. Future research should clarify the relation between RR-O and treatment outcome.

Objective: This qualitative study explores patients' experiences of psychotherapy, focusing on elements perceived as helpful or unhelpful and suggestions for improvement in the context of public mental health care., Methods: A total of 148 adults (Mean age = 32.24, SD = 9.92) who had been or are currently receiving psychological treatment from the National Health Service (NHS) responded to an online survey. The survey included open-ended questions regarding their experiences of psychotherapy, asking them to identify helpful or unhelpful aspects, and suggestions for improvement. Using thematic analysis, key themes were identified., Results: The analysis highlighted the patient's preference for personalized treatment, the importance of therapeutic alliance, the demand for depth in therapy, and life skills and agency as therapeutic outcomes. Participants suggested improvements such as more tailored approaches and stronger therapist-patient relationships, supporting an adaptable, patient-centered model., Conclusion: The study highlights challenges in public mental health services where patients might feel their specific needs are not being recognized and met and underscores the importance of personalized treatment plans that satisfy and evolve with patient needs, suggesting that therapists must be attentive and responsive to individual desires to enhance the patient experience.

Objective: The strength of the therapeutic alliance is widely understood to impact treatment outcomes, however, the alliance-outcome relationship in teletherapy has remained relatively unexamined. The aim of this meta-analysis is to systematically summarize the relationship between therapeutic alliance and treatment outcomes in teletherapy with adult patients conducted via videoconferencing or telephone., Methods: We conducted a systematic search of the databases PsycINFO, PsycARTICLES, ProQuest Dissertation Databases, EMBASE, The Cochrane Library, MEDLINE, Google Scholar, and PubMed for studies published before June 26, 2023. We identified 31 studies with 34 independent samples (4862 participants)., Results: The average weighted effect size was 0.15, p = .001, 95% CI [0.07, 0.24], k = 34. reflecting a small effect of therapeutic alliance on mental health outcomes. There was significant heterogeneity in the effect sizes, which was driven by between-study differences in the alliance-outcome correlation. The alliance-outcome effect was larger when the alliance was measured late in treatment and when the outcome was measured from the patient's perspective., Conclusion: Very few teletherapy treatment studies were identified that initially reported on alliance-outcome associations, underlining that this is an under-researched area. The association between alliance-teletherapy outcomes in this meta-analysis was small but significant, and somewhat weaker than the alliance-outcome associations reported for in-person treatments and other online interventions. This might indicate that there are other processes at play in teletherapy that explain variance of treatment outcomes, or that the therapist (and the relationship) has less influence on the treatment outcomes than in in-person therapy., Competing Interests: Declaration of competing interest none. All authors declare that they have no conflict of interest. No funding was received for this project. KAVD initiated the project, conceptualized the review, led the systematic search and quality analysis, reached out to authors, and led the writing process. DS lead the preregistration, systematic search, and data-analysis, as well as write up of the results. SH co‑lead the systematic search steps and write-up of methods and results. VB contributed to the conceptualization, quality analysis, and write-up of the review., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Although teletherapy is increasingly common, very little is known about its impact on therapeutic relationships. We aimed to examine differences between therapists' experiences of teletherapy and in-person therapy post-pandemic with regard to three variables pertinent to the therapeutic relationship: working alliance, real relationship, and therapeutic presence., Methods: In a sample of 826 practicing therapists, we examined these relationship variables, as well as potential moderators of these perceived differences including professional and patient characteristics and covid-related variables., Results: Therapists reported feeling significantly less present in teletherapy and their perceptions of the real relationship were somewhat impacted, but there were no average effects on their perceived quality of the working alliance. Perceived differences in the real relationship did not persist with clinical experience controlled. The relative reduction in therapeutic presence in teletherapy was driven by the ratings of process-oriented therapists and therapists conducting mostly individual therapy. Evidence for moderation by covid-related issues was also found, with larger perceived differences in the working alliance reported by therapists who used teletherapy because it was mandated and/or not by choice., Conclusion: Our findings might have important implications for generating awareness around the therapists' lowered sense of presence in teletherapy compared to in-person teletherapy.

Objective: In an attempt to operationalize an implicit aspect of the therapeutic relationship, this study assesses reciprocal linguistic style entrainment (rLSM) between the patient and therapist. rLSM is defined as the dynamic adjustment of function word usage to synchronize or to be in rhythm with another person as they change over time., Method: In this exploratory study, levels of rLSM per talk turn were analyzed for 540 sessions of 27 long-term psychoanalytic treatments in relation to treatment outcomes., Results: Within sessions, rLSM appeared to decrease by the end of sessions and followed a negative linear trajectory, β linear  = -0.0002, SE  < .001, t  = -13.04, p  < .001. Between sessions, rLSM showed significant variability such that neither a linear, nor a quadratic, nor a cubic trend line fit the session-by-session change over treatment. On average, therapist talk turns had significantly lower rLSM than patient talk turns, while accounting for the nested nature of the data using multilevel models β SpeakerT  = -0.033, SE  = 0.009, t  = -3.65, p  < .001. Levels of rLSM did not relate to treatment outcome., Conclusion: Most of the rLSM variance was at the within-patient and within-session level. rLSM was no indicator of psychoanalytic treatment outcomes.

Objective: The Real Relationship (RR) describes the aspect of the psychotherapy relationship that is based on a genuine connection and a realistic view between patient and therapist. In the current study, we aimed to develop a Psychotherapy Process Q-set (PQS) prototype of the RR to facilitate post-hoc assessment of the RR in psychotherapy session recordings. We also aimed to measure the association between the RR-PQS and current PQS measures of theoretical treatment principles and the working alliance., Method: We developed an RR-PQS prototype based on ratings of an ideal RR session by eight RR experts. We assessed the associations between the RR-PQS and existing cognitive behavioral and psychodynamic process prototypes, and seven PQS items known to predict the working alliance., Results: RR experts agreed on the ideal RR session ratings to a high degree (ICC = 0.89). The RR-PQS was moderately related to both cognitive behavioral ( r  = 0.66, p  < 0.01), and psychodynamic prototypes ( r  = 0.56, p  < 0.01). PQS items predictive of the working alliance were characteristic of the RR-PQS., Conclusion: The RR-PQS prototype appears to behave in theoretically predicted ways and may be a valid measure of the RR.

