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Psychotherapy has historically focused on symptom reduction. However, there are calls for increasing our understanding of how psychotherapy impacts clients' flourishing. In this study, licensed mental health professionals and trainees across different clinical settings with diverse therapeutic orientations were interviewed about their perspectives on the cultivation of flourishing in psychotherapy, as well as their own personal experiences with flourishing. We were interested in understanding how therapists define flourishing, how they integrate flourishing into their work with clients, and any barriers or catalysts for engaging in this process. To do so, we conducted eight focus groups, and interviews were analyzed using grounded theory to form a hierarchy of categories. The results were used to create a three-part grounded theory. Results suggested that flourishing is a distinct concept from well-being that involves active engagement, emotional connection and meaning making. Our three-part grounded theory of flourishing elucidates how flourishing can be pursued by guiding clients towards their experiences of suffering in order to engage in meaning making and to identify their values, as well how systemic barriers can be navigated. Themes emerged related to the training of psychotherapists to promote flourishing, and the associated clinical and training implications are discussed [ABSTRACT FROM AUTHOR]

Transgender and nonbinary (TGNB) people report experiencing discrimination from therapists. A step to reducing these microaggressions is for therapists to be able to identify them. Psychological trainees and psychologists (n = 105) were randomly assigned to watch a video vignette therapy session: a session with (a) blatant therapist microaggressions (nonaffirming), (b) therapist-led transition focus (transition affirming), and (c) gender exploration focus (nonbinary affirming). There was no difference in microaggression detection between the two affirming conditions. The microaggression condition of participants had a negative effect on ratings of therapist multicultural orientation (MCO). Additionally, attitudes towards transgender people moderated the relationship between microaggression conditions and ratings of therapist's cultural humility for the affirming conditions; participants in the nonbinary affirming condition rated the therapist more culturally humble as their positive attitudes towards TGNB people increased, and participants rated the therapist as less culturally humble as TGNB attitudes increased in the transition affirming condition. [ABSTRACT FROM AUTHOR]

Research has failed to consistently show that therapists facilitate better client outcomes as they gain more experience. The present study was designed to examine changes in early client retention over the course of extended periods of time among 2591 therapists in private practice. Naturalistic data collected between 2018 and 2022 was extracted from a technology‐enabled practice‐research group (PRG). Therapists displayed an increase in client dropout rates as they gained more experience on the PRG. Additionally, larger caseloads on the PRG were associated with lower increases in client dropout over time. Finally, therapists working with clients paying higher out‐of‐pocket fees (e.g., co‐pays) had higher increases in client dropout over time. These findings provide additional evidence supporting the distinction between clinical experience and expertise. [ABSTRACT FROM AUTHOR]

This study examined whether biological sex moderates the relationship between experiences of workplace culture and urinary levels of catecholamines and their metabolites. We conducted a series of regression analyses (predictors: 3-methoxytyramine (3MT), 5-hydroxyindolacetic (5HIAA), and dopamine (DA); outcomes: employee engagement and workplace culture) in a sample of 218 participants. Compared to men, women rated workplace culture less positively (r = −0.210; p < 0.01) and had stronger positive associations with 3MT (r = 0.328; p < 0.001), DA (r = 0.376; p < 0.001), and 5HIAA (r = 0.168; p < 0.01). There was a significant moderation effect between 3MT and sex on employee engagement (b = −1.76 (SE = 0.84); p < 0.01), and 3MT had a positive significant association for men with engagement (p < 0.05); however, there was no significant association for women. Findings suggest that for women, less positive experiences with workplace culture could elevate 3MT, stimulating sympathetic nervous tone and potentially amplifying risks for negative health outcomes. Conversely, men who reported higher employee engagement had higher levels of 3MT, suggesting possible health risks associated with high levels of engagement, rather than lack of engagement. Overall, study findings suggested differential health risks based on biological sex, potentially impacting health risk policy development. [ABSTRACT FROM AUTHOR]

