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While the current discussion on new forms of quality assurance (QA) in outpatient psychotherapy, exemplified by the new german »DeQS«-guidelines, is dominated by issues of outcome quality, a new model is introduced that expands the QA discussion to include quality monitoring for the exploration and management of process quality in psychotherapy. The so-called »circle model« (www.therapiefeedback.de) is a transdisciplinary, digital, case-oriented, intersubjective, and reflective model for capturing the process quality of outpatient psychotherapy (quality monitoring). The circle model enables both therapists and patients to provide individual feedback on the shared psychotherapeutic process through self-reporting according to scientific quality criteria. Both response behaviors (patient and therapist) can then be superimposed in a color-coded circular network diagram, allowing the therapy process to be intersubjectively reflected upon during joint consideration. The construction of the feedback axes is theory- and research-based. The model is applicable across all four german psychotherapeutic guideline procedures (psychodynamically oriented therapy, psychoanalytic psychotherapy, cognitive behavioral psychotherapy, systemic psychotherapy). The specificity of the intersubjective approach emphasizes that the understanding of psychotherapeutic processes does not occur in isolation but is rooted in a network of relationships and social exchange characterized by reciprocity, shared meanings, exchange of experiences, co-construction of reality, and empathy. Important impulses for potential adjustments and management of the therapy process for QA are made possible. The aim is to develop an innovative (digital) instrument that optimizes the psychotherapeutic process from within the process itself (quality monitoring through process feedback) and contributes to greater active participation of patients in the psychotherapy process. By collecting data from multi-level response scales, which are then interactively integrated and jointly reflected upon, the model methodologically combines quantitative and qualitative approaches. Initial qualitative results from an exploratory pilot study are presented. The results provide initial insights into the utility of the model for QA in outpatient psychotherapy, with a focus on process quality. The compatibility of the system with established peer-reviewed QA systems, such as peer review (»intervision«), supervision, and quality circles, is emphasized. The necessity for further and systematic research is discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The text discusses enhanced psychotherapy, which seeks to improve traditional psychotherapy by incorporating innovative treatment approaches. The goal is to enhance treatment effectiveness and sustainability, particularly for difficult-to-treat symptoms and patients who may not benefit as much from traditional methods. This approach includes personalized treatment strategies within the framework of precision mental health care and precision medicine. Various approaches, such as digital technology and virtual reality, are used to tailor interventions to individual needs and improve treatment outcomes. The text also highlights the importance of further research and development in certain areas to enhance the effectiveness of psychotherapy. It introduces the concept of One Health, which considers the interconnectedness of human health with animals and the environment, as a holistic approach to health. The text explores innovative trial designs, such as adaptive platform trials and modular therapy, that aim to tailor interventions and improve treatment outcomes. The German Centre for Mental Health (DZPG) is introduced as an initiative that aims to advance psychotherapy research and implementation, with a focus on patient involvement and data-driven approaches. Overall, the text presents a positive outlook for the future of mental health treatment. [Extracted from the article]

Introduction: In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD. Methods: In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up. Results: Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: –0.58–7.22], p = 0.094, d = −24 [–0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88–3.02], ST: d = 1.78 [1.26–2.29]). Conclusion: Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes. [ABSTRACT FROM AUTHOR]

Background: The reliable assessment of competence is crucial for promoting the professional development of therapists. However, competence assessments are rarely included in training and research as these procedures are resource-intensive and costly, commonly relying on independent raters with high levels of expertise and extensive training. This study aimed to compare the interrater reliability (IRR) of raters with different levels of expertise. We also examined the impact of different camera perspectives on IRR. Methods: We examined the IRR of six independent raters based on competence assessments in a standardized setting. Two raters were experienced psychotherapists (experts), and four were psychology students (novices; with/without supervision). All raters evaluated N = 359 videos of students performing role plays with standardized patients who were simulating depressive symptoms and behavior. For each video, the raters independently assessed basic communication skills (Clinical Communication Skills Scale–Short Form; CCSS-S), psychotherapeutic competence (Cognitive Therapy Scale; CTS), empathy (Empathy Scale; ES) and therapeutic alliance (Helping Alliance Questionnaire; HAQ). Results: IRR varied depending on rater expertise and assessment measures, with the lowest intraclass correlation coefficients (ICCs) for empathy (ES; ICCs = 0.39-0.67) and the highest ICCs for psychotherapeutic competence (CTS; ICCs = 0.66-0.78). The concordance between expert raters and supervised novice raters was good (ICCs = 0.71-0.86). The camera perspective did not influence the reliability of the ratings. Conclusions: With appropriate training and regular supervision, the novices assessed therapeutic behavior in standardized role plays with reliability comparable to that of the experts. Further research is needed regarding the reliable assessment of more complex therapy situations. [ABSTRACT FROM AUTHOR]

Objective: Although researchers have begun to use MTurk for psychotherapy‐related studies, little is known about the quality of psychotherapy research data that can be obtained through this platform. The fourfold purpose of this study was to (1) compare data collection times between clients recruited through MTurk and those recruited through traditional clinic sources, (2) test for differences in demographic and treatment use variables between these two samples, (3) examine whether psychotherapy research data gathered through these different strategies shows comparable properties and (4) test whether recruitment decisions within MTurk can impact the quality of the data obtained. Method: Clients (828 recruited through MTurk and 62 recruited through outpatient clinics) completed an online survey that included treatment history questions and six measures that are frequently used in psychotherapy research. Results: Highly similar demographics, treatment history and properties for the measures (i.e., means, standard deviations, internal consistency, factor structure and convergent validity) were found between the samples. For the most part, the quality of the MTurk data did not differ depending on the compensation amount or participant restrictions. Conclusion: These results suggest that MTurk can be a quick, reliable and valid resource for participant recruitment when conducting some types of psychotherapy research. [ABSTRACT FROM AUTHOR]