Competing Interests: Declaration of competing interest Michael Barkham has co-produced outcome measures used in routine outcome monitoring and also jointly published a text on routine outcome monitoring but receives no financial payment for these activities. Christopher G. Beevers has received funding for his research from the National Institutes of Health, Brain and Behavior Foundation, Aiberry Inc., and other private, not-for-profit foundations. He has received income from the Association for Psychological Science for his editorial work and from Orexo, Inc. for serving on a Scientific Advisory Board related to digital therapeutics. Dr. Beevers' financial disclosures have been reviewed and approved by the University of Texas at Austin in accordance with its conflict-of-interest policies. Tim Dalgleish has received payment for consultancy work with Princeton Biopartners, Boehringer Ingelheim and Felix Inc. He delivers paid workshops on psychological therapies. He receives royalties for books on affect and psychological disorders. Nicholas C. Jacobson declares the following conflicts of interest. He has edited a book that includes discussion of this topic from which he receives royalties. Additionally, he has accepted paid speaking invitations from various organizations. Dr. Jacobson confirms that these interests do not influence the research, interpretation, or conclusions presented in this manuscript. Daniel R. Karlin is an employee, officer, and shareholder of MindMed; shareholder and director at Sonara Health; trustee at Trudeau Institute; shareholder and consultant to NightWare; consultant to Otsuka, Tempus, Limitless Ventures, Recovery Delivered, and 4YouandMe. Cheri A. Levinson has a financial interest in BeWell and Awaken Digital Solutions. Lorenzo Lorenzo-Luaces has received consulting fees from Syra Health who had no involvement in the current research. Stephen M. Schueller serves on the Scientific Advisory Board for Headspace for which he receives compensation and has received consulting payments from Boehringer Ingelheim, K Health (Trusst), and Otsuka Pharmaceuticals for unrelated work. Greg J. Siegle receives royalty payments on a patent regarding a vibroacoustic intervention for psychiatric conditions, licensed to Apollo Neurosciences. Wolfgang Lutz and Eva-Lotta Brakemeier initiated and chair the Interest Group "Evidence-Based Personalized Psychotherapy Research (ePePsy)" of the German Psychological Association.

When therapists provide teletherapy they can choose between teletherapy via phone and teletherapy via videoconferencing, however, little is known about differences between using these two teletherapy formats. We aimed to compare therapists' attitudes, level of professional self-doubt, and experience of the therapeutic relationship in sessions conducted via phone versus via videoconferencing. We administered an online survey to 117 therapists who had experience with sessions both via phone and videoconferencing. The results suggested that therapists' attitudes and perceptions of the therapeutic relationship were similar. However, therapists' level of professional self-doubt was higher in sessions conducted via videoconferencing. Therapists with previous experience of conducting teletherapy via phone perceived phone sessions more positively. Thus, familiarity with videoconferencing technology might be more important in shaping therapists' attitudes and confidence than the type of technology per se. This highlights the importance of practicing with new technologies.

Background: In contrast to the vast clinical, theoretical, and empirical literature on the impact of trauma, relatively few studies have reviewed the trauma measures that researchers and clinicians can choose to use in their work. This scoping review aimed to catalog all trauma measures (trauma exposure and its subjective responses) that have been published in the peer-reviewed literature, developed for use with adult populations., Method: Through a systematic search of the literature and the screening of 19,631 abstracts, a total of 363 unique trauma measures were identified., Result: Most of these measures were developed for assessment purposes rather than for clinical screening or diagnostic purposes. Most of these measures are patient-self-report measures that assess trauma exposure in the patients' lifetime, or subsequent symptoms, particularly cognitive impairments., Discussion: Complications in the trauma literature are highlighted, including the use of very similar abbreviations of measures, substantial discrepancies regarding the definition of trauma, and the general assumption that a potentially traumatic event inevitably leads to traumatic distress rather than a path of resilience., (© 2023 Wiley Periodicals LLC.)

