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

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

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

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

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

The use of routine outcome monitoring (ROM) has been shown to improve treatment outcomes, reduce symptom deterioration and treatment dropout, and is especially relevant for training clinics. However, the use of ROM in a psychodynamic training clinic has remained relatively unexplored. We aimed to instigate an open dialogue about the use and usefulness of ROM within the context of contemporary psychodynamic clinical practice. As a graduate trainee and professor in a psychodynamic training program, we reflect on the seemingly irreconcilable differences between psychoanalytic thinking and ROM, the anxiety around being evaluated as a trainee, whom ROM is for, the pragmatic challenges when trying new tools and technology (especially when not chosen yourself), and the limitations of standardized self-report measures, such as the OQ. Overall, these complexities suggest that although ROM is likely worthwhile for patients, therapists, supervisors, and researchers, it will only come to its fruition if we integrate it into the tri-legged stool of evidence-based practice. We will need to engage in a genuine discussion about the use of ROM and consider the possibility that ROM might even improve our psychodynamic practices. Integrating ROM into psychodynamic didactic courses and supervision in graduate training could be a good starting point. [ABSTRACT FROM AUTHOR]

Objective. During the COVID-19 pandemic, the use of teletherapy became mandatory for most therapists. Many therapists who had previously felt reluctant to try teletherapy ultimately transitioned to teletherapy with little experience or training. We qualitatively examined therapists’ subjective experiences of providing teletherapy, particularly regarding their future plans and advice for colleagues who will be using teletherapy.Methods. A total of 31 psychotherapists participated in semi-structured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method. Results. Within the overarching domain Plans for after the pandemic, we identified five main categories: 1) For whom and when teletherapy is helpful; 2) Therapists’ future practice plans; 3) Therapists’ attitudes towards teletherapy; 4) Helpful professional support, and 5) Helpful to keep in mind when starting. Many therapists found teletherapy more acceptable than they expected and discovered that it was surprisingly useful for patients. Therapists highlighted the importance of professional peer support in tackling teletherapy’s technical, legal, and therapeutic challenges. Conclusion. Overall, these results suggest great variability in therapists’ subjective experiences with teletherapy during this time of forced transition. Although for some, teletherapy remains a second-best option, many now prefer hybrid treatment options for optimal flexibility. [ABSTRACT FROM AUTHOR]

During the early months of the COVID-19 pandemic, patients in individual psychotherapy needed to suddenly transition to telepsychotherapy (TPT), and for many patients it was their first experience of remote treatment. Since TPT appears to be here to stay after the pandemic ends, it is crucial to understand which factors determine whether TPT is a good fit for patients. We aimed to examine patients' relational predictors, both trait- (attachment avoidance and attachment anxiety) and state-like (working alliance, real relationship) of patients' attitudes towards TPT, and the potential mediating role of state-like relational variables between trait-like variables and attitudes. We used a longitudinal design, where patients (N = 719) who were in individual TPT participated in an online survey at the beginning of the pandemic and at follow-up three months later. Patients completed measures of symptom severity, Covid-related distress, attachment anxiety and avoidance, perceived quality of the therapeutic relationship (working alliance and real relationship), and attitude towards TPT. Results suggested that higher levels of attachment avoidance predicted more negative attitudes towards TPT, and that patient-reported quality of the real relationship in their TPT sessions mediated this negative relationship between attachment avoidance and attitudes towards TPT. Patient's attachment avoidance and the real relationship are important predictors of patients' attitudes towards TPT, and could indicate suitability of the TPT format, as well as inform clinicians' efforts in building a real and genuine connection with their patients online. [ABSTRACT FROM AUTHOR]

Pre-practicum training in professional psychology to close the research-practice gap: Changing attitudes toward evidence-based practice. Most notable for the field of psychotherapy training is the degree of change in attitudes toward PDT among students who began the course with a primarily CBT orientation, who reported the largest shift in attitudes toward PDT. Keywords: evidence-based; psychodynamic; graduate training; attitude change EN evidence-based psychodynamic graduate training attitude change 311 316 6 06/30/23 20230401 NES 230401 The past four decades have seen a consistent move toward evidence-based clinical practices (EBPs). Although the content and format of the evidence-based PDT courses were similar, it is important to mention that the course taught within the School-Clinical Child Program emphasized treatments for children and adolescents, as might be expected, whereas the course taught within the Clinical Psychology Program emphasized treatments for adults. [Extracted from the article]