Psychotherapeutic Research Research Articles

Psychotherapeutic research and practice: Do we need to talk about ‘efficacy’?

ABSTRACT In this article, we address how standardisation in psychotherapeutic research and practice can create a ‘procrustean bed’ which leads to conformity rather than an ethical response to what emerges in the moment. Articulated, three points of conflict in which we discuss how the therapist or researcher may be rendered ‘ineffective’ in the name of ‘efficacy’. We explore some of the implications for idiosyncratic practices in psychotherapy, which are rooted in a foundation of ethics and philosophy, when the paradigm of empirically ‘evidence-based practices’ (EBP), which are rooted in measurement, takes centre stage and are overwhelmingly favoured in the industry of funded therapies. The first point of conflict is in relation to conversation itself; exploring the place of hermeneutics and interpretation within therapeutic dialogue and research. The second point explores what it means to take up a discovery-oriented stance and the implications this has for ‘evidence’; further delving into the way our demand for ‘evidence’ may be impacting how psychotherapeutic research and practice is carried out. The final point aims to explore the infrastructure and work environment of funded therapies in the United Kingdom.

Drop-out rates in animal-assisted psychotherapy - Results of a quantitative meta-analysis.

Animal-assisted psychotherapy is an emerging field with great potential and growing popularity. However, empirical research on its effectiveness is insufficient, and consistent evidence about patients' commitment is missing. The present meta-analysis addresses this gap by systematically comparing drop-out rates in animal-assisted psychotherapy and by relating the resulting across study drop-out rate to across study drop-out rates reported in meta-analyses on conventional psychotherapy. Fifty-seven studies published until August 2022 were identified as eligible for meta-analytic comparison, that is, they conducted animal-assisted psychotherapy on at least one group of psychiatric patients and reported drop-out rates. Potential moderating influences of the type of animal and patients' disorder were considered, as well as multiple other demographic and study design variables. The across study drop-out rate in animal-assisted psychotherapy was 11.2%. This was significantly lower than the across meta-analyses drop-out rate of conventional psychotherapy (d = -.45, p = .0005). Although effects of moderator variables could not be evaluated statistically due to too small and heterogeneous data sets, descriptive results suggest influences of the type of animal and patient disorder. However, study quality ratings identified serious shortcomings regarding proper research design, most critically concerning the report of effect size measures, the use of standardized intervention plans and Open Science practices. Drop-out constitutes a major problem of psychotherapeutic research and practice. By proposing that the inclusion of an animal in the psychotherapeutic setting can enhance patients' commitment and by outlining challenges and opportunity of animal-assisted psychotherapy, this meta-analysis offers a starting point for future research in this evolving field.

How does psilocybin therapy work? An exploration of experiential avoidance as a putative mechanism of change

BackgroundPsilocybin therapy is receiving attention as a mental health intervention with transdiagnostic potential. In line with psychotherapeutic research, qualitative research has highlighted the role of reductions in experiential avoidance (and increases in connectedness) within psilocybin therapy. However, no quantitative research has examined experiential avoidance as a mechanism underlying psilocybin therapy's therapeutic effects. MethodData was used from a double-blind randomized controlled trial that compared psilocybin therapy (two 25 mg psilocybin session plus daily placebo for six weeks) with escitalopram (two 1 mg psilocybin sessions plus 10–20 mg daily escitalopram for six weeks) among individuals with major depressive disorder (N = 59). All participants received psychological support. Experiential avoidance, connectedness, and treatment outcomes were measured at pre-treatment and at a 6 week primary endpoint. Acute psilocybin experiences and psychological insight were also measured. ResultsWith psilocybin therapy, but not escitalopram, improvements in mental health outcomes (i.e., well-being, depression severity, suicidal ideation, and trait anxiety) occurred via reductions in experiential avoidance. Exploratory analyses suggested that improvements in mental health (except for suicidal ideation) via reduction in experiential avoidance were serially mediated through increases in connectedness. Additionally, experiences of ego dissolution and psychological insight predicted reductions in experiential avoidance following psilocybin therapy. LimitationsDifficulties inferring temporal causality, maintaining blindness to condition, and reliance upon self-report. ConclusionsThese results provide support for the role of reduced experiential avoidance as a putative mechanism underlying psilocybin therapy's positive therapeutic outcomes. The present findings may help to tailor, refine, and optimize psilocybin therapy and its delivery.

