Search

Ann-Christin Pfeifer,1,2 Juan Martin Gómez Penedo,3 Johannes C Ehrenthal,2 Eva Neubauer,1 Dorothee Amelung,4 Corinna Schroeter,1 Marcus Schiltenwolf1 1Department of Orthopedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany; 2Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany; 3CONICET and Universidad de Buenos Aires, Buenos Aires, Argentina; 4School of Health Sciences, University of Surrey, Guildford, UK Background: Insecure attachment patterns are related to the onset and development of chronic pain. However, it is less documented on how short- and long-term effects of pain therapy might differ with the attachment style in interaction with specific pain conditions. We therefore examined how two different groups of chronic pain patients differ in their treatment trajectories and in regard to attachment.Method: N=85/76/67 (T1/T2/T3) patients with medically unexplained musculoskeletal pain (UMP group) were compared to n=89/76/56 patients with joint pain from osteoarthritis (OA group), using multilevel modeling. UMP patients received a multimodal pain program, and OA patients received surgery. Pain intensity before (T1) and after (T2) treatment and at a 6 months follow-up (T3) was assessed by using a visual analog scale of pain.Results: Pain patients report a significant reduction in pain intensity upon the completion of the treatment compared to T1. Over the next 6 months, the pain intensity has further declined for patients with low attachment anxiety. In contrast, patients with highly anxious attachment report an increase in pain intensity. This main effect of anxious attachment on pain is significant when predicting changes both in acute treatment and during follow-up while controlling for group effect. In addition, there is also an interactive effect of group by avoidant attachment. In the UMP group, high scores in avoidant attachment were associated with the lower reduction in pain severity, while in the OA group, high scores in attachment avoidance were associated with a steeper reduction in pain severity.Conclusion: The results indicate that insecurely attached patients with pain symptoms only benefit from a multimodal pain therapy in limited ways in regard to posttreatment trajectories. Maintaining positive results over a period of 6 months is a challenge, compared with securely attached patients.Significance: The results of this study suggest the importance of direct and indirect mechanisms of attachment and its relevance for the management of pain experiences. Therefore, to include the individual attachment patterns in the treatment may be a promising way to enhance the treatment prospects.Keywords: attachment theory, chronic pain, multimodal treatment

Psychotherapy is an interpersonal process of collaboration toward specified treatment goals. The therapeutic alliance is well established as an important factor of psychotherapeutic change. However, the experience of distress in social interactions, commonly referred to as interpersonal problems, might be interfering with the collaborative process during psychotherapy. This study systematically reviews the literature and obtains an estimate of the relationship between pretreatment interpersonal problems and the quality of the therapeutic alliance. Overall, 27 studies with 48 correlation coefficients were included in the final analysis. Due to the nested structure of the data, a three-level meta-analytic approach with a restricted maximum likelihood estimator was applied. Alliance assessment phase, alliance rater, alliance measure instrument, and treatment type were tested as potential moderators. Heterogeneity and publication bias test were performed. The meta-analysis showed a small, but significant negative relationship between interpersonal problems at the beginning of psychotherapy and subsequent therapeutic alliance ( r = -.12, SE = .02, 95% CI [-.16, -.08], p < .001, d = -.27). Only alliance assessment phase accounted for significant variability. There were no indications for a substantial publication bias. Interpersonal problems of patients before psychotherapy are a robust predictor for lower therapeutic alliance quality, albeit a small effect size. Consequently, patients who experience interpersonal problems may face greater challenges in developing a strong alliance with their therapists, especially in early stages of the treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

In the last two decades, several working groups in the international psychoanalytic community have been interested in the development of systematic tools for psychodynamic diagnosis, case formulation and treatment planning. Such psychodynamic diagnostic manuals are efforts to systematically integrate an enormous and rich amount of historically partialized and dispersed information, but which constitute the substantial contribution of psychoanalysis to the field of mental health. The aim of the present article is to provide an updated review on this kind of systematic tools for diagnosis, case formulation and therapeutic planning, designed for the field of psychodynamic approaches. To this end, we describe the aims and structure of: 1) the Psychodynamic Diagnostic Manual 2 (PDM-2), 2) the Operationalized Psychodynamic Diagnosis (OPD-2/OPD-3) and 3) the Operationalized Psychodynamic Diagnosis for Children and adolescents 2 (OPD-CA-2). The contributions of these current tools to clinical practice and empirical research are discussed, as well as the need to disseminate these types of instruments in our regional context., (CC BY NC ND)

Ecological momentary assessment (EMA) allows measuring intra-individual processes moment by moment, identifying and modeling, in a naturalistic way, individual levels and changes in different psychological processes. However, active EMA requires a high degree of adherence, as it implies a significant burden for patients. Moreover, there is still no consensus on standardized procedures for implementation. There have been few results in detecting desirable characteristics for the design and implementation of an EMA device. Studies that address these issues from the perspectives of participants in psychotherapeutic processes are needed. To analyze the perspectives of patients, therapists and supervisors on the implementation of an EMA device in a psychotherapeutic treatment for depression. The sample will include eight patients, eleven therapists and five supervisors, taken from a research project that implemented an EMA system for monitoring the dynamics of affectivity at the beginning of psychotherapies for depression. Semi-structured interviews specific to each group are being conducted and analyzed from a qualitative approach based on consensual qualitative research (CQR). Participants reported having a positive evaluation of the study's informational resources and implementation. Difficulties were expressed in responding in the morning hours and the importance of having a customized EMA that is tailored to the needs of the patients was expressed. Furthermore, patients and therapists agreed that the impact of the use of the monitoring system on treatment was neutral or positive. In contrast, patients considered the EMA to be positive for their daily life., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet., Objective: This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA., Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science., Results: A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics., Conclusions: AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder., (©Javier Fernández-Álvarez, Desirée Colombo, Juan Martín Gómez Penedo, Maitena Pierantonelli, Rosa María Baños, Cristina Botella. Originally published in JMIR Mental Health (https://mental.jmir.org), 04.04.2024.)

