Psychotherapy Outcome Research Research Articles

Increasing outcome measurement precision: Network analysis of items on the Outcome Questionnaire-45.

Psychotherapy outcome research mainly focuses on scale-level changes and constructs that were developed using cross-sectional statistical analysis, possibly concealing important findings on the level of single items, and limiting the clinical utility of outcome scales. Our goal was to explore changes in symptoms, interpersonal problems, and level of functioning in everyday life and to establish groups of items with similar rates of change that could be used to form more coherent targets for measuring different therapeutic outcomes. Triangulated maximally filtered graphs were used to model the network structure of the Outcome Questionnaire-45 in a data set of N = 12,075 university counseling center patients. Dynamic exploratory graph analysis was used to establish communities of items with similar rates of change. Five item communities (anxiety, hopelessness, interpersonal problems, well-being, and work impairment) were found. Compared to the original Outcome Questionnaire-45 subscales, they showed better fit to the data. The "hopelessness" community, which describes the extent of a patient's demoralization before the start of therapy, had a significantly higher rate of change compared to other communities. The discerned item communities provide clinicians with theoretically grounded, precise targets for outcome tracking, thereby enhancing the responsiveness and adaptability of treatment interventions to individual client trajectories. Such granularity enriches our understanding of therapeutic change, with direct implications for tailoring intervention strategies to maximize early therapeutic gains and sustain long-term recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

From Theory to Practice: A Transtheoretical Treatment and Training Model (4TM).

In this paper, we present the conceptual background and clinical implications of a research-based transtheoretical treatment and training model (4TM). The model implements findings from psychotherapy outcome, process, and feedback research into a clinical and training framework that is open to future research. The framework is based on interventions targeting patient processes on a behavioral, cognitive, emotional, motivational, interpersonal, and systemic/socio-cultural level. The 4TM also includes a data-based decision support and feedback system called the Trier Treatment Navigator (TTN). We discuss important problems associated with clinical orientations solely based on one school of thought. We then contrast these concerns with a clinical and training framework that embraces ongoing research, serving as a guiding structure for process-based transtheoretical interventions. Such research-based psychological therapy can take both traditional and novel clinical developments as well as findings from psychotherapy research into account and be adaptively disseminated to a variety of patient populations.

Changes in group counseling engagement and conflict and growth in emotional cultivation for children and adolescents.

Group climate is an important factor in group counseling and psychotherapy process and outcome research. The current investigation examined group climate changes (from early to late sessions) at the within-group (i.e., group members) and between-group (i.e., group-as-a-whole) levels in predicting changes in group members' emotional cultivation in group counseling. A total of 236 Taiwanese children and adolescents across 41 groups participated in this study. Members' ratings of group climate (i.e., engagement and conflict) were partitioned into within-group and between-group components, and polynomial regression with response surface analysis was used to examine the association between changes in group engagement and conflict (at the member- and group-level) from early to late group sessions on changes in emotional cultivation. Results supported the theoretical hypothesis that when a group-as-a-whole reported increasing engagement from early to late group sessions, relative to other groups (i.e., between-group effect), members of that group experienced greater growth in emotional cultivation. Results also indicated that group members reported greater growth in emotional cultivation when there was consistent and high engagement or consistent and low conflict from early to late group sessions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predicting dropout from psychological treatment using different machine learning algorithms, resampling methods, and sample sizes

Objective: The occurrence of dropout from psychological interventions is associated with poor treatment outcome and high health, societal and economic costs. Recently, machine learning (ML) algorithms have been tested in psychotherapy outcome research. Dropout predictions are usually limited by imbalanced datasets and the size of the sample. This paper aims to improve dropout prediction by comparing ML algorithms, sample sizes and resampling methods. Method: Twenty ML algorithms were examined in twelve subsamples (drawn from a sample of N = 49,602) using four resampling methods in comparison to the absence of resampling and to each other. Prediction accuracy was evaluated in an independent holdout dataset using the F 1-Measure. Results: Resampling methods improved the performance of ML algorithms and down-sampling can be recommended, as it was the fastest method and as accurate as the other methods. For the highest mean F 1-Score of .51 a minimum sample size of N = 300 was necessary. No specific algorithm or algorithm group can be recommended. Conclusion: Resampling methods could improve the accuracy of predicting dropout in psychological interventions. Down-sampling is recommended as it is the least computationally taxing method. The training sample should contain at least 300 cases.