The integration of neuroscience and psychotherapy research has long been a topic of interest in the field of mental health. A significant challenge in psychotherapy research is understanding the dyadic interaction between patient and therapist. This interaction is complex, emerging from a myriad of multi-level factors such as gestures, verbal communication, mentalization, and environmental influences. This article aims to present a roadmap for the future integration of neuroscience and psychotherapy research, addressing the complexities of human interaction. We introduce the 4E/MoBI approach, a framework that combines theoretical and methodological tools to study the dynamics of the brain, body, and environment in real-world settings. This approach emphasizes the use of physiological systems (e.g., heart and brain), behavioral interactions (e.g., conversations and eye-tracking), and environmental video recordings. Additionally, the scalable experimental design (SED) heuristic is discussed as a method to blend controlled experiments with real-world scenarios, allowing for the parametric testing of neurobehavioral markers. As a practical demonstration of the SED heuristic within the 4E/MoBI framework, a concrete experimental example using the N170 event-related potential (ERP) component is presented. While the N170 ERP component is not posited as the foundational marker in the field, it serves to illustrate the application of hypothesis-driven designs and analyses. The 4E/MoBI approach offers a promising avenue for the integration of neuroscience and psychotherapy research. By addressing existing gaps, such as the physiology and phenomenology of expertise in psychotherapy, this framework can foster a virtuous relationship between the two disciplines, paving the way for more comprehensive and nuanced understandings of therapeutic interactions. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine therapeutic responsiveness across three different therapeutic models. The construct of responsiveness consists of two conceptual features: optimal responsiveness, which involves adapting therapist behavior to the unique therapeutic relationship, and appropriate responsiveness, a more refined concept. While aligned with interpersonal principles, the responsiveness construct challenges prevailing statistical methods by emphasizing the therapist’s adaptive responses. A comparative analysis of Gestalt, psychodynamic, and systemic therapies revealed unique patterns of responsiveness within each model, ranging from an emphasis on empathy and intuition to the significance of countertransference. Methodologically, a literature review and textual analysis using Atlas.ti allowed for nuanced exploration. The results also revealed a core commonality—"experience”—across these models, positioning responsiveness as an “extra-specific” factor amidst shared conceptual ground. In conclusion, this study sheds light on the nuances of responsiveness, which is central to advancing psychotherapeutic practice in an evolving landscape. An in-depth examination of the construct of responsiveness helps identify therapist characteristics that can be enhanced, enriched, and supported during training and supervision.

Mental health services are experiencing notable transformations as innovative technologies and artificial intelligence (AI) are increasingly utilized in a growing number of studies and services. These cutting-edge technologies carry the promise of substantial improvements in the field of mental health. Nevertheless, questions emerge about the alignment of novel technologies and AI systems with human needs, especially in the context of vulnerable populations receiving mental healthcare. The practice-oriented research (POR) model is pivotal in seamlessly integrating these emerging technologies into clinical research and practice. It underscores the importance of tight collaboration between clinicians and researchers, all driven by the central goal of ensuring and elevating client well-being. This paper focuses on how novel technologies can enhance the POR model and highlights its pivotal role in integrating these technologies into clinical research and practice. We discuss two key phases: pre-treatment, and during treatment. For each phase, we describe the challenges, present the major technological innovations, describe recent studies exemplifying technology use, and suggest future directions. Ethical concerns and the importance of aligning humans and technology are also considered, in addition to implications for practice and training. [ABSTRACT FROM AUTHOR]

Objective: Therapeutic alliance is often considered as a predictor for therapeutic success. This study explored dyadic synchrony of skin conductance response (SCR) during naturalistic therapeutic interactions and investigated its potential as an objective biomarker for predicting therapy effectiveness. Methods: In this proof‐of‐concept study, skin conductance from both dyad members was continuously measured via wristbands during psychotherapy. Patients and therapists completed post‐session reports capturing their subjective appraisal of therapeutic alliance. Additionally, patients completed symptom questionnaires. Each therapeutic dyad was recorded twice in a follow‐up design. The first session of the follow‐up group was assessed for physiological synchrony (Single Session Index (SSI)). Therapy outcome was captured by the difference between symptom severity scores over time. Results: SCR synchrony significantly predicted the outcome variable of change in patients' global severity index (GSI). High positive SCR concordance was linked to a reduction in patients' GSI, while negative or small positive SSI values were linked to an increase in patients' GSI. Conclusion: The results demonstrate the presence of SCR synchrony in clinical interactions. Skin conductance response synchrony was a significant predictor for change in patients' symptom severity index, emphasizing its potential as an objective biomarker in the context of evidence‐based psychotherapy. [ABSTRACT FROM AUTHOR]

Researchers who conduct studies comparing the efficacy of two treatments often find that their preferred treatment outperforms the comparison treatment. This finding has been labelled the allegiance association. Although this association is robust, it is unclear whether it reflects an allegiance bias on the part of the researchers or whether it is noncausal, with researchers being allied to the more effective treatments. This study applied a quasi‐experimental method proposed by a previous study to 19 pairs of treatment comparison studies. Each member of a pair had used the same two psychotherapies to treat clients with the same disorder, but the researchers in each of the two studies had opposing allegiances. If the authors of one study in the pair concluded that their preferred treatment was superior and the authors of the other study concluded that their preferred treatment was superior or that the two treatments were equivalent, these patterns would suggest allegiance bias. In 10 of the 19 pairs, the patterns were consistent with the operation of an allegiance bias, indicating that although allegiance biases are not inevitable, they are ubiquitous. Practitioners and other psychotherapy research consumers should use caution when interpreting the findings from treatment comparison studies. [ABSTRACT FROM AUTHOR]

Objective: Digital supplements to tele-psychotherapy are increasingly needed. The purpose of this retrospective study was to investigate the association between outcomes and the use of supplemental video lessons based on the Unified Protocol (UP), an empirically supported transdiagnostic treatment. Methods: Participants included 7,326 adults in psychotherapy for depression and/or anxiety. Partial correlations were calculated between number of UP video lessons completed and change in outcomes after 10 weeks, controlling for number of therapy sessions and baseline scores. Then, participants were divided into those who did not complete any UP video lessons (n = 2355) and those who completed at least 7/10 video lessons (n = 549), and propensity-matched on 14 covariates. Repeated measures analysis of variance compared these groups (n = 401 in each group) on outcomes. Results: Among the entire sample, symptom severity decreased as the number of UP video lessons completed increased, with the exception of lessons on avoidance and exposure. Those watching at least 7 lessons showed significantly greater reduction in both depression and anxiety symptoms than those who did not watch any. Conclusion: Viewing supplemental UP video lessons in addition to tele-psychotherapy had a positive and significant association with symptom improvement and may provide an additional tool for clinicians to implement UP components virtually. [ABSTRACT FROM AUTHOR]

