Change In Psychotherapy Research Articles

Seeing the past in a new light: change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms

ABSTRACT Objective As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes. Method Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment. Results After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge. Conclusion The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.

Ethics in Psychotherapy: Informed Consent, Digital Professionalism, and Sexual Misconduct.

Ethics in Psychotherapy: Informed Consent, Digital Professionalism, and Sexual Misconduct.

Early trajectories of symptom change and working alliance as predictors of treatment outcome

ABSTRACT Objective We aim to examine how different trajectories of symptom change and working alliance in early psychotherapy predict treatment outcomes. Method We performed a growth mixture model (GMM) to examine trajectories of symptom change and working alliance in the first five therapy sessions in a sample of 272 outpatients and tested the association of early symptom trajectories and alliance patterns with treatment outcome. Results We identified two symptom trajectories: high symptom/steady change (63.2%) and early improving (36.8%), and four alliance development patterns: undeveloped alliance (40.1%), strengthening moderate alliance (31.6%), optimal alliance (17.3%), and improved alliance (11%) in early psychotherapy. The symptom trajectories and alliance patterns both independently and interactively predicted treatment outcomes. The optimal alliance was generally associated with the best outcome. The effect of improved alliance on treatment outcome was moderated by symptom trajectories: for high symptom/steady change subgroup, the improved alliance was related to better treatment outcome, whereas for early improving subgroup, the improved alliance was associated with poorer outcome. Conclusions Patients fell into different trajectories regarding symptom reduction and alliance development in early psychotherapy that affected final treatment outcome. Combining early symptom trajectories and alliance trajectories simultaneously can facilitate routine outcome monitoring and contribute to the prediction of treatment outcome.

The Moderating Influence of Religiousness/Spirituality on COVID-19 Impact and Change in Psychotherapy

The COVID-19 pandemic has spurred a global surge in empirical research examining the influence of the pandemic on individuals’ mental health symptoms and well-being. Within this larger literature is a rapidly growing literature on the associations among religiousness/spirituality, COVID-19 impact, symptoms and well-being. Largely absent from this literature is a specific research focus on psychotherapy clients, and the influence of religiousness/spirituality and COVID-19 impact on change during treatment. One prominent theory in the existing literature centers on the notion that religiousness/spirituality is a coping resource for individuals during times of adversity. Yet, existing empirical findings present mixed evidence for the religious/spiritual coping hypothesis. We expanded upon these emerging research trends to examine the influence of religious/spiritual struggles, religious/spiritual commitment, religious/spiritual exploration, and COVID-19 impact ratings on psychotherapy change in a sample of adult clients (N = 185; Mage = 38.06; SD = 15.78; range = 19–81; 61.1% female; 69.7% White). The results of latent trajectory analysis identified three subgroups that differed on initial levels of symptoms and well-being and the nature of change over three time points. The COVID-19 impact ratings predicted change trajectories. As more positive ratings of COVID-19 impact increased, membership in the no change trajectory was more likely relative to the deterioration trajectory at high levels of both religious/spiritual commitment and exploration. The implications emphasize the need for judicious assessment of religiousness/spirituality and COVID-19 impact before integrating religiousness/spirituality into treatment.

Mentalizing Mediates the Association between Narcissism and Psychotherapeutic Treatment Outcome in a Mixed Clinical Sample

Introduction: Pathological narcissism has been a challenge for the success of psychological treatment, whereas mentalizing has turned out to be an important mechanism of change in psychotherapy. This study focused on the classic narcissistic self (CNS) (i.e., narcissistic grandiosity) as predictor of the outcome. It further investigated whether mentalizing mediates this relation. Methods: A mixed clinical sample of 205 patients was investigated. The CNS scale of the Narcissism Inventory and the Mentalization Questionnaire was used to measure the features of narcissistic grandiosity and the capacity to mentalize, respectively. The symptom outcome was assessed with the Hamburg Modules for the Assessment of Psychosocial Health. Results: Contrary to our expectations, we did not find a direct association between narcissistic grandiosity and a decrease in symptoms. However, mentalizing was found to mediate the association between the CNS as well as between the narcissistic furor and outcome. Conclusion: Our results confirm the ambiguity concerning the clinical significance of narcissistic grandiosity. However, in order to improve the treatment outcome in patients with narcissistic features, especially narcissistic furor, individualized treatment plans might consider introducing interventions that enhance the capacity to mentalize.