The efficacy and effectiveness of psychotherapy for depression are well established in many clinical settings. Nonetheless, its effectiveness in private practice, perhaps the most common clinical setting, has yet to be examined. Likewise, the trajectories of change in depressive symptoms observed during psychotherapy for depression in private practice have yet to be studied. The present study harnessed a large practice-research group of private practitioners to address these important omissions in the literature. The sample of clients with depression (N = 2,268) included in the study displayed medium-to-large and large-sized reductions in depressive symptoms following treatment (depending on baseline severity). These effects were benchmarked against those synthesized from randomized controlled trials (RCTs), a comparable benchmark study, and the course of untreated depression. The outcomes exhibited by the private practice clients were found to be superior to no treatment, equivalent to those reported in other naturalistic clinical settings, and nonequivalent to those exhibited by experimental groups in RCTs. Furthermore, the analysis of trajectories of change indicated that higher session frequency early on in treatment led to better outcomes. Overall, these findings attest to the effectiveness of psychotherapy for depression delivered in private practice. Additionally, they provide clinically useful findings underscoring the importance of higher session frequency in the early phase of psychotherapy. Public Significance Statement: Findings from the present study support the effectiveness of psychotherapy for depression delivered in private practice. Moreover, they underscore the importance of higher session frequency in the early phase of treatment. [ABSTRACT FROM AUTHOR]

Couple therapy has outperformed control conditions in randomized clinical trials (RCTs). However, there have been some questions whether couple treatment in naturalistic settings is as effective as those with more rigorous controls. The current meta‐analysis examined 48 studies of couple therapy in non‐randomized clinical trials. The pre–post effect size was Hedge's g = 0.522 for relational outcomes and Hedge's g = 0.587 for individual outcomes. However, there was significant heterogeneity in the results. Several moderators explained some of the variance in these estimates. For relationship outcomes, studies who had older couples and longer length of relationship had better outcomes. Studies with a higher percentage of racial/ethnic minority (REM) couples and studies in Veteran Affairs Medical Centers (VAMC) had lower relational outcomes. For individual outcomes, studies that had more sessions, older couples, and VAMC had better outcomes. Studies with a higher percentage of REM couples also had worse individual outcomes. Trainee status was not consistently related to relational or individual outcomes. Implications for research and practice are provided. [ABSTRACT FROM AUTHOR]

Relationship education programs (REPs) have substantial bodies of evidence that support their efficacy as community-based relationship education interventions for many couples, including racial/ethnic minority (REM) couples and couples from low-income households. While many studies support the efficacy of REPs, less is known about the characteristics of couples who experience worse relationship functioning after these interventions. Accordingly, we examined whether pre-intervention relationship factors would be associated with couples who reported worse relational commitment post-intervention. A total of 1,710 individuals (N = 855 couples) from a large, low-income, urban center participated in REPs. The sample was predominantly African American/Black (58.1%) and Hispanic/Latinx (40.6%), including 16 same-sex couples. Across all outcome variables (dedication, constraint, and separation), the participants receiving the intervention in a group format were more likely to report worse relationship functioning after the intervention. Negative communication was found to be more predictive than positive communication, and higher baseline respect counter-intuitively predicted greater odds of deterioration, especially for female partners. This study calls attention to why couples may experience worsening of commitment after REPs, and ultimately, may help predict which low-income, REM couples may benefit from relationship education, as well as how programs can be better culturally tailored to meet their needs. [ABSTRACT FROM AUTHOR]

Objective: Mental health disparities between racial/ethnic minorities (REM) and White individuals are well documented. These disparities extend into psychotherapy and have been observed among clients receiving care at university/college counseling centers. However, less is known about if campus RE composition affects outcomes from psychotherapy for REM and White clients. Method: This study examined psychotherapy outcomes from 16,011 clients who engaged in services at 33 university/college counseling centers. Each of these clients completed the Behavioral Health Measure as a of part routine practice. Campus RE composition was coded from publicly available data. Results: The results demonstrated that White clients had better therapy outcomes than REM clients when they were at campuses where there were more White students. For universities 1 SD below the mean percentage of White students, the average difference in therapy outcomes for White and REM clients was Cohen's d = .21 (with White students experiencing more improvement); however, for universities 1 SD above the mean, the between group outcome disparity was greater (Cohen's d = .38). Conclusion: Therapists and higher education professionals should consider environmental impacts on counseling services. Implications for higher education, counseling centers, and mental health disparities are provided. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the feasibility and potential concept of a 4-week positive psychology group intervention (Activating Happiness©) for cancer survivors and caregivers that emphasized mindfulness, self-compassion, and gratitude. Nine facilitators led 6 intervention groups for 49 participants (35 cancer survivors, 14 caregivers). Of eligible participants, 63% enrolled and of those, 89% completed all study activities. Participants completed self-report measures at baseline, after the second and final sessions, and 3-month post-intervention, and provided qualitative feedback after the final session. Qualitative data demonstrated that participants found the intervention acceptable. The intervention's potential proof-of-concept was supported by benchmarking outcomes against those reported in randomized controlled trials, with effect sizes for mindfulness, self-compassion, anxiety, and depression for caregivers and survivors, and for pain for survivors comparable to size estimates for efficacy in clinical trials. [ABSTRACT FROM AUTHOR]

