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The clinical need for lesbian, gay, bisexual, and queer (LGBQ+) affirmative psychotherapies has been widely recognized; however, empirical research on the outcomes of such psychotherapies is limited. Moreover, key questions about whom such psychotherapies are for and what they comprise require critical consideration. We begin by offering definitions to answer these questions and delineate four key themes of LGBQ+ affirmative psychotherapies. We conceptualize LGBQ+ affirmative psychotherapies not as sexual orientation group-specific, but rather as considerations and practices that can be applied with all clients. We then summarize our own search for studies to attempt a meta-analysis and we discuss limitations and directions for research based on our literature review. We end by delineating diversity considerations and recommending therapeutic practices for advancing LGBQ+ affirmative psychotherapy with clients of all sexual orientations.

This study examined transgender community belongingness as a mediator between strength of transgender identity and well-being. A total of 571 transgender adults (n = 209 transgender women, n = 217 transgender men, and n = 145 nonbinary-identified individuals) completed an online survey assessing transgender community belongingness, strength of transgender identity (operationalized as the extent to which a person self-categorizes their identity as transgender and the extent to which they believe their gender transition to be important to their self-definition), and well-being (using measures of self-esteem, satisfaction with life, and psychological well-being). Structural equation modeling was used to analyze the data. When controlling for participants' income, age, and stage of gender transition, transgender community belongingness fully mediated the relationship between strength of transgender identity and well-being. Strength of transgender identity was indirectly and positively related to well-being through community belongingness, but was not directly related to well-being. Results suggest that transgender community belongingness is an important construct in the mental health of transgender people. The strength of a person's transgender identity also appears to be a significant construct in transgender people's well-being via its relationship with transgender community belongingness. Implications of the findings are discussed. (PsycINFO Database Record

In order to receive medically necessary gender-affirming treatments, transgender individuals are required to provide evidence of their readiness for gender transitioning. Most often, this evidence includes 1 letter for hormone therapy and 2 letters for surgery. According to the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC), psychotherapists or other eligible health professionals are the only individuals qualified to write these letters. The present case study examined how psychotherapist gatekeeping and letter writing for a transgender client were intertwined with psychotherapy processes and outcomes. Over the course of 12 months of treatment, the client was assessed through 8 time points using multiple methods. Six of the assessments were conducted with validated outcome measures (baseline; Sessions 5, 10, 15, and 20; and termination); 1 of the assessments was conducted as a clinical interview for letter-writing purposes and additional outcome measures (Session 8); and evaluating the process of letter writing was an aspect of psychotherapy (Session 20). Symptom alleviation, improvement in psychological well-being, and increases in overall quality of life occurred from baseline to termination. Results indicate that psychotherapy assisted with the process of gender transitioning, which in turn improved client outcomes. Recommendations for writing letters for clients who desire a gender transition are included.

Objective The current study used multilevel growth mixture modeling to ascertain groups of patients who had similar trajectories in their psychological functioning over the course of short-term treatment. Method A total of 10,854 clients completed a measure of psychological functioning before each session. Psychological functioning was measured by the Behavioral Health Measure, which is an index of well-being, symptoms, and life-functioning. Clients who attended 5 to 25 sessions at 46 different university/college counseling centers and one community mental health center were included in this study. Client diagnoses and the specific treatment approaches were not known. Results A 3-class solution was a good fit to the data. Clients in classes 1 and 3 had moderate severity in their initial psychological functioning scores, and clients in class 2 had more distressed psychological functioning scores. The trajectory for clients in class 1 was typified by early initial change, followed by a plateau, and then another gain in psychological functioning later in treatment. The trajectory for clients in class 2 demonstrated an initial decrease in functioning, followed by a rapid increase, and then a plateau. Last, the clients in class 3 had a steady increase of psychological functioning, in a more linear manner. Conclusion The trajectories of change for clients are diverse, and they can ebb and flow more than traditional dose-effect and good-enough level models may suggest.