Therapists' Views of Mechanisms of Change in Psychotherapy: A Mixed-Method Approach.

The question of what works in psychotherapy has been a subject of debate in the recent years, occupying both clinicians and researchers. In this study, we aimed to assess the current perspectives held by clinicians regarding the processes which produce changes in psychotherapy, as well as the predictors of specific views. Licensed therapists (n = 107), consisting mainly of psychodynamically and integratively oriented psychologists, were asked to write in their own words what they think works in psychotherapy. Thematic analysis was employed to assess the main mechanisms of change as perceived by the therapists. Differences in the prevalence of specific themes were assessed using Friedman and Wilcoxon signed-rank tests. Univariate logistic regressions were employed to assess the factors that predict the probability of reporting a specific mechanism of change. The results indicated that the therapeutic bond was the most highly reported mechanism of change, followed by theory-driven mechanisms of change, therapist characteristics, therapist professionalism, and client motivation. Male therapists were more likely to indicate the professionalism as a mechanism of change compared to female therapists. Higher education was associated with lower reports of therapists’ characteristics as the mechanisms of change. These results suggest that therapists acknowledge the importance of the working alliance, and that the perception of the mechanism of change is associated with various factors which comprise therapist orientation. Limitations and directions for future research are discussed.

Emotional clarity and tolerance of emotional distress as mechanisms of change in short-term psychodynamic psychotherapy for chronic depression.

The aim of this naturalistic process study was to investigate the relationship between emotional clarity and tolerance of emotional distress and depressive symptoms over the course of short-term psychodynamic psychotherapy for chronically depressed patients. Weekly self-reports of emotional clarity, tolerance of emotional distress, and depressive symptoms (PHQ-9) were provided by 252 patients with chronic depression who were admitted to a 13-week inpatient treatment program. Latent curve modeling with structured residuals (LCM-SR) was applied to investigate the between- and within-person effects of week-to-week change in emotional clarity and tolerance of emotional distress as predictors of subsequent depression. The relationship between emotional clarity and tolerance of emotional distress was also investigated. At the within-person level, higher level of emotional clarity and tolerance of emotional distress predicted subsequent lower level of depression. A reciprocal relationship was found for tolerance of emotional distress (lower level of depression predicted subsequent level of tolerance emotional distress) but not for emotional clarity. No within-person effect between emotional clarity and tolerance of emotional distress was found. The results indicate that emotional clarity and tolerance of emotional distress may be mechanisms of change in short-term psychodynamic psychotherapy for chronic depression. The results are consistent with previous findings of the importance of emotional clarity and tolerance of emotional distress in psychotherapy. This study demonstrated the utility of LCM-SR as a method to identity mechanisms of change in psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Field Theory in Contemporary Gestalt Therapy Part Two: Paradoxical Theory of Change Reconsidered

ABSTRACTConceptualization of change processes presents a significant source of therapist’s self-support in demanding clinical situations. Three perspectives on understanding the process of change used in Gestalt therapy are set forth in a systematic way: mono-personal, bi-personal, and field theory. Changes in psychotherapy in clinical practice, conceptualized from a field theory perspective, are addressed in order to support both the growing edge of contemporary Gestalt therapy and to add a Gestalt therapy contribution to the current emphasis on field theory in psychotherapy. The Paradoxical Theory of Change, as the leading theoretical concept for Gestalt therapy theory of change, is reconsidered from a field theory perspective, and the consequences for clinical work are addressed.

The effect of attitudes toward online therapy and the difficulties perceived in online therapeutic presence.

The ongoing COVID-19 pandemic has led to changes in every aspect of life. Online therapy creates both difficulties and learning opportunities for therapists. The literature shows that therapeutic presence is an important variable in efficacy and therapeutic change. Attitudes toward online therapy seem to impact the acceptance and adoption of telehealth interventions. The present cross-sectional study aims to understand whether attitudes toward online interventions and therapists' perceived difficulties in online therapy have an effect in therapeutic presence in a sample composed of psychologists and psychotherapists (N = 445). The data indicate that therapists' attitudes toward online interventions (s = .31;p < .001) and therapists' perceived difficulties (s = -.49;p < .001) are both significant predictors. These data have practical implications. Enhancing online psychological service could be done by improving therapeutic presence. Finally, ameliorating therapeutic presence could be possible by doing interventions on the other 2 variables under study. Further research is needed on this topic, which appears to be gaining importance in view of the ongoing pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement The results of this research suggest that both attitudes towards online therapy and difficulties perceived by therapists in online therapy have a significant effect on their therapeutic presence. The literature shows that during the present pandemic, with an enormous uncertainty facing the future, psychological support becomes even more necessary. Most therapists have been forced to start online therapy without experience and training, and more research is needed to clarify how we can improve online psychology services. The present research tried to find a possible way: it is suggested that doing interventions on difficulties perceived and in the attitudes towards online therapy the therapeutic presence of the therapist will increase. The therapeutic presence is a variable that appears in the literature as a common factor associated with a stronger therapeutic relationship and a more positive therapeutic alliance. These last two variables are considered as two consistent factors of change and effectiveness in psychotherapy. Research on how to improve online psychological support services is scarce, and thus a significant research effort is needed for present and future practical recommendations. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