In this longitudinal study (N = 98), we examined whether drinking for suppression reasons moderated the relation between depressive symptoms and hooking up for self-affirmation reasons and negative hookup consequences. No moderation was found for hooking up for self-affirmation reasons, but the effect for negative hookup consequences approached significance. When drinking for suppression reasons is low, participants with fewer depressive symptoms reported more negative consequences, and participants with more depressive symptoms reported fewer negative consequences 2 months later. Results are discussed within the context of sex education and mental health programming for young adults. [ABSTRACT FROM AUTHOR]

There is a paucity of empirical studies that demonstrate psychotherapy trainees improve at assisting their clients' therapy outcomes over time. We examined whether trainees (i.e., practicum. predoctoral interns, and postdoctoral fellows) improved in their clients' therapy outcomes over time. We examined 114 trainees (i.e., who were trainees for the first client in the database) and had over 12 months of client outcome data (M = 45.31 months). At the start of their time in our database, about half of the participants (48.2%) were predoctoral interns, 42.1% were practicum students, and 9.6% were postdoctoral fellows. Collectively, they treated 2,991 clients (M = 26 clients per trainee). Clients completed the Behavioral Health Measure, which assesses general psychological functioning (i.e., well-being, symptom distress, and life functioning), as a measure of therapy outcomes. Trainees demonstrated small-sized growth in their clients' outcomes over time (d = 0.04 per year); however, this growth was moderated by client severity. That is, trainees demonstrated growth over time in working with clients who were less distressed (d = -0.13 to 0.10 over time), but there was no change over time for trainees when working with more distressed clients (d = 0.67 to .65 over time). The results were consistent across trainee level (i.e., practicum, predoctoral intern, postdoctoral fellow), yet trainees varied in their patterns of growth. Psychotherapy training has a small, but positive, effect on trainees' ability to foster positive outcomes with their clients over time. [ABSTRACT FROM AUTHOR]

This is the first study to explore the relationship between aspects of a therapists' personal therapy and the subsequent psychotherapy process and outcome they perform. The participants were 14 graduate clinicians with various experiences in personal therapy, who treated 54 outpatients engaged in short-term psychodynamic psychotherapy at a university-based community clinic. Results demonstrated non-significant relationships between the duration of personal therapy as well as a graduate clinician's overall alliance in their personal therapy with alliance ratings made by themselves as therapists and their patients, as well as the number of psychotherapy sessions attended by patients. However, the clinician's personal therapy alliance was significant and positively related to their patients' rating of outcome. Additionally, a significant negative correlation was observed between the degree of perceived helpfulness in their personal therapy and how these clinicians rated alliances, as the therapist, with their patients. The current findings suggest a relationship between a clinician's personal therapy alliance and the outcome of treatments they conduct. Implications for clinical training and practice as well as future research are discussed. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message While graduate clinician's personal therapy alliance was not significantly related to their patients' ratings of alliance, it was related to their patients' ratings of outcome., Trainee satisfaction with or quality of their personal therapy may be a more relevant than the amount or duration of their treatment in regard to the process and outcomes of their patients., The findings from retrospective clinician surveys on the helpfulness of their personal therapy may not be entirely consistent with empirical examination of these issues., The relation of personal therapy and outcome may work through improving the therapist's level of adaptive functioning (i.e., psychological-relational-emotional health) and future research should examine this simpler, more parsimonious, explanation for our findings. [ABSTRACT FROM AUTHOR]