Do I Like Me Now? An Analysis of Everyday Sudden Gains and Sudden Losses in Self-Esteem and Nervousness

Although rapid changes in symptom severity, or sudden gains and losses, are well known in psychotherapeutic research, much about the underlying processes that lead to them is still unclear. The revised theory of sudden gains and the complexity theory of psychopathology offer explanations of why sudden gains and sudden losses occur and how they can be predicted. To test the implications of these two theories, we investigated sudden gains and losses in a daily diary study focusing on their frequency, stability, and association with certain statistical indicators. To this end, we examined the daily self-esteem and nervousness ratings of 98 young adults over 82 consecutive days. Generally supporting the theoretical frameworks above, our findings suggest that everyday sudden gains and losses seem to be a common but unstable phenomenon associated with increased within-person variance.

The General View of Psychotherapy / The Meta Model and Predictive / Preventative Mental Health Care Have Seven Groups of Reasons That Affect the Four Cornerstones of Well-Being

A common goal among the many schools of psychotherapy these days is to find elements of psychotherapy that apply to many of them. The basis for which a general view like this can be found consists at least of the language and terms used, discovery of new activities, the structure of therapy and the work environment. Since the realization of psychotherapy also attempts to prevent a patient's situation from worsening, the following question comes up: does the search for a psychotherapy metamodel feature elements that are similar to predictive mental health care? Mental health care in Finland employs a categorization of seven reasons and four cornerstones of well-being to prevent mental malaise, mental disorders, and negative exceptional behavior. This study collected a file of psychotherapeutic research results and compared it against a file regarding predictive mental health care, which affirmed the thesis “the general view of psychotherapy and preventative mental health care have a functional common categorization that consists of seven groups of reasons and four cornerstones”.

Ambulantes Assessment in der klinischen Kinder- und Jugendpsychologie

Over the past 20 years ambulatory assessment (AA) became an important component of the methodological repertoire in clinical psychological research of childhood and adolescence. AA allows to repeatedly assess behaviors and subjective experiences in the everyday lives of children, adolescents and their families. The popularity of the method stems from the fact that AA captures (dys)functional behavioral and experiential patterns along with corresponding triggers analogous to clinical theory. In other words, context-dependent dynamic processes within a child or adolescent can be empirically tested, such as when and under which circumstances specific symptoms are expressed in daily family or school life. That way, AA contributes to increased generalizability of the acquired data to typical behavioral spectra of the participants. This article illustrates how AA can contribute to more accurate and more truthful descriptive models of mental disorders in childhood and adolescence and how AA may aid empirical tests of clinical theories in psychotherapeutic research and practice. The article concludes with a discussion of the potential utility of AA for individualized interventions in the everyday lives of affected children, adolescents, and their families.

Treated together-changed together: The application of dyadic analyses to understand the reciprocal nature of alliances and couple satisfaction over time.

In a Norwegian study of 73 couples attending a residential couple therapy program lasting between 6 and 12 weeks, weekly self-report data on therapy alliance and couple satisfaction were collected using routine outcome monitoring (ROM). The aim was to show how dyadic analyses could be applied to examine the predictive association between alliances and couple satisfaction. Results showed that improved alliance between dyad members and their couple therapist predicted their spouses' couple satisfaction. Furthermore, improved couple satisfaction predicted improvement in spouse's alliance. The clinical implication of these findings should heighten awareness to the importance of establishing and maintaining the alliance of male partners in couple therapy, something that predicts their spouses' couple satisfaction. These findings help nuance the already existing literature on the working alliance. Furthermore, we propose that dyadic analyses should be widely used in any psychotherapeutic research that aims to understand the reciprocal effects of dyads.

An Academic and Personal Approach to Supervising Project Groups

This article investigates and exemplifies the personal side of our supervising skills. This is inspired from psychotherapeutic research specialized in investigating open-minded contact and authentic meetings. The article is based on our experiences supervising project groups at Roskilde University. Supervision is sometimes a challenging task that may manifest and confront personally-related issues. We advocate combining an academic and personal approach to supervising project groups. We provide a range of empirical examples from the supervising project groups, illustrating the type of personal challenges we meet. These challenges are characterized and conceptualized, and some concrete ways to deal with them are proposed.