The usefulness of therapists' self-disclosure (TSD) in psychotherapy remains controversial, and little is known regarding the potential risks and benefits of TSD in times of global crisis such as the COVID-19 pandemic and in teletherapy. We examined two independent samples of therapists (N = 1705; Study 1) and patients (N = 772; Study 2) on their perceptions of increases in TSD during the transition to teletherapy early in the COVID-19 pandemic (spring 2020). Approximately 20% of therapists and 14% of patients reported perceptions of definite increases in TSD. Therapists' top reasons for increased TSD were therapists' heightened distress and an effort to connect with patients in teletherapy. Importantly, therapist perceptions of their increased TSD were positively related to subjective vicarious trauma, real relationship, psychodynamic theoretical orientation and negatively with humanistic orientation, but not with age, race/ethnicity, length of clinical experience, working alliance, or professional self-doubt. Patients' perceptions of increased TSD were positively related with patient pandemic-related traumatic distress and their own self-disclosure, but not with patient-reported therapeutic relationship variables. Longitudinally, patients' perceptions of TSD increases predicted higher pandemic-related traumatic distress at 3-month follow-up, after controlling for their baseline traumatic distress and other variables. These results highlighted that increased TSD in teletherapy may be a potential marker for heightened distress in both patients and therapists during a global crisis and a transition to teletherapy. The findings also contrasted the literature and emphasized that therapists, but perhaps not patients, may have considered increased TSD as a reflection of genuine therapeutic connection., (© 2023 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Introduction: Providing teletherapy requires a unique therapeutic approach and mastery of the teletherapy context. We aimed to develop a self-report scale for therapeutic interventions pertinent to teletherapy, and to examine its relationship with teletherapy process variables, and therapists' attitudes towards teletherapy technology., Method: A total of 839 therapists participated in a survey study that included standardized measures of therapeutic process (real relationship, working alliance, therapeutic presence), attitudes towards and intention to use teletherapy in the future, and a list of 13 teletherapy intervention items that we hypothesized to be specific to the teletherapy format., Results: Twelve of the 13 teletherapy intervention items loaded on one factor, with good reliability. The 12-item Teletherapy Intervention Scale was positively related to working alliance, the real relationship, therapeutic presence in teletherapy sessions, as well as to positive attitudes towards teletherapy and intention to use teletherapy in the future., Discussion: Aspects specific to the practice of teletherapy may be successfully captured by a self-report scale, and adequately navigating the challenges and opportunities of teletherapy might enhance the therapeutic process. Further studies are needed to provide additional validation of the scale, and in how to best use this Teletherapy Intervention Scale in research and clinical training., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Békés, Aafjes-van Doorn, Luo, Balarajan and Hopwood.)

Objective: In the wake of the COVID-19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process., Methods: Thirty-one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method., Results: Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in-person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process., Conclusion: Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process-level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities., (© 2022 Wiley Periodicals LLC.)

Interpersonal guilt often encompasses pathogenic beliefs that imply omnipotent responsibility for others and concerns about abandoning, humiliating or threatening others. This study sought to examine how interpersonal guilt may influence patients' and therapists' ratings of early working alliance and the potential moderating effect of perceived adverse parenting in childhood. Ninety-five patients and their 19 therapists in an outpatient psychotherapy clinic rated their early working alliance after the first and the fifth session in treatment. We conducted separate moderation analyses for patient and therapist-reported working alliance and controlled for psychological distress at baseline. Results suggest that perceived adverse parenting in childhood significantly moderated the effect of interpersonal guilt on the working alliance in such a way that for patients reporting very low levels of perceived adverse experiences, the interpersonal guilt beliefs had a positive effect on working alliance, whereas for those with very high levels of perceived adverse experiences, interpersonal guilt had a negative effect on working alliance. This same pattern of moderation was found for patient- and therapist-reported working alliance at session 1 and therapist-reported working alliance at session 5. Thus, although the effect of interpersonal guilt on the working alliance depends somewhat on the perspective of the working alliance rating (patient or therapist), it mainly depends on developmental experiences of the patient., (© 2022 John Wiley & Sons Ltd.)

This exploratory study assesses the use and quality of therapeutic immediacy in short-term psychodynamic psychotherapy for depression. We aimed to identify what constitutes effective here-and-now discussions of the therapeutic relationship by examining a sample of four treatment cases drawn from a previous randomized clinical trial for depression. Transcripts of 16 treatment sessions (four time points per treatment) were analyzed using the consensual qualitative research for case study method. The therapists' contributions to therapeutic immediacy were assessed qualitatively by independent judges and then quantitatively analyzed in relation to immediate session outcome as well as overall treatment outcome (reduction in depressive symptoms). A total of 41 immediacy events were identified across 16 sessions, of which 35 were therapist-initiated and subsequently organized into 18 discrete categories. High-quality immediacy events (as assessed by the judges) were associated with higher patient involvement. Two immediacy categories were significantly different between good and poor outcome cases. Therapists "acknowledged their patient's progress in therapy" more often in good outcome cases, whereas they "assessed patients' feelings about the overall progress of therapy" more often in poor outcome cases. No significant relationship was found between frequency, rated quality of immediacy events, and treatment outcome. Four immediacy events rated by the judges as high- and low-quality are presented as clinical examples illustrating positive and negative therapists' contributions to therapeutic immediacy. Therapist behaviors that may improve the effectiveness of therapeutic immediacy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This study examined patients' personality traits as operationalized by the five-factor model in relation to early alliance and reduction of interpersonal distress through an intensive group treatment program for personality dysfunction. A sample of 79 consecutively admitted psychiatric outpatients with personality dysfunction who attended an 18-week intensive group treatment program completed the NEO Five-Factor Inventory at pretreatment, the Inventory of Interpersonal Problems at pre- and posttreatment, and the Edmonton Therapeutic Alliance Scale, a measure of the therapeutic alliance with the program therapist, at Session 5. Results indicated that patients who were relatively extraverted tended to rate the alliance with their program therapist higher and subsequently reported more improvement of interpersonal distress. The presence of a personality disorder did not moderate this mediation. Patients' extraversion likely promotes a bonding with the therapist and facilitates the interpersonal group work necessary for improvement. Assessing patients' level of extraversion before starting intensive group treatment might indicate which intervention strategies could be useful with that patient within the program frame.

Routine outcome monitoring (ROM) involves measuring an outcome variable (e.g., symptoms and alliance) at a regular interval over time (e.g., before each session), using a standardized patient self-report measure. Several computerized ROM system exists that also provide the therapist with benchmarks for these measures based on expected treatment responses (ETRs) for a patient, and clinical support tools (CSTs) to help the therapists in making clinician decisions in the treatment. When implementing ROM into clinical practice, a therapist needs to decide what patient-self report measure to use as well as what ROM system might be most clinically helpful and cost-effective. Although the use of ROM has shown to be effective, especially in reducing dropout and reducing deterioration of patients, the implementation of ROM can be challenging. The use of ROM always requires the active involvement of the therapist, but the implementation in treatment may look different for each patient. It is thus helpful to see case illustration of exactly how ROM might be useful or not so useful in clinical practice., (© 2022 Wiley Periodicals LLC.)