Randomized clinical trials (RCTs) are the primary mechanism through which treatments are determined to reduce symptoms for personality disorders (PDs). Evidence regarding treatments for PDs indicates that the effect sizes for PD psychotherapy treatments are large, leading researchers to conclude that psychotherapy treatments reduce PD symptomology. However, these conclusions can be misleading in light of theoretical and methodological concerns related to PDs and their treatments. The primary concerns that exist for testing the effectiveness of treatments for PDs include an unsound theoretical basis for PDs that impact the measurement and testing of psychotherapy treatments. Evidence of high comorbidity rates of PDs with other PDs and psychiatric diagnoses are indicative of incorrect classification of diagnostic criteria. Additionally, clinician bias when diagnosing PDs can impact the inclusion of participants into RCTs testing psychotherapy treatments. Finally, criticisms of how RCTs measure outcomes related to PDs are included, such as using symptom measures for other diagnoses to indicate the effectiveness of a treatment for a PD diagnosis. Recommendations are offered to enhance the ways in which RCTs test psychotherapy treatments for PDs, including theory that can be empirically tested for PDs, training researchers and clinicians about diagnostic bias related to PDs, and creating and implementing valid targeted measures that test the effectiveness of psychotherapy treatments that are specific to PDs.Keywords: personality disorders, randomized clinical trials, personality assessment, diagnostic bias, comorbidityResumeLes essais cliniques aleatoires (ECA) sont le principal moyen de determiner les traitements visant a reduire les symptomes des troubles de la personnalite (TP). Les preuves au sujet des traitements pour les TP indiquent que l'ampleur de l'effet de la psychotherapie est significative, ce qui a permis aux chercheurs de conclure que celle-ci reduit les symptomes associes aux TP. Toutefois, ces conclusions peuvent etre trompeuses lorsqu'on tient compte des preoccupations d'ordre theorique et methodologique reliees aux TP et a leur traitement. Parmi les principales preoccupations figure le fait que l'evaluation de l'efficacite des traitements pour les TP se fonde en partie sur une base theorique incorrecte, ce qui influe sur la mesure et l'essai des traitements au moyen de la psychotherapie. Des taux eleves de comorbidite avec d'autres TP ainsi que des diagnostics psychiatriques revelent une classification incorrecte des criteres de diagnostic. De plus, le biais du clinicien durant le diagnostic des TP peut influer sur le choix des participants a des ECA pour l'evaluation de la psychotherapie a titre de traitement. L'article se termine par une critique de la facon dont sont mesures les resultats des ECA en ce qui a trait aux TP, comme l'usage de mesures de symptomes d'autres diagnostics pour indiquer l'efficacite d'un traitement de TP. Suivent des recommandations visant a ameliorer l'evaluation d'ECA de psychotherapies pour TP, qui incluent le recours a des fondements theoriques pouvant etre testes empiriquement, la formation des chercheurs et des cliniciens afin qu'ils reconnaissent les biais dans le diagnostic de TP ainsi que la creation et l'application de mesures valides ciblees pour evaluer l'efficacite de la psychotherapie propre au traitement des TP.Mots-cles : troubles de la personnalitee, essais cliniques aleatoires, evaluation de la personnalite, biais de diagnostic, comorbidite.Randomized clinical trials (RCTs) are the primary mechanism through which treatments are determined to reduce symptoms for PDs. To date, a debate continues as to whether RCTs (derived from a medical model) establish which psychotherapy treatments are more effective than others or whether most treatments are equally effective (Wampold, 2001). Though numerous studies have been conducted regarding the efficacy and effectiveness of treatments for personality disorders (PDs), the equality of PD treatments continues to be unknown. …

The current study used grounded theory methods to analyze trans men’s positive emotions. The sample included 11 participants who were assigned a female sex at birth and currently identify with a binary male identity. Results yielded eight positive emotion themes emerging for trans men, which included the following: confidence, comfort, connection, feeling alive, amazement, pride, happiness, and interpersonal reactionary emotions. Participants reported specific gender experiences within these themes, including a sense of brotherhood, excitement related to taking testosterone, authentic pride in identifying as a man, and happiness connected to others using correct gender language (e.g., pronouns, family labels, greetings). A theoretical model from the eight themes and 39 higher order categories emerged, indicating the importance of initial internal emotions, confidence related to trans men’s identity processes, and the ways in which positive interpersonal interactions affect positive emotions. Implications include using emotion-focused therapy and including more positivity into trans individuals’ experiences and emotions.