Integrating Multicultural Orientation into Cancer Care for Sexual and Gender Minorities: A New Paradigm for Leadership, Practice, and Research

The American Society of Clinical Oncology’s (ASCO) 2017 position statement drew attention to the need to address cancer care disparities experienced by sexual and gender minority populations (SGM). In response to the ongoing disparities in cancer care faced by sexual and gender minorities, we adapt the Multicultural Orientation (MCO) framework as a needed paradigm to actualize affirmative cancer care. MCO has been studied in psychotherapy and supervision process and outcome research, demonstrating promise for improving treatment outcomes. The MCO framework encourages providers to convey cultural humility, recognize and respond to cultural opportunities, and self-reflect on their level of cultural comfort. Building upon the extensive body of MCO research in psychotherapy, we present how the MCO framework can be applied in oncology leadership, practice, and research with SGM communities. More specifically, we outline how cultural humility can prompt cancer care leaders, providers, and researchers to examine the structural and societal factors that contribute to disparate cancer care conditions. Cultural opportunities exist in leadership priorities, in how clinical care is structured, and in the research that is conducted. Transformational and authentic leadership styles and intersectionality can be infused into these cultural opportunities to address cancer care disparities faced by the SGM populations. Further, self-reflexivity at the level of leaders, providers, and researchers is key to creating affirmative SGM cancer care environments.

Symptom distress and disability: Different sides of the same coin? An investigation of the relationship between symptom distress and disability over time in patients receiving treatment for internalizing disorders.

Most psychotherapy outcome research focuses on symptom reduction as a primary outcome. However, most patients do not seek psychological treatment exclusively for symptom relief, but mainly because they can no longer do what they want to do or used to do. Therefore, besides symptom reduction, also disability in daily functioning should be a focus of psychotherapy outcome research. Yet, until now there is a paucity in research pertaining to the relation between symptom reduction and reduction of disability during psychological treatment. For this reason, the aim of the current study was to examine the relationship between changes in symptom reduction (reduction in general symptom distress) and changes in self-reported disability over a period of two years in patients that receive psychotherapy for mood and anxiety disorders (N = 1182). We found strong correlations between both outcome measures at all measurement points. Furthermore, results demonstrated a decrease in both outcome measures from start to end of treatment with a moderate effect for symptom distress and a small effect for experienced disability. Cross-lagged panel analysis demonstrated that a decrease in symptom distress predicted a subsequent decrease in self-reported disability, and a decrease in self-reported disability equally predicted a subsequent decrease in experienced symptom distress. Our results seem to indicate that both outcome measures are interchangeable in psychotherapy outcome studies for internalizing disorders.

A 15-Year Progress Report on the Presence of Humanistic/Existential Psychology Principles in Mental Health Outcome Measurement: Thematic Discourse and Summative Content Analyses

Fifteen years ago, Pfaffenberger (2006) applied five implicit paradigmatic assumptions identified by Slife of the dominant positivistic medical model paradigm—hedonism, universalism, atomism, materialism, and objectivism—to psychotherapy outcome research and its practice implications. Her applied theoretical essay revealed critical issues involving hidden power and privilege dynamics therein. Furthermore, Levitt et al.’s (2005) research examined nine then-common outcome instruments to determine the extent to which their item content reflected humanistic psychology principles in nine domains derived from the authors’ systematic review and thematic analysis of the humanistic literature. Their content analysis revealed that the majority of those domains were inadequately represented. In this article, using thematic discourse analysis (aka latent thematic analysis), I first identify how the philosophical and political assumptions summarized by Pfaffenberger are apparent in three outcome instruments that are commonly used in U.S. community mental health settings today: the Adult Needs and Strengths Assessment, the Ohio Mental Health Consumer Outcomes System, and the DSM-5 assessment measures. As part of my analysis, I contrast paradigmatic assumptions of the medical model with those of humanistic/existential psychology as a basis for contextualizing and understanding the implications of measurement-based care as articulated through the two discourses. Then, second, based on a summative content analysis of the three instruments, I report on the progress that both has been and remains to be made in their item content since Levitt et al. noted the general dearth of humanistic principles in mental health outcome measurement. Suggestions for future research and instrument development are discussed.