Routine outcome monitoring (ROM) involves the use of patient-reported standardized outcome measures to monitor progress throughout the course of treatment, followed by feedback of the patient's scores to the therapist. The potential benefits of ROM have been established, however, from our own experiences, we know that the implementation in clinical practice can be challenging. We therefore wanted to explore in more detail exactly how we might be able to apply ROM in difficult clinical contexts. The inspiring case illustrations in this issue of Journal of Clinical Psychology: In Session highlight the heterogeneity in ROM systems, and the way in which ROM can be used in treatment. Just as there are many ways of interpreting a survey data-point, there are also many ways in which ROM may be used to complement the treatment and supervision. Whether or not ROM is implemented may partly be determined by clinic policies and routines, but there remain a multitude of clinical decisions that require careful consideration by the individual therapist. To complement the evidence supporting the benefits of using ROM, further empirical support and clinical guidance is needed on how exactly therapists are to use ROM in their work and how ROM may be used in evidence-based practice. We make suggestions for additional uses of ROM for deliberate practice, and teletherapy practice, and look toward novel ways of assessing progress in the near future., (© 2022 Wiley Periodicals LLC.)

The most frequently examined aspect of the therapeutic relationship is the working alliance, which reflects the conscious collaborative bond, and agreement on task and goal. In addition to the established importance of the working alliance, the therapists' attunement and responsiveness might reflect another important aspect of the therapeutic relationship that can be considered in relation to session-by-session progress over treatments. Emerging research suggests that the quality of the working alliance not only differs between patients but also within patients over time. However, little is known about the quality of the therapeutic relationship between and within patients in relation to progress in psychotherapy. We examined fluctuations of the working alliance measure (WAI) and the newly developed measure of the Patients' Experiences of Attunement and Responsiveness (PEAR) during treatment in a naturalistic sample of patients in an outpatient psychotherapy clinic. Multilevel modelling was used to examine the respective contribution of these measures to subsequent improvement in psychological functioning longitudinally. Results suggest that the within-patient effect, instead of between-patient effect, was significant for WAI (and did not reach significance for PEAR), indicating that the fluctuation of WAI was predictive of psychological functioning in the subsequent month. Based on these findings, therapists and their patients might benefit from regular tracking of the patient-reported working alliance. The findings underscore the importance of the alliance, specifically at the within-patient level. It also highlights the challenge for research to tap into other aspects of the therapeutic relationship that can help explain progress in therapy. Given the breadth and accessibility of the working alliance construct, more work is needed for researchers to examine the construct of attunement and responsiveness., (© 2022 John Wiley & Sons, Ltd.)

During the Covid-19 pandemic, psychotherapists quickly transitioned to provide online therapy, while facing many challenges. This study aimed to explore psychodynamic and psychoanalytically oriented therapists' ( N = 1450) experiences with online therapy during the first weeks of the pandemic and two months later. Results showed that therapists had little pre-pandemic experience with providing online therapy and even less training in it, and that younger therapists reported more challenges in the transition to online therapy. During the first weeks of the pandemic, most therapists thought that online therapy was less effective than in-person therapy, and they reported a wide range of relational and technical challenges, feeling more tired, less confident and competent, and less connected and authentic in online sessions, compared to previous in-person sessions. At follow-up, therapists viewed online therapy as more comparable to in-person therapy; the majority felt connected and authentic as they had during the initial weeks of the pandemic, or more so, but were still as tired as before. The most challenging aspect of online therapy was distraction in sessions, which increased over time. This study demonstrates the professional adaptability of therapists and highlights the need for more training and professional support for clinicians providing remote psychotherapy.

This commentary on six articles comprising this Journal of Clinical Psychology: In Session issue on the therapeutic process in group psychotherapy brings together relevant clinical challenges and opportunities concerning the unique processes of change in group treatments. As illustrated by these six inspiring group therapy cases, therapy groups may vary widely in content and context. To balance the rich clinical illustrations of successful group treatments and the different theoretical formulations offered in these case studies, we highlight the processes that these treatments appear to have in common. Specifically, we describe the clinical considerations about the group format and the group members. We also reflect on the relational dynamics as they play out within the complex interplay between group leaders and group members; the facilitation of the corrective emotional experience as a change mechanism in group therapy, as well as the relational challenges and opportunities inherent in group treatments more generally. It is hoped that in this issue, clinicians will not only be inspired by the clinical description of successful change processes in group treatments but will also be reminded of the therapeutic nuances and opportunities of this multilayered treatment format., (© 2022 Wiley Periodicals LLC.)

Objective: We aimed to develop a self-report measure of therapist acceptance of telepsychotherapy based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework., Methods: Using a cross-sectional survey design, 1265 therapists completed the UTAUT-T, as well as additional questions., Results: Confirmatory analysis indicated that the original UTAUT model did not fit the therapist context well. Exploratory factor analysis specified a better-fitting five-factor model, which showed good internal validity fit (χ 2  = 17,753.36, RMSEA = 0.063, TLI = 0.886, SRMSR = 0.04). The five UTAUT-T subscales showed high internal consistency (Cronbach's α = 0.86) and together predicted the intention to use online therapy in the future (R 2  = 0.42, F(5, 1259) = 181.9, p < 0.001)., Conclusion: The 21-item UTAUT-T offers a promising self-report measure of therapist acceptance of telepsychotherapy and intention towards using it in the future. Future studies on the convergent and predictive validity of the UTAUT-T are warranted., (© 2021 Wiley Periodicals LLC.)