As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively., (© 2023. The Author(s).)

Objective: During treatment, the therapeutic alliance is characterized by rupture and repair episodes, which in turn are associated with psychotherapy outcome. It would be important to have a parsimonious tool to identify ruptures in psychotherapy sessions to provide therapists with meaningful feedback about when they occur. The present study thus aims to establish whether measuring self-reported alliance dynamics can function as a measure of alliance ruptures., Method: The sample consisted of 58 depressed patients, who received 22 sessions of cognitive therapy for depression in an outpatient setting. The observer-rated Rupture Resolution Rating System (3RS) was applied to 58 sessions where the self-reported Working Alliance Inventory (WAI) completed by patients after each therapy session indicated that alliance ratings declined more than 2 SDs from that patient's individual mean. For comparison purposes, the 3RS was also applied to 58 randomly chosen sessions from the same treatment phase (early, middle, late)., Results: Results showed significant differences between sessions where the WAI indicated a drop in the alliance and randomly chosen sessions of the same treatment phase with regard to the frequency and impact of ruptures., Conclusion: This speaks for the construct validity of the 3RS. Session-by-session alliance ruptures may reliably be measured using a case-sensitive approach to identify meaningful drops in alliance self-report (WAI). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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

Objectives: The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA., Methods: The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q)., Results: Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients)., Conclusion: We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children., (© 2023 Wiley Periodicals LLC.)

This study aimed to develop and test algorithms to determine the individual relevance of two psychotherapeutic change processes (i.e., mastery and clarification) for outcome prediction. We measured process and outcome variables in a naturalistic outpatient sample treated with an integrative treatment for a variety of diagnoses ( n = 608) during the first 10 sessions. We estimated individual within-patient effects of each therapist-evaluated process of change on patient-evaluated subsequent outcomes on a session-by-session basis. Using patients' baseline characteristics, we trained machine learning algorithms on a randomly selected subsample ( n = 407) to predict the effects of patients' process variables on outcome. We subsequently tested the predictive capacity of the best algorithm for each process on a holdout subsample ( n = 201). We found significant within-patient effects of therapist perceived mastery and clarification on subsequent outcome. In the holdout subsample, the best-performing algorithms resulted in significant but small-to-medium correlations between the predicted and observed relevance of therapist perceived mastery ( r = .18) and clarification ( r = .16). Using the algorithms to create criteria for individual recommendations, in the holdout sample, we identified patients for whom mastery (14%) or clarification (18%) were indicated. In the mastery-indicated group, a greater focus on mastery was moderately associated with better outcome ( r = .33, d = .70), while in the clarification-indicated group, the focus was not related to outcome ( r = -.05, d = .10). Results support the feasibility of performing individual predictions regarding mastery process relevance that can be useful for therapist feedback and treatment recommendations. However, results will need to be replicated with prospective experimental designs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Although interpersonal problems are assumed to play an important role in the treatment of depression and anxiety, meta-analytic attempts to explore the association between interpersonal problems and outcome in psychotherapy for these patients are missing. This study aims to conduct a systematic review and meta-analytic synthesis of the association between patients' baseline interpersonal problems and outcome in psychotherapy for depressive and anxiety disorders., Method: We conducted a three-level meta-analysis (i.e., disaggregating sampling variance, within-study variance, and between-study variance) of the interpersonal problems-outcome prediction (IPOP; as measured by the total distress factor of Inventory of Interpersonal Problems)., Results: We found 40 effect sizes (ESs) nested within 21 primary studies. The three-level model showed a significant aggregated effect size of IPOP, r = -.13, SE = 0.02, 95% CI [-.18, -.09]; t (39) = -5.71, p < .001; d = -0.27, with greater interpersonal distress being associated with worse psychotherapy outcome. Results showed significant heterogeneity across effect sizes with considerable variability across studies ( I ² = .39) and to a lower extent across reported outcomes ( I ² = .19). Graphical measures did not show evidence of a substantial publication bias., Conclusions: This meta-analysis showed that baseline overall interpersonal problems are a small but robust negative predictor of psychotherapy outcome. Therapists might benefit from exploring patients' interpersonal problems at the beginning of therapy to enhance their prognostic inferences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: In process-outcome research, there is a growing body of literature investigating the therapeutic mechanisms underlying the promotion of positive change. This study investigated the between- and within-patient effects of problem mastery and motivational clarification on outcome in patients receiving two variations of cognitive therapies for depression., Methods: This study drew on data of a randomized controlled trial conducted at an outpatient clinic and included 140 patients randomly assigned to 22 sessions of either cognitive-behavioral therapy or exposure-based cognitive therapy. To address the nested structure of the data and analyze mechanism effects, we used multilevel dynamic structural equations models., Results: We found significant within-patient effects of both problem mastery and motivational clarification on subsequent outcome., Conclusion: The results suggest that changes in problem mastery and motivational clarification precede symptom improvement during cognitive therapy for depressed patients and thus there may be benefit in fostering these putative mechanisms during psychotherapy., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Aim: The therapeutic alliance is a robust predictor of treatment outcome. However, little is known about the way alliance negotiation contributes to psychotherapy outcome. The aim of the present study was to analyze the effects of alliance negotiation on treatment outcome in the first four sessions of psychotherapy., Methods: Ninety-six patients diagnosed with emotional disorders received weekly Solution-Focused Brief Therapy. Each patient completed both the Alliance Negotiation Scale (ANS) and the Outcome Questionnaire 45 (OQ.45) after each of the first four sessions. Both between- and within-patients effects of alliance negotiation on symptom severity were analyzed using Hierarchical Linear Models., Results: Results showed significant between and within patient effects of alliance negotiation on symptom severity. Patients with higher levels of alliance negotiation across treatment showed lower levels of symptom severity (between-patient effect). Also, in a session with higher alliance negotiation compared to the average session of this patient, symptom severity was lower than in the average session (within-patient effect)., Discussion: The results indicate that therapies characterized by higher alliance negotiation and sessions with higher alliance negotiation are beneficial for early outcome., Conclusion: From a clinical point of view, the results suggest that alliance negotiation is a meaningful factor for therapy outcome and that therapists may benefit from training and monitoring alliance negotiation during the early stages of treatment., (© 2023 The Authors. Journal of Clinical Psychology published by Wiley Periodicals Inc.)