This research explored identity processes related to mid-life gender transitioning in 13 trans women (assigned male at birth), ages 44–67 years, who lived in the Midwestern United States. Participants completed a semi-structured qualitative interview with questions about transgender identity development and experiences of gender transitioning. Interview transcripts were analyzed using grounded theory methodology. Themes representing cognitive and interpersonal processes differed in salience throughout the gender transitioning process: cognitive processes were more salient earlier and later in the transition, whereas interpersonal experiences were more salient in the middle of transitioning. Results from this study can inform counseling practice by improving cultural competency in counselors through increasing knowledge about how trans women form their gender identities and experience gender transitioning.

Research has just begun to study associations between sexual fluidity and health among cisgender individuals; only one cross-sectional study examined these links among transgender individuals. The goals of the current study were to prospectively examine fluidity in sexual attractions and fluidity in sexual orientation identity, and associations with health-related outcomes. Participants were a community-based sample of 45 transgender men, ages 16-51 years, who had recently begun testosterone, and 95 cisgender individuals (53 women, 42 men), ages 18-55 years, who completed surveys either in-person or via mail. Analyses tested for group differences in sexual fluidity, sociodemographic predictors of sexual fluidity among transgender men, and associations between sexual fluidity and health across the three groups. As hypothesized, transgender men reported more fluidity in sexual attractions and sexual orientation identity than did cisgender individuals. Contrary to our hypotheses, testosterone use was not significantly associated with sexual fluidity, although less education was. As hypothesized, fluidity in sexual orientation identity was associated with more adverse mental health outcomes among transgender men (depression and anxiety) and cisgender women (anxiety and stress), as well as decreased vitality among transgender men and cisgender women, and decreased social functioning among cisgender women. In contrast, fluidity in sexual attractions was only associated with less depression among cisgender women, but was not significantly associated with any other health-related outcomes. This study increases knowledge about sexual fluidity among transgender men and implications for health and can inform clinical work with this population.

Objective: The current study examined the good-enough level (GEL) and dose-effect model on three outcome variables: well-being, symptom distress, and life functioning, while accounting for therapist effects. The dose-effect model assumes the rate of change is consistent across clients, and the GEL model assumes that the rate of change will vary according to the total length of treatment. Method: The sample included 13,664 clients who completed 2–100 sessions of therapy. Results: The GEL model was a better fit to the data compared to the dose-effect model for all outcomes. There were fewer changes in life functioning compared to well-being and symptom distress for clients. There were significant therapist effects for changes in symptom distress and life functioning, but not for the rates of change in well-being. Conclusion: Therapists should consider the rates of change for their own clients as well as by outcome.

This study examined the relationships between social support, coping, depression, and anxiety in a sample of genderqueer individuals (n = 64). Genderqueer is a label used within the broader transgender community and is defined as a gender identity that is outside the binary construct of male and female. Findings indicate that 53% (n = 34) of participants reported clinical levels of depression and 39% (n = 25) reported clinical levels of anxiety. There was a direct relationship between social support and depression and anxiety, indicating that more social support is associated with less depression and anxiety when statistically excluding coping factors. In addition, more facilitative coping (e.g., seeking help) was related to less anxiety, whereas more avoidant coping (e.g., avoiding emotions) was related to more anxiety and depression. There was a significant interaction between social support and coping factors when predicting anxiety, such that individuals who reported higher social support used more fa...

Interpersonal therapy (IPT) is a particularly useful approach to use when working with clients who identify as transgender or gender nonconforming. All transgender individuals will experience changes and adjustment throughout their identity process, often referred to as transitioning. IPT offers specific interventions for psychotherapists to use with clients whose presenting concerns are specifically related to transitions. The current article outlines a case example of a transgender man who is experiencing difficulty with "role transitions" and offers four transgender-specific clinical intervention strategies derived within the traditional IPT framework.