In psychotherapy research, the first applications of dynamical systems research (DSR) date back to the 1990s. Over time, DSR has developed three main lines of research: the study of oscillations in synchronization; the study of oscillations between stability and flexibility of process variables (S–F oscillations); the mathematical modeling to analyze the evolution of psychotherapy process. However, the connections among the empirical results and their implications for psychotherapy practice are unclear. For this reason, for the first time in the literature, this work carries out a comprehensive review of all three lines of research, including the main scientific contributions from the 1990s to the present day. For each line of research, the work critically analyzes the results, proposes future developments, and underlines the connections between empirical results and implications for psychotherapy practice. Furthermore, the work highlights the model of change that emerges from the empirical results, and its clinical correlates. In the conclusions, the author summarizes the results and the evolution of psychotherapy process in accordance with the DSR. [ABSTRACT FROM AUTHOR]

Nine psychotherapists from five different approaches were interviewed by questionnaire between April and July 2022 about two video sequences of a recorded psychotherapy session. This was followed by the recorded colloquia. Using the example of the client in the video, the selected interventions were explained, justified and described in concrete terms. The primary data analysis was carried out using the PAP-S rating manual (Tschuschke et al. 2014), which assigns the intervention suggestions mentioned to general and school-specific psychotherapeutic interventions. At the second survey time point, the participants’ comments on the first results were generated in order to make their previous answers more precise. The findings show that there are similarities and differences between the groups, both across and within groups. They made use of both school-specific and general psychotherapeutic interventions, which confirms the assumption that not only school theory knowledge but also general psychotherapeutic interventions such as the therapeutic relationship are used in psychotherapy. Sometimes similar interventions were used at other times or by means of other school psychotherapy concepts and explanatory models, which suggests that, on the one hand, the variety of interventions is used and, on the other hand, that they partly correspond to each other. [ABSTRACT FROM AUTHOR]

Introduction: Schema therapy (ST) reduces depressive symptoms, but clinical trials have not investigated its effectiveness for patients suffering from severe forms of depression and high rates of comorbidities. There is high demand for exploring and improving treatments for this patient group. The objective of the current study was to evaluate whether ST is more effective than individual supportive therapy (IST) and noninferior compared with cognitive behavioral therapy (CBT) in treating depression. Methods: For this clinical trial, medicated patients were recruited in inpatient and day clinic settings. The major inclusion criteria were age between 18 and 75 years and primary diagnosis of depression without psychotic symptoms. A total of 292 participants were randomized to ST, CBT, or IST and received 7 weeks of psychotherapy (up to 14 individual and 14 group sessions). The primary outcome was change in depression severity after treatment measured by Beck Depression Inventory-II. Primary test for efficacy was superiority of ST over IST. Secondary test was noninferiority of ST compared with CBT. Multilevel modeling was conducted. The results at 6-month follow-up were explored. Results: Across treatment, ST was not superior to IST. Secondary outcome analyses and completer analyses showed similar results. However, ST showed clinically relevant noninferiority compared with CBT. Conclusion: ST for depression as part of a psychiatric care program showed clinical noninferiority compared to CBT, without being superior to IST. ST represents a potentially useful addition to the therapeutic repertoire for the treatment of depression but its efficacy, including long-term efficacy, should be evaluated further. [ABSTRACT FROM AUTHOR]

Epistemic trust can be defined as the ability to rely on social and cultural information from others. It allows to integrate the new knowledge in the vision of self and world, promoting the learning from experience. Recently, the issue of epistemic trust is gaining growing interest in literature thanks to the recognition of the significant implications that it may have for treatment effectiveness but not only, as evidenced by the extension of it field of research and application to different contexts and psychopathological conditions. However, this makes it increasingly difficult to identify a unique relational dynamic between epistemic trust, attachment and mentalization. In addition, this issue is still predominantly addressed on the theoretical level, while empirical studies are still scarce, and this allows each researcher to make a different hypothesis. Therefore, this systematic review aims at exploring the role of epistemic trust in the relationship between attachment and mentalization, looking also at factors able to affect this bond. The keywords were the following: “mentalization”, “attachment” and “epistemic trust” and its dimensions and dysfunction. Articles were included if they explicitly focused on the relationship between attachment, mentalization and epistemic trust, and if they were research articles. Studies were excluded if they addressed only one or two of the three constructs, and if they were theoretical articles, opinion articles, commentary, book chapters and interviews. Results predominantly showed a relation of interdependence between these variables, although from studies that empirically investigated this topic an interesting, contrasting datum emerges: there seems to be a relationship of interdependence only between mentalization and epistemic mistrust or credulity, but not between mentalization and epistemic trust. These findings highlight the need to empirically deepen the link between these three variables and suggest therapists to pay attention not only to the creation of a secure therapeutic relationship and the improvement of mentalizing abilities, but also to clients’ epistemic trust, especially to its disrupted forms. [ABSTRACT FROM AUTHOR]

The author proposes a frame of reference for Gestalt therapists who want to do research from a field perspective. She outlines fundamental aspects of phenomenological research that includes aesthetics of contact and the relational therapeutic approach. Ethical aspects of Gestalt therapy research, from the need of outcome research to the responsibility to show what we do in our practice, are described, in support of the discovery of new territories to advance our humanity. Two examples are offered: research on the construct of aesthetic relational knowing (ARK) to explore therapeutic intuition and responsiveness from a Gestalt viewpoint, and research to describe the process of change in the dyad therapist/client, seen as a "dance" of reciprocal, intentional movements that draws on attachment learnings. [ABSTRACT FROM AUTHOR]

If evidence points to the equal efficacy of all bona fide treatments for borderline personality disorder (BPD) in general, it may not necessarily be true for a specific individual, nor do such general conclusions help in the triage of clients in clinical services. We investigated potential therapy outcome predictors for participants with a BPD diagnosis (N = 99). They were assessed on scales including the Outcome Questionnaire-45.2 (OQ-45), the Inventory of Interpersonal Problems-64, and the Borderline Symptom List. Our analyses revealed that individuals with low levels of symptom distress at intake had the smallest change in total OQ-45 score over the course of brief treatment, while the individuals with high levels of symptom distress had a mean large change in total score (-23). We observed that individuals with high symptom loads AND low levels of interpersonal problems at intake seemed to have the best progress. [ABSTRACT FROM AUTHOR]