How a transdiagnostic approach can improve the treatment of emotional disorders: Insights from clinical psychology and neuroimaging.

Multiple psychological treatments for emotional disorders have been developed and implemented, improving the quality of life of individuals. Nevertheless, relapse and poor response to psychotherapy are common. This article argues that a greater understanding of both the psychological and neurobiological mechanisms of change in psychotherapy is essential to improve treatment for emotional disorders. It aims to demonstrate how an understanding of these mechanisms provides a basis for (i) reconceptualizing some mental disorders, (ii) refining and establishing the evidence for existing therapeutic techniques and (iii) designing new techniques that precisely target the processes that maintain these disorders. Possible future directions for researchers and practitioners working at the intersection of neuropsychology and clinical psychology are discussed.

Parental Representations Changes in Brief Psychotherapy to Promote Sensitivity: A Case Study of Siblings’ Adoption

ABSTRACT Some brief psychotherapies aim to increase parental sensitivity in the post-adoption period. However, there is a lack of systemic approaches to evaluate the psychotherapeutic process. The current study aimed to understand how parental representations changed during ten psychotherapy sessions of a brief intervention to promote parental sensitivity during the post-adoption period. A couple (35-year-old mother and 39-year-old father) who were having severe difficulties bonding with their recently adopted children (three, five, and eight years old boys) participated in the study. The construct ‘sensitivity’ was used to analyze the psychotherapy process using a theme analysis applied to the psychotherapy transcriptions. The frequency of the deductive themes and the construction of new ones (inductive) through sessions guided the analyses. Initially, parents interpreted their children’s intentions negatively, which caused a chain of hostilities in the relationship. Throughout the intervention, parents gradually became better able to represent their children in a more complex way and understand how their children communicate their needs. Along with the sensitivity improvements noted, the couple reported an improvement in the parent-child bond, and adoption breakdown was no longer a topic of the sessions as it was in the beginning.

Movement-based patient-therapist attunement in psychological therapy and its association with early change.

ObjectiveAttunement is a novel measure of nonverbal synchrony reflecting the duration of the present moment shared by two interaction partners. This study examined its association with early change in outpatient psychotherapy.MethodsAutomated video analysis based on motion energy analysis (MEA) and cross-correlation of the movement time-series of patient and therapist was conducted to calculate movement synchrony for N = 161 outpatients. Movement-based attunement was defined as the range of connected time lags with significant synchrony. Latent change classes in the HSCL-11 were identified with growth mixture modeling (GMM) and predicted by pre-treatment covariates and attunement using multilevel multinomial regression.ResultsGMM identified four latent classes: high impairment, no change (Class 1); high impairment, early response (Class 2); moderate impairment (Class 3); and low impairment (Class 4). Class 2 showed the strongest attunement, the largest early response, and the best outcome. Stronger attunement was associated with a higher likelihood of membership in Class 2 (b = 0.313, p = .007), Class 3 (b = 0.251, p = .033), and Class 4 (b = 0.275, p = .043) compared to Class 1. For highly impaired patients, the probability of no early change (Class 1) decreased and the probability of early response (Class 2) increased as a function of attunement.ConclusionsAmong patients with high impairment, stronger patient-therapist attunement was associated with early response, which predicted a better treatment outcome. Video-based assessment of attunement might provide new information for therapists not available from self-report questionnaires and support therapists in their clinical decision-making.