This study examined the use of the Inventory of Countertransference Behavior (ICB) as an observer-rated measure of countertransference (CT). The ICB was originally designed for use by direct psychotherapy supervisors who assess their supervisees, but this limits its use in research and with practitioners who are not in supervision. To increase the use of the ICB as an observer-rated scale, we developed clarifying statements and examples of in-session therapist behaviors for each of its 21 items, creating an Inventory of Countertransference Behavior-Observer (ICB-O). Two separate teams of observers rated therapist CT using the ICB-O while listening to audiotaped recordings and reading transcripts of four psychotherapy dyads' sessions. Our analyses indicate that the ICB-O can be used reliably as an observer-rated measure of CT, and that differences emerged in the development of positive CT over time. We also obtained ratings of client insight and clients' and therapists' ratings of quality of sessions, and present variations in these ratings, including CT, when the treatment was classified as either more or less successful. We end the paper by presenting ways in which the ICB-O can be used in supervision, training, and research. [ABSTRACT FROM PUBLISHER]

Racial and ethnic microaggressions in everyday life can negatively impact the well-being of racial and ethnic minorities (REM). When microaggressions are perceived in therapy they can interfere with therapeutic progress. However, little is known about whether microaggressions are addressed in therapy and if so, does addressing them impact the therapeutic relationship. REM clients from a university counseling center (n = 120) reported on their therapy experience. Approximately 53% of clients reported experiencing a microaggression from their therapist. Clients' perceptions of microaggressions were negatively related to the working alliance, even after controlling for their current psychological well-being, number of sessions, and therapist racial and ethnic status. Of those clients who reported a microaggression, nearly 76% reported that the microaggression was not discussed. For those clients who experienced a microaggression and did not discuss it, alliance ratings were lower as compared with clients who did not experience a microaggression or who experienced a microaggression but discussed it. [ABSTRACT FROM AUTHOR]

This study examined the associations between fear of extradyadic involvement (a subtype of romantic jealousy defined as the experience of anxiety, suspicion, worry, and mistrust about a partner engaging in EDI) with relationship, intrapersonal, partner, and contextual variables. A cross-sectional design was conducted and multiple regression was used to examine the associations between the identified predictors and fear of EDI using a sample of adult participants (N = 306) recruited from online resources. The overall regression model was statistically significant and the results indicated that anxious attachment, negative communication, opportunity, and partner alcohol use were predictive of fear of EDI. Implications for relationship education programs, couple therapists, and future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the current study was to disentangle within- and between-case variability in the adherence-outcome association. Specifically, we expected that increases or decreases in within-case adherence ratings would be positively associated with therapy outcomes. Method: Seventy clients (74% women, 26% men; Mage = 29.8 years, SD = 11.00) received psychodynamic psychotherapy at a university-based community outpatient clinic. Adherence to core principles of a psychodynamic treatment model were coded by independent raters at the 3rd, 9th, and termination phase sessions using a psychotherapy technique scale. Therapy outcomes were assessed at both the symptom and the broadband levels of functioning. Results: Within-case variability in adherence ratings was significantly associated with therapy outcomes (accounting for approximately 10% of the variance in outcomes), after controlling for alliance, between-case variability, and the proportion of outcomes attributed by therapists. Conclusion: The flexibility therapists demonstrate regarding the use of technique within a given treatment appears to be related to better outcomes across their caseload in relation to therapists who are less flexible with their interventions at the individual client level. The clinical implications of flexibility in adherence to a treatment model are discussed. [ABSTRACT FROM AUTHOR]

Six client/therapist dyads (three therapists each working with two clients) were studied to determine how the real relationship unfolds over the course of time-limited treatment and how this unfolding relates to the development of the client/therapist working alliance, client transference, and therapist countertransference. We also examined how these indices of the relationship fluctuate as a function of treatment outcome. Results indicate that in general for all six dyads, therapists’ and clients’ ratings of the real relationship and working alliance were strong throughout treatment. However, patterns of real relationship and working alliance over the course of treatment varied between dyads categorized as more vs. less successful. Therapists’ countertransference was low, as was client transference, but differences in ratings were evident when the dyads were classified by outcome. [ABSTRACT FROM PUBLISHER]

