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This issue of Journal of Clinical Psychology: In Session focuses on the nature and consequences of psychotherapy clients' disclosures, secrets, and dishonesty, with a particular emphasis on the ways in which therapists can best facilitate greater and more honest disclosure. This introduction to this issue reviews the growing theoretical and empirical literature on the frequency, types, motives, and consequences of client and therapist dishonesty (broadly defined); it also reviews the contributions within this issue, noting the welcome focus of the majority of these papers on the nature of client dishonesty in specific disorders (e.g., eating disorders; substance abuse) and/or specific clinical settings (e.g., prisons). Taken together, these papers speak to the ways that therapists may tailor their clinical interventions to match the specific ways that dishonesty manifests in different clinical populations.

Starting with Freud who wrote about Dostoyevsky, Michelangelo, and da Vinci, therapists have acknowledged that the humanities and arts contain great sources of insight into human nature. In this paper, I argue for the need to incorporate insights acquired by artists into the training of psychotherapists. Specifically, I present and describe a graduate-level seminar I teach that uses cinema as a tool to train mental health practitioners. Films are used to expose students to a range of universal human issues; we discuss film characters' conflicts, motivations, sources of suffering, and attempts to cope. Further efforts should be devoted to search for ways to use art to inform and enrich the practice, training, and teaching of psychotherapDirected by Robert Redford and produced in the United Statesy.

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.

Cultural competence refers to our ability to understand, engage, and treat patients from diverse backgrounds or belief systems different from our own. Although addressing culture and cultural difference as part of diversity is important, it is also critical to consider how systemic and economic forces influence the patient's presenting problem and clinical interactions. Summarizing research on cultural competence, attachment, and inequality, this paper reconsiders diversity considerations by discussing how structural inequities disrupt one's ability to trust others interpersonally and across cultural difference. Psychotherapy from this point of view is a relationship that attempts to address the effects of inequality at an individual level by repairing trust and using that trust to work toward change. To illustrate this perspective, the author presents a case of a Puerto Rican migrant whose developmental and family history was impacted by colonial, racial, cultural, and socioeconomic inequality.

This paper introduces and describes the theory and practice of a novel treatment approach to eating disorders-internal language enhancement therapy (ILET)-illustrated with a case study. This treatment approach is informed by the neurobiology of emotional processing integrated with elements of psychoanalytic theory and practice, early maternal preoccupation, development of the self, early right hemisphere language development, and techniques from cognitive behavioral therapy. ILET is based on the Discontinuous Model of Neural Emotional Processing, which means that emotions are processed in the brain either symbolically or concretely. The aim of ILET is to open up and reinforce the underused brain pathway to the symbolic functions by forensically working back to and accurately identifying the emotional material that triggers the concrete state. When the emotional trigger is identified it is explored using symbolic and metaphoric language that reconnects the patient to the symbolic state. ILET posits that eating disorders only appear in the concrete state.

Objectives This paper explores the ways empirically supported treatments (ESTs) help patients, therapists, and institutional administrators contain anxiety regarding complex human problems. Method The authors synthesized relevant literature with their experience as clinicians and psychotherapy researchers. Results ESTs may manage patient anxieties by framing their symptoms in clearly stated mechanisms and relying on a therapist who is an "expert" capable of healing them quickly. ESTs allow therapists to streamline treatment decisions and minimize intersubjective aspects of treatment which reduces the complexity of therapy. ESTs assist institutional administrators in the top-down dissemination of treatments and limit concerns about malpractice and insurance reimbursement by providing assurance that interventions have been vetted. Conclusions While recognizing the benefits of ESTs, relying on ESTs to manage anxieties may diminish the importance of patient factors and clinical judgment, the other critical aspects of evidence-based practice, and thus limit the potential of clinical practice to reduce human distress.

The aim of this case study is to illustrate the importance of collaborative care as part of Maudsley Anorexia Nervosa Treatment for Adults (MANTRA). Mothers are often at the foreground of providing support within the family. However, fathers have the potential to play a profound role. In this paper, we describe a patient with anorexia nervosa treated with the MANTRA. The formulation of this case included autistic spectrum traits in both the father and daughter leading to social isolation. We describe how the family members were engaged into treatment and how paternal support was used to promote social connection and an improved quality of life in the daughter. Some details of the case have been altered to maintain confidentiality.

This paper offers an integration of social issues, psychoanalytic theory, and analytic experience in the treatment of a patient whose political values and identifications differed significantly from my own. Our political leanings facilitated a dynamic tension of difference, power, and aggression that mirrored how each of us felt in relation to the current social-political milieu. In particular, the sadomasochistic dynamics on display in the treatment offered me a unique way of understanding my relationship with my patient and opened new ways of understanding the political present. In the end, I learned to stop worrying about getting rid of anger, aggression, and splitting, and instead to embrace what these feelings and behaviors can tell me as a therapist, and what they can inform for my patients about the nature of relationality, identity, and difference.