This overview addresses for whom and under what conditions psychotherapy produces change, the course of change over sessions, and why change happens. Specifically, the most confirmed moderators are pretreatment symptoms level, readiness for change, assertiveness, agency, defense maturity, quality of object relationships, mentalization, and interpersonal functioning. Regarding the course of change, processual models better describe change than stage ones, capturing its nonlinear and time-embedded nature. Moreover, trajectories of change describe different classes of change by clients (i.e., from three to five) and might be helpful feedback for clinicians. Furthermore, the most confirmed change mechanisms in literature for individual psychotherapy are insight, affective awareness, reflective functioning, externalizing difficulties, self-talk, coping, emotion regulation, the reappraisal of threat, fear extinction, change of interpersonal cognitions/avoidance, compensatory skills, mood regulation expectancies, diet habits, and self-efficacy. Conversely, emotional closeness, couple satisfaction, blamer softening, family functioning, and parental competence are confirmed mechanisms for couple/family psychotherapy. Finally, transversal mechanisms common to many approaches should not be considered equal to common factors, such as alliance, emotional regulation, and insight. [ABSTRACT FROM AUTHOR]

Epistemic trust can be defined as the ability to rely on social and cultural information from others. It allows to integrate the new knowledge in the vision of self and world, promoting the learning from experience. Recently, the issue of epistemic trust is gaining growing interest in literature thanks to the recognition of the significant implications that it may have for treatment effectiveness but not only, as evidenced by the extension of it field of research and application to different contexts and psychopathological conditions. However, this makes it increasingly difficult to identify a unique relational dynamic between epistemic trust, attachment and mentalization. In addition, this issue is still predominantly addressed on the theoretical level, while empirical studies are still scarce, and this allows each researcher to make a different hypothesis. Therefore, this systematic review aims at exploring the role of epistemic trust in the relationship between attachment and mentalization, looking also at factors able to affect this bond. The keywords were the following: “mentalization”, “attachment” and “epistemic trust” and its dimensions and dysfunction. Articles were included if they explicitly focused on the relationship between attachment, mentalization and epistemic trust, and if they were research articles. Studies were excluded if they addressed only one or two of the three constructs, and if they were theoretical articles, opinion articles, commentary, book chapters and interviews. Results predominantly showed a relation of interdependence between these variables, although from studies that empirically investigated this topic an interesting, contrasting datum emerges: there seems to be a relationship of interdependence only between mentalization and epistemic mistrust or credulity, but not between mentalization and epistemic trust. These findings highlight the need to empirically deepen the link between these three variables and suggest therapists to pay attention not only to the creation of a secure therapeutic relationship and the improvement of mentalizing abilities, but also to clients’ epistemic trust, especially to its disrupted forms.

The temporary closure of the Outpatient Psychotherapy Clinic at the Sigmund Freud Private University in Vienna during the Covid-19 pandemic demanded an immediate and unexpected reaction to assure further psychotherapeutic services. Both psychotherapists and patients were forced into a rapid transition to online psychotherapy. While Covid-19 research has comprehensively described challenges of online psychotherapies, we were interested in learning specifically how early stage psychotherapists-in-training, who started their clinical work with patients exclusively in the online setting, experienced this unprecedented clinical situation.Sixteen in-depth interviews were conducted with psychotherapists in training. The data were analyzed using a thematic analysis. The analysis revealed how psychotherapists in training were able to cultivate a set of early-training resources and competencies in the online therapy setting without evidence-based guidelines from supervisors and the institution. This study highlighted the necessity of incorporating specific and novel educational input that is necessary for achieving specific online skills in the early training phase. Recognizing that the therapeutic landscape has undergone an irreversible transformation, the data suggest that distinct techniques are necessary to equip early-training psychotherapists for the now commonly practiced alternation between online setting and in-person setting in psychotherapeutic processes.

Abstract Objective Therapeutic alliance is often considered as a predictor for therapeutic success. This study explored dyadic synchrony of skin conductance response (SCR) during naturalistic therapeutic interactions and investigated its potential as an objective biomarker for predicting therapy effectiveness. Methods In this proof‐of‐concept study, skin conductance from both dyad members was continuously measured via wristbands during psychotherapy. Patients and therapists completed post‐session reports capturing their subjective appraisal of therapeutic alliance. Additionally, patients completed symptom questionnaires. Each therapeutic dyad was recorded twice in a follow‐up design. The first session of the follow‐up group was assessed for physiological synchrony (Single Session Index (SSI)). Therapy outcome was captured by the difference between symptom severity scores over time. Results SCR synchrony significantly predicted the outcome variable of change in patients' global severity index (GSI). High positive SCR concordance was linked to a reduction in patients' GSI, while negative or small positive SSI values were linked to an increase in patients' GSI. Conclusion The results demonstrate the presence of SCR synchrony in clinical interactions. Skin conductance response synchrony was a significant predictor for change in patients' symptom severity index, emphasizing its potential as an objective biomarker in the context of evidence‐based psychotherapy.

INTRODUCTION: Theoretical and practical psychotherapy training improves psychiatrists' case management and treatment skills. However, little is known about the extent that in Turkey early career psychiatrists have access to these opportunities and their experiences, so in this study, we aimed to investigate various aspects of the psychotherapy training of early career adult, child and adolescent psychiatrists in Turkey. METHODS: A 22 items questionnaire was disseminated in Turkey to psychiatry trainees and early career psychiatrists (psychiatry and child and adolescent psychiatry trainees and specialists who are in the first 5 years of their career and younger than 40). The questionnaire inquired about participants': i) sociodemographics; ii) the quality of the psychotherapy training; iii) organizational aspects of psychotherapy training; iv) satisfaction with psychotherapy training. RESULTS: A total of 103 individuals (n=41 psychiatrists, n=37 psychiatry trainees, n=12 child and adolescent psychiatrists, and n=13 child and adolescent psychiatry trainees) responded to this questionnaire. While 68% of the participants stated that psychotherapy training is included in psychiatry training, 89.3% stated they have conducted psychotherapy training themselves and 76.7% reported that they received supervision. Only 41.7% stated that they were going to their own personal psychotherapy or had gone before, and 59.2% were not a qualified psychotherapist. DISCUSSION AND CONCLUSION: One third of psychiatry and child and adolescent psychiatry trainees in Turkey cannot access psychotherapy training in their institutes, and one fourth cannot access supervision opportunities, and more than half are deprived of their personal therapy processes. This should be addressed to improve the skills and competencies of psychiatrists that train in Turkey.