РОССИЙСКАЯ АДАПТАЦИЯ ОПРОСНИКА «МНОГОМЕРНАЯ ОЦЕНКА ИНТЕРОЦЕПТИВНОГО ОСОЗНАВАНИЯ» (MAIA-R)

Background of the study is related to the problem on the lack of psychodiagnostic tools allowing to operationalize the concept of “interoceptive awareness”. Th e interoceptive awareness is an aspect of body awareness, focused on sensory bodily processes associated with the state of the internal environment of the body, and plays an important role in the regulation of emotional states. Objective. To operationalize this concept, the Russian-language version of Th e Multidimensional Assessment of Interoceptive Awareness questionnaire (MAIA) (Mehling et al., 2012) was validated. Th e purpose of the study is to test the psychometric characteristics of MAIA-R and standardize it. Methods. Th e study was conducted on a sample of 1100 people aged 16 to 66 years (M=26.9; SD=10.4); 19.3% men, 80.7% women. To assess the criterion validity, following contrasting groups with diff erent levels of interoceptive awareness were identifi ed: 1) psychotherapists (N=50), 2) professional athletes (N=103), 3) respondents with experience in bodily practices as a hobby (N=81), 4) with no experience in bodily practices (N=123). Processing of the received data was carried out by the methods of mathematical statistics (t-Student, factor analysis, one-factor analysis of variance, correlation analysis, Cronbach’s alpha). Results. Th e cultural specifi city of the MAIA questionnaire was confi rmed; the content of the factors, diff erent from the original, is refl ected in the titles: «Noticing», «Not-distracting», «Not-worrying», «Attention Regulation», «Awareness of a Negative Emotional State», «Self-regulation Based on Active “Listening” to the Body», «Trusting» and «Awareness of a Positive Emotional State». Th e orthogonal nature of the structural components of interoceptive awareness and their independence from the gender factor have been established. High rates of internal consistency and retest reliability were obtained. Conclusion. Th e questionnaire can be used in psychotherapeutic research and practice, as well as in the work of sports psychologists to assess the level of awareness of bodily processes and the dynamics of self-regulation of athletes.

Find Your Way Back: Black Colleagues Return to the Erotic

This paper provides an analysis of the effects anti-Black violence have had on the return of Black colleagues (administrators, faculty, and staff) to higher education after the the 2020 murder of African American citizen George Floyd at the hands of now former Minneapolis police officers. Riffing off of R&B singer Beyoncé Knowles-Carter’s song of return, “Find Your Way Back” and using it as a loose organizational rubric—each section is titled from the song’s lyrics—I ask what answers we might find between return and resignation. The analysis starts with the question of return: How in the hell do Black colleagues return to the university after a collective trauma? The essay centralizes the concerns of Black colleagues in higher education, positioning us between resignation and return. It seeks to consider (pending a return) to what are we returning. To explore this liminal dilemma—resignation or return—the essay will trace the lineage of racism located in higher education to slavery and the violent exclusion of African Americans from gaining access to knowledge. Briefly tracing American education’s lineage to White supremacy, I aim to frame our possible return against an institution that parodies its paternal line. The essay will show that the racism characteristic of American history morphed into an insidious, invisible source of oppression termed microaggressions. To address the consequences of racial microaggressions, I draw on psychotherapeutic clinical research on the effects of racial microaggressions on Black workers. Mirroring clinicians’ approach to addressing the race-based problems of higher education, I call on the Black feminist scholar Audre Lorde’s notion of “the erotic” as a spiritual power source. I look at how Lorde explored Black psychology and trauma within higher education in her poem “Blackstudies.” Mining this and her other triumphant essay “Uses of the Erotic: The Erotic as Power,” I look to establish “the erotic” as a comparable counterpunch to microaggressions in higher education.

When online and face to face counseling work together: assessing the impact of blended or hybrid approaches, where clients move between face-to-face and online meetings

ABSTRACT During the global pandemic, therapists have offered distance-based approaches to counseling and psychotherapy, often online. Although online therapy is not a new phenomenon, until recently it was offered by a minority of practitioners. Now, following the changes imposed by the pandemic, it is familiar to the majority. Therapists and clients have met and worked together in separate spaces in new ways mediated by digital technology following rapidly changing regulations and these changes have had an impact on resulting therapeutic work. This article explores ways in which individuals may respond uniquely and collectively to changing contexts and offers possible explanations for these responses, drawn from existing psychotherapeutic research and leading to recommendations that additional assessment and monitoring procedures should be used with hybrid or blended approaches.