The physical spaces in which we conduct psychotherapy are an important yet underacknowledged aspect of psychotherapeutic work. Although a few contemporary publications have provided suggestions for the creation of welcoming, comfortable, and efficient practice spaces, considerations of what it means to transform a room into a therapeutic space have remained largely absent from recent literature. This paper reviews the existing literature on this subject and describes the ways in which the therapist's office is intimately tied to several processes of the therapy itself, by way of creating an adaptive environment that is able to meet the needs of both therapist and client over the course of their work together.

OBJECTIVE Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. METHOD In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. CONCLUSION The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies.

Using data from a large longitudinal naturalistic study on course and outcome of psychotherapy, the present paper investigates the amount of interpersonal problems in an outpatient sample (N = 714) and the extent to which a patient's interpersonal problems determine the quality of the helping alliance. The results show that at the beginning of psychotherapy, subjects reported significant interpersonal distress on 2.43 of the eight IIP scales. Interpersonal problems were most prevalent in the octants "introverted," "submissive," "exploitable," and "overly nurturant." Furthermore, interpersonal problems were related to the helping alliance in different ways: "Too hostile" patients reported relatively poor initial helping alliance whereas "too friendly" patients rated more favorably the relationship to the therapist. However, interpersonal problems at intake did not predict the therapeutic alliance one-and-a-half years later. The results indicate that a poor initial helping alliance might be reversed during the course of treatment. Implications for future research and psychotherapeutic practice are discussed.

Based on a narrative account, this paper highlights and reviews the experiences of the author, a psychologist, experiencing a chronic illness. Areas covered include coping with doctors and medical personnel, adjusting to illness, complying, actively coping, and even, at times, resisting unwarranted medical procedures. Experiences such as loss of trust, a sense of isolation, re-working relationships, and generative reaching-out are also covered. Some positive consequences of chronic illness for personal growth are suggested. Suggestions for conducting psychotherapy with clients who are dealing with serious chronic illness are made.

This paper describes a social-developmental approach to interventions in chronic illness using naturally occurring processes of change during family life-cycle transitions to promote more positive developmental outcomes. Clinical interventions can help build resilience by creating a therapeutic collaboration designed to help patients improve their use of existing and new resources in multiple systems. They can then better meet demands of the illness as it impacts on shared development. A case example of a 13-year-old daughter with complex, chronic health problems and developmental disabilities illustrates clinical interventions designed to promote family resilience during the entry into adolescence and a transition in schooling. This approach involves focusing on the family's own definition of the current problem and relevant history, constructing a multidimensional, coherent story of the illness and its impact that recognizes stressors yet highlights strengths, and normalizing their strategies for stability under circumstances of developmental stress. These interventions with mother, daughter, and family helped improve health efficacy, communication toward mutual understanding and shared problem solving, and better use of existing and new resources to enhance current and future developmental adaptation.

This article focuses on the difficulties facing the neophyte trainee in the field of psychotherapy. Three areas of such difficulties are identified, defined, and discussed: feelings of inadequacy and incompetence, anxieties concerning supervisors, and confusion concerning multiple theoretical views of clinical work. Two vignettes from the early training of the paper's junior authors illustrate and discuss these problems and their resolution in applied contexts. A conclusion is offered which emphasizes the value of supervisory recognition of these dimensions of trainees' experience, as well as their potential for modeling processes of growth that are likely to help supervisees' patients as well.

Recently, the psychological construct mindfulness has received a great deal of attention. The majority of research has focused on clinical studies to evaluate the efficacy of mindfulness-based interventions. This line of research has led to promising data suggesting mindfulness-based interventions are effective for treatment of both psychological and physical symptoms. However, an equally important direction for future research is to investigate questions concerning mechanisms of action underlying mindfulness-based interventions. This theoretical paper proposes a model of mindfulness, in an effort to elucidate potential mechanisms to explain how mindfulness affects positive change. Potential implications and future directions for the empirical study of mechanisms involved in mindfulness are addressed.

The present study focused on the relationships between therapists' preferences and expectations with regard to their own and their clients' role behaviors. Fifty therapists completed the Role Expectations and Preferences Questionnaire before entering 147 counseling sessions with clients. It was found that therapists' preferences differ from their expectations. This was more pronounced with regard to clients' behaviors than to therapists' role behaviors. Both preferences and expectations changed over time in therapy, but, contrary to hypothesis, the preferences-expectations gap did not decrease over time. The overall pattern of results indicated that preferences-expectations discrepancies reflect the therapists' assessment of the clients' willingness and/or ability to behave in ways prescribed by the therapists' theoretical orientation. The paper suggests that future research consider the time-related aspects of role preferences and expectations and the consequences of preferences-expectations gap.