Objective: Given the increasing incidence and prevalence of chronic pain, effective treatments for chronic pain are needed. This study aimed to investigate the role of cognitive and behavioral pain coping regarding the prediction of treatment outcomes among inpatients with chronic primary pain participating in an interdisciplinary multimodal treatment program., Methods: At intake and discharge, 500 patients with chronic primary pain completed questionnaires on pain intensity, pain interference, psychological distress, and pain processing., Results: Patients' symptoms, cognitive and behavioral pain coping improved significantly after treatment. Similarly, separate cognitive and behaviroal coping skills improved significantly after treatment. Hierarchical linear models revealed no significant associations of pain coping with reductions in pain intensity. Whereas the overall level and improvements in cognitive pain coping predicted reductions in pain interference and psychological distress, the overall level and improvements in behavioral pain coping were associated with reductions in pain interference alone., Discussion: Since pain coping seems to influence both pain interference and psychological distress, improving cognitive and behavioral pain coping during an interdisciplinary multimodal pain treatment seems to be a key component in the successful treatment of inpatients with chronic primary pain, enabling them to function better physically and mentally despite their chronic pain. Clinically, it might be worth fostering and exercising cognitive restructuring as well as action planning in treatment to reduce both pain interference and psychological distress levels post-treatment. In addition, practicing relaxation techniques might help reduce pain interference post-treatment, whereas making experiences of personal competence might help reduce psychological distress post-treatment., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Routine Outcome Monitoring (ROM) has emerged as a strong candidate to improve psychotherapy processes and outcome. However, its use and implementation are greatly understudied in Latin-America. Therefore, the aim of the present pilot study conducted in Argentina was to implement a ROM and feedback system grounded on a psychometrically sound instrument to measure session by session outcome in psychotherapy., Methods: The sample consisted of 40 patients and 13 therapists. At baseline, the patients completed the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, and they also completed the Hopkins Symptom Checklist-11 before each of the first five sessions. To estimate patient change during the first sessions, we conducted a quantitative analysis using Hierarchical Linear Models. Furthermore, we conducted a qualitative analysis using Consensual Qualitative Research to analyze therapist perception regarding the ROM and feedback system., Results: Results showed a significant reduction in patients' symptomatic severity during the first five sessions. Additionally, baseline depression significantly predicted the estimated severity at the end of the fifth session. Feedback was given to the therapists after the first four sessions based on these analyses. With regard to the perception of the feedback system, clinicians underlined its usefulness and user-friendly nature. They also mentioned that there was a match between the information provided and their clinical judgment. Furthermore, they provided suggestions to enhance the system that was incorporated in a new and improved version., Discussion: Limitations and clinical implications are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gómez-Penedo, Manubens, Areas, Fernández-Álvarez, Meglio, Babl, Juan, Ronchi, Muiños, Roussos, Lutz and grosse Holtforth.)

Objective: Histrionic personality disorder (HPD) with a lifetime prevalence rate of 1.8% is an under-researched psychiatric diagnosis. The present study therefore aimed to investigate both the processes and outcomes of psychotherapy for HPD in a non-controlled study., Methods: A total of 159 patients diagnosed with HPD were recruited and received clarification-oriented psychotherapy. Sessions 15, 20, and 25 were video-recorded and analysed using the Process-Content-Relationship Scale. Therapy outcome was assessed with symptom measures at intake and discharge. Hierarchical linear modelling was applied to estimate the changes in the psychotherapeutic outcome and associations with patient and therapist process developments., Results: Improvements in relationship processes of patients and therapists were systematically related to outcome while only partial relationships were found on the levels of process and content., Conclusion: The present study represents the first systematic insight into core changes in patients with HPD undergoing psychotherapy., (© 2022 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Objective: This study explores in cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) to what degree therapists' perceptions of their patients as interpersonally challenging (IC) is explained by the therapist or patient effects, if baseline patients' characteristics predict IC, and if IC is related to outcome., Method: Eighty patients diagnosed with GAD and treated by 20 therapists with 16 sessions of CBT were randomized to two different implementation conditions. Patients completed baseline measures of depression, anxiety, interpersonal problems, and interpersonal strengths. The therapists completed a single-item assessing IC session-by-session. As an outcome, patients completed a worry measure at baseline, session 5, session 10, and posttreatment., Results: Multilevel models showed meaningful therapist effects, explaining 18% of IC variance. Interpersonal strengths were the only baseline predictor significantly and negatively associated with IC during treatment. Structural equation models showed significant negative IC effects on subsequent patient worry during therapy., Conclusions: IC might represent a risk factor for psychotherapy outcome. Patient interpersonal strengths at baseline may buffer therapists perceiving their patients as ICs. The therapist effects on IC suggest that CBT clinicians treating GAD might benefit from identifying cases that are interpersonally challenging for them and reflecting about what might trigger that perception.