The impact of common factors on coaching outcomes

ABSTRACT Previous studies examining coaching outcomes generally rely on cross-sectional data which limits our understanding of the enduring and long-term effects of coaching. To address this issue, this study, based on longitudinal data, explores several popular variables associated with coaching outcomes. The study is underpinned by Lambert’s [(1992). Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross, & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). Basic Books] four-factor model of common factors and recognises them as variables which are customary to all coaching approaches contributing to coaching outcomes. The study considers stress, wellbeing, resilience, goal attainment and coaching effectiveness as coaching outcomes. Working alliance mediates the impact of self-efficacy, outcome expectations; and perceived social support which are regarded as the predictors of the coaching outcomes. The results indicate that social support predicts working alliance, and working alliance in turn predicts wellbeing and coaching effectiveness over time. The findings suggest that it is vital for coaches to monitor changes in the coachees’ social networks and their working alliance since these have a significant bearing on the effectiveness of the sessions and the coachees’ wellbeing.

Psychotherapy outcome research: Implications of a new clinical taxonomy.

Since the publication of DSM-III in 1980, the scientist-practitioner gap in clinical psychology has expanded, as almost all outcome research in clinical psychology has been on diagnosed mental disorders within a medical model using drug trial methodologies, whereas most practising clinicians undertake functional analyses and case formulations of clinical psychological problems (CPPs) and then apply tailored interventions within an ongoing hypothesis-testing methodology. But comparatively reliable assessment and generalizable conclusions in psychotherapy outcome research require a comprehensive theory-derived conception or operational definition of 'CPPs', standardized functional analyses, and a taxonomy of CPPs comparable to DSM's listings of mental disorders. An alternative conception and taxonomy of CPPs have recently been proposed, offering improvements in the reliability and generalizability of case formulation-based psychotherapy outcome research. It conceives of CPPs as instances of the formation and operation of self-sustaining problem-maintaining circles (PMCs) of psychological-level causal elements-that is, at the level of cognitions, behaviours, emotions, and events or situations (stimuli). The paper describes this new conception of CPPs, a subsequent nascent taxonomy of evidence-based PMCs which standardizes the underlying mechanisms that maintain CPPs, and ensuing benefits to research (as well as to practice) in clinical psychology. These benefits include being able to encompass all treatment-worthy CPPs, not just diagnosable mental disorders; to assess theory-derived intervention strategies, not just arbitrary therapy bundles; and to directly feed back into psychological theories, not just expand an atheoretical list of patented "evidence supported therapies."

What too strict a method obscures about the validity of outcome measures

Objective: To assess the outcome of psychotherapeutic treatments, psychotherapy researchers often compare pre- and post-treatment scores on self-report outcome measures. In this paper, the common assumption is challenged that pre-to-post decreasing and increasing outcome scores are indicative of successful and failed therapies, respectively. Method: The outcome of 29 psychotherapeutic treatments was evaluated by means of quantitative analysis of pre- and post-treatment scores on commonly used outcome measures (such as the Symptom Checklist-90-R, the Inventory of Interpersonal Problems, and the General Health Questionnaire-12), as well as through consensual qualitative research. Results: Overall, a moderate to low convergence between qualitative and quantitative evaluations of outcome was observed. Detailed analyses of six cases are presented in which pre-to-post comparisons of outcome measures proved misleading. Conclusions: It is concluded that psychotherapy outcome research might benefit from assessment strategies that are sensitive to the singularities of individual treatments and to the complexity of the phenomenon of therapeutic outcome. Furthermore, classical psychometric evaluations of the validity of outcome measures might be supplemented with less-systematic evaluations that take any contingent source of information on outcome into account.

Why it is Important to Look Closely at What Happens When Therapy Clients Complete Symptom Measures

