Responsiveness to clients' spirituality and/or religion (S/R) is a core dimension of multicultural and clinical competence. S/R might support or hinder clients' well-being and recovery from mental health conditions that might lead them to seek psychotherapy. Further, clients from across the spectrum of S/R diversity often want therapists to attend to their spiritual and/or religious identities in the treatment process. However, many counselors, marriage and family therapists, psychologists, social workers, and other psychotherapy practitioners do not receive training in foundational knowledge, attitudes/dispositions, and skills related to S/R in graduate school or later in their professional careers to adhere to these pillars of evidence-based practice. Of the many solutions to overcoming these training gaps, therapists might need resources and tools to cultivate the necessary expertise to treat spiritually and religiously diverse clientele (including atheist, agnostic, or secular). Further, as such work proceeds, researchers will ideally clarify the most acceptable, feasible, and effective strategies for promoting S/R competence in different training settings. With this background in mind, this introduction to the Psychotherapy special section, titled "Spiritual and Religious Competence in Psychotherapy Training," describes the inspiration, rationale, and purposes of a collection of articles that present novel training methods, evaluation strategies, and pedagogical tools to develop spiritual and religious competence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This article describes the author's perceptions of the value and legacy of Charles Gelso's ("Charlie's") work and his contributions to the field of psychotherapy research, practice, and training. Charlie's major theoretical and empirical contributions on the therapy relationship, most notably the tripartite model and the real relationship, and the research-training environment are discussed, alongside personal reflections of Charlie as a mentor. Lessons learned and suggestions for carrying his legacy forward, as we continue to advance psychotherapy research, practice, and training, are suggested. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Relational competence is a key determinant of psychotherapy outcomes, yet its development during training remains insufficiently understood. The present study adopts a qualitative, trainee-centered approach to examine how psychotherapy trainees conceptualize relational competences, evaluate their strengths and limitations, and identify the experiences most influential in their development. Forty-nine trainees from a four-year psychotherapy training program completed a structured interview, and data were analyzed using inductive qualitative content analysis. Findings revealed four main themes: i) the conceptualization of relational competence as a foundational and multidimensional component of clinical practice; ii) a predominantly external, patient-driven locus of validation for perceived strengths; iii) the context-dependent and relationally situated nature of perceived limitations; and iv) the central role of experiential learning contexts in fostering relational development. Overall, relational competence emerged as a dynamic and developmental construct, shaped by the integration of personal dispositions, experiential learning, and evolving professional identity. These findings highlight the need for training models that more effectively integrate experiential and reflective components while supporting the development of more internalized standards of professional competence.

This study aimed to explore the educational experiences of medical students and psychiatry residents within a large mental health trust, identifying areas for improvement. A qualitative methodology using four focus groups was employed, grouped by training level: medical students, foundation doctors, core psychiatry residents and higher-specialty residents. Discussions were guided by a standardised topic guide and analysed thematically. Participants highlighted key issues including induction length and quality, access to written information, rota gaps and inadequate facilities; challenges in achieving psychotherapy competencies, teaching inconsistency, lack of supervision and insufficient development of non-clinical skills were also noted. Enhancement of induction, supervision, psychotherapy training and non-clinical skills development can significantly improve psychiatric education. Addressing structural and systemic issues will strengthen trainee experience and support high-quality patient care.

The growing demand for mental health services in the United States has intensified pressure to expand the psychiatric workforce, prompting some systems to consider deploying nonpsychiatric nurse practitioners (NPs), such as family, adult-gerontology, and pediatric NPs, to independently staff psychiatry-only practices. This essay argues that such a strategy is unsafe, unethical, and inconsistent with advanced practice nursing standards. Psychiatric-mental health NPs receive specialized training in psychopathology, advanced assessment, psychopharmacology, and psychotherapy that generalist NPs do not. The diagnostic and pharmacologic complexity of specialty psychiatric care, particularly for severe and treatment-resistant conditions, amplifies the risks of misdiagnosis, inappropriate prescribing, and inadequate risk management when care is provided by nonspecialists. Case-based evidence and regulatory guidance highlight patient safety concerns and liability exposure when NPs practice beyond their certified scope. The essay differentiates appropriate mental health management in primary care from specialist psychiatric practice and rebuts arguments grounded in workforce shortages and "experience-based" competence. It concludes by outlining safer evidence-informed solutions, postmaster's psychiatric-mental health NP certification, telepsychiatry, and collaborative care models, that expand access while maintaining high standards of psychiatric care.