The therapeutic alliance is considered a robust predictor of psychotherapy outcome. Ruptures and resolutions in the alliance have been the focus of recent alliance literature. Most previous studies investigated their between-patient effects. We used hierarchical linear models to disaggregate the between- and within-patient effects of ruptures on the alliance from patient- and therapist perspective and symptom severity. Further, the moderating effects of rupture resolutions were analyzed. The sample consisted of 56 patients diagnosed with depressive or anxiety disorders who received 25 ± 3 sessions of integrative cognitive behavioral therapy in the outpatient setting. The observer-rated rupture resolution rating system was applied to all 1st, 8th, 16th and 24th therapy sessions. The alliance quality and symptom severity were assessed using self-report questionnaires after these four sessions. Results showed that a higher intensity of ruptures across treatment was associated with lower alliance ratings from both patient- and therapist perspectives during treatment. After sessions with more intense confrontation ruptures, both reported a weaker alliance. Rupture resolutions significantly moderated the withdrawal rupture effect on the alliance. The results provide meaningful practical implications for therapist feedback and training. They further underline the importance of using appropriate statistical analyses to the data structure and nature of psychotherapy to better understand the role of the alliance, rupture, and repair during therapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective Many patients with personality disorders (PDs) present with problematic interaction patterns. These may also manifest in the therapeutic relationship. For successful treatment, therapists must therefore find effective ways to address such problematic interaction patterns. Methods: A total of 382 patients with PDs were recruited within a naturalistic setting and received integrative cognitive-behavioral therapy (CBT). Two subscales of the observer-rated Process-Content-Relationship Scale were applied to sessions 15, 20, and 25 of treatment: one on patient interaction patterns and the other on therapist addressing these. Symptom severity was assessed at intake and discharge. Mediation analysis was applied. Results: We found significant main effects of (1) therapists' addressing problematic interaction patterns in session 15 on patients' changes in such patterns from session 15 to 25 and (2) patients' changes in problematic interaction patterns on symptom severity at treatment termination. Further, the effect of therapists' addressing problematic interaction patterns on outcome was mediated by changes in patients' interaction patterns. Conclusion: The results indicate that therapists' addressing of PD patients' problematic interaction patterns may be particularly important to improve such patterns and thereby treatment outcome. Future research should identify in which patients the mechanism of addressing interaction patterns works best.

Background: Despite that pediatric COVID-19 is usually asymptomatic or mild, SARS-CoV-2 infection typically results in the development of an antibody response. Contradictory observations have been reported when the antibody response of children and adults were compared in terms of strength, specificity and perdurability., Methods: This observational study includes three cohorts infected with SARS-CoV-2 between March 2020-July 2021: unvaccinated infected children (n=115), unvaccinated infected adults (n=62), and vaccinated infected children (n=76). Plasma anti-spike IgG antibodies and neutralising activity against Wuhan, Delta and Omicron variants after 7-17 months post-infection were analysed., Findings: More than 95% of unvaccinated infected children and adults remained seropositive when evaluated at 382-491 and 386-420 days after infection, respectively. Anti-spike IgG titers and plasma neutralising activity against Wuhan, Delta and Omicron variants were higher in children compared to adults. No differences were found when unvaccinated infected children were stratified by age, gender or presence/absence of symptoms in the acute phase of SARS-CoV-2 infection, but a slight decrease in the antibody response was observed in those with comorbidities. Vaccination of previously infected children with two doses of the inactivated BBIBP-CorV or the mRNA vaccines, BNT162b2 and/or mRNA-1273, further increased anti-spike IgG titers and neutralising activity against Wuhan, Delta and Omicron variants., Interpretation: Unvaccinated infected children mount a more potent and sustained antibody response compared with adults, which is significantly increased after vaccination. Further studies including not only the analysis of the immune response but also the effectiveness to prevent reinfections by the different Omicron lineages are required to optimise vaccination strategy in children., Funding: National Agency for Scientific and Technological Promotion from Argentina (PICTO-COVID-SECUELAS-00007 and PMO-BID-PICT2018-2548)., Competing Interests: Declaration of interests The authors have nothing to disclose., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: This meta-analysis examined the relative efficacy of bona fide psychotherapy conditions in generalized anxiety disorder (GAD) from posttreatment to follow-up in adults., Methods: Omnibus tests of relative efficacy across bona fide psychotherapies for primary and secondary outcomes were conducted. Longitudinal multilevel subgroup analyses investigated, (a) applied relaxation versus cognitive behavioral therapy (CBT) without applied relaxation and (b) well-established CBT versus augmented integrative CBT., Results: In total, 54 repeated effect sizes nested in 23 studies were included in this meta-analysis. Omnibus test of relative efficacy indicated no significant differences among the bona fide psychotherapy contrasts in primary and some differences in secondary outcomes. When contrasting applied relaxation with CBT without applied relaxation, negligible relative efficacy differences were found at each assessment time. There were small efficacy differences in favor of augmented integrative CBT in comparison to well-established CBT., Conclusion: Small relative efficacy differences were found between bona fide psychotherapies in GAD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: We aimed to develop and test an algorithm for individual patient predictions of problem coping experiences (PCE) (i.e., patients' understanding and ability to deal with their problems) effects in cognitive-behavioral therapy. Method: In an outpatient sample with a variety of diagnoses ( n =1010), we conducted Dynamic Structural Equation Modelling to estimate within-patient cross-lagged PCE effects on outcome during the first ten sessions. In a randomly selected training sample (2/3 of the cases), we tried different machine learning algorithms (i.e., ridge regression, LASSO, elastic net, and random forest) to predict PCE effects (i.e., the degree to which PCE was a time-lagged predictor of symptoms), using baseline demographic, diagnostic, and clinically-relevant patient features. Then, we validated the best algorithm on a test sample (1/3 of the cases)., Results: The random forest algorithm performed best, explaining 14.7% of PCE effects variance in the training set. The results remained stable in the test set, explaining 15.4% of PCE effects variance., Conclusions: The results show the suitability to perform individual predictions of process effects, based on patients' initial information. If the results are replicated, the algorithm might have the potential to be implemented in clinical practice by integrating it into monitoring and therapist feedback systems.