The current study examined the interaction of clients' perceptions of the psychodynamic-interpersonal (PI) and cognitive-behavioural (CB) techniques that their therapist utilized in their most recent therapy session and working alliance in the prediction of post-session changes. Seventy-five clients were treated by 25 therapists at a counselling centre in the USA. We posited that alliance would interact with clients' perceptions of their therapists' use of PI and CB techniques in the prediction of post-session changes. The results revealed a three-way interaction between clients' perceptions of the alliance, PI techniques and CB techniques in the prediction of post-session changes. More PI and more CB techniques and more PI but fewer CB techniques were associated with better post-sessions changes in the context of higher alliances. More CB techniques but fewer PI techniques and fewer PI and fewer CB techniques were not significantly associated with post-session changes in the context of higher (or lower) alliances. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Clients' perceptions of PI techniques in the context of stronger alliances were most beneficial for post-session outcomes. Thus, a high alliance will likely maximize the impact of PI techniques., Clients who rated their therapist as being relatively inactive reported fewer positive post-session outcomes, suggesting that an idle therapeutic approach is not advantageous., Therapist differences explained two to three times more variation in session outcomes than client ratings of alliance or techniques. Some therapists are better at facilitating positive session outcomes as compared with others, suggesting that a potential key barometer of therapists' effectiveness may be captured by session outcomes. [ABSTRACT FROM AUTHOR]

Relationship education programs have been shown as an effective way to increase relationship functioning. There is less known about how process factors, such as alliance with the leader or group dynamics, affect outcomes in these interventions. We examined group cohesion and alliance with the leader in a relationship education program tailored for individuals. Specifically, we examined whether participants' ratings (n = 126) of the group cohesion and alliance with the leader were associated with changes in relationship adjustment, relationship confidence, and communication quality from pre- to postintervention. The results demonstrated that participants' perceptions of the cohesion among the members in their relationship education group, but not the leader-participant alliance, made a significant contribution to the changes in participants' relationship functioning. These results suggest that the group dynamics among the members in the group are important ingredients in relationship education. Implications for relationship programs are provided. [ABSTRACT FROM AUTHOR]

The current study examined the associations among clients’ perceptions of self- and social stigma for seeking help, session outcomes, and working alliance. Ninety-one clients were treated by 26 therapists, at a large university counseling center. All clients were currently in therapy. We expected that clients’ perceptions of self- and social stigma would be negatively associated with session outcomes and working alliance, after controlling for number of sessions, psychological well-being, and client and therapist race/ethnicity and sex. The results showed that clients’ perceptions of self-stigma (but not social stigma) were negatively associated with working alliance. Counter to our expectations, clients’ perceptions of social stigma were positively associated with session outcomes. Although clients’ perceptions of self-stigma did not have a direct association with session outcomes, there was an indirect effect between self-stigma and session outcomes via working alliance. [ABSTRACT FROM PUBLISHER]

From choosing a partner to date to deciding to cohabit or marry, individuals are faced with many relationship choices. Given the costs of failed relationships (e.g., personal distress, problems with work, lower well-being for children, lost opportunities to meet other partners), it is important to consider how individuals are approaching these decisions. The current study tested if more thoughtful and clear relationship decision-making processes would relate to individuals’ levels of satisfaction with and dedication to their partners as well as their extradyadic involvements. In a sample of 252 men and women, the results showed that regardless of relationship status (i.e., dating, cohabiting, or married), those who reported more thoughtful decision-making processes also reported more dedication to their partners, higher satisfaction with the relationship, and fewer extradyadic involvements. [ABSTRACT FROM PUBLISHER]

The current study examined whether young adults who start their exclusive romantic relationship via Friends with Benefits (FWB) relationships differed in relationship functioning from those who did not. After controlling for other salient predictors of relationship functioning (e.g., alcohol use, attachment style), young adults who were in FWB relationships prior to becoming exclusive reported lower relationship satisfaction when compared to young adults who did not. There were no significant associations between FWB status and communication quality or ambiguity in commitment levels. FWB status was not associated with relationship termination over the course of 4 months. Collectively, starting exclusive romantic relationships via FWB relationships had little apparent impact on later relationship functioning. [ABSTRACT FROM AUTHOR]

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)-a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities. [ABSTRACT FROM AUTHOR]

The article presents a study to examine the perceptions of Asian American male college students on people's stereotype about Asian American men guided. The study is guided by social identity theory which identified perceived stereotypes including interpersonal deficits, intelligence and intense diligence. Results of the study revealed outsider stereotypes have higher levels of depressive symptoms compared to body-mind and nerd stereotype clusters.