Objective: This study aimed to examine therapists' unfolding response to the challenges of vicarious traumatization and transitioning to online therapy in the wake of the pandemic. This is the first study to empirically examine therapists' experience of resilience and posttraumatic growth during COVID-19., Method: This longitudinal study reports on the self-reported resilience and posttraumatic growth of 185 psychotherapists (mostly White, female and North American) across 4 time points during the COVID-19 pandemic. Therapist-reported working alliance, vicarious traumatization, and acceptance of online therapy at baseline were examined as potential predictors of professional self-doubt at baseline as well as potential predictors of subsequent resilience (e.g., reduction of professional self-doubt) and posttraumatic growth., Results: Therapists experienced moderate levels of professional self-doubt, more than outside pandemic times, and this self-doubt decreased over time, thus showing a resilient trajectory. Professional self-doubt at baseline was predicted by higher vicarious trauma and weaker working alliance, less clinical experience, and less acceptance of online therapy technology. Higher levels of resilience over time were predicted by less acceptance of online therapy. Moreover, therapists reported relatively low levels of posttraumatic growth, and this remained consistent during the subsequent 12 weeks. Posttraumatic growth was predicted by high levels of vicarious trauma, and acceptance of online therapy technology., Conclusions: Therapists in our study reported resilience during the initial months of COVID-19. Those who were relatively more traumatized and more comfortable in their online work during the pandemic experienced more posttraumatic growth. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: This study aimed to develop predictive models of three aspects of psychotherapists' acceptance of telepsychotherapy (TPT) during the COVID-19 pandemic, attitudes towards TPT technology, concerns about using TPT technology and intention to use TPT technology in the future., Method: Therapists (n = 795) responded to a survey about their TPT experiences during the pandemic, including quality of the therapeutic relationship, professional self-doubt, vicarious trauma and TPT acceptance. Regression decision tree machine learning analyses were used to build prediction models for each of three aspects of TPT acceptance in a training subset of the data and subsequently tested in the remaining subset of the total sample., Results: Attitudes towards TPT were most positive for therapists who reported a neutral or strong online working alliance with their patients, especially if they experienced little professional self-doubt and were younger than 40 years old. Therapists who were most concerned about TPT were those who reported higher levels of professional self-doubt, particularly if they also reported vicarious trauma experiences. Therapists who reported low working alliance with their patients were least likely to use TPT in the future. Performance metrics for the decision trees indicated that these three models held up well in an out-of-sample dataset., Conclusions: Therapists' professional self-doubt and the quality of their working alliance with their online patients appear to be the most pertinent factors associated with therapists' acceptance of TPT technology during COVID-19 and should be addressed in future training and research., (© 2021 John Wiley & Sons, Ltd.)

Abstract: This study examined the mediating role of pathogenic beliefs on the relationship between patients' recollections of experienced adverse parenting in childhood and adult interpersonal and social problems. A total of 210 psychotherapy outpatients rated their experiences of perceived adverse parenting in childhood and completed measures of psychological distress, interpersonal problems and social impairment, and internalized beliefs about self and others. Significant mediation effects were observed for two of the three belief domains: "cannot rely on others" and "undeserving." Although both were significant mediators between adverse parenting and symptom distress, only "cannot rely on others" was a significant mediator predicting interpersonal problems, and only "undeserving" was a significant mediator predicting impaired social functioning. Thus, patients' underlying convictions regarding their self-worth seem to play a role in the ability to develop social roles, whereas the beliefs about the steadfastness of others play an important role in the capacity for interpersonal relating., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The early months of the COVID-19 pandemic have been a challenging time for many psychotherapy patients. To understand why certain patients were more resilient, we examined the role of patients' attachment anxiety and attachment avoidance, as well as collaborative therapy experiences (perceived working alliance and therapeutic agency) in their online sessions on their COVID-related traumatic distress over a three-month period. A total of 466 patients in online psychotherapy completed a survey during the first weeks of the pandemic, and 121 of those completed a follow-up survey three months later. Lower distress at follow-up was predicted by patients' lower attachment anxiety and higher therapeutic agency in their online sessions after controlling for baseline distress and time of survey completion. Higher working alliance predicted less distress at follow-up only for patients with high attachment anxiety. For patients with low attachment avoidance (i.e., more securely attached), higher therapeutic agency predicted less distress. These findings suggest that patients' attachment anxiety and therapeutic agency may play significant roles also in online therapy during COVID-19 in patient's experienced traumatic distress, and that working alliance and therapeutic agency may be differentially important for patients with different levels of attachment anxiety and avoidance.

Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients' defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients' attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients' attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Békés, Aafjes-van Doorn, Spina, Talia, Starrs and Perry.)

This is the first study to examine psychotherapists' levels of defense mechanisms, their concurrent relationship with professional work-related stress (professional self-doubt and vicarious trauma), and how their levels of defense mechanisms predict the changes in these professional stresses over the course of 3 months since the start of the COVID-19 pandemic. Data from two online studies (Study 1; N = 105 and Study 2; N = 336), using two self-report measures of therapists' defense mechanisms (Defense Style Questionnaire-40 in Study 1 and Defense Mechanism Rating Scales Self-Report-30 in Study 2), are presented. Therapists reported higher levels of mature defense mechanisms, and lower levels of immature defense mechanisms, compared to published community and clinical populations assessed before and during the pandemic. Therapists' lower level of mature defense mechanisms and higher levels of neurotic and immature defense mechanisms were related to higher concurrent levels of vicarious trauma and professional doubt. Therapists who reported higher levels of mature defense mechanisms at 3-month follow-up showed less vicarious trauma and professional self-doubt at follow-up, after controlling for these professional stressors at baseline. Implications for clinical supervision and training are discussed. The context and professional challenges during the pandemic are unique and future replications of the results outside the pandemic context are warranted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Aafjes-Van Doorn, Békés, Luo, Prout and Hoffman.)