This article seeks to clarify and distinguish how phenomenological definitions of empathy may be applied in psychotherapy. It argues that effective therapeutic practice relies not only on narrative engagement but also on embodied attunement, often referred to as empathic resonance. Rather than viewing the therapist's feelings as passive emotional mirroring of the client, the authors propose a critical and situated perspective in which these feelings are understood as embodied responses that emerge within the therapeutic relationship. In doing so, the authors aim to contribute to the enhancement of clinical training in psychotherapy. They specifically advocate for a stepwise approach to training, in which narrative tracking and bodily self-awareness are developed and cultivated as separate skills in the early phases of psychotherapy training. The progressive integration of these skills eventually enables therapists to use their feelings as instruments of empathy rather than sources of interference. Thus, empathic therapists do not limit themselves to a purely cognitive, intellectual understanding of a client's story. Instead, they cultivate a comprehensive form of empathy, allowing themselves to resonate with the client's experience at a bodily, prereflexive level.

Clinical services need more than categorical labels to guide safe dosing, maintain alliance, and plan functional recovery. The Conflict-Square Algorithm (CSA) offers a compact bedside grammar for moment-to-moment decisions during psychotherapy. Clinicians track four observable signals—defense, anxiety/affect tolerance, progression, and superego/shame—and gate intervention intensity by three safety thresholds (A–C). Each clinically meaningful moment is summarized as one auditable episode line in plain language: trigger, observable response, threshold, action, and expected functional impact (Mini-ICF-APP). To strengthen reproducibility, we provide i) operational threshold definitions with observable markers and common misclassification errors, grounded in established anxiety-channel descriptions [striated muscle, smooth muscle, and cognitive-perceptual disruption (CPD)]; ii) a short scope and contraindication checklist; iii) several consecutive worked micro-episodes demonstrating node shifts, threshold transitions, and dose modulation over time; and iv) a minimal machine-readable schema plus a threshold-gating state diagram. As a proof-of-concept feasibility demonstration, we report aggregate coding statistics from three published psychotherapy training videos distributed by the ISTDP Institute (transcribed for analysis with written permission; N = 2,809 speaker turns) using a three-label therapist intervention mapping (invite progression/defense work/anxiety regulation) aligned with CSA nodes. CSA is presented as a teachable, testable decision framework—not as a validated diagnostic instrument—and we outline a pragmatic validation program (rater agreement, safety-rule adherence, usability, and functional outcomes) and future multimodal extensions (e.g., optional physiological monitoring for biofeedback and threshold detection).

little is known about the impact of conflict or war on Palestinian mental health professionals, as well as their strategies for dealing with these problems. Given the continuous war in Palestine, the purpose of this study was to investigate the prevalence of depression, anxiety, and coping strategies among healthcare professionals. The study utilized a cross-sectional research design. Self-reported questionnaires included the Hospital Anxiety and Depression Scale (HADS) and the Brief COPE scale was used. The relationships between the study's variables were examined using descriptive statistics (frequencies and percentages), Pearson correlation, and multivariate regression. A total of 713 health professionals were recruited. Anxiety and depression had a prevalence of 51.5% and 45.3%, respectively. The multivariate analysis revealed that those who utilized self-distraction, active coping, substance use, emotional support, and acceptance as coping strategies were less likely to suffer depression. Also, participants who employed denial, venting, and planning as coping strategies were more likely to develop depression. In addition, males were less likely to experience anxiety than females, and those who utilized emotional support and acceptance as coping mechanisms were less likely to feel anxious. However, participants who utilized denial, behavioral disengagement, venting, and planning were more likely to experience anxiety. The findings revealed a high prevalence of depression and anxiety among health professionals during wartime and political violence. As a result, health professionals need assistance in enhancing their mental well-being through psychological support, psychotherapy, and comprehensive training in stressor management.