Why it is Important to Look Closely at What Happens When Therapy Clients Complete Symptom Measures John McLeod (bio) A concern for evidence can be viewed as a fundamental aspect of human existence. The biological structure of our bodies evolved during over thousands of years in which survival was predicated on a capacity to interpret small signs, such as crushed grass, smells, and sounds as evidence of the whereabouts of prey. The emergence of modern science and medicine was built on the ability to learn about what counted as evidence for what, and to observe it reliably. Evidence is information that matters. Drinking a glass of water because one feels thirsty is not evidence, unless there is a suspicion of an underlying condition for which water intake is a symptom. Appraisal of evidence is a complex task. It relies on the existence of some kind of theory that predicts and explains a link between what is observed and some broader state of affairs that it signifies. It requires agreement on criteria for accepting an observation as relevant. Finally, given the likelihood that multiple sources of evidence are available, there needs to be some kind of procedure through which different types of evidence are weighed against each other. It is inevitable, therefore, that the search for evidence tends to be characterized by differences in opinion, continual revision of theories and criteria, and skepticism around efforts to impose premature closure. Psychotherapy is an activity in which the search for reliable evidence represents a constant challenge. The actual practice of therapy involves client and therapist appraisal of the meaning and evidential significance of a very wide range of information that occurs within therapy sessions: thoughts, feelings, patterns of behavior, gestures, ways of talking, and so on. Weaving through the process of therapy is the question, "Is it making a difference?" The issue of therapy outcome or effectiveness opens out into an even broader set of perspectives, beyond the views of the client and therapist themselves, on what counts as evidence. For example, do members of their family view the client's therapy as having been worthwhile? Does the government health agency that paid for the client's course of treatment regard it as having been cost-effective? Research into the effectiveness of psychotherapy has been carried out since at least the 1950s [End Page 133] (see, e.g., Schjelderup, 1955). The first phase of this global research initiative was marked by a high degree of methodological pluralism in which different types of data (e.g., questionnaire ratings, interviews, responses to projective tests) were collected from different sources (e.g., the client, therapist, independent observer, and significant others such as family members) and subjected to single case analysis as well as trends across groups (Strupp & Hadley, 1977.)The next phase, from about 1980, was marked by a shift in the direction of evaluating therapy outcome almost entirely through comparing scores on self-report symptom measures completed by the client at the start of therapy and at the end. At the level of scientific discourse, this narrowing of outcome focus was driven by a desire to emulate the achievements associated with the use of randomized clinical trial methodology in medicine, which depends on the prior identification of a primary outcome measure. It was also influenced by the relative simplicity and ease of administration of self-report measures, and the possibility of assembling very large data sets. In the background, these rationales fitted well with a broader neoliberal sociopolitical agenda that advocated the adoption of a markets and competition in public services, rather than collaborative consensus. In recent years, following more than three decades of psychotherapy outcome research based on evidence from client self-report data generated during randomized clinical trials, a further shift has become apparent. There is growing dissatisfaction with the quality of scientific knowledge and policy-making associated with established methodologies, which has fueled determined efforts to build alternative strategies. These initiatives have mainly focused on greater exploration of the qualitative and single-case evidence in relation to therapy outcome, and the development of meta-analytic techniques for combining findings from studies using different methodologies. An important contribution has involved philosophical analysis of...

Treating a Cluster of Internalizing Disorders With the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Case Study

Psychotherapy outcome research rarely focuses on the ideographic application of treatment manuals, though some modules might prove markedly more important for a client than others. Clients in need of psychoeducation, emotion regulation skills, and changes in maladaptive patterns of thinking might balk at portions of the Unified Protocol for the Treatment of Emotional Disorders that seem irrelevant to their concerns. The current case study focused on emotion dysregulation and perfectionism given their role in anxiety, depression, obsessions, and compulsions. The Overall Anxiety Severity and Impairment Scale (OASIS), Overall Depression Severity and Impairment Scale (ODSIS), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) confirmed qualitative reports and therapist observations of improvement. Additional sessions focused on fostering self-compassion and processing the termination of a romantic relationship rather than completing every section of the manual. This case demonstrates that flexible adaptation of a transdiagnostic treatment manual, in conjunction with a strong working alliance and other non-specifics of therapy, can produce beneficial outcomes even when other modules are not applied. These results might support ideographic application of select modules from treatment manuals and support a symptoms approach to psychotherapy.

Discrepancies from registered protocols and spin occurred frequently in randomized psychotherapy trials—A meta-epidemiologic study

ObjectivesThis study aimed to investigate the relationship between trial registration, trial discrepancy from registered protocol, and spin in nonpharmacological trials. Study Design and SettingRecent psychotherapy trials on depression (2015–2018) were analyzed regarding their registration status and its relationship to discrepancies between registered and published primary outcomes and to spin (discrepancy between the nonsignificant finding in a study and an overly beneficial interpretation of the effect of the treatment). ResultsA total of 196 trials were identified, of which 78 (40%) had been registered prospectively and 56 (29%) had been registered retrospectively. In 102 (76%) of 134 registered trials, discrepancies between trial and protocol were present. Of 72 trials with a nonsignificant difference between treatments for the primary outcome, 68 trials (94%) showed spin. Discrepancies from protocol were less frequent in prospectively than in retrospectively registered trials (odds ratio= 0.19; 95% confidence interval [CI]: 0.07–0.52), but regarding the amount of spin, there was no difference between prospectively and retrospectively registered trials (rb = −0.12; 95% CI: −0.41 to 0.19) or between registered and unregistered trials (rb = −0.22, 95% CI −0.49 to 0.08). ConclusionProtocol discrepancies and spin have a high prevalence in psychotherapy outcome research. The results show no relation between registration and spin, but prospective registration may prevent discrepancies from protocol.