Objective: The use of qualitative methods for investigating causation has been controversial ever since the "paradigm wars" of the 1980s. Quantitative and experimental researchers have largely dismissed the relevance of qualitative research for causal investigations, while many qualitative researchers have rejected the concept of causation entirely. However, a growing number of scholars, in both research methods and philosophy, have proposed an alternative perspective, one that sees quantitative and qualitative approaches as having complementary strengths and limitations in understanding causation. In this article, we consider this perspective in relation to the study of causality in psychotherapy research. Method: This paper reviews and integrates key descriptions of the mechanisms for identifying causal processes using qualitative research. Results: An overview of how qualitative methods study causation is presented, considering its implications for both identifying causality and for generalizing causal conclusions. Conclusion: The paper holds relevance for establishing outcomes caused by psychotherapy treatments and for developing clinical practice guidance for the field. [ABSTRACT FROM AUTHOR]

Randomized control trials (RCTs) have played a critical role in psychotherapy research. This article discusses RCTs in the context of the criteria for drawing causal inferences in psychotherapy and intervention research more generally. The article also highlights underused variations of RCTs and how they not only establish causal relations but also address critical questions that can improve our intervention portfolio and patient care. Random assignment is discussed in terms of what it can and cannot do in relation to drawing conclusions about the effects of interventions. Finally, RCTs are examined in the context of multiple questions that can guide therapy research, improve patient care, and develop treatments that reach people in need of psychological services. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral activation (BA) is effective for the treatment of depression. The Health Action Process Approach (HAPA), which is derived from health psychology, can provide a motivational-volitional framework of BA. Objective: This study investigated the efficacy of a HAPA-based internet-delivered BA intervention (iBA; called InterAKTIV) in individuals with depression, also assessing HAPA-based motivational and volitional outcomes. Methods: In a two-arm randomized controlled efficacy trial with a parallel design, 128 participants with a major depressive episode were randomly allocated to the intervention group (IG; TAU + immediate access to iBA) or control group (CG; TAU + access to iBA after follow-up). The primary outcome of clinician-rated depressive symptoms and secondary outcomes were assessed at baseline (T1), 8 weeks (T2), 6-month after randomization (T3). Data were analyzed on an intention-to-treat basis. Results: Linear mixed model analyses revealed a significant group*time interaction effect on clinician-rated depressive symptoms favoring the IG (F2, 156.0 = 7.40; p < 0.001, d = 0.79 at T2, d = 0.25 at T3). The IG was also superior regarding self-rated depressive symptoms, BA, most motivational, and all volitional outcomes. Conclusion: This study shows that HAPA-based iBA can significantly improve clinician-rated depressive symptoms, as well as outcomes used in the HAPA model in people with depression. Building on these efficacy results, in the next step, the relationship between BA interventions and activity levels should be investigated, taking into account motivation and volition as potential mediators. [ABSTRACT FROM AUTHOR]

Background: Studies measuring hair cortisol concentration (HCC) have been increasingly conducted to document stress-related, endocrine changes aggregated over time. Previous studies have shown that HCC reflects abnormalities in the hypothalamic-pituitary-adrenocortical axis (HPA axis) in the context of somatic diseases, such as Cushing's syndrome. HCC variations also reveal a corresponding alteration in HPA-axis-function in mental disorders, highlighting its potential role as a biomarker for interventions targeting mental health problems. Aims: The aim of this study was to investigate the role of HCC in various psychological and neuropsychiatric interventions and to explore the extent to which HCC can serve as a predictive or outcome parameter in such interventions by conducting a PRISMA-compliant review of the literature. Methods: From May to July 2022, the databases Web of Science, Google Scholar, PsychINFO, and ResearchGate were systematically searched using different combinations of relevant keywords. Studies of different types that examined HCC in the context of a wide range of psychological and neuropsychiatric interventions were included. Studies in languages other than English or German and animal studies were excluded. The MMAT tool was used, to assesses the Risk of bias. Results: The initial search identified 334 studies. After applying the inclusion and exclusion criteria, 14 publications with a total number of 1,916 participants were identified. An association between HCC and PTSD, depressive disorders, and ongoing social and family stress can be documented. The effect of relaxation techniques, mental training, CBT, or PTSD therapy on HCC has been studied with equivocal results. Some studies found decreased HCC after treatment, while others did not show a clear effect. Baseline HCC appears to be of particular importance. In some studies, higher baseline HCC was associated with increased treatment response, providing a predictive value for HCC. Discussion: HCC is increasingly being used as a biomarker for the mapping of psychological and neuropsychiatric interventions. However, due to the wide range of study populations and interventions, results are still heterogeneous. Nevertheless, HCC seems to be an encouraging biological parameter to describe the trajectory of different interventions aimed at improving mental health. [ABSTRACT FROM AUTHOR]

Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of "self affectively relating to others" should be observed in the transference prior to shifts in daily relationships. Using ecological momentary assessment (EMA), a patient with BPD rated daily interpersonal events for 2-week periods during 18 months of TFP; at 9 and 18 months these ratings included interactions with the therapist. Results suggest that positive perceptions of her therapist that ran counter to her negatively biased perception in other relationships preceded changes in her perceptions of others. EMA shifts corresponded to improvements in self-reported symptoms, interview-based personality functioning, and therapist assessments. Implications for assimilation of a trusting experience with the therapist as a mechanism of change in TFP are discussed. [ABSTRACT FROM AUTHOR]

This article serves as both the foreword and the afterword to the special section of Psychotherapy Research devoted to research reviews of psychotherapist skills and methods: it introduces the interorganizational Task Force that guided the reviews and then features its conclusions. We begin by operationally defining therapist skills and methods and then contrasting them with other components of psychotherapy. Next, we consider the typical assessment of skills and methods and how they are linked with outcomes (immediate in-session, intermediate, and distal) in the research literature. We summarize the strength of the research evidence on the skills and methods reviewed in the 8 articles in this special section and in the companion special issue in Psychotherapy. We end with diversity considerations, research limitations, and the formal conclusions of the interorganizational Task Force on Psychotherapy Skills and Methods that Work. [ABSTRACT FROM AUTHOR]