Abstract Implementing self-care practices has shown to enhance professional confidence among therapists. Research and theoretical frameworks indicate that self-care and professional confidence are critical constructs in psychological therapies. This study examines the impact of self-care on self-efficacy and identifies variables that may influence these constructs. 207 clinical psychologists were invited to complete a self-report questionnaire assessing self-care practices, personal therapy, and professional self-efficacy. The results showed that professional development and cognitive strategies (in self-care) are correlated with psychologists’ self-efficacy. Both professional support and work-life balance showed moderate correlations with self-efficacy. Clinical experience and personal therapy were not significantly correlated with self-efficacy, whereas older age and psychotherapy training were associated with higher self-efficacy. The study highlights the importance of self-care practices in enhancing self-efficacy and the need for further research into the factors that influence self-care among clinical psychologists.

Psychological inflexibility (PI) is a potentially important yet understudied factor in therapist training, as it may hinder engagement in learning activities central to psychotherapy education and is negatively associated with learner wellbeing. However, few instruments have been developed to assess PI in educational and training contexts, and evidence from psychotherapy training population is limited. This study aimed to develop a new measure of PI intended for use in educational settings, and to evaluate its psychometric properties within the specific context of psychotherapy training In Study One, an initial version of the scale was developed and tested with 195 mental health professionals who were currently or previously enrolled in psychotherapy continuing education. Preliminary psychometric evaluation included expert review, cognitive interviews, exploratory factor analysis, and Mokken scale analysis. Rasch methodology was then applied to assess dimensionality, item independence, response category ordering, targeting, invariance, and reliability. In Study Two, a new sample (n = 337) was used to validate the revised instrument through Rasch analysis Results supported a unidimensional, 7-item scale demonstrating good model fit, local independence, ordered thresholds, invariance, and acceptable reliability. Additional analyses suggested a small but statistically significant negative association between age and psychological inflexibility ( rho = -0.18), while no consistent differences were found across gender or profession The resulting instrument – the Karolinska Inner-Barriers Scale for Education (KIBS-Ed) – offers a brief and psychometrically sound measure of psychological inflexibility, suitable for use in educational and training settings. Our evaluation within two samples from the psychotherapy training population supports its application within therapist education. Despite providing only preliminary validation and requiring further evaluation with additional outcomes and instruments, the present study represent a rigorous and important first step. • Learner psychological inflexibility is understudied in therapist training • Measuring PI may clarify learner engagement and wellbeing • The KIBS-Ed shows initial validity and reliability in two samples • Findings support the KIBS-Ed as an education-specific assessment tool • Further research is needed to confirm validity evidence

From innovation to implementation: Artificial intelligence in cognitive behaviour therapy training and supervision.

ABSTRACT Background The population of classical Adlerian practitioners represents one theoretical branch of Adlerian psychology, but little empirical research has been conducted within this population. The classical Adlerian approach features a 12‐stage depth psychotherapy model that targets the dissolving of the style of life and fictional final goal and paves the emergence of the self, other, and task actualisation. Individuals study the classical Adlerian approach through postgraduate professional training in a one‐on‐one mentorship style in which a trainee is matched with a training analyst. Purpose This qualitative research aimed to explore how classical Adlerian practitioners navigate developing their professional identity in the context of the classical Adlerian mentorship training style. The research question of this study was: What are the lived experiences of developing professional identity through a mentorship‐style training among classical Adlerian practitioners? Method We employed purposive sampling and interviewed five classical Adlerian practitioners, each of whom took part in two semi‐structured interviews. We adopted interpretative phenomenological analysis to explore these classical Adlerian practitioners' experiences developing professional identity through mentorship‐style psychotherapy training. Findings Our analysis revealed four themes. Findings revealed that, first, all contributing participants recognised their mentors' influence on who they were as professionals. Second, the classical Adlerian practitioners who participated in this study reported that their experiences in classical Adlerian mentorship fostered a mentor spirit and a joy in mentoring. Third, the one‐on‐one mentoring relationship was underscored by participants, each presenting a unique descriptive account. Fourth, participants emphasised the value of a learning process in a mentorship‐style training and highlighted the integration of learning and application for learning theory and becoming Adlerian practitioners.

