Psychotherapy Process Research Articles

Regulation Focused Psychotherapy for Children (RFP-C) with Externalizing Behaviors: Comparing the Successful Case of "Jack," and the Unsuccessful Case of "Oliver"

Regulation Focused Psychotherapy for Children (RFP-C) is a manualized, time-limited, psychodynamic approach for children who experience challenges with emotion regulation and demonstrate externalizing behavior problems (Hoffman et al., 2016). In research settings, it takes place over ten weeks and includes 16 sessions with the child and four with the child’s parents. This protocol can be extended or modified in regular clinical practice. The current study utilized a dual case study method to analyze pretreatment and post-treatment measures and compare psychotherapy outcomes and process in RFP-C between a successful and an unsuccessful case. Data examined included (a) quantitative outcome measures; (b) case conceptualizations and clinical vignettes drawn from review of session videos; (c) post-treatment interviews with parent, child, and therapist; and (d) psychotherapy process codings of child and parent sessions. These data were employed to (a) identify differential psychotherapy processes; (b) assess parental defense mechanisms; (c) assess parental attachment classifications; and (d) evaluate therapist countertransference ratings. Results indicated that many variables contributed to successful versus unsuccessful treatment outcomes, including but not limited to (a) the child’s spontaneity; (b) the child’s active participation and emotional expression throughout treatment; (c) themes of child play; (d) the therapist’s countertransference; (e) the child and parental defense mechanisms; and (f) the parental attachment styles. Taken together, findings from this study contribute to the literature on therapeutic outcomes for children and families and highlight some of the essential characteristics of successful psychotherapy process. Limitations of the study and directions for future research are also discussed.

Insights from a Dual Case Study of Regulation Focused Psychotherapy for Children (RFP-C) with Externalizing Behaviors: The Cases of "Jack" and "Oliver"

This dual case study involving "Jack" and "Oliver" provides critical insights into the efficacy and therapeutic processes of Regulation Focused Psychotherapy for Children (RFP-C), a manualized psychodynamic approach designed to address emotion regulation difficulties in school-age children. The study demonstrates both the strengths and limitations inherent in case study research within child therapy. Strengths include the extensive use of diverse measures and a thorough examination of the complexities involved in child therapy. Nevertheless, limitations arise from challenges in generalizing findings and the intricacies of the methodology. This commentary addresses these aspects, highlighting how case studies can enrich and complement randomized controlled trial results by offering a nuanced understanding of psychotherapy processes and outcomes. Such insights are essential for enhancing clinical practice. Future research should improve methodological rigor and investigate key psychotherapy variables, especially the dynamics of building and maintaining therapeutic alliances with children and parents. Additionally, rigorous qualitative analysis of interviews with children, parents, and therapists could offer valuable insights into the complexities of therapeutic interventions.

Travma Sonrasi Stres Bozukluğu Bilişsel Davranişçi Terapi İle Tedavisi Üzerine Bir Olgu Sunumu

Post-Traumatic Stress Disorder (PTSD) is a disorder that arises after experiencing an event that threatens one’s life or causes significant stress. Symptoms of PTSD include intense stress, fear, anxiety, worry, sleep disturbances, difficulty concentrating, and negative cognitive and emotional changes. These are some of the hallmark symptoms of PTSD.This case study examines the therapeutic process of a 20-year-old female university student diagnosed with PTSD based on DSM-5 criteria. The treatment process involved 10 therapy sessions. The client reported symptoms such as self-blame for the verbal and physical abuse she experienced, trust issues with other people, fear of reliving the traumatic event, and sleep problems. Cognitive-behavioral therapy (CBT) was applied during the therapeutic process. Psychoeducation was provided to the client regarding the therapy approach to be used and the progress of the therapy process. The initial phase of therapy focused on building a therapeutic alliance. Dysfunctional and self-blaming thoughts and core beliefs were identified and replaced with functional, realistic, and adaptive thoughts through cognitive restructuring. Subsequently, behavioral techniques, including exposure exercises and homework assignments, were employed. Keywords: Post-Traumatic Stress Disorder (PTSD), Cognitive Behavioral Therapy (CBT), Case study, Trauma treatment, Psychoeducation, Exposure therapy, Traumatic events, Mental health, Psychotherapy processes, Psychological support

Psychotherapy process variables in implementation of CBT for Inflammatory Bowel Disease:Therapist competence, fidelity, and patient themes