Existing research on trans individuals has primarily focused on their negative experiences and has disproportionately examined coming-out processes and identity development stages. Using a grounded theory approach, this qualitative study sought to examine facilitative coping processes among trans-identified individuals. Facilitative coping was operationalized as processes whereby individuals seek social support, learn new skills, change behaviors to positively adapt, and find alternative means to seek personal growth and acceptance. The sample included 15 participants who self-identified with a gender identity that was different from their assigned sex at birth. Results yielded a total of nine overarching themes: Accepting Support from Others, Actions to Increase Protection, Active Engagement Throughout the Transition Process, Actively Seeking Social Interactions, Engaging in Exploration, Internal Processes Leading to Self-Acceptance, Self-Efficacy, Shifts Leading to Embracing Change and Flexibility, and Utilization of Agency. Based on the analysis, a theoretical model emerged that highlighted the importance of internal and external coping processes in facilitating gender identity development and navigating stressors among trans individuals. Clinical implications focusing on how to implement facilitative coping processes are discussed. (PsycINFO Database Record

This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated Adjusted Risk Ratios (aRR) and 95% Confidence Intervals (95% CI) to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all p’s < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.

Do adolescents model their mothers’ self-objectification? We measured self-objectification (body surveillance and body shame), body mass index, body esteem, and quality of the mother–adolescent relationship in 179 female and 162 male adolescents at age 15, as well as self-objectification in their mothers. Initial analyses indicated no improvement in model fit if paths were allowed to differ for females and males; therefore, a single model was tested for the combined sample. Findings revealed that mothers’ body surveillance negatively predicted adolescents’ body surveillance. Mothers’ body shame was unrelated to adolescents’ body shame but positively predicted adolescents’ body surveillance. Results for the relationship between mothers’ and adolescents’ self-objectification suggest that adolescents engaged in more individuation than modeling. A more positive mother–adolescent relationship predicted lower body shame and higher body esteem in adolescents, suggesting that the quality of the relationship with the mother may be a protective factor for adolescents’ body image. Mother–adolescent relationship quality did not moderate the association between mothers’ and adolescents’ self-objectification. These findings contribute to our understanding about the sociocultural role of parents in adolescents’ body image and inform interventions addressing negative body image in this age group. The quality of the mother–adolescent relationship is a clear point of entry for such interventions. Therapists should work with adolescents and their mothers toward a more positive relationship quality, which could then positively impact adolescents’ body image.

Eighteen transgender-identified individuals participated in semi-structured interviews regarding emotional and coping processes throughout their gender transition. The authors used grounded theory to conceptualize and analyze the data. There were three distinct phases through which the participants described emotional and coping experiences: (a) pretransition, (b) during the transition, and (c) posttransition. Five separate themes emerged, including descriptions of coping mechanisms, emotional hardship, lack of support, positive social support, and affirmative emotional experiences. The authors developed a model to describe the role of coping mechanisms and support experienced throughout the transition process. As participants continued through their transitions, emotional hardships lessened and they used facilitative coping mechanisms that in turn led to affirmative emotional experiences. The results of this study are indicative of the importance of guiding transgender individuals through facilitative coping experiences and providing social support throughout the transition process. Implications for counselors and for future research are discussed.

Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers concerning their Latino patients, in particular issues affecting their patients’ access to and utilization of services. Interviews were conducted with eight primary care providers and analyzed using consensual qualitative research methods. In addition, observations were conducted of the primary care setting to contextualize providers’ perspectives. Providers indicated that care for Latinos was affected by several domains: (a) practical/instrumental factors that influence access to care; (b) cultural and personal factors that shape patients’ presentations and views about physical and mental health and treatment practices; (c) provider cultural competence; and (d) institutional factors that highlight the context of care. In addition to recommendations for research and practice, the need for interdisciplinary collaboration between psychology and medicine in reducing ethnic minority disparities was proposed.