Transarterial chemoembolization (TACE) is an important treatment for unresectable intermediate to advanced hepatocellular carcinoma, but it is often accompanied postoperatively by postembolization syndrome, with pain as the core symptom, severely affecting patients' quality of life and treatment compliance. This article systematically reviews the research progress on perioperative pain associated with TACE, covering pain characteristics and classification, pathophysiological mechanisms, assessment tools, and management strategies. Pain mainly presents as upper right abdominal distension or dull pain within hours to 48 hours after the procedure and is closely related to tissue ischemia, necrosis, and the release of inflammatory mediators. Pain assessment commonly uses the visual analog scale (VAS) and numeric rating scale (NRS), emphasizing dynamic and multi-timepoint evaluation. Current pain management focuses on multimodal analgesia, combining nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant analgesics, while gradually integrating non-pharmacological interventions such as acupuncture, psychotherapy, and rehabilitation training. Multidisciplinary team collaboration plays a key role in optimizing pain management. Future efforts should focus on conducting high-quality research to promote personalized, preventive, and integrated pain management, improving the overall treatment experience and rehabilitation quality for TACE patients.

Embedding psychotherapy training into advanced practice curricula is possible but greater evaluation is needed.

ABSTRACT Objectives This study aimed to explore how therapists understand and approach patients' transitions between everyday life and therapy sessions. Design This was a qualitative study of therapists' experiences, making their implicit knowledge explicit and systematised. Methods Twelve semi‐structured interviews were conducted with psychodynamic/psychoanalytic therapists and analysed with inductive thematic analysis. Results The therapists lacked a conceptual framework for patients' transitions but could use conversations about transitions as a tool for deepening the therapeutic work. Clear therapeutic frames made the transitions more visible. Facilitating transitions into a therapy session was easier than out of a session. The therapists described a wide variation in their understanding of patients' behaviours at the threshold of sessions, which was a rich source of information about the patients' problems and the therapeutic progress. Conclusion Therapists have to pay attention and adapt to each patient's transitional needs and the phase of the therapeutic process. The transitions seem to be linked to emotions related to the therapeutic setting and thus need to be addressed. Our study showed that therapists had implicit knowledge in this area. This knowledge needs to be made explicit and available in the treatment of patients, for psychotherapy training, supervision and continuing education. Furthermore, there is a need for theoretical and conceptual developments within this area. This study highlights a phenomenon in therapy that has not been explored at length in research, and thus adds a new perspective when it comes to face‐to‐face sessions.

ABSTRACT This paper explores the importance of integrating decolonial perspectives into therapist education, emphasising the need to challenge Eurocentric frameworks that marginalise diverse worldviews, healing practices, and lived experiences. Drawing on research findings from a study of therapists’ discussion of trauma-informed care for Black queer men, this paper examines their reflections on their early training and experiences in psychotherapy. Semi-structured interviews were conducted with nine practitioners who reflected on their views on the dominance of Eurocentric frameworks in UK psychotherapy training. Reflexive Thematic Analysis was used to analyse the interviews. Findings underscore that decolonisation of UK psychotherapy training is a critical step towards reimagining therapy as a truly inclusive and human-centred discipline. We advocate for a model of counselling and psychotherapy training which consciously and overtly discusses epistemic injustice and implicit colonial knowledge systems. Additionally, we articulate a model of pedagogy in higher education (HE) which embraces relational aspects of counselling and psychotherapy training, utilising the ‘human’.

ABSTRACT This paper explores the challenges that the profession faces in addressing the legacies of colonisation. The process of decolonisation is understood to mean challenging Eurocentric frameworks, addressing systemic oppression, promoting greater inclusivity and considering societal, cultural, and intergenerational factors alongside individual experiences in shaping psychic and social life. The author uses their own experience of seeing things ‘otherwise’ to understand how psychotherapy trainings might want to reflect on the epistemologies that inform the current curricula whilst also examining the resistance that institutions and trainers have to owning their own implicated positions. Based on the work of Michael Rothberg and The Implicated Subject, the author calls for a process of ‘unlearning’, expanding awareness of responsibilities and working through defensive states of shame and guilt. This paper calls for a critical reflection and a radical approach to both teaching and clinical practice to address and integrate the ongoing impacts of our colonial histories and their enduring effects.