Therapists' forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists' views and challenges with online therapy. This study aimed to investigate the main challenges experienced by therapists during the transition from in-person to online therapy at the beginning of the pandemic and 3 months later, and the association between these challenges and therapists' perception of the quality of the relationship with their online patients, and therapists' attitudes and views about online therapy and its efficacy at these two timepoints. As part of a large-scale international longitudinal survey, we collected data from 1,257 therapists at two timepoints: at the start of COVID-19, when many therapists switched from providing in-person therapy to online therapy, as well as 3 months later, when they had had the opportunity to adjust to the online therapy format. At both timepoints, therapists reported on perceived challenges, quality of working alliance and real relationship, attitudes toward online therapy, and their views on online therapy's efficacy compared to in-person therapy. Factor analysis of individual survey items at both timepoints identified four different types of challenges among this therapist sample: Emotional connection (feeling connected with patients, reading emotions, express or feel empathy), Distraction during sessions (therapist or patient), Patients' privacy (private space, confidentiality), and Therapists' boundaries (professional space, boundary setting). Older and more experienced therapists perceived fewer challenges in their online sessions. At baseline, all four types of challenges were associated with lower perceived quality of the therapeutic relationship (working alliance and real relationship), and more negative attitudes toward online therapy and its efficacy. After 3 months, perceived challenges with three domains - Emotional connection, Patients' privacy, and Therapists' boundaries significantly decreased - whereas challenges in the fourth domain - Distraction - increased. In our study, therapists' concerns about being able to connect with patients online appeared to be the most impactful, in that it predicted negative attitudes toward online therapy and its perceived efficacy 3 months later, above and beyond the effect of therapists' age and clinical experience. Clinical and training implications are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Békés, Aafjes-van Doorn, Luo, Prout and Hoffman.)

Abstract: The way people derive inferences from actual adverse experiences plays an important role in the development of psychopathology. This study aims to examine the mediating role of pathogenic beliefs (i.e., emotion-laden, powerful, painful convictions about self and others) on the relation between perceived adverse parenting behaviors in childhood and subsequent adult psychopathology. Participants (mostly Caucasian and heterosexual) were 204 consecutively admitted patients with a range of psychological difficulties, including depression, anxiety, and interpersonal problems, at a low-fee outpatient clinic. Participants completed standard self-report assessments of perceived parental style, depressive and anxiety symptoms, and a clinically derived measure of pathogenic beliefs. We examined the indirect effects of adverse parenting on anxiety and depressive symptom severity through pathogenic beliefs. Pathogenic beliefs reflecting the unreliability of others significantly mediated the relationship between adverse parenting and anxiety symptoms. The other mediation model is consistent with the theory that perceived adverse parenting contributes to the severity of depressive symptoms through beliefs about not being deserving and other people being unreliable. Within the limitations of the cross-sectional, retrospective, and self-report nature of the data, our results seem to suggest that attending to intermediary subjective beliefs might be important in understanding psychopathology development in the context of childhood adversity. Aiming to modify the beliefs in therapy might modify the symptoms. However, this would remain to be demonstrated through formal intervention research., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Collateral work with parents is a widely adopted practice within child psychotherapy. Therapeutic process within these parent sessions has not been empirically studied or defined, despite a sizable process-outcome literature in both child and adult individual therapy. This link between research and practice is particularly important among manualized, child-focused treatments, where the proposed therapeutic action and clinical approach to parent work is defined according to distinct theoretical principles. To address this gap in the child treatment literature, the present study used the Psychotherapy Process Q Set to examine the in-session processes of parent sessions from 16 treatments of regulation-focused psychotherapy for children (RFP-C). RFP-C is a manualized, psychodynamic treatment for children with disruptive behaviors that consists of 16 child sessions and four collateral parent sessions. The parent-session process ratings were compared to existing adult therapy prototypes and the RFP-C child session prototype. Results indicated that observer-coded psychotherapy process in RFP-C parent sessions was most similar to a cognitive-behavioral therapy prototype and moderately correlated with both a supportive-expressive psychodynamic psychotherapy and a reflective functioning prototype. Observer-coded parent session process was distinct from the RFP-C child prototype. Limitations and directions for future research and clinical practice are discussed. The findings of this study indicate the need to intentionally examine process in parent sessions, both within RFP-C and across modalities, as these sessions have their own unique mechanisms of therapeutic action that ultimately may be additive with regard to child outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The way that people internalize adverse experiences plays an important role in the development of psychopathology. The Pathogenic Belief Scale (PBS) is intended to operationalize a transtheoretical understanding of repetitive patterns of emotion-laden beliefs that develop in childhood and continue to influence people's current experience. Using a cross-sectional survey design, we recruited a large heterogeneous sample of 246 clinic outpatients and 732 adults in the community. Besides the PBS, measures of adverse parenting experiences and common psychopathology were administered. An exploratory factor analysis of the total sample of 978 participants was conducted followed by a convergent validity analysis for the 246 clinic outpatients. The three-factor solution included "cannot rely on others," "undeserving," and "interpersonal guilt," and it showed good psychometric properties, including convergent validity with the measures of adverse parenting experiences and psychopathology. The 34-item PBS offers a promising self-report measure that could help delineate and understand the pathogenic beliefs that heterogeneous samples of patients may hold. Pathogenic beliefs may be relevant to the psychotherapy process, regardless of model or theoretical context.