Psychotherapy process variables in implementation of CBT for Inflammatory Bowel Disease:Therapist competence, fidelity, and patient themes

A brief overview of the therapeutic alliance: historical, theoretical and contemporary debates

The therapeutic alliance has a historical importance in psychiatry, especially in the effectiveness of psychotherapies. The therapeutic alliance is a critical concept that reflects the quality of the relationship between the patient and the therapist in the psychotherapy process and for many clinicians it is the main factor in the patient's recovery. While a strong alliance increases the success of the therapy, in cases of weak alliance, it is difficult to achieve therapeutic goals. Although different psychotherapy approaches position the concept of therapeutic alliance differently, in the future, in-depth exploration of the therapeutic alliance in different contexts and populations will contribute to the scientific knowledge in this field. The therapeutic alliance is a valuable concept not only in psychotherapy, but also in every field of psychiatry, and even wherever there is a physician-patient relationship. In this article, the therapeutic alliance is examined in the historical process, its importance in psychotherapy is discussed, and the prevention of rupture or what to do in case of rupture is explained.

“Choreographing Empathy” in Walking Miracles, an Original Dance/Theater Work Created from Stories Told by Six Adult Survivors of Child Sexual Abuse

Walking Miracles, a dance/theater project, was created from the stories of six adult survivors of child sexual abuse and completed due to the conscientious work of many collaborators. A psychotherapy group of fourteen sessions was audiotaped and attended by the six survivors, three dancer/choreographers, and one psychotherapist. Our goals were to provide positive psychotherapeutic experiences for the survivors and the foundation for a dance/theater piece that would then be presented to the public at the conclusion of the group sessions. Our hope was that audiences would gain a deeper empathetic understanding of child sexual abuse and would become stronger allies for the survivors and stronger advocates for child abuse prevention. Empathetic abilities were critical for this project—in the psychotherapy process, in the care taken to protect the trust and confidentiality of the survivors, and in the creation of the script, choreography, music, and poetry. I will examine the nature of empathy and the processes for creating specific movements from such dark experiences. How does one approach a work about issues so intensely personal? What care do we need to provide for the participants during the progression of the work? What are the ethical aspects of such projects that use the personal narratives of hidden communities?

Client characteristics and early working alliance development: A person-centered research approach

Objective Certain client characteristics are associated with early working alliance difficulties in psychotherapy. However, there is limited quantitative evidence on whether combinations of these characteristics (e.g., intersectional identities, prior treatment experiences) are related to alliance development. The present study leveraged a person-centered research approach to examine profiles of early alliance development and differences in the latent class structure of client characteristics among alliance development profiles. Method Individual psychotherapy clients (N = 2,579) rated the working alliance for their first four sessions and self-reported demographics, treatment history, and psychological distress. Therapists provided their assessment of clients’ primary presenting concerns at baseline. Results Latent profile analysis revealed three profiles of working alliance development: high and stable, moderate and increasing, and low and stable. Follow-up person-centered analyses (multigroup confirmatory latent class analysis) indicated that clients in the alliance profiles differed in their combinations of clinical and demographic characteristics. For example, women of color with high baseline distress and a history of prior psychotherapy were over-represented in the low and stable alliance profile. Conclusion These results are consistent with recommendations to holistically consider how clients’ characteristics and experiences shape psychotherapy processes. Results also highlight the utility of person-centered quantitative methods in psychotherapy research.