ABSTRACT In this commentary, I emphasise the importance of a focus on inequities as opposed to diversity, and on racism in particular as opposed to all inequities. I suggest that for decolonizing the curriculum to not end up as a superficial tick-box exercise, tackling the structural impact of racism is essential. At the same time, it requires deep personal work to critically analyse each of our own complicities in racist structures and internalized racist ideologies. Decolonising Counselling and Psychotherapy training is an essential endeavour if we don’t want to be complicit in the profession perpetuating and enhancing the inequitable systems that we have all inherited. I introduce each of the papers in this collection, suggesting that they demonstrate the depth and breadth of work necessary to decolonize psychotherapy training.

Psychotherapy's integration into Southeast Asia (SEA) clinical practice is limited despite its recognized effectiveness. This study examined psychiatrists' and psychiatry trainees' perspectives on barriers to accessing psychotherapy, expectations for its future delivery, and attitudes toward digital mental health. A cross-national survey was conducted between March and August 2024 among 253 psychiatrists and psychiatry trainees from Indonesia (n = 121), Malaysia (n = 39), Singapore (n = 6), Thailand (n = 74), and Vietnam (n = 13). The questionnaire explored perspectives on delivering psychotherapy including barriers, provider roles, therapy formats, and digital delivery. Data were analyzed descriptively and comparatively. Key barriers to delivering psychotherapy included time constraints, cost concerns, systemic limitations, and insufficient psychotherapy skills, respectively. Regarding preferences for psychotherapy providers, trainees rated psychiatrists as most suitable, while psychiatrists preferred psychologists. Crisis intervention and individual therapy were the top priorities for training. Although videoconferencing and mobile apps were favored for future delivery, concerns about clinical effectiveness and system-level limitations hindered wider acceptance of digital psychotherapy. A major barrier was that psychotherapy is too time-consuming, and a lack of skills was a significant challenge for healthcare professionals. Both psychiatrists and trainees agreed that training should prioritize crisis intervention and individual therapy. For internet-based psychotherapy, the primary challenge was concern over its low clinical effectiveness, as many felt face-to-face interaction was necessary. The findings highlight the need for enhanced psychotherapy training, systemic support, and digital infrastructure to improve psychotherapy accessibility in SEA. These insights can inform the development of targeted interventions and policies to promote the effective integration of psychotherapy into mental health services in the region.

Purpose Social Anxiety Disorder (SAD) typically onsets in adolescence. Few studies have targeted delivery of evidence-based interventions for SAD in mental health services for adolescents. In specific, no prior studies have examined group cognitive therapy (CT) for SAD in adolescent services delivered by method-trained staff. We implemented group CT in psychiatric outpatient units to assess its feasibility and effectiveness in routine services. Materials and methods In the context of a region-wide implementation program launched by Helsinki University Hospital (HUH), eleven psychiatric nurses and psychologists were trained to deliver group CT for SAD at its outpatient clinics. None of them had prior psychotherapy training. A two-day training workshop and monthly group supervision were arranged. Clinicians treated 13-to-18-year-old adolescents with primary SAD. Dropout rate, completer/dropout analysis, and effects of group CT on SAD symptoms and general psychological distress were assessed. Results Of adolescents referred to group CT, 75% completed the intervention. Magnitude of pre-to-post change in SAD symptoms was large (d = 0.85), comparable to findings from studies of group CBT/CT for SAD in adult services. General psychological distress of adolescents decreased somewhat, however, only 20% showed reliable change. The program was maintained in the HUH outpatient clinical services over an 8-year period. Conclusions Group-adapted CT for SAD based on the cognitive model of SAD appears feasible for young people. It was transferable to clinical units using a cross-regional implementation model. Our results support further controlled research of group CT for SAD delivered by method-trained staff of routine services.