Objective: This study aimed to investigate the effects of changes in interpersonal cognitions on outcome during cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) and how these effects are moderated by patients' interpersonal problems at intake., Method: A sample of 80 adult patients diagnosed with GAD who were undergoing CBT within a randomized controlled trial completed a questionnaire concerning interpersonal problems at baseline as well as measures of changes in interpersonal and self-related cognitions and in worry severity session by session. We conducted dynamic structural equation modeling to estimate cross-lagged within-patient effects of changes in interpersonal cognitions on worry, adjusting for the effects of self-related cognitions. Furthermore, we included interpersonal problems as a moderator of the effects of changes in interpersonal cognitions., Results: We found significant cross-lagged effects of changes in both interpersonal cognitions and self-related cognitions on subsequent worry levels. Greater changes in interpersonal cognitions and self-related cognitions in a given session were associated with lower worry levels at the beginning of the next session. When adjusting for self-related cognitions, the effects of changes in interpersonal cognitions on subsequent worry remained significant. However, there were no interactive effects of changes in interpersonal cognitions by patients' interpersonal problems on worry severity., Conclusions: The results present evidence supporting changes in interpersonal cognitions and self-related cognitions as relevant change mechanisms in CBT for GAD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This study analyzed patient-therapist in-session interpersonal complementarity effects on the therapeutic alliance and depression severity during the initial and working phase of cognitive-behavioral therapy for depression. It also explored whether patients' interpersonal problems moderate those complementarity effects. We drew on a sample of 90 dyads derived from a randomized controlled trial of two cognitive-behavioral therapies for depression. Using an observer-based measure, we assessed patients' and therapists' interpersonal behavior in Sessions 1, 5, 9, and 13 and computed their complementarity regarding interpersonal affiliation (i.e., correspondence) and dominance (i.e., reciprocity). Patients completed measures of interpersonal problems at baseline and session-by-session measures of depression severity and quality of the therapeutic alliance. Response surface analyses based on polynomial regressions showed that patient-therapist complementarity in higher affiliative behaviors was associated with a stronger alliance. Interpersonal problems regarding agency moderated the complementarity effects of the dominance dimensions on depression severity. Overly dominant patients benefited more from a nonreciprocal relationship in the dominance dimension, whereas submissive patients benefited more from complementarity in that dimension. Furthermore, interpersonal problems of communion significantly moderated the effects of complementarity in affiliative behaviors on both the alliance and outcome. These results suggest the relevance of both interpersonal correspondence and reciprocity for the psychotherapy process, informing clinical practice in terms of interpersonal responsiveness. The moderation effects of interpersonal problems provide preliminary evidence, which should be replicated in future research, to determine relevant markers indicating for whom a complementary approach would be beneficial in cognitive therapy for depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Both good therapeutic bond as well as extra-therapeutic social support seem to enhance treatment outcomes. Some features of the therapeutic bond are similar to experiences in extra-therapeutic relationships (e.g., feelings of trust or belongingness). Patients with a lack of social support might benefit particularly from a good therapeutic bond, because a well-formed bond can partly substitute relationship needs. This study replicates former research (main effects of bond and social support) and investigates the hypothesized interaction between both constructs. Method: Data from 1206 adult patients receiving cognitive-behavioral outpatient therapy were analyzed. Patients rated early therapeutic bond, their impairment, as well as their social support. Multilevel regression analyses were applied to test for main effects and interactions between bond and social support predicting therapy outcome post treatment. Results: Consistent with prior research, both therapeutic bond and social support predicted therapy outcome. Among patients with high social support, the impact of the therapeutic bond was minimal, while patients with low social support benefited most from a good therapeutic bond. Conclusions: Results suggest that both the therapeutic bond and social support play a role in therapy outcomes and that good therapeutic bond quality might be especially important if a patient lacks social support.

In psychotherapy research, the measurement of treatment processes and outcome are predominantly based on self-reports. However, given new technological developments, other potential sources can be considered to improve measurements. In a feasibility study, we examined whether Ecological Momentary Assessments (EMA) using digital phenotyping (stress level) can be a valuable tool to investigate change processes during cognitive behavioral therapy (CBT). Seven outpatients undergoing psychological treatment were assessed using EMA. Continuous stress levels (heart rate variability) were assessed via fitness trackers (Garmin) every 3 min over a 2-week time period (6,720 measurements per patient). Time-varying change point autoregressive (TVCP-AR) models were employed to detect both gradual and abrupt changes in stress levels. Results for seven case examples indicate differential patterns of change processes in stress. More precisely, inertia of stress level changed gradually over time in one of the participants, whereas the other participants showed both gradual and abrupt changes. This feasibility study demonstrates that intensive longitudinal assessments enriched by digitally assessed stress levels have the potential to investigate intra- and interindividual differences in treatment change processes and their relations to treatment outcome. Further, implementation issues and implications for future research and developments using digital phenotyping are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hehlmann, Schwartz, Lutz, Gómez Penedo, Rubel and Lutz.)