МЕТАФОРИЧНІ СЦЕНАРІЇ В ПСИХОТЕРАПЕВТИЧНОМУ ДИСКУРСІ ІРВІНА ЯЛОМА

The article focuses on investigating psychotherapeutic discourse in view of cognitive linguistic approach. The objective of the present research is to reveal and describe the metaphor scenarios that constitute the range of the conceptual metaphor with the target domain PSYCHOTHERAPY, objectifi ed in the psychotherapeutic discourse. The study is based on the novels When Nietzsche Wept (1992) and The Schopenhauer Cure (2005) by a contemporary American existential psychiatrist, professor of psychiatry Irvin Yalom, the author of psychotherapeutic fi ction and nonfi ction. The psychotherapeutic discourse under study is viewed as a specifi c type of discourse that combines the properties of scientifi c discourse of individual and group psychotherapy and fi ction. The methodology of the practical analysis is based on the Conceptual Metaphor Theory. Specifi cally, by applying the theory of metaphor scenarios, grounded by Andreas Musolff , we analyze metaphor scenarios that structure the particular source domains in their discourse manifestations. Within this approach, metaphor scenarios are viewed as discourse-mediated mininaratives, more specifi c than domains. The article discusses the following metaphor scenarios, objectifying the target domain (i.e., the process of group and individual psychotherapy) in the psychotherapeutic discourse by Irving Yalom: PSYCHOTHERAPY IS JOURNEY → PSYCHOTHERAPY IS MOUNTAIN TRIP BY THE TORRENT, PSYCHOTHERAPY IS SEA VOYAGE, PSYCHOTHERAPY IS FAMILY RELATIONS, PSYCHOTHERAPY IS HOUSECLEANING, PSYCHOTHERAPY IS CHIMNEY SWEEPING, PSYCHOTHERAPY IS CHESS GAME, PSYCHOTHERAPY IS GARDENING, PSYCHOTHERAPY IS DRESS REHEARSAL. The metaphoric scenarios, being discourse-based, highlight the relevant conceptual properties of the target domain in the novels, revealing focal points for conceptualizing group and individual therapy process. The analyzed scenarios highlight the therapist-patient cooperation properties, as well as the metaphoric roles of the therapist and patient within the scenarios under study, such as: GUIDE (RAILING BY THE TORRENT, CRUTCH) /TRAVELLER (STUDENT), SEA CAPTAIN/PASSENGER, PARENT/CHILD, OPENER OF RUSTY GATES, CHIMNEY-SWEEPER/OVERSEER, CHESS PLAYERS/OPPONENTS, GARDENER/ PLANT (LATE BLOOMER), THEATRE ACTORS. Key words: conceptual metaphor, domain, the range of metaphor, cognitive mechanisms, psychotherapeutic discourse, frame, metaphor scenario.

Psychotherapists' outcome expectations: How are they established?

Therapists' outcome expectations influence the psychotherapy process and outcomes, but little is known about the factors influencing their development. This study explored therapists' experiences with establishing outcome expectations for their patients. The participants were 35 therapists from a public mental health setting, who were interviewed in five different focus groups. Interviews were transcribed and analyzed using thematic analysis. Three themes and 10 subthemes were identified. In Theme 1 (understanding the problem), participants' expectations were influenced by (a) their patients' diagnoses and the diagnostic process, (b) their perceptions of the complexity of the presenting problem, (c) how stable the patients' symptoms and situations were, and (d) whether they experienced familiarity with the patient or the patients' situation. In Theme 2 (the patient's openness to change), participants' expectations were influenced by (a) the patient's stated reason for seeking treatment, (b) the patient's conceptualization of their problem/situation, and (c) their perception of the patient's willingness to invest in the treatment. In Theme 3 (the fit between the therapist and patient), the participants discussed the factors that influenced whether they felt they were a good fit for working with an individual patient and how this perception of personal and professional fit influenced their expectations. We identify several ways that therapists' situational factors and their recognition of the patient through their own past experiences can influence their expectations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Quran From The Perspective Of Acceptance And Commitment Therapy

The purpose of this study is to discuss how the verses in the Holy Quran can be related to the flexible hexagon of Acceptance and Commitment Therapy. The issues discussed in the six steps of the Act are the issues emphasized in the Quran in order to ensure the happiness of people in this world and the hereafter. For believers, religion is the most important element that directs their lives. For this reason, when individuals who aim to continue their worldly life according to religious values encounter a problem or pain and want to get psychological support, both the client and the counselor may hesitate. Seeing the similar aspects of the Quran verses with ACT will make the work of the counselor and the client easier in the psychotherapy process. While applying this therapy to a believing client, the counselor will be able to benefit from the Holy Quran, which is the most important source according to his belief; The client will feel the pleasure that the counselor cares about his religious values. Therefore, the fact that psychological counseling techniques coincide with the messages given by the verses of the Quran will make it easier for Muslim clients to overcome the pain they experience, cope with difficulties, and most importantly, they will be able to go through the counseling process happily because it does not contradict their beliefs. For this reason, in the study, the components of the Act are explained in detail and its relationship with the verses in the Holy Quran is revealed.