How to become a responsive therapist: A study of experiences of developing therapists

ABSTRACT Objective : A growing body of empirical evidence suggests that psychotherapy is more effective when therapists tailor interventions to fit their specific clients’ needs, a concept referred to as therapist responsiveness in the psychotherapy literature. However, the question of how therapists learn to become responsive rarely has been examined. Method : The central question of this study, put to eleven graduate student therapist trainees, was, “How did you learn to be responsive to clients as a novice therapist, and in what ways have you become responsive?” A critical-constructivist grounded theory method was employed to generate themes from trainees’ replies. Results : The analysis showed that trainees learned to improve their responsiveness to clients by: (1) becoming more aware of cues that signaled the need to adapt interventions (as related to psychotherapy change processes, client-therapist relational dynamics, clients’ identities and cultural contexts, and the maximizing of clients’ agency); (2) developing attunement to their own emotions and engaging in self-care; and (3) adopting mindsets that facilitated their trying new relational or therapy approaches while also maintaining professionalism. Conclusion Based upon these findings, preliminary suggestions for responsiveness training are presented to guide programs that wish to train responsive psychotherapists .

Temporal and specific pathways of change in cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for depression

BackgroundThe present study investigated the specific and temporal role of putative mechanisms of change in cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD). Method200 patients were randomized to CBT weekly, CBT twice weekly, IPT weekly or IPT twice weekly. Outcome and putative mechanisms of change (i.e., dysfunctional thinking, behavioral activation, CBT skills, IPT skills, therapeutic alliance, compliance, motivation) were measured multiple times up to six months after the start of treatment. Latent change score models were used to investigate temporal relations and test mediation. Explorative analyses tested whether baseline working memory moderated the effect of mechanism change on outcome change. ResultsCBT skills and dysfunctional thinking mediated the relation between treatment modality and changes in depression. In both treatments, IPT skills and behavioral activation were related to subsequent change in depression while a decrease in depression led to subsequent improvement in therapeutic alliance and a decrease in autonomous motivation. Change in compliance was unrelated to change in depression. Baseline working memory was related to therapy skill improvement. ConclusionCBT skill improvement seems a specific mechanism of change leading to subsequent decrease in depression in CBT. Changes in IPT skills acted as a non-specific mechanism, subsequently reducing depression regardless of treatment modality. The specific role of cognitive change and behavioral activation remains unclear. Future studies should investigate the specificity and direction of the potential mechanisms of change throughout the course of therapy and investigate whether these mechanistic pathways differ between individuals.

Rosalind Dymond Cartwright (1922-2021).

Memorializes Rosalind Dymond Cartwright (1922-2021). She was a pioneer in the fields of empathy and psychotherapy research and one of the first women to make significant contributions to the science of sleep and dreams and the field of sleep medicine. Upon receiving her PhD in 1949, she took a position at Mount Holyoke College. After 2 years, she moved to the University of Chicago where Carl Rogers hired her to oversee the many studies of audiotaped psychotherapy sessions that he was conducting to test the effectiveness of client-centered therapy. In 1954, she and Rogers coedited the landmark book, Psychotherapy and Personality Change. She also held positions at the University of Illinois College of Medicine, University of Chicago, and Rush University Medical Center. From 1971 to 1993 she was a grant reviewer for the National Institute of Mental Health, a role that allowed her to advocate anonymously for the support of research and training programs that greatly influenced the course of sleep research in the United States. Beginning in 1990, Roz served pro bono as an expert witness for the defense in several murder cases that involved a defense of sleepwalking, a non-REM parasomnia. At age 90 she immersed herself in the technology of spectral analysis scoring of polysomnogram data to argue that recent laboratory-based discoveries about sleepwalkers could be used to determine whether an alleged crime might have been committed during an arousal from sleep in which consciousness was impaired. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mediators and Theories of Change in Psychotherapy for Young People With Personality Disorders: A Systematic Review Protocol.

Background: Personality disorders (PDs) are a severe health issue already prevalent among adolescents and young adults. Early detection and intervention offer the opportunity to reduce disease burden and chronicity of symptoms and to enhance long-term functional outcomes. While psychological treatments for PDs have been shown to be effective for young people, the mediators and specific change mechanisms of treatment are still unclear.Aim: As part of the “European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders” (TREATme), funded by the European Cooperation in Science and Technology (COST), we will conduct a systematic review to summarize the existing knowledge on mediators of treatment outcome and theories of change in psychotherapy for young people with personality disorders. In particular, we will evaluate whether mediators appear to be common or specific to particular age groups, treatment models, or outcome domains (e.g., psychosocial functioning, life quality, and adverse treatment effects).Method: We will follow the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched for prospective, longitudinal, and case–control designs of psychological treatment studies, which examine mediators published in English. Participants will be young people between 10 and 30years of age who suffer from subclinical personality symptoms or have a personality disorder diagnosis and receive an intervention that aims at preventing, ameliorating, and/or treating psychological problems.Results: The results will be published in a peer-reviewed journal and at conference presentations and will be shared with relevant stakeholder groups. The data set will be made available to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. The review has been registered in PROSPERO (evaluation is pending, registration number ID 248959).Implications: This review will deliver a comprehensive overview on the empirical basis to contribute to the further development of psychological treatments for young people with personality disorders.