BackgroundStudies measuring hair cortisol concentration (HCC) have been increasingly conducted to document stress-related, endocrine changes aggregated over time. Previous studies have shown that HCC reflects abnormalities in the hypothalamic–pituitary-adrenocortical axis (HPA axis) in the context of somatic diseases, such as Cushing’s syndrome. HCC variations also reveal a corresponding alteration in HPA-axis-function in mental disorders, highlighting its potential role as a biomarker for interventions targeting mental health problems.AimsThe aim of this study was to investigate the role of HCC in various psychological and neuropsychiatric interventions and to explore the extent to which HCC can serve as a predictive or outcome parameter in such interventions by conducting a PRISMA-compliant review of the literature.MethodsFrom May to July 2022, the databases Web of Science, Google Scholar, PsychINFO, and ResearchGate were systematically searched using different combinations of relevant keywords. Studies of different types that examined HCC in the context of a wide range of psychological and neuropsychiatric interventions were included. Studies in languages other than English or German and animal studies were excluded. The MMAT tool was used, to assesses the Risk of bias.ResultsThe initial search identified 334 studies. After applying the inclusion and exclusion criteria, 14 publications with a total number of 1,916 participants were identified. An association between HCC and PTSD, depressive disorders, and ongoing social and family stress can be documented. The effect of relaxation techniques, mental training, CBT, or PTSD therapy on HCC has been studied with equivocal results. Some studies found decreased HCC after treatment, while others did not show a clear effect. Baseline HCC appears to be of particular importance. In some studies, higher baseline HCC was associated with increased treatment response, providing a predictive value for HCC.DiscussionHCC is increasingly being used as a biomarker for the mapping of psychological and neuropsychiatric interventions. However, due to the wide range of study populations and interventions, results are still heterogeneous. Nevertheless, HCC seems to be an encouraging biological parameter to describe the trajectory of different interventions aimed at improving mental health.

Research supervision remains an undertheorised, under‐regulated and often unsupported profession. This article focuses on what research supervisors and research supervisees regard as “helpful” supervision on doctoral programmes in the field of counselling, psychotherapy and counselling psychology. The paper is based on a mixed methods study consisting of an online survey (N = 226) with closed and open questions and optional interviews (10) analysed by “artfully interpretive reflexive thematic analysis” (Supporting research in counselling and psychotherapy qualitative, quantitative, and mixed methods research 19–38. Palgrave Macmillan.). In the survey questions, respondents rated “research knowledge” and “empathy” almost equally. The free‐text comments and interview data added, in turn, deeper and more nuanced understandings into what both research “knowledge” and “empathy” might involve for different people—and at different stages of the research process. The analysis of free‐text comments and interviews moved iteratively back and forth across six stages, typical for reflexive thematic analysis, and was influenced by our interests into “narrative knowing.” We started with the free‐text comments and then read the interviews—to return to our free‐text comment themes from new angles, which eventually were shared in a focus group with supervisors in training. The paper describes the development of a suggested “relational 3C model” with clarity, containment and compassion as key supervisory dimensions applied across eight areas with actions from supervisory contracts to research completion. [ABSTRACT FROM AUTHOR]

Five years ago, the German «Scientific Advisory Board on Psychotherapy» (WBP) not only rejected Humanistic Psychotherapy as a «scientifically recognized procedure» in an expert opinion, but even withdrew the «recommendation for advanced training» from Person-centered Psychotherapy – an approach which had already been recognized by the WBP in 2002. After initial protests by many scientists and institutions against this evaluation, a standstill must be reported. The WBP evades discourses about this critique and the evaluation complained. This paper takes the 5-year anniversary as an opportunity to provide a report of the contexts and circumstances of this blockage of Humanistic Psychotherapy in Germany. This is because many are unfamiliar with this German administrative regulatory framework. The report focuses on publications after 2018. For it is becoming increasingly clear that the German ideology of strictly separated approaches, whose «scientificity» must be proven exclusively by experimental RCT studies with regard to specific factors, does not stand up to findings from international psychotherapy research. Increasingly, research supports a view which has prevailed especially by Wampold since 2001, according to which contextual factors in particular contribute significantly to the success of therapy. These are above all aspects that play a central role in Humanistic Psychotherapy. The article concludes with the hope that the WBP will register these discourses and come to a changed evaluation of Humanistic Psychotherapy. [ABSTRACT FROM AUTHOR]

The concept of »evidence-based medicine« (EBM) is actually a very good proposal to keep a sufficient overview with respect to the abundance of research literature – also in the field of psychotherapy – and thus to be able to make better decisions for the benefit of patients. It is shown that this good concept is now predominantly misused. Instead of taking into account the breadth of relevant information on an issue, EBM in Germany has been substantially converted into an instrument for selection and regulation. Only studies that follow the logic of pharmaceutical trials – RCTs – are taken into account, although this approach is inadequate for a wide range of psychotherapy. Moreover, these results are then summarized by means of »effect sizes« using the methods of meta-analysis – although »effect size« does not (only) measure treatment success. [ABSTRACT FROM AUTHOR]

The authors, both professors of psychiatry, trained as psychoanalysts according to the standards of the International Psychoanalytic Association (IPA), recount 30 years of conceptual and empirical research work for the construction of a model of brief and adaptive psychodynamic psychotherapy applicable at the Primary Health Care level. The many milestones of this journey are reviewed, starting with the difficulties and obstacles encountered when pursuing this task within IPA institutions. Once the authors decided to conduct the task outside the analytic institution, they created two training programs for psychodynamic therapists and a research group in psychotherapy, all of which have attained excellence. This effort gave birth to several institutions that are still in operation, such as the Chilean and Latin American chapters of the Society for Psychotherapy Research, the Chilean Congress of Psychotherapy, the PhD Program in Psychotherapy, and finally the Millennium Institute for Research and Personality (MIDAP). In its 8 years of existence, MIDAP has become a national and Latin American reference center for research in Mental Health, aimed at implementing preventive and psychotherapeutic interventions in vulnerable populations at the primary health care and community level. The article ends with a description of the main components and the final process of the construction of the Protocol of Psychotherapeutic Competences for the Treatment of Depression in Primary Health Care level. [ABSTRACT FROM AUTHOR]

Introduction: Most psychological treatments are administered in a one‐to‐one therapy format, which has proven effective but has limitations in complex clinical situations. Teamwork can help address these limitations by going beyond the one‐to‐one therapy approach and involving the client's professional and relational network in therapy interventions to promote and secure change. In this issue of Journal of Clinical Psychology: In Session five effective teamwork practices are presented illustrating how clinicians integrate teamwork into treatment delivery to improve outcomes in an array of cases presenting high complexity. Purpose: In this commentary section, we describe the role and essence of these teamwork practices from a systems thinking approach as a theoretical umbrella to understand the diversity of processes hindering and facilitating effective teamwork Conclussion: From this approach we discuss the core skills that psychotherapists should train to master team working and interprofessional collaboration. The basic professional competence consists in the ability to foster and coordinate shared frames of understanding in case formulation. An advanced systemic skill is based on the ability to formulate and change relational patterns, given that interpersonal processes are the main key factor to understand barriers and facilitators of effective teamwork to overcome stalemated complex clinical situations. [ABSTRACT FROM AUTHOR]