Background: Although a wide body of research links depression to interpersonal deficits, Cognitive-Behavioral Therapy (CBT), considered the gold standard in the treatment of this condition, has not been developed to specifically address interpersonal difficulties. However, cognitive changes on a relational level occurring during CBT might play an important role in the treatment of depression. Interpersonal clarification refers to the process of better understanding the nature of one's interpersonal patterns during therapy. The aim of this study is to analyze the effects of interpersonal clarification in CBT and how they are moderated by the therapeutic alliance., Methods: A sample of 621 patients diagnosed with depression were treated with CBT by 126 therapists in a university outpatient clinic. Patients completed measures of interpersonal problems and depression severity at baseline, measures of symptomatic evolution before each session and process measures (assessing interpersonal clarification and alliance) after each session. Multilevel models separating between-patient (BP) and within-patient (WP) effects of interpersonal clarification, and including BP and WP alliance effects as covariates and moderators of the interpersonal clarification effects were conducted., Results: Analyses showed both significant BP and WP effects interpersonal clarification, even when adjusting for alliance effects. Furthermore, significant interactive effects were found between outcome of WP interpersonal clarification with both BP alliance and WP alliance., Limitations: Interpersonal clarification was measured with one single-item and adherence to CBT was not explicitly measured., Conclusions: The results present preliminary evidence for considering interpersonal clarification a meaningful change process in CBT for depression, especially in the context of a stronger therapeutic alliance., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background and Objectives: This paper examines the discrepancy between implicit and explicit negative self-associations (NSA) after cognitive psychotherapy for depression as a predictor of long-term outcome., Methods: One hundred and twenty patients completed an Implicit-Association Test relating the self with depressive attributes and a self-report questionnaire with identical item content, at the end of time-limited outpatient depression psychotherapy. At post-treatment and at 3-, 6-, and 12-month follow-up, patients completed the BDI-II. We used different strategies to operationalized implicit and explicit NSA discrepancies and three-level Hierarchical linear models to analyze the effects., Results: We found significant interactive effects of discrepancy between implicit and explicit NSA and the direction of the discrepancy on long-term outcome. In patients with a greater explicit than implicit NSA (a damaged self-esteem pattern) a greater absolute discrepancy was associated with worse long-term outcome in terms of BDI scores at the end of follow-up and rate of change during follow-up. Consistently, with an alternative method, we found that damaged self-esteem discrepancies were associated with worse estimated BDI-II scores at the end of follow-up., Limitations: The inclusion in the sample of only treatment completers limits the generalizability of the results. Furthermore, the follow-up period captured only the first 12 months after treatment., Conclusions: Our results support the notion that a discrepancy between implicit and explicit negative self-associations may pose a risk factor for deterioration after psychotherapy for depression., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Abstract There is a great need to identify predictors of treatment response, and the analysis of defense mechanisms is a promising approach. Defensive functioning may influence psychotherapy outcome in two ways: First, when it is generally higher or lower for some patients relative to others and second, as it shifts in individual patients over time. The present study examined both within- and between patient effects of defenses using hierarchical linear modeling. Forty-seven patients diagnosed with depression, anxiety, or adjustment disorders received 25 ± 3 sessions of integrative cognitive-behavioral therapy in a university outpatient clinic. The Defense Mechanism Rating Scale (DMRS) was used to assess defenses in the 1st, 8th, 16th, and 24th session and relate them to symptom severity of depression and anxiety. A higher number of adaptive defense mechanisms was associated with less severe depressive symptoms during treatment while a higher number of immature defenses was related to more severe depressive and anxiety symptoms. An increase in adaptive and a decrease in immature defenses over the course of treatment predicted symptom reduction of depression whereas a decrease in neurotic and immature defenses was associated with reductions in anxiety symptoms. Our results empirically support defensive functioning as a mechanism of change in psychotherapy.

Objective: This study aimed to identify differential patient change processes and mechanisms associated with long-term outcome in exposure-based cognitive therapy (EBCT) and cognitive-behavioral therapy (CBT) for depression., Method: We drew on a randomized controlled trial in which 149 patients were randomly assigned to either EBCT or CBT, with the treatments showing comparable efficacy at 12-month follow-up (grosse Holtforth et al., 2019). Based on Doss's (2004) 4-step model of psychotherapy change and using sequential multilevel structural equation models, we tested putative theory-based change processes and mechanisms for both treatments. Specifically, we examined emotional processing and cognitive restructuring during treatment as hypothesized change processes of EBCT and CBT, respectively. Furthermore, as potential change mechanisms during follow-up, we examined theory-relevant mechanisms for each treatment, preselected via multilevel models., Results: Although the full serial mediational pathways were not supported, EBCT fostered greater during-treatment increases in emotional processing and higher self-efficacy during follow-up than CBT, both of which associated with better long-term depression outcome. Unexpectedly, cognitive restructuring change did not differ between EBCT and CBT. Across both CBT and EBCT, greater during-treatment increases in cognitive restructuring related to lower cognitive-behavioral avoidance and greater self-efficacy across follow-up, which associated with lower long-term depression., Conclusions: Results suggest that therapists might improve long-term depression outcome by fostering both emotional processing (via emotion-focused techniques as included in EBCT) and cognitive restructuring (by using general CBT techniques included in both treatments), which operate either directly or through varied treatment-common mechanisms (e.g., greater self-efficacy and reduced cognitive-behavioral avoidance). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: This study analyses the psychometric properties of the Working Alliance Inventory adapted for guided Internet interventions (WAI-I)., Methods: We drew on the data set from a multicenter trial that examined a guided Internet intervention (deprexis) for patients with mild to moderate depression. Two hundred twenty-three patients completed the WAI-I and the Patient Satisfaction Questionnaire (ZUF-8) at posttreatment, and the Attitudes toward Psychological Online-Interventions Questionnaire (APOI) at baseline. We ran confirmatory factor analyses (CFA) testing two- and three-factor solutions and calculated Cronbach's α, item-total correlations, and correlations of the WAI-I with APOI and ZUF-8., Results: The results suggested a two-factor solution, with a very good model fit and evidence of factor independency, adequate internal consistency, and external validity for the complete scale and the sub-scales., Conclusions: The WAI-I showed as a reliable and valid instrument to capture alliance in guided Internet interventions, which might facilitate process-outcome research and treatment development efforts., (© 2019 Wiley Periodicals, Inc.)

Objective: This study aimed to analyze the associations among depressive and anxiety and pain symptoms in patients diagnosed with chronic pain., Materials and Methods: Four hundred fifty-four inpatients who were consecutively admitted in a multimodal 3-week treatment in a tertiary, psychosomatic university clinic completed 25 items from the Brief Pain Inventory and the Hospital Anxiety and Depression Scale at baseline and after treatment termination. Associations among symptoms were explored by network analyses using the graphical least absolute shrinkage and selection operator to estimate their partial correlations, whereas Extended Bayesian Information Criterion was used to select the best network solution for the data. We explored symptoms' centrality and expected influence within the network and the minimum spanning tree for the network., Results: Besides expected associations within depressive and anxiety and pain symptoms, the estimated network showed several local associations between depressive and pain interference symptoms. The lacks of being cheerful and of laughing are 2 of the depressive symptoms that showed the greatest associations with pain interference and a strong centrality within the network. Sleep problems were associated with both anxiety and depressive symptoms and pain intensity symptoms. Although at posttreatment most of the symptoms showed a significant decrease, the strength of the associations between the symptoms within the network was significantly higher than at baseline., Discussion: The results support focusing psychosocial interventions in chronic pain treatment not only on reducing pain, anxiety, and sleep symptoms but also on enhancing positive affect. Future research is needed to replicate these findings using repeated within-person measures designs.