This study explored the work experiences of individuals who have started transitioning from their biological sex to a different gender expression through 18 interviews of transgender-identified individuals. Thirteen of the participants identified as male-to-female transsexuals, 2 participants identified as female-to-male transsexuals, 2 participants identified as female-bodied gender queer individuals, and 1 participant identified as a biological male cross-dresser. Using a grounded theory (K. Charmaz, 2006) approach, 2 separate work experience models emerged: (a) the process of gender transitioning at work and (b) the career decision-making process. The 3 phases of the first model included a pretransition phase, during the transition phase, and posttransition phase. Within these 3 phases, the following 5 major themes emerged: preparation for the work transition, coming out at work, presentation and appearance at work, others’ reactions at work, and affective/coping experiences related to work. The second model resulted in 6 major themes related to career decision making: occupational barriers, occupational prospects, occupational aspirations, taking action, occupational gratification, and contextual influences.

This study examines the academic and career goals set by urban youth as well as their perceived career barriers and the strategies they anticipate using to face these barriers. Nine adolescents in the 11th and 12th grades from two large, urban public schools in the Midwest were interviewed for this study. Students’ responses were analyzed using the consensual qualitative research method developed by Hill and colleagues. Seven domains were identified in participant responses, addressing participant ideas about both ideal and alternate career choices, the influences on their career choices, potential obstacles in their future, and methods for managing obstacles. Categories and subcategories are described and discussed and implications for practice and future research are offered.

Allegiance effects have been discussed, debated, and tested over the past several decades. The evidence clearly shows that allegiance affects the findings and representation of therapies that are considered efficacious. We argue that allegiance effects are evident in randomized controlled trials of supportive therapy. Supportive therapy is an established and bona-fide therapy but its implementation as a control group for non-specific elements is a treatment that does not resemble supportive therapy as would be used therapeutically. Allegiance effects in the use of supportive therapy are caused by the design of supportive therapy controls, the therapists who deliver supportive therapy, and the patients who are enrolled in the trials.

Using a sample of 174 inner-city urban high school students, this study examined the degree to which family and peer support would moderate the negative impact of exposure to violence on academic performance, symptoms of distress, and persistence intentions. Over 94% of the students reported having been exposed to at least one form of community violence at some point in their lives. Using hierarchical linear regression, the results indicated that family support provided a protective-stabilizing moderating effect between exposure to violence and symptoms of distress. Peer support was found to have a protective-stabilizing moderating effect between exposure to violence and persistence intentions. Although exposure to violence and persistence intentions were both related to grade point average, family and peer support were not found to moderate the impact of violence exposure and grades. © 2009 Wiley Periodicals, Inc.

The Behavioral Health Measure-20 (BHM-20; Kopta & Lowry, 2002) through the computer-based CelestHealth System-MH (CHS-MH) has proven to be an effective and efficient instrument for assessing psychotherapy outcomes and providing feedback to psychotherapists. This article describes its features, the psychometric and research support of the measure, as well as its use in clinical training and practice. Additionally, we offer some hopes and possibilities for the future of clinical feedback systems.

Research on mentoring in higher education is increasingly widespread. This article aims to provide insight into different kinds of mentoring programs and the research conducted to determine the eff...

As tension continues to exist between those who endorse contextual versus medical explanations for the efficacy of psychotherapy, it remains undetermined how psychotherapy works. One of the primary purposes of this chapter is to provide a rationale on evolved social and relational characteristics for the efficacy of psychotherapy. In conjunction with an evolutionary explanation for why psychotherapy is effective, we provide compelling evidence that there is a neurological and social context for three separate pathways—which we call the tripartite model of the relationship. The first path includes the real relationship between the patient and the therapist. The second path is comprised of expectations that are maintained and generated via cogent rationales and treatments. The third path consists of the benefits of healthy actions and how specific ingredients contribute to these behaviors.