A Systematic Narrative Review of Evaluating Change in Psychotherapy With the Rorschach Test

Abstract. In 2004, Grønnerød conducted a meta-analysis on the use of the Rorschach Test to detect change in psychotherapy. Results showed which Rorschach variables were associated with change in clients, and to what extent. The purpose of this study was to update the picture from the year of publication of the previous meta-analysis until 2019. A systematic review of the literature was carried out, including 17 studies of relevance to this research. Results showed that the Rorschach Test captures the changes in patients after psychotherapy, particularly when treatment is tailored to the unique needs of clients. We describe the limitations of the studies included in this systematic review and propose strategies to increase the effectiveness of using the Rorschach to evaluate treatment outcome.

A Commentary on “A Systematic Narrative Review of Evaluating Change in Psychotherapy” (Aschieri &amp; Pascarella, 2021)

A Commentary on “A Systematic Narrative Review of Evaluating Change in Psychotherapy” (Aschieri &amp; Pascarella, 2021)

Insight as a dual-perspective construct: Convergence between patients' and professional evaluators' perspective on baseline level of insight and on changes in insight.

Insight gained by patients during treatment has been theorized to be a central mechanism of change in psychotherapy, but empirical studies examining the association between patients' insight and psychopathological symptoms have produced mixed results. The present study addresses these inconsistencies by investigating convergence between the perspectives of patient and professional evaluator on insight and disentangling two potentially distinct components of insight: pretreatment individual differences and changes in insight during treatment. A sample of 393 patients receiving psychodynamic psychotherapy completed pre- and posttreatment measures on symptoms and insight. Professional evaluators evaluated patients' insight based on clinical interviews pre- and posttreatment. Polynomial regression and response surface analyses were used to examine congruence. The results indicate that when there was agreement between the patient and the evaluator on insight, both baseline level of insight and the changes in insight during treatment were found to be related to symptomatic change, although showing different patterns of association. Lower baseline levels of insight were significantly associated with greater symptomatic improvement than were higher levels of insight. At the same time, greater increase in insight during treatment was moderately significantly associated with greater reduction in symptoms, as long as the changes in insight were not minimal. The findings underscore the importance of assessing the congruence between patients' and professional observers' perspectives on patient insight and the potentially distinct roles of between-patients baseline differences and within-patient changes in insight during treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Initial validation of the Defense Mechanisms Rating Scales Q-sort: A Comparison of Trained and Untrained Raters

Objectives: Defense mechanisms underlie a range of healthy and pathological psychological phenomena and are important mechanisms of change in psychotherapy. Thus, the identification of defense mechanisms in clinical work is crucial, however, measures commonly used for their assessment have various limitations. The Defense Mechanisms Rating Scale Q-set (DMRS-Q; Di Giuseppe, 2014) was developed to address these problems, and to provide an easy-to-use, valid, and reliable tool for the assessment of defense mechanisms. The present study aimed to evaluate the reliability of the DMRS-Q when used by trained versus untrained coders, and to examine the criterion validity of the DMRS-Q in relation to its original observer-rated version, the Defense Mechanisms Rating Scale (DMRS; Perry, 1990). Methods: Collateral sessions ( n = 13) with parents of children with externalizing problems were coded with the DMRS-Q by trained and untrained raters, and on the DMRS by an expert rater. Results: We found that both trained and untrained coders were able to assess most defense categories and levels with moderate to excellent reliability on the DMRS-Q, and that untrained coders’ reliability was comparable although slightly lower than untrained coders’ reliability. Moreover, our results indicate the generally good criterion validity of the DMRS-Q when compared to the original DMRS. Discussion: These findings suggest that the DMRS-Q is a promising measure that can be used by clinicians and researchers at all levels of training and with minimal knowledge of defense mechanisms as a reliable and valid method to assess defense mechanisms in clinical settings.