Objective: Several studies have reported significant within-patient effects of the therapeutic alliance on outcome. However, it remains uncertain whether there are specific patient groups for whom an improved alliance might be particularly beneficial. The relational nature of the alliance makes patients' interpersonal problems a promising candidate for examining such differential effects. This study aims to analyze (i) between- and within-patient effects of the alliance on depression severity, (ii) the effects of patients' baseline interpersonal problems on the within-patient alliance-outcome association, and (iii) whether within-patient effects of the alliance remain significant when adjusting for patients' initial interpersonal problems., Method: A sample of 141 patients with depression and undergoing outpatient psychotherapy completed the Inventory of Interpersonal Problems at baseline as well as a brief version of the Working Alliance Inventory and the Well-Being Index (as a proxy of depression severity) session by session., Results: Multilevel models revealed both significant between- and within-patient effects of the alliance on improvements in depression severity. Patients' problems relating to agency had a significant effect on the within-patient effect of alliance, with more submissive patients benefiting more from an improved therapeutic alliance. Finally, the between- and within-patient effects of the alliance remained significant when adjusting for the patients' agentic interpersonal problems and treatment condition., Conclusions: The results provide evidence on which types of patients would particularly benefit from an improved therapeutic alliance. For patients suffering from low interpersonal agency and reporting problems with submissiveness, an enhanced alliance during the therapy process might improve treatment outcome. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Background: Therapeutic alliance has been well established as a robust predictor of face-to-face psychotherapy outcomes. Although initial evidence positioned alliance as a relevant predictor of internet intervention success, some conceptual and methodological concerns were raised regarding the methods and instruments used to measure the alliance in internet interventions and its association with outcomes., Objective: The aim of this study was to explore the alliance-outcome association in a guided internet intervention using a measure of alliance especially developed for and adapted to guided internet interventions, showing evidence of good psychometric properties., Methods: A sample of 223 adult participants with moderate depression received an internet intervention (ie, Deprexis) and email support. They completed the Working Alliance Inventory for Guided Internet Intervention (WAI-I) and a measure of treatment satisfaction at treatment termination and measures of depression severity and well-being at termination and 3- and 9-month follow-ups. For data analysis, we used two-level hierarchical linear modeling that included two subscales of the WAI-I (ie, tasks and goals agreement with the program and bond with the supporting therapist) as predictors of the estimated values of the outcome variables at the end of follow-up and their rate of change during the follow-up period. The same models were also used controlling for the effect of patient satisfaction with treatment., Results: We found significant effects of the tasks and goals subscale of the WAI-I on the estimated values of residual depressive symptoms (γ 02 =-1.74, standard error [SE]=0.40, 95% CI -2.52 to -0.96, t 206 =-4.37, P<.001) and patient well-being (γ 02 =3.10, SE=1.14, 95% CI 0.87-5.33, t 198 =2.72, P=.007) at the end of follow-up. A greater score in this subscale was related to lower levels of residual depressive symptoms and a higher level of well-being. However, there were no significant effects of the tasks and goals subscale on the rate of change in these variables during follow-up (depressive symptoms, P=.48; patient well-being, P=.26). The effects of the bond subscale were also nonsignificant when predicting the estimated values of depressive symptoms and well-being at the end of follow-up and the rate of change during that period (depressive symptoms, P=.08; patient well-being, P=.68)., Conclusions: The results of this study point out the importance of attuning internet interventions to patients' expectations and preferences in order to enhance their agreement with the tasks and goals of the treatment. Thus, the results support the notion that responsiveness to a patient's individual needs is crucial also in internet interventions. Nevertheless, these findings need to be replicated to establish if they can be generalized to different diagnostic groups, internet interventions, and supporting formats., (©Juan Martín Gómez Penedo, Anna Margarete Babl, Martin grosse Holtforth, Fritz Hohagen, Tobias Krieger, Wolfgang Lutz, Björn Meyer, Steffen Moritz, Jan Philipp Klein, Thomas Berger. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.03.2020.)