Objective The purpose of Study 1 was to examine the relative efficacy of evidence-based treatments (EBTs) when compared to treatment-as-usual (TAU) for adults diagnosed with a personality disorder (PD). The purpose of Study 2 was to investigate the strength of the differences between bona fide psychotherapeutic treatments for PDs. Method Two separate computerized searches were conducted of: (a) studies that directly compared an EBT with a TAU for treatment of PDs, or (b) studies that compared at least two bona fide treatments for PDs. Meta-analytic methods were used to estimate the effectiveness of the treatments when compared to one another and to model how various confounding variables impacted the results of this comparative research. Results A total of 30 studies (Study 1; N = 1662) were included in the meta-analysis comparing EBTs to TAU. A total of 12 studies (Study 2; N = 723) were included in the meta-analysis comparing bona fide treatments. Study 1 found that EBTs were superior to TAU, although the TAU conditions were not comparable in many respects (e.g., not psychotherapy, lacking supervision, lacking training, etc.) to the EBT and there was significant heterogeneity in the effects. Study 2 found that some bona fide treatments were superior to others.

Objective The purpose of the current study was to examine facilitative and avoidant coping as mediators between distress and transition status, social support, and loss. Method A total of 351 transgender individuals (n = 226 transgender women and n = 125 transgender men) participated in this study. Participants completed measures on transgender identity, family history of mental health concerns, perceptions of loss, coping, depression, and anxiety. Results The rates of depressive symptoms (51.4% for transgender women; 48.3% for transgender men) and anxiety (40.4% for transgender women; 47.5% for transgender men) within the current study far surpass the rates of those for the general population. Structural equation modeling (SEM) was used to analyze the data-2 separate models were hypothesized, based on reports of anxiety or depression. The SEM results suggest that the processes for transgender women and transgender men are primarily similar for depression and anxiety; avoidant coping served as a mediator between transition status and both distress variables. Social support was directly related to distress variables, as well as indirectly related through avoidant coping. Conclusion Results suggest the need for practitioners to focus on interventions that reduce avoidant coping strategies, while simultaneously increasing social support, in order to improve mental health for transgender individuals. Individuals who are in the beginning stages of their transition will use different coping strategies than those who are in later stages; interventions should be adjusted on the basis of the transition status of transgender clients.

This study investigated psychotherapy trainees' ability to facilitate change in outcomes (e.g., well-being, symptom reduction, and life functioning) specifically related to the phase model. Four different psychotherapist experience levels (beginning practicum, advanced practicum, intern/postdoc, and psychologist) were compared to determine whether there are training differences related to significant change for psychotherapy outcomes according to the phase model. A total of 1,318 clients from a university counseling center, treated by 64 psychotherapists, were included in the analysis for this study. Results indicate that interns/postdocs' clients achieve more significant change than psychologists' and advanced practicum students' clients related to life functioning. In addition, interns/postdocs' clients achieve more significant change related to symptom reduction, when compared with the clients of psychologists. Implications for these results, given the hypotheses of both the phase model and competency models, are discussed.

Sexual pressure can have detrimental effects to individuals both physically and emotionally; however, research in this area is lacking regarding the experiences by lesbian, gay, bisexual, queer, and questioning (LGBQ) women. This online study qualitatively examined sexual pressure experienced and explained by LGBQ women (n = 50) using grounded theory methodology. Participants responded to open-ended questions by providing perspectives from both those who were on the receiving end of the sexual pressure (recipients) and from those who pressured their partners (initiators). Results indicated that there were eight overarching themes, 43 higher order categories, and 241 line-by-line codes. The eight overarching themes included: Reasons to Not Want Sex, Reasons for Pressuring, Reasons for Giving In, Actions of Initiators, Expectations, Communication, Negative Outcomes, and Positive Reactions. Negative Outcomes was the most common theme endorsed. Several higher order categories indicated the unique experiences of sexual minority women, namely trying to be “normal” (e.g., engaging in sexual acts as a result of internalized homophobia), experiencing more pressure from men, and self-consciousness (specifically related to lack of knowledge about sex with women). Implications for the current study include the importance of addressing sexual pressure with sexual minority women and creating interventions, such as assertiveness training and communication skills, that could assist both recipients and initiators with engaging in mutually satisfactory sexual practices.

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

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