Attributed Contribution of Therapist's Emotional Variables to Psychotherapeutic Effectiveness: A Preliminary Study.

BackgroundThe aim of this manuscript is to analyze the degrees of responsibility for healing that psychotherapists attribute to a set of emotional variables of the therapist involved in the therapeutic process. Such variables, framed within the well-known common factors in psychotherapy, have been proven to be essential in making the therapeutic process effective, as has been shown by research in psychotherapy in recent decades.Materials and MethodsBased on an extensive literature review, the responses from a sample of 69 psychotherapists to a tool created ad hoc are analyzed to verify whether their attributions are in line with the results of said review.ResultsThe therapists have doubts about the factors responsible for psychotherapeutic effectiveness, as well as about the value of common variables, including those of an emotional nature, not valuing them above those of a specific type. They also argue against the similar effectiveness of different psychotherapeutic models.ConclusionDiscrepancies have thus been found between the conclusions reached by research on therapeutic processes and the statements made by the therapists studied, which could indicate an insufficient impact of psychotherapeutic research on clinical practice. We also propose courses of action such as establishing training programs for the acquisition and development of emotional skills for therapists that could increase the effectiveness of their interventions.

Conceptualization and Management of Chronic Pain in an Over 65 Using an ACT Lens—A Single Case Study

This single case study illustrates the application and utility of Acceptance and Commitment Therapy (ACT) for a 72-year-old Australian male presenting with chronic pain and complex health conditions. Chronic pain often entails complexity among older adults and can impact the patient’s life across a range of domains. Psychological approaches, as stand-alone or adjunct to medical intervention, are widely acknowledged as potentially beneficial to older persons experiencing pain. ACT has been supported as a viable psychological approach for chronic pain and especially suitable for older persons with chronic pain. This study describes an ACT treatment approach for an older person with chronic pain informed via development of an extension of the existing ACT conceptualization of chronic pain. The development of the ACT based model is in keeping with recommendations to seek out mechanisms of change in psychotherapeutic research. Measures of Quality of Life, Depression, Physical Activity, and Acceptance/Avoidance were taken at pre and post treatment, as well as across treatment phases. Improvement was noted in self-reported measures of QOL, depression, and physical activity.

Psychoanalytical Transgression from Communicative Mode to Fragmented Discourse Murnau’s Nosferatu and Lynch’s Mulholland Drive as Case Studies

Artists worldwide have been interested in psychoanalytical approaches since 1890s when the well-renowned neurologist Sigmund Freud started his psychotherapeutic research aiming at finding crucial answers to personality development and the relationship between the conscious and the subconscious. With the advent of cinema, Psychoanalysis has attracted many film directors because it suggests interesting conflict between inner human drives and authoritative social norms (Freud, 2005, p. 40). This conflict becomes the thematic tool of classical narrative that is mainly based on the representation of the duality between two contradictory trajectories; most of the times are referred to as the good and the bad. Psychoanalytical representation, in this context, is tackled as a linear reality asit follows a certain logical causation within an ascendant development of events. Psychoanalytical and classical films are, hereafter, communicative since they suggest networks of coded signs that can be decoded through afathomable semiotic method. However, avant-gardist film directors try to adapt psychoanalytical modes with their nonconventional styles that are mainly based on fragmented narrative. On so doing, they abandon the communicative purpose of cinema to shape rather a mental discursive one.

The private life of meaning - some implications for psychotherapy and psychotherapeutic research

ABSTRACT This article outlines differences between phenomenology and method, with implications for psychotherapy and psychotherapeutic research. Drawing on a study exploring how mental health nurses are therapeutic, we focus on how taking experience seriously is encouraged through being phenomenological. We look at how research method and theory – and fixed beliefs or ideas – tend to constrict language, so that personal (sensual) meaning is lost or curtailed. Being phenomenological instead ‘opens up’ language and consequently meaning, in an act of truthfulness through speaking one’s experience, which we see as both psychotherapeutic and a valid form of research.

Finding my voice: Telling stories with heuristic self-search inquiry

ABSTRACT It has been argued that qualitative research can be valuable in providing a forum for the voices of those who may usually be excluded from academic discourse and that it is therefore well suited to exploring individuals’ experiences of illness. This article is informed by the authors’ research into how people diagnosed with ‘schizophrenia’ experience their personal therapy. It focuses upon the usefulness of phenomenological research methods for investigating personal experience whilst at the same time considering how these methods might enable the researcher to hear the experience of others. It is proposed that personal stories can be seen as being closer to literature and so something of their essence can be killed off by having to shape them through systematic approaches to research. Therefore, the aim here is to explore whether it is possible or indeed desirable to take a systematic approach to personal experience when conducting psychotherapeutic research and how this might be beneficial or detrimental to researcher and participants.