How Can Near‐Infrared Spectroscopy (NIRS) Help Understanding of the Psychotherapy Process? A Scoping Review of Therapeutic Interactions

AbstractIn recent years, near‐infrared spectroscopy (NIRS) has garnered significant attention for its potential clinical applications as a non‐invasive and straightforward method for measuring brain functions. While NIRS has become useful in psychiatric contexts by aiding in the differential diagnosis of depression, its application in clinical psychology is still developing. Due to its ecological validity, which allows for measurements in natural settings, NIRS shows promise in revealing the dynamic elements of the psychotherapy process. In this study, we conducted a scoping literature review of the use of NIRS in psychotherapeutic interactions, exploring its potential to unveil the complexities of psychotherapy settings involving interpersonal interactions. Employing a scoping review approach, we systematically searched the PubMed, PsycINFO, and Web of Science databases for articles published through October 19, 2023 about studies using NIRS as a measurement instrument: This yielded various therapeutic interactions. Of the 155 retrieved results that remained after the initial screening, seven met the inclusion criteria. Of these, six studies examined the synchronization of brain functions through the simultaneous brain activity measurements (hyperscanning) of two participants. The review revealed that, despite the anticipated potential of NIRS, it has become evident there is a dearth of research focusing on interactions during psychotherapy. Furthermore, the few available studies have not explored changes in line with the progression of psychotherapeutic interactions. Consequently, future studies should address whether NIRS can effectively assess alterations in brain function resulting from micro‐level events, such as the therapeutic interaction between therapists and clients during psychotherapy.

A Novel Approach to Examining Working Alliance Instability During Psychotherapy for Borderline Personality Disorder.

This study aimed to quantify the instability of psychotherapy process variables by using a novel data-analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem. Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between-person associations of alliance instability with self-esteem. Although some preliminary analyses showed an association between a more stable alliance and higher self-esteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level. This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.

Change processes associated with functional improvement in a web-based version of Skills Training in Affective and Interpersonal Regulation (webSTAIR) for trauma-exposed veterans.

In spite of the evidence that both symptom reduction and functional improvement are important for supporting recovery from trauma, psychotherapy process research has largely focused on mechanisms of symptom reduction. A better understanding of how change occurs in treatments that emphasize functional improvement rather than trauma processing is critical for optimizing effective, patient-centered care. This study involved secondary analysis of data collected in three multisite trials of a 10-module web-based version of Skills Training in Affective and Interpersonal Regulation, a skills-focused transdiagnostic intervention. The sample included 314 trauma-exposed veterans (38% male; 64% non-Hispanic White) who screened positive for elevated symptoms of posttraumatic stress disorder and/or depression. Latent change score modeling examined prospective relationships between changes from pre-to-mid and mid-to-post treatment in four potential mechanisms (emotion regulation, interpersonal problems, posttraumatic stress disorder symptoms, and depression symptoms) and the association of these changes with overall functional improvement (at posttreatment and follow-up). Emotion regulation change during the first half of treatment predicted interpersonal and symptom improvements during the second half of treatment, but not vice versa. Changes in each potential mechanism were uniquely associated with functional improvement and together statistically accounted for 78% additional variance in functional improvement beyond what was associated with baseline functioning and covariates. Results support emotion regulation as an early mechanism of transdiagnostic therapeutic change in web-based version of Skills Training in Affective and Interpersonal Regulation and highlight the relevance of all four potential mechanisms to functional improvement. The study contributes to an understanding of how change occurs in skills-focused interventions for trauma-exposed individuals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The complexity of interpersonal physiology during rupture and repair episodes in the treatment of borderline personality disorder: a proof-of-concept multimethod single case study of verbal and non-verbal interactional dynamics.

The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. The multimethod includes outcome assessment of patient self-reporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy.

The development of the psychoanalytic psychotherapy process with a depressed adolescent: an empirical case study

ABSTRACT This paper explores the psychotherapy process in a short-term psychoanalytic treatment (STPP) with a depressed adolescent. The empirical case study draws on both quantitative and qualitative data to examine the development of the psychotherapy process over time. 15 of the 29 audio recorded therapy sessions with a 16-year-old boy were sampled at intervals across the treatment. Session transcripts were coded using the Adolescent Psychotherapy Q-Set (APQ) and data analysed descriptively to compare characteristics of the process across the three treatment phases – beginning, middle, and ending. Descriptive statistics are supported with session extracts. Analysis of the APQ data suggests change in the patient’s presentation across the therapy. In the early stages, he appeared withdrawn and made minimal responses to the therapist’s attempts to work together; in the middle phase, he became more engaged, more able to talk about feelings, and more active in the sessions; and this was reflected in a less depressed presentation in the final phase. The therapist maintained a consistent therapeutic approach across all phases: supportive, non-judgemental, and working to make sense of the young person’s experiences, looking for patterns and inviting curiosity about how things might be understood differently. Despite increased engagement in the therapy, depressive symptoms remained in the clinical range.