Machine learning (ML) offers robust statistical and probabilistic techniques that can help to make sense of large amounts of data. This scoping review paper aims to broadly explore the nature of research activity using ML in the context of psychological talk therapies, highlighting the scope of current methods and considerations for clinical practice and directions for future research. Using a systematic search methodology, fifty-one studies were identified. A narrative synthesis indicates two types of studies, those who developed and tested an ML model ( k =44), and those who reported on the feasibility of a particular treatment tool that uses an ML algorithm ( k =7). Most model development studies used supervised learning techniques to classify or predict labeled treatment process or outcome data, whereas others used unsupervised techniques to identify clusters in the unlabeled patient or treatment data. Overall, the current applications of ML in psychotherapy research demonstrated a range of possible benefits for indications of treatment process, adherence, therapist skills and treatment response prediction, as well as ways to accelerate research through automated behavioral or linguistic process coding. Given the novelty and potential of this research field, these proof-of-concept studies are encouraging, however, do not necessarily translate to improved clinical practice (yet).

Background: Rates of aggression in inpatient secure care are higher than in other psychiatric inpatient settings. People with intellectual disabilities in secure care require adapted psychological treatments. Interpersonal art psychotherapy incorporates the use of creative art making approaches by participants, thus reducing sole reliance upon verbal interactions during psychotherapy for people who may have communication difficulties. During interpersonal art psychotherapy, participants are individually supported by their therapist to consider how they conduct relationships. This includes the influence and impact of interpersonal issues resulting in repeated patterns of conflict. The key feasibility objectives were to assess recruitment and retention rates, follow-up rates and trial procedures such as randomisation, allocation and identifying any practical or ethical problems. In addition, a preliminary 'signal' for the intervention was considered and an indicative sample size calculation completed. The acceptability of a potential third trial arm attentional control condition, mindful colouring-in, was assessed using four single-case design studies and a UK trial capacity survey was conducted., Methods: Adult patients with intellectual disabilities in secure care were recruited and randomised to either interpersonal art psychotherapy or delayed treatment in this multi-site study. Outcomes were assessed using weekly observations via the Modified Overt Aggression Scale and a range of self-report measures. Within study reporting processes, qualitative interviews and a survey were completed to inform trial feasibility., Results: Recruitment procedures were successful. The target of recruiting 20 participants to the trial from multiple sites was achieved within 8 months of the study opening. All participants recruited to the treatment arm completed interpersonal art psychotherapy. Between-group differences of interpersonal art psychotherapy versus the delayed treatment control showed a 'signal' effect-size of .65 for total scores and .93 in the verbal aggression sub-scale. There were no amendments to the published protocol. The assessment of key feasibility objectives were met and the trial procedures were acceptable to all involved in the research., Conclusion: This study suggested that a randomised controlled trial of interpersonal art psychotherapy is acceptable and feasible., Trial Registration: ISRCTN14326119 (Retrospectively Registered).

Scientific understanding about the psychological impact of the COVID-19 global pandemic is in its nascent stage. Prior research suggests that demographic factors, such as gender and age, are associated with greater distress during a global health crisis. Less is known about how emotion regulation impacts levels of distress during a pandemic. The present study aimed to identify predictors of psychological distress during the COVID-19 pandemic. Participants ( N = 2,787) provided demographics, history of adverse childhood experiences, current coping strategies (use of implicit and explicit emotion regulation), and current psychological distress. The overall prevalence of clinical levels of anxiety, depression, and post-traumatic stress was higher than the prevalence outside a pandemic and was higher than rates reported among healthcare workers and survivors of severe acute respiratory syndrome. Younger participants (<45 years), women, and non-binary individuals reported higher prevalence of symptoms across all measures of distress. A random forest machine learning algorithm was used to identify the strongest predictors of distress. Regression trees were developed to identify individuals at greater risk for anxiety, depression, and post-traumatic stress. Somatization and less reliance on adaptive defense mechanisms were associated with greater distress. These findings highlight the importance of assessing individuals' physical experiences of psychological distress and emotion regulation strategies to help mental health providers tailor assessments and treatment during a global health crisis., (Copyright © 2020 Prout, Zilcha-Mano, Aafjes-van Doorn, Békés, Christman-Cohen, Whistler, Kui and Di Giuseppe.)

Improvement in life satisfaction is hard to achieve for any patient with personality psychopathology, and possibly even moreso for those who feel hopeless at the start of treatment. The present research investigated the potential influence of hopelessness in the treatment of patients with personality dysfunction, using data from patients who completed an intensive group therapy program designed to reduce symptom distress and support optimal psychosocial functioning (N = 80). In the present study, we sought to examine whether hopelessness would moderate (i.e., strengthen or weaken) relations between compatibility ratings and life satisfaction outcome. Hopelessness had a significant moderating effect on the relationship between compatibility and outcome, suggesting that, for patients who entered treatment feeling more hopeless, higher appraisals of fit within the group facilitated better gains in life satisfaction. If replicated, the findings underlie the importance of focusing on increasing hope and perceived group affiliation in the treatment of personality dysfunction.

This is the first review to rigorously examine the mediating role of cognitive factors in the relationship between childhood trauma and subsequent adult psychopathology, and highlight areas for future research. A database search (Child Development & Adolescent Studies, ERIC, Global Health, PsycARTICLES, and PsycINFO) was conducted to identify empirical studies on cognitive factors, explaining the relationship between different types of adverse childhood experiences and adult psychopathology across clinical and nonclinical populations. A narrative synthesis and appraisal of the methodological quality of the studies was conducted. Ninety-eight mediation studies were identified, comprising 4,137 clinical and 28,228 nonclinical participants. Despite great variation in methodological quality of the studies, our narrative synthesis suggests that cognitive factors mediate the relationship between early trauma and later psychopathology. This finding is consistent across different measures of traumatic experiences, psychopathology, and cognitive mediators. Cognitive mediators represent potentially valuable intervention targets for (non)clinical patients who have experienced childhood adversity. Future studies are needed to (a) establish longitudinal causal connections, and (b) assess the effect of interventions that specifically target cognitive change in patients with different levels and types of pathology.