Time to rethink the whole thing: The cul-de-sac of psychotherapy outcome research.

Time to rethink the whole thing: The cul-de-sac of psychotherapy outcome research.

Trauma-Focused Presence

The purpose of this article is to capture and illuminate a trauma-focused presence in psychotherapy treatment. The goal is to highlight an integrative approach that centers on the trauma survivor’s battle with freedom and limitation. Both the expansive and the constrictive tendencies of many traumatized clients are exemplified, focusing on the dichotomous or polarized positions that clients present. Key factors of evidence-based therapeutic relationships that can guide therapist stances and engagement efforts are explored. This approach moves away from an overemphasis on and strict adherence to the medical model framework and toward a contextual standard grounded in a humanistic blanket and characterized by a person-centered and relationally driven therapeutic approach. The trauma therapist chiefly fosters engagement and makes space or pathways for an assortment of therapeutic interventions that are congruent with the client’s theory of change and take shape organically. Developing intrapersonal and interpersonal presence are primary focal points that correlate with the importance of personal and interactive processes in successful psychotherapy outcome research. Meaning making is at the core of a trauma-focused presence and takes place through client and therapist dialogue.

Cochrane’s risk of bias tool in the context of psychotherapy outcome research

The Cochrane risk of bias tool (RoB) is a widely used measure for methodological quality of randomized controlled trials. This paper discusses RoB’s rationale and risk of bias domains, reports on its application in current psychotherapy meta-analyses, and offers comments regarding the application of RoB in the context of psychotherapy outcome research. Our suggestions include focusing on patient’s and therapist’s expectations when judging the domain “blinding of personnel and participants” and paying greater attention to the domain “selective outcome reporting” and to matters of “treatment implementation.”Clinical or methodological significance of this article: This paper discusses the rationale of a widely used tool to assess the methodological quality of primary studies for meta-analysis and provides suggestions for its use in the context of psychotherapy outcome research.

Effect size calculation in meta-analyses of psychotherapy outcome research

Meta-analysis of psychotherapy intervention research normally examines differences between treatment groups and some form of comparison group (e.g., wait list control; alternative treatment group). The effect of treatment is normally quantified as a standardized mean difference (SMD). We describe procedures for computing unbiased estimates of the population SMD from sample data (e.g., group Ms and SDs), and provide guidance about a number of complications that may arise related to effect size computation. These complications include (a) incomplete data in research reports; (b) use of baseline data in computing SMDs and estimating the population standard deviation (σ); (c) combining effect size data from studies using different research designs; and (d) appropriate techniques for analysis of data from studies providing multiple estimates of the effect of interest (i.e., dependent effect sizes).Clinical or Methodological Significance of this article: Meta-analysis is a set of techniques for producing valid summaries of existing research. The initial computational step for meta-analyses of research on intervention outcomes involves computing an effect size quantifying the change attributable to the intervention. We discuss common issues in the computation of effect sizes and provide recommended procedures to address them.

The case for integrating trauma informed family therapy clinical practice within the school context

ABSTRACTCounselling services are an integral part of a school's pastoral response to children and adolescents experiencing mental health or behavioural challenges. Professional practice documents published within Australia, the United Kingdom and the United States of America uniformly articulate the capacity of the counsellor to intervene when presented with a student experiencing emotional, psychological or behavioural distress. However, there are some referral concerns that call for a systemic approach that not only engages with parents but extends further to conceptualise the family as the system in need of change. This paper will suggest that the increasing shift towards the application of principles underpinning trauma-informed practice – particularly attachment and systemic constructs – within the classroom must be mirrored within the counselling space from which these theories originate. This paper will conclude with a description of common school based counselling referral criteria that are well suited to family therapy responses. In doing so, this paper will address the concern that the need to attend to the theoretical approach adopted by the school based counsellor represents an important logistical consideration [Zirkelback & Reese, 2010, p. 1095. A review of psychotherapy outcome research: Considerations for school-based mental health providers. Psychology in the Schools, 47(10), 1084–1100].