The current study examined 181 lower income unmarried African American couples who were expecting or had a child (3 months or younger). All couples received couple relationship education (PREP). We examined whether changes in communication quality and perceived social integration were related to changes in relationship satisfaction and dedication and whether these associations were consistent for men and women. The results demonstrated that men's and women's change in positive communication and social integration were related to higher ratings of their own dedication and relationship satisfaction. Men reported more relationship satisfaction when their partner's negative communication decreased and when their partner reported more social integration; however, there was no association between women's rating of relationship satisfaction and men's changes in negative communication or social integration. [ABSTRACT FROM AUTHOR]

Cultural humility is important in supervision; however, studies have primarily sampled White supervisees. Racially and ethnically minoritized trainees experience microaggressions during their training, yet cross-racial supervision is less often studied. We examined a moderated mediation model to test whether the supervisory working alliance mediated the relationship between frequency of racial microaggressions and satisfaction with supervision, and whether the impact of racial microaggressions on the supervisee and supervisor cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance. In a sample of supervisees of color (N = 102; majority cisgender women, 86.2%, and heterosexual, 59.8%; 35.3% Black/African American, 28.4% Asian/Pacific Islander, 18.6% Hispanic/Latine) receiving clinical supervision from White supervisors, we found that racial microaggression frequency was negatively associated with satisfaction with supervision, and this relationship was fully accounted for by the supervisory working alliance. Racial microaggressions in supervision were found to be detrimental to the supervisory working alliance, which was then related to lower satisfaction with supervision. Further, racial microaggression impact and cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance; this relationship was strongest when racial microaggression impact was high and cultural humility was average or high. The social bond hypothesis suggests we are more likely to allow ourselves to be vulnerable when we assess cultural humility to be high. We posit that the observed moderation effect may be due to supervisees experiencing greater shock when experiencing racial microaggressions from supervisors whom they perceived to be culturally humble. Public Significance Statement: The current findings demonstrate that racial microaggressions in cross-racial clinical supervision are negatively related to supervisees' satisfaction with supervision through their detrimental impact on the supervisory working alliance; and they appear to be most impactful when supervisor cultural humility is high. Still, even when microaggressions occurred, the supervisory working alliance was still stronger when supervisory cultural humility was higher. These results emphasize the importance of cultural humility as well as repairing microaggression-related ruptures in cross-racial clinical supervision. [ABSTRACT FROM AUTHOR]

The aims of this practice-based evidence study were to (a) examine clients' trajectories of psychological and spiritual distress over the course of spiritually integrated psychotherapies (SIPs) and (b) explore the role of varying types of spiritual interventions in these outcomes. In total, 164 practitioners of SIPs from 37 settings in a practice-research network administered the Clinically Adaptive Multidimensional Outcome Survey (Sanders et al., 2018) at each session with 1,227 clients and reported their use of theoretical orientations and spiritual interventions on an after-session summary checklist. Focusing on sessions over an initial 12-week period, latent growth curve modeling analyses revealed that clients, on average, experienced significant reduction of psychological distress during their engagement in SIPs with improvements occurring most sharply in the first month. Further, other findings revealed a salient reciprocal interplay with spiritual distress throughout treatment, such that clients who were struggling with their religious faith and/or spirituality were more psychologically distressed and displayed a more attenuated and gradual pattern of symptom reduction. In such cases, clinicians frequently utilized spiritual interventions involving basic skills (e.g., spiritual assessment), virtues (e.g., discuss self-control), and religious attachment (e.g., encourage acceptance of divine love) that were uniquely associated with clients' rate and duration of decline in psychological and spiritual distress. The present findings affirm the routine effectiveness of SIPs along with highlighting the potential value of certain spiritual interventions in supporting holistic recovery among clients who want clinicians to be culturally responsive to their spiritual and/or religious identities. Public Significance Statement: Clients who engaged in spiritually integrated psychotherapies typically experienced clinical improvement with the sharpest changes in psychological distress occurring in the first month of treatment. Clinicians' use of certain spiritual interventions (e.g., spiritual assessment, exploring religious questions/doubts) was generally favorably linked with clients' rate and duration of changes in psychological and spiritual distress over the course of their psychotherapy. [ABSTRACT FROM AUTHOR]