In a recent trial for generalized anxiety disorder (GAD), cognitive-behavioral therapy (CBT) integrated with motivational interviewing (MI) promoted more long-term worry reduction than CBT alone (Westra, Constantino, & Antony, 2016). A follow-up analysis found that CBT vs. MI-CBT clients evidenced greater increases in friendly submissiveness (FS) across treatment, which in turn promoted lower long-term worry (Constantino, Romano, Coyne, Westra, & Antony, 2018). It was unsurprising that traditional directive CBT promoted more FS than when person-centered MI was integrated; however, given that problematic low agency characterizes GAD, that greater FS promoted better outcome was unexpected. To further unpack this unexpected result, we tested the following moderated mediation hypothesis: for clients with more vs. less problematic low agency at baseline, CBT would still promote more in-session FS than MI-CBT, but this increase would in turn predict increased worry over follow-up. Clients receiving CBT (n = 43) or MI-CBT (n = 42) rated their interpersonal problems at baseline and their worry after treatment and across 12-month follow-up. Therapists rated clients' in-session FS multiple times. As predicted, multilevel modeling revealed that for clients with more problematic low agency, CBT vs. MI-CBT facilitated greater FS, which in turn related to increased worry across follow-up. For clients with more problematic high agency, CBT's facilitation of greater FS related to reduced worry across follow-up. A baseline interpersonal problem characteristic of GAD may have implications for treatment matching and for appreciating different pathways to long-term improvement, or deterioration, for different GAD subgroups., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: The aim of this study was to identify differential baseline profiles of interpersonal problems in patients with emotional disorders and investigate their ability to predict the extent to which alliance is important for early treatment outcome in therapy., Method: Ninety-six patients diagnosed with emotional disorders were admitted to psychotherapy at an independent practice center. After the first session, participants completed the Inventory of Interpersonal Problems and, after each of the first four sessions, the Alliance Negotiation Scale and the Outcome Questionnaire. We characterized the interpersonal problems of the sample using the circular statistics and the structural summary methods. Based on evidence of heterogeneity between patients, we conducted cluster analysis to identify differential profiles of interpersonal problems. We tested whether the identified profiles can predict the strength of the association between alliance negotiation and early treatment outcome using hierarchical linear models., Results: A two-cluster solution showed the best fit for the data. One cluster was characterized by Cold interpersonal problems (too hostile) and the other by Overly Nurturant interpersonal problems (too dependent). The identified profiles were significant predictors of the early alliance negotiation-outcome association. Overly Nurturant patients showed greater early improvements in outcome in the face of a stronger alliance negotiation., Conclusions: Results support the importance of personalized approaches using patients' interpersonal profiles to determine the importance of alliance negotiation for early treatment outcome. Findings should be replicated in randomized controlled trials using strategies to manipulate alliance negotiation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The aim of the current study was to design and evaluate a therapist version of the Alliance Negotiation Scale (ANS). The ANS was created in order to operationalize the construct of dyadic negotiation in psychotherapy and to augment existing conceptualizations of the working alliance. The ANS has existed only as a client self-report form since its inception and has demonstrated promise as a psychotherapy process measure. This research intended to develop a complementary therapist self-report version of the measure. The scale creation process is discussed in detail, and the results of a preliminary psychometric investigation are reported. The ANS-Therapist version (ANS-T) was developed using a sample of therapists (n = 114) through a principal components analysis procedure. The ANS-T contains 9 unidimensional items and was moderately correlated with therapist-reported working alliance (r = .468). The results of the study support the composition of the ANS-T and provide initial support for the reliability and validity of the measure., (© 2018 John Wiley & Sons, Ltd.)

There is no consensus among different therapeutic approaches on the process of termination when therapy does not have a prefixed duration. Moreover, both clinicians and researchers are still exploring decision making in the termination of treatment. The present study assessed former client's perspective of therapy termination in a nonprobabilistic sample from Buenos Aires, Argentina. Seventy-three semistructured interviews, lasting ∼60 min each, were conducted with participants that had finished a therapeutic treatment or dropped out. They were asked about several aspects of therapy, including their experience of termination, specifically who decided to terminate, if there was agreement on termination or not, and their thoughts on the termination process. All interviews were transcribed and analyzed using an adaptation of Consensual Qualitative Research (CQR). Quantitative analyses were also conducted to examine associations between variables. Two main factors emerged from the analysis: client/therapist initiative on termination; and level of agreement between client and therapist regarding termination. Whereas nearly all (95%) of therapist-initiated termination cases agreed on termination, client-initiated termination cases could be sorted in agreed (49%) and disagreed (51%) terminations. Both therapist-initiated terminations and agreed upon terminations presented more categories of positive termination motives, better therapeutic bond, and higher overall satisfaction with treatment. Implications for research and clinical practice are discussed. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

In the last years, studies of patients' satisfaction in drug abuse treatments have become a valuable tool for assessing the quality of treatment and predicting their outcome. However, no previous research has been found that examine patients' conditions that could predict satisfaction. This study analyzes the relationship between patients' characteristics and their degrees of satisfaction in treatment using a probabilistic sample of 216 patients from institutions specializing in addictions within the metropolitan area of Buenos Aires. Participants complete a questionnaire about their satisfaction with different elements of the treatment. Statistical analysis shows that some patients' variables are associated with different levels of satisfaction. Belonging to the male gender, having a significant other, and having lower levels of education were significantly linked with greater satisfaction. Fewer amounts of substances consumed as well as fewer substances that motivated the reason for consultation were associated with a higher degree of satisfaction. The results show the importance of assessing these existing features when designing treatments to suit the specific needs of patients; to seek higher levels of satisfaction, and ultimately, better overall results.

The purpose of this research is to investigate former client's perception of change, reasons for consultation, therapeutic relationship, and termination. Semistructured interviews were conducted with 17 former clients who had been in a psychotherapeutic treatment. A qualitative approach, based on consensual qualitative research (CQR) was used to analyze the interviews. Results show how the balance of negative and positive aspects of the therapeutic relationship is associated with the perception of change. Likewise, categories related to reasons for consultation were associated with types of change and therapy termination. The relevance of the client's perspective is increasingly being recognized as valuable for the understanding of the psychotherapeutic processes and generates hypotheses for future research.

Although there is a growing body of research in both cross-cultural issues in psychotherapy and in the client's perspective, little is known about differences or similarities in the way clients from different cultures, particularly those from different nations, subjectively experience therapy. The present study addressed this gap through a qualitative analysis of interviews with former therapy clients in Argentina and the United States. The researchers used a consensual qualitative research (CQR; C. E. Hill, B. J. Thompson, & E. N. Williams, 1997, A guide to conducting consensual qualitative research, The Counseling Psychologist, Vol. 25, pp. 517-572; C. E. Hill, S. Knox, B. J. Thompson, E. N. Williams, S. A. Hess, & N. Ladany, 2005, Consensual qualitative research: An update, Journal of Counseling Psychology, Vol. 52, pp. 196-205) methodology and provide illustrative examples from the raw transcripts. Among other differences, Argentine and U.S. participants differed in their experience of the therapy setting, the interventions their therapists used, and in the types of change they reported to result from therapy. Also notable, Argentine participants spoke a great deal more about change than U.S. participants. Results are preliminary, but provide implications for the adaptation of treatments to different cultures and for the cross-cultural validity of researchers' and policymakers' current definitions of treatment efficacy.