Psychotherapy can be an emotionally laden conversation, where both verbal and nonverbal interventions may impact the therapeutic process. Prior research has postulated mixed results regarding how clients emotionally react following a silence after the therapist is finished talking, potentially due to studying a limited range of silences with primarily qualitative and self‐report methodologies. A quantitative exploration may illuminate new findings. Utilising research and automatic data processing from the field of linguistics, we analysed the full range of silence lengths (0.2–24.01 s), and measures of emotional expression—vocally encoded arousal and emotional valence from the works spoken—of 84 audio recordings of Motivational Interviewing sessions. We hypothesised that both the level and the variance of client emotional expression would change as a function of silence length; however, due to the mixed results in the literature, the direction of emotional change was unclear. We conducted a multilevel linear regression to examine how the level of client emotional expression changed across silence length, and an ANOVA to examine the variability of client emotional expression across silence lengths. Results of both analyses indicated that as silence length increased, emotional expression largely remained the same. Broadly, we demonstrated a weak connection between silence length and emotional expression, indicating no persuasive evidence that silence leads to client emotional processing and expression. [ABSTRACT FROM AUTHOR]

Sexual assault is one of the most challenging experiences to manage since it can have devastating effects on the individual's mental and physical health, and can cause many psychological problems, especially PTSD and depression. In this study, a psychotherapy process based on the schema therapy model was conducted with six women who were sexually assaulted in Turkey, and the psychotherapeutic change process was examined with both qualitative and quantitative methods. According to the descriptive results from Post Traumatic Stress Disorder Symptoms Scale‐Self‐Report (PSS‐SR), Beck Depression Inventory (BDI) and Symptom Check list‐90 (SCL‐90), the scores in the post‐test and follow‐up stages decreased compared to the pre‐test stage, and this decrease also had clinical significance for PSS‐SR both at post‐test (p <.05,.01 and.001 for each participant) and at follow‐up (p <.01 and.001 for each participant) stages. From the results of the narrative analysis, on the other hand, it was concluded that the psychotherapy process was completed in three stages (the introduction, the body, the conclusion); the participants conveyed the stories of some schema modes (the abused child, the punitive parent, the demanding parent, the angry‐protector, the avoidant and detached protector); and an important transitional stage was experienced (meeting the psychological needs, self‐awareness, self‐acceptance, self‐control and healthy boundaries, confrontation and normalisation) during the transformation of these stories into healthy adults. It is recommended that this discovered transitional stage is investigated in further schema therapy research. All findings are discussed in detail and a brief intervention protocol based on the schema therapy model is proposed. [ABSTRACT FROM AUTHOR]

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Introduction/Objective: Treatment results of anorexia nervosa (AN) are modest, with fear of weight gain being a strong predictor of treatment outcome and relapse. Here, we present a virtual reality (VR) setup for exposure to healthy weight and evaluate its potential as an adjunct treatment for AN. Methods: In two studies, we investigate VR experience and clinical effects of VR exposure to higher weight in 20 women with high weight concern or shape concern and in 20 women with AN. Results: In study 1, 90% of participants (18/20) reported symptoms of high arousal but verbalized low to medium levels of fear. Study 2 demonstrated that VR exposure to healthy weight induced high arousal in patients with AN and yielded a trend that four sessions of exposure improved fear of weight gain. Explorative analyses revealed three clusters of individual reactions to exposure, which need further exploration. Conclusions: VR exposure is a well-accepted and powerful tool for evoking fear of weight gain in patients with AN. We observed a statistical trend that repeated virtual exposure to healthy weight improved fear of weight gain with large effect sizes. Further studies are needed to determine the mechanisms and differential effects. [ABSTRACT FROM AUTHOR]

Objective: Theoretical and practical psychotherapy training improves psychiatrists' case management and treatment skills. However, little is known about the extent that in Turkey early career psychiatrists have access to these opportunities and their experiences, so in this study, we aimed to investigate various aspects of the psychotherapy training of early career adult, child and adolescent psychiatrists in Turkey. Method: A 22 items questionnaire was disseminated in Turkey to psychiatry trainees and early career psychiatrists (psychiatry and child and adolescent psychiatry trainees and specialists who are in the first 5 years of their career and younger than 40). The questionnaire inquired about participants': i) sociodemographics; ii) the quality of the psychotherapy training; iii) organizational aspects of psychotherapy training; iv) satisfaction with psychotherapy training. Results: A total of 103 individuals (n=41 psychiatrists, n=37 psychiatry trainees, n=12 child and adolescent psychiatrists, and n=13 child and adolescent psychiatry trainees) responded to this questionnaire. While 68% of the participants stated that psychotherapy training is included in psychiatry training, 89.3% stated they have conducted psychotherapy training themselves and 76.7% reported that they received supervision. Only 41.7% stated that they were going to their own personal psychotherapy or had gone before, and 59.2% were not a qualified psychotherapist. Discussion: One third of psychiatry and child and adolescent psychiatry trainees in Turkey cannot access psychotherapy training in their institutes, and one fourth cannot access supervision opportunities, and more than half are deprived of their personal therapy processes. This should be addressed to improve the skills and competencies of psychiatrists that train in Turkey. [ABSTRACT FROM AUTHOR]

Psychotherapy is a conversation, whereby, at its foundation, many interventions are derived from the therapist talking. Research suggests that the voice can convey a variety of emotional and social information, and individuals may change their voice based on the context and content of the conversation (e.g. talking to a baby or delivering difficult news to patients with cancer). As such, therapists may adjust aspects of their voice throughout a therapy session depending on if they are beginning a therapy session and checking in with a client, conducting more therapeutic 'work' or ending the session. In this study, we modelled three vocal features—pitch, energy and rate—with linear and quadratic multilevel models to understand how therapists' vocal features change throughout a therapy session. We hypothesised that all three vocal features would be best fit with a quadratic function—starting high and more congruent with a conversational voice, decreasing during the middle portions of therapy where more therapeutic interventions were being administered, and increasing again at the end of the session. Results indicated a quadratic model for all three vocal features was superior in fitting the data, as compared to a linear model, suggesting that therapists begin and end therapy using a different style of voice than in the middle of a session. [ABSTRACT FROM AUTHOR]

In psychotherapy research, the first applications of dynamical systems research (DSR) date back to the 1990s. Over time, DSR has developed three main lines of research: the study of oscillations in synchronization; the study of oscillations between stability and flexibility of process variables (S–F oscillations); the mathematical modeling to analyze the evolution of psychotherapy process. However, the connections among the empirical results and their implications for psychotherapy practice are unclear. For this reason, for the first time in the literature, this work carries out a comprehensive review of all three lines of research, including the main scientific contributions from the 1990s to the present day. For each line of research, the work critically analyzes the results, proposes future developments, and underlines the connections between empirical results and implications for psychotherapy practice. Furthermore, the work highlights the model of change that emerges from the empirical results, and its clinical correlates. In the conclusions, the author summarizes the results and the evolution of psychotherapy process in accordance with the DSR.