Does technique matter? A multilevel meta-analysis on the association between psychotherapeutic techniques and outcome.

The extent to which psychotherapeutic techniques have an impact on outcome has been studied on a regular basis. To date, there are no meta-analytic attempts to clarify the association between techniques and outcome in multi-therapeutic approach measures. This study aims to conduct a meta-analysis of the described association. A three-level meta-analysis and moderator-analysis were used. The meta-analysis revealed 13 studies with a total of 177 effect sizes. There was a significant effect r=.193 (t[176]=4.77, p<.01) with higher use of psychotherapeutic techniques being associated with better outcome. Significant moderator was therapeutic approach-specific subscales. The mean effect of cognitive-behavioral techniques was r=.088 (t[147]=1.50, p=.14, d=0.18; s=11, k=79), and the mean effect of psychodynamic techniques was r=.286 (t[147]=5.06, p<.01, d=0.60; s=11, k=70). The measurements for psychotherapeutic technique (Comparative Psychotherapy Process Scale and Psychotherapy-Process Q-Sort) showed no significant difference related to the association between technique and outcome (F[1, 175]=0.38, p=.54). This meta-analysis showed a positive relation between psychotherapeutic techniques and outcome. This leads to the assumption that specific psychotherapeutic techniques have positive effects on post-treatment outcome.

An Integrative Model to Increase Client Motivation During the Psychotherapy Process

An Integrative Model to Increase Client Motivation During the Psychotherapy Process

The development of the Moments of Flourishing Experience Scale: a new scale to measure positive, affect-based flourishing state experiences

ABSTRACT Flourishing has been a focus of positive psychology, with increased attention to its translation into psychotherapy practice. Flourishing is an emergent process manifested in momentary experiential states characterized by positive emotions. A conceptualization of flourishing as an innate potential that psychotherapeutic interventions can help cultivate informs the development of this scale. The current study details the development of the Moments of Flourishing Experience Scale (MFES), a 23-item scale. The data were obtained from four different studies involving a total of 1472 adults (normative sample n = 1312; clinical sample n = 160). A bifactor model with four distinct positive affective experience subscales, yielded by factor analysis and then supported by a confirmatory factor analysis, was as follows: Calm & Self-Acceptance; Vitality; Generosity of Spirit & Gratitude; and Connection & Purpose. Across studies, the MFES showed discriminant validity from psychopathology measures and convergent validity with positive psychological functioning measures. The overall scale, as well as each of four subscales, also demonstrated strong reliability in both general and clinical populations. The MFES has initial psychometric support for the study of flourishing and shows promise as a tool to study flourishing as both outcome and process in psychotherapy.

Engaging the child-parent relationship to treat early trauma: The challenge and promise of scaling with fidelity.

There is an urgent imperative to scale up access to effective, family-focused mental health services for trauma-exposed infants, toddlers, and preschoolers, who represent the most vulnerable and most underserved sector of the clinical child population. This article describes the process of scaling child-parent psychotherapy, an evidence-based treatment currently used in 39 U.S. states and six countries, as an example of the promise and challenge of large-scale implementation of relationship-based treatments.

How Can We Study Change Processes in Psychotherapy While Addressing Its Interactive Nature

Does the empathy or personality of psychotherapists influence the way they do therapy? Is the therapeutic relationship the key to success? Questions such as these are commonly shared in Change Process Research (CPR) and outcome studies. However, these statements, posed in descriptive cross-sectional terms, often imply the use of strategies grounded in causal-linear explanatory models. The present study offers an alternative tool to measure elements of psychotherapy in dynamic, interactive, and interdependent terms. With nine observational categories defined under analytical-behavioral lens, the Acoveo System is an instrument designed to detect the potential functions of verbal exchanges that take place in the psychotherapeutic context from any theoretical orientation. A guide to its application is provided, and its usefulness is elaborated on two of the pivotal common factors in change process research: empathy and therapeutic alliance.