In psychotherapy, emotional tears occur frequently but have received limited attention. We set out to replicate and extend findings of previous studies conducted in Italy (Genova et al., 2021) and Israel (Katz et al., 2022) with U.S. clients. We hypothesized that positive crying experiences would be associated with improvement and stronger alliance, as well as that insecurely attached patients would tend to view crying as more intense but also more meaningful. One hundred twenty-four patients completed an online survey about crying in therapy as well as measures assessing therapeutic change, working alliance, and attachment. Findings revealed that postcrying positive feelings were linked with greater reported improvement. Several crying experiences were related to both change and alliance. All significant relationships between crying experiences and change remained significant after partialing the effects of attachment, and all but one remained significant after partialing the effects of the alliance. Participants who cried in therapy reported greater improvement compared to those who denied crying in therapy. Despite greater discomfort, less securely attached clients tended to report feeling better understood by their therapists after crying. These findings replicate and extend previous international studies in a U.S. sample, providing support for their cross-cultural relevance and previous evidence that clients' crying experiences are related to both change and alliance. In conclusion, we suggest that therapists conceptualize instances of crying in therapy as a sensitive relational moment with potential positive or negative consequences, dedicate time to exploring experiences around crying, and specifically process crying experiences of insecurely attached patients. Public Significance Statement: This study demonstrates that patients' crying experiences in psychotherapy are linked with reported treatment change and the working alliance. In addition, those who endorse higher levels of insecure attachment tend to be more sensitive to how crying in therapy is experienced but also tend to find value in relation to being understood by their therapist. These findings are particularly important for psychotherapists in considering strategies responding to crying in psychotherapy as well as the value of exploring crying's experience and meaning with the client. [ABSTRACT FROM AUTHOR]

Research has demonstrated that therapists' multicultural orientation (MCO)--consisting of cultural humility, cultural comfort, and cultural opportunities--is key to client outcomes. The primary method for training psychotherapists is clinical supervision, and recent quantitative research provides preliminary support for the importance of MCO in clinical supervision. To date, however, there has been no qualitative inquiry of clinical supervision since the introduction of new models of cultural responsiveness. Thus, we sought to understand helpful experiences, unhelpful experiences, and supervisee expectations regarding culturally responsive clinical supervision through qualitative examination. Supervisees' (N = 102) responses resulted in three categories: (a) helpful cultural supervisory experiences, (b) unhelpful cultural supervisory experiences, and (c) missed opportunities in supervision. Subthemes emerged related to supervisor characteristics, and supervision processes and content. Participants also described negative experiences, including microaggressions, cultural discomfort, and avoidance. Consistent with recent quantitative research, supervisees emphasized helpful and hindering supervision experiences related to the MCO model, especially the importance of cultural discussions. Supervisees also emphasized some experiences consistent with the multicultural competencies model, such as desiring didactic information. [ABSTRACT FROM AUTHOR]

Building on recent theory stressing multicultural orientation, as well as the development of virtues and dispositions associated with multicultural values, we introduce the construct of cultural humility, defined as having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual's cultural background and experience. In 4 studies, we provide evidence for the estimated reliability and construct validity of a client-rated measure of a therapist's cultural humility, and we demonstrate that client perceptions of their therapist's cultural humility are positively associated with developing a strong working alliance. Furthermore, client perceptions of their therapist's cultural humility were positively associated with improvement in therapy, and this relationship was mediated by a strong working alliance. We consider implications for research, practice, and training. [ABSTRACT FROM AUTHOR]

This study examined the relationship between adherence flexibility early in treatment and outcome within psychodynamic psychotherapy of depression. For this purpose, we used multilevel modeling (MLM) to examine the relationship between adherence to global psychodynamic-interpersonal (PI) technique early in treatment with outcome, the impact of flexibly incorporating some limited cognitive-behavioral (CB) interventions, as well the role of therapist effects. Our sample included 46 outpatients who were consecutively enrolled in individual psychodynamic psychotherapy, received a Diagnostic and Statistical Manual of Mental Disorders (4th ed.: DSM-IV: American Psychiatric Association [APA], 1994) Axis I diagnosis of a depressive spectrum disorder, and were assessed pre- and posttreatment through self-report of depressive symptoms. Psychotherapy sessions were videotaped and 3rd and 9th sessions were independently rated on the Comparative Psychotherapy Process Scale (CPPS) for use of PI and CB techniques, with excellent interrater reliability (intraclass correlation coefficient [ICC] > .75). Mean technique ratings across the two early treatment sessions (3rd and 9th) were calculated. Our findings suggest that flexibly incorporating a limited amount of CB strategies early in psychodynamic therapy for depression can add some benefit to the unique positive relationship between PI adherence and outcome. Implications for clinical work and future research directions are discussed. [ABSTRACT FROM AUTHOR]