Psychological research often seeks general rules applying across individuals, an aim that is in tension with examining that which is unique to any individual. There are general statistical regularities across individuals' subjective self-report which enable much psychology and psychotherapy research to combine data from self-report questionnaire responses with statistical and psychometric methods to create a fundamental part of Cronbach and Meehl's foundational nomological networks of validity. However, these methods only apply when most participants answer the same questions on measures creating nomothetic data and this has led to a neglect of idiographic data. This paper reviews a method of analysis of idiographic data, of "rigorous idiography": the method of derangements. This is a remarkably simple statistical test of whether purely idiographic data convey reliable information. We show how the method appeared to become stuck in a bibliometric backwater but we expand on its potential for research and practise and hope it will be taken up and used correctly and more widely. [ABSTRACT FROM AUTHOR]

Objective: Psychotherapists differ in their treatment effectiveness as measured by the therapy outcome of their patients. One possible factor for therapist effects seems to be the therapists' interpersonal skills. Therapist assessments of interpersonal skills have demonstrated sufficient predictive validity, but little is known about underlying skills and related constructs. The purpose of the present study is to compare the different constructs of interpersonal skills with each other and to investigate possible underlying abilities. Study Population and Methods: In this exploratory study, the concept of interpersonal skills was investigated using three survey methods (questionnaires, computer tests, and assessments) and comparing two measurements each. For this purpose, 6 measures of interpersonal skills were collected from 20 prospective psychotherapists as well as 28 psychology students (total N = 48). Alongside more traditional methods, the correlations and overlaps of the constructs were examined using partial and Bayesian networks. Results: Moderate to high correlations are found within the self-report measures. The assessments, however, did not correlate with self-report measures nor with computer tests. Discussion and Conclusion: The similarities in the self-assessments indicate stable self-concepts of interpersonal skills, which, however, cannot be explained by the underlying skills nor by the observer-based evaluations. The marginal correlation between the assessments also indicates that interpersonal, therapy-related abilities must be interpreted in a situation-specific manner. [ABSTRACT FROM AUTHOR]

Objective: Despite the importance of modeling for learning, it has only so far been investigated in a few controlled studies in psychotherapy training. We, therefore, investigated, across several study outcomes, whether modeling outperformed a control group. Method: Sixty-nine trainees (i.e., psychology students; mean age 25.58 years, 81.2% women and 81.2% Caucasian) were randomly assigned to the intervention group (IG, manual reading plus modeling) or control group (CG, manual reading). After manual reading, IG participants watched a video of a skillfully conducted therapy session, whereas CG participants watched an unspecific tutorial (e.g., solving a Rubik's Cube). Trainees then demonstrated cognitive behavioral interventions in videotaped role-plays with (SPs). Psychotherapeutic competences and counseling skills were rated by two independent raters, on the Cognitive Therapy Scale (CTS) and the Clinical Communication Skills Scale–Short Form (CCSS-S). In addition, raters, trainees, and SPs assessed empathy (Empathy Scale [ES]) and alliance (Helping Alliance Questionnaire [HAQ]). Results: Multilevel modeling revealed Significant Time × Group Effects, that is, psychotherapy competences (CTS, β =.26, p =.026) and counseling skills (CCSS-S, β =.31, p =.004) to increase more pre–post in the IG than in the CG (rater perspective). The same applied to the alliance (HAQ) from the external rater and SP perspectives. Trainees evaluated the alliance as improving in both groups from pre to post training (main effect). Conclusions: The results provide initial support for modeling as important for fostering psychotherapy skills. Future studies should focus on more complex training and real patient encounters. What is the public health significance of this article?: The study suggests that the active training strategy of modeling plays an important role in building therapeutic competences, basic counseling skills, and alliance. The maintenance of training effects and the transfer to other groups of trainees remain the focus of further research. [ABSTRACT FROM AUTHOR]

Routine outcome measurement is an important practice to improve the quality of mental health services. Since 2011, it has been mandatory for health services to offer psychotherapy in Uruguay's National Health System. Adolescents and young people are a priority population. The lack of information about the functioning and the effectiveness of the mental health services focused on youth is an obstacle to assess and, as a consequence, to improve the services. The objective of this study was to evaluate the implementation of a system to establish the characteristics and outcomes of psychological treatment received by young people at services provided by Uruguay's National Health System. The present study was the first of its kind to examine the outcomes of psychotherapy offered in mental health services. A pre‐post design in a naturalistic setting was used. Sixty‐nine participants, aged 16 to 24 years, and 26 therapists from four health services participated. Sociodemographic and clinical questionnaires, the Clinical Outcome Routine Evaluation‐Outcome Measure (CORE‐OM; Evans et al., 2002) and a semi‐structured interview were applied to assess the perception of change. CORE‐OM results portrayed a decrease in psychological distress. Interview data helped to better understand the perception of change. A high number of dropouts revealed the need for the services to use strategies to prevent early dropouts in young users. The CORE‐OM appears to be a valuable tool. Barriers for outcomes system implementations are discussed and may prove useful to other countries where there is a lack of an outcome‐oriented clinical culture. [ABSTRACT FROM AUTHOR]

Over the last 30 years we have seen two models of empirical evidence dominate funding for psychotherapies and for researching the psychotherapies. The first, still the dominant model, 'Evidence-Based Practice (EBP)' is based on Randomized Controlled Trial (RCT) evidence. More recently, Embedded Change Management (ECM) is the rising pre-paradigm, offering an alternative to EBP. I argue that neither model understands how evidence it is best shared between therapists as both are based on fundamentally flawed epistemologies and ideas of what constitutes pertinent evidence about the psychotherapies. Twenty-eight years ago, I was a co-creator of the CORE (Clinical Outcomes in Routine Exploration) system designed to support Practice-Based Evidence (PBE). I suggest that re-thinking the rather neglected PBE model at the heart of the original CORE system design might help change this situation. However, I recognize that the political models beneath both EBP and ECM create such vested interests within the 'global North' that real change will probably have to come from elsewhere. [ABSTRACT FROM AUTHOR]