Экономичность психотерапии

The paper reports the results of the analysis of modern notions about the economics of psychotherapy. Despite its great practical significance, this issue is insufficiently represented in Russian publications, arising mostly in foreign works. We consider two general concepts: efficiency and equity. The practice of research evaluation in psychotherapy distinguishes between (a) the efficacy of therapy — results of empirical psychotherapeutic research; (b) clinical (qualitative) effectiveness of therapy — results of psychotherapy in everyday practice; and (c) the notion of cost-effectiveness — a practical criterion; it characterizes the expenses for the achievement of a goal. Other expenses also ought to be taken into consideration. Additionally, we mark out progressive cost-effectiveness as a separate coefficient.

Innovative psychotherapy research: towards an evidence-based and process-based individualized and modular psychotherapy

Psychotherapy has been proven to be effective; however, this statement applies in particular to the "average patient" in randomized controlled trials. As aconsiderable proportion of patients do not show any benefits despite the constant development of new therapy methods and the mechanisms of action are still too little understood, innovative psychotherapy research has to address both problems. In addition, the idea of personalization that originated in somatic medicine or -from our point of view more appropriately- individualization or person-centering should be taken up. After providing an overview of further developments in psychotherapy beyond disorder-specific methods, this article presents an evidence- and process-based individualized and modular psychotherapy as avisionary goal of psychotherapeutic research: Beyond syndromes and disorders, as many biopsychosocial characteristics as possible and the processes and mechanisms underlying the mental problems should be analyzed and bundled in an individual comprehensive functional analysis. Based on this functional analysis, evidence-based techniques and modules should be selected. The individual response during the course of therapy should be continuously documented, so that feedback helps to determine the further therapeutic procedure. In order to pursue this vision, studies are needed that are oriented towards the individual patient, investigate the central mechanisms of action and generate large translational datasets. These should be analyzed by ideographic analyses and reduce the gap between research and practice, thus contributing to the paradigm of apractice research network, which is now consistently moving to the centre of research.

The Effect of Career Counselor Behavior on Reemployment

When looking at career interventions, one-on-one career counseling is one of the most effective and firmly established types of intervention. Furthermore, career counseling process quality has been validated as a predictor of job seekers’ reemployment. To elucidate the underlying components of a high-quality counseling process, the effects of counselor behavior in mandatory counseling sessions at three Swiss job centers are investigated. Based on a transfer of psychotherapeutic effectiveness research into the domain of career counseling, three behavior categories are proposed as components of a high-quality counseling process: providing structured guidance during the counseling process, providing personalized support, and activating job seekers’ resources. Scientific observers rated these counselor behavior categories in 32 counseling sessions. The ratings of “providing structured guidance” predicted job seekers’ reemployment speed at a correlation of .58. The measured effect equals yearly savings of 831 million Swiss Francs CHF (US$839) in Swiss unemployment benefits. The correlations with the other two behavior category ratings were in the same direction but nonsignificant.

Cognitive-behavioral therapy for adults with inflammatory bowel disease: A meta-analysis of randomized controlled trials with implications for clinical social work

ABSTRACTBackground: Psychotherapeutic research on inflammatory bowel disease (IBD) is of particular importance to licensed clinical social workers since they represent the biggest source of mental health providers in the United States.Objective: The purpose of the present meta-analysis is to determine the depression, anxiety, and quality of life (QOL) summary effects of experimental CBT studies for adults with IBD and to discuss specific implications for clinical social work practice.Methods: In March 2018 a systematic review was completed via searching online databases and the reference lists of included studies. To include the maximum number of articles which met inclusion criteria, temporal constraints were not used in the database searches.Results: The random-effects model meta-analysis found a small (Hedges’ g = −0.35), statistically significant reduction in depression among persons who were treated with CBT and small, statistically insignificant effects regarding anxiety (Hedges’ g = −0.24) and QOL (Hedges’ g = −0.15). All of the summary effects were ultimately homogenous.Discussion: Discussion pertaining to limitations, strengths, implications for clinical social workers, and areas of future research is provided.