During the COVID-19, psychotherapists are often exposed to traumatic material in their sessions, potentially leading to vicarious traumatization. We surveyed 339 therapists about their professional practices and experiences during the pandemic. Results showed that on average therapists experienced moderate levels of vicarious trauma, whereas about 15% experienced high levels of vicarious trauma. A higher level of vicarious trauma was associated with younger age, less clinical experience, and negative online treatment experiences. The results imply a need for personal and professional support for therapists working remotely amid a global health crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: This paper reports on a focus-group discussion of four expert psychotherapy researchers facilitated at an international conference from the Society of Psychotherapy Research. A discussion was facilitated to explore their perspectives on psychotherapy practices of personal growth (intentionally working towards a strengthened sense of autonomy, mastery, and self-acceptance) in different countries (United States, Canada, Argentina, and Chile) and different modalities (psychoanalysis, humanistic therapy, and cognitive behavioral therapy)., Methods: Following the conference, the audio recording of this discussion was transcribed and analyzed using consensual qualitative research methods., Results: Six domains were identified; definition of personal growth, mental health care systems, psychotherapy practice, psychotherapy research, client and therapist characteristics, and social stigma., Results: Six domains were identified; definition of personal growth, mental health care systems, psychotherapy practice, psychotherapy research, client and therapist characteristics, and social stigma., Conclusion: Future research examining the cost-effectiveness and benefits of psychotherapy for personal growth is warranted. Building on the six domains, specific future research projects on the evidence-based practice of psychotherapy for personal growth are suggested., (© 2020 Wiley Periodicals, Inc.)

In an attempt to operationalize an implicit aspect of the therapeutic alliance, this article proposes the use of the innovative, objective, and time-efficient analysis of language style matching (LSM; Niederhoffer & Pennebaker, 2002). LSM, defined as the degree of similarity in rates of function words in dyadic interactions, is thought to reflect the extent to which conversational partners are automatically coordinating language styles to achieve a common goal. Although LSM has often been researched in the context of everyday conversations, little is known about the matching of clients and therapists' language style in the psychotherapy process. To demonstrate the clinical usefulness of the LSM approach in psychotherapy, 2 exploratory examples of the application of LSM in long-term psychoanalytic treatments are provided. First, LSM analyses per session and per speaking-turn are described for psychotherapy data of 140 sessions of 7 long-term psychoanalytic treatments in relation to outcome measures. Then, a case study is described in which LSM is triangulated with an observer-rated measure of working alliance in relation to outcome measures. These 2 demonstrative empirical examples were explorative in character and illustrate how LSM might tap into an implicit aspect of the therapeutic relationship, different from the working alliance measured by observers, and relevant for treatment outcome. Future larger-scale psychotherapy studies into the relationship between these implicit aspects of the alliance and treatment outcome and relevant clients and therapists' variables are warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Remote therapy has been used by analytic therapists for quite some time, though many have been reluctant to use it regularly, out of concern that it might distort analytic frame and relational dynamics. Now the Covid-19 pandemic has forced therapists to make a sudden, across-the-board transition to remote therapy. This study reports on survey responses from 190 analytic therapists on their transition to online therapy via videoconferencing during the pandemic and their previous experience with remote therapy (the majority had such experience). During the pandemic they prepared themselves and their patients for the transition in a variety of ways. The majority of those surveyed reported feeling as confident and as competent in their online sessions as in their earlier in-person work. Moreover, despite technical and relational challenges, they remained as strong, emotionally connected, and authentic in their online therapy sessions as they were in person. These experiences during the pandemic led to more positive views of online therapy than they held before, but a majority still considered online therapy less effective than in-person sessions.

Reduced social impairment and improved life satisfaction are important objectives in group treatment for patients with personality dysfunction. Knowledge regarding patient characteristics and group treatment processes that contribute to these outcomes, however, remains limited. Dispositional connectedness, the valuing of interpersonal connections, may be an important patient factor that influences patients' experience of group treatment in ways that facilitate therapeutic benefits. The present study investigated the roles of dispositional connectedness and group engagement in contributing to improvement in social functioning and life satisfaction through integrative group treatment for personality dysfunction. Seventy-nine patients who completed an integrative group treatment programme were assessed for dispositional connectedness at baseline and social functioning and life satisfaction at pretreatment and posttreatment; each also provided ratings of group engagement during treatment. Regression analyses using bootstrap confidence intervals found significant indirect effects for dispositional connectedness regarding improvement in both social functioning and life satisfaction, through the mediating effect of group engagement. Thus, patients who entered treatment with tendencies towards interpersonal connectedness perceived a higher level of engagement in the group environment. Group engagement in turn contributed to greater improvement in social functioning and to greater improvement in life satisfaction following treatment. The findings indicate dispositional connectedness as a salient characteristic in selecting patients for group treatment and highlight the role of an engaged interpersonal climate in facilitating improvement in social functioning and life satisfaction., (© 2020 John Wiley & Sons, Ltd.)

Objective: We aimed to investigate change in self-esteem through intensive group treatment for personality dysfunction, by exploring: (a) the relationship between patients' experience of therapeutic alliance and improvement in self-esteem during treatment, including patients' quality of object-relations (QOR) as a possible moderator; and (b) the association between improvement in self-esteem during treatment, and depressive symptoms 9 months later., Method: Eighty patients with personality dysfunction, consecutively enrolled in a group-oriented treatment program, were assessed at pretreatment, posttreatment, and 9 months follow-up., Results: Especially for patients with lower QOR, alliance predicted self-esteem change during treatment. In addition, change in self-esteem during treatment predicted follow-up depression severity, even when controlling for within-treatment symptom change., Conclusions: Patients with impoverished inner relational representations may benefit more from a secure alliance in terms of improving their self-esteem. Change in self-esteem may also be important in preventing relapse of depressive symptoms in people with personality dysfunction., (© 2019 Wiley Periodicals, Inc.)