The Common Factors Discrimination Model: An Integrated Approach to Counselor Supervision

Clinical supervision is a cornerstone of counselor training (Barnett, Erickson Cornish, Goodyear, & Lichtenberg, 2007) and serves the cardinal functions of providing support and instruction to supervisees while ensuring the welfare of clients and the counseling profession (Bernard & Goodyear, 2014). Numerous models of clinical supervision have been developed, varying in emphasis from models based on theories of psychotherapy, to those that focus on the developmental needs of the supervisee, to models that emphasize the process of supervision and the various roles of the supervisor (Bernard & Goodyear, 2014). However, despite the abundance of available supervision models, there is little evidence to support that any one approach is superior to another (Morgan & Sprenkle, 2007; Storm, Todd, Sprenkle, & Morgan, 2001). Thus, a growing body of clinical supervision literature underscores a need for strategies that integrate the most effective elements of supervision models into a parsimonious approach rather than emphasizing differences between models (Lampropoulos, 2002; Milne, Aylott, Fitzpatrick, & Ellis, 2008; Morgan & Sprenkle, 2007; Watkins, Budge, & Callahan, 2015). Common factors models of supervision bridge the various approaches to supervision by identifying the essential components that are shared across models, such as the supervisory relationship, the provision of feedback, and supervisee acquisition of new knowledge and skills (Milne et al., 2008; Morgan & Sprenkle, 2007). Other common factors approaches to supervision draw on psychotherapy outcome research, aiming to extrapolate common factors of counseling and psychotherapy-such as the therapeutic relationship and the instillation of hope-to clinical supervision approaches (Lampropoulos, 2002; Watkins et al., 2015).Although reviews of the supervision literature allude to commonalities among supervision approaches (Bernard & Goodyear, 2014), there is a dearth of published literature offering practical strategies for bridging common factors of counseling and supervision. Perhaps even more limited is literature that addresses the necessary convergence of both common and specific factors, or the integration of common factors of supervision with particular interventions that are applied in various supervision approaches (e.g., role-playing or Socratic questioning; Watkins et al., 2015). In a recent article, Watkins and colleagues (2015) proposed a supervision model that extrapolates Wampold and Budge's (2012) psychotherapy relationship model to specific factors of supervision, encouraging supervisors to apply such relationship common factors to some form of supervision. However, there remains a need for a structured approach to supervision that integrates the common factors of counseling and supervision with the specific factors of commonly used, empirically supported models of clinical supervision.Because the common factors are, by definition, elements that are shared among theories of counseling and supervision, it can be argued that common factors approaches can be applied to almost any supervision model. However, we argue for the integration of common factors with the discrimination model for several reasons. First, the relationship has been found to be the essential common factor shared among counseling (Lambert & Barley, 2001; Norcross & Lambert, 2014) and supervision approaches, and is often cited as the most critical element of effective supervision and other change-inducing relationships, such as counseling, teaching and coaching (Lampropoulos, 2002; Ramos-Sanchez et al., 2002). The supervisory roles of teacher, counselor and consultant are built into the discrimination model, providing supervisors with natural avenues for fostering a strong supervisory relationship. However, the proposed Common Factors Discrimination Model (CFDM) expands on the discrimination model by providing specific recommendations for how supervisors might use such roles as opportunities for developing and maintaining the supervisory relationship. …

Symptom Reduction Without Remoralization: A Randomized, Waiting-List Controlled Study Aimed at Separating Two Beneficial Psychotherapy Outcome Effects.

Treatment effects in psychotherapy outcome research are generally based on the reduction of symptoms. Standard inclusion of other beneficial treatment effects such as remoralization (increase of hope, self-efficacy, well-being) might lead to more elaborate findings in the field of psychotherapy. On the other hand, it is also possible that symptom reduction and remoralization always go hand in hand in the experience of patients. The present study sought to experimentally test this assumption. A total of 78 patients suffering from panic disorder were randomly assigned to brief remoralization treatment, brief exposure treatment, or waiting list (WL). Both treatments increased remoralization and both reduced symptoms of panic disorder as compared to WL. It is unlikely that patients experience remoralization without symptom reduction or symptom reduction without remoralization. These findings do not favor the assumption that conclusions within psychotherapy outcome research are flawed because of its heavy reliance on measurements of symptom reduction.