Correction to Psychotherapist Mindfulness and the Psychotherapy Process, Bruce et al (2010).

Reports an error in Psychotherapist mindfulness and the psychotherapy process by Noah G. Bruce, Rachel Manber, Shauna L. Shapiro and Michael J. Constantino (Psychotherapy: Theory, Research, Practice, Training, 2010[Mar], Vol 47[1], 83-97). The order of authorship and the affiliations of the authors was incorrectly printed. The correct order and affiliations are as follows: Noah Bruce, Shauna L. Shapiro, Michael J. Constantino, and Rachel Manber; Kaiser Permanente, Santa Clara University, University of Massachusetts, Stanford University. (The following abstract of the original article appeared in record 2010-05168-010.) A psychotherapist’s ability to relate to his or her patients is essential for decreasing patient suffering and promoting patient growth. However, the psychotherapy field has identified few effective means for training psychotherapists in this ability. In this conceptual article, we propose that mindfulness practice may be a means for training psychotherapists to better relate to their patients. We posit that mindfulness is a means of self-attunement that increases one’s ability to attune to others (in this case, patients) and that this interpersonal attunement ultimately helps patients achieve greater self-attunement that, in turn, fosters decreased symptom severity, greater well-being, and better interpersonal relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural influences on the process of conducting psychotherapy: Personal reflections of an ethnic minority psychologist.

I was asked to reflect how being a member of an ethnically diverse minority group, that is, Japanese American, may have influenced my clinical practice as a psychologist and psychotherapist. I first define the various facets of my “diversity status,” followed by an offering of reflections on how being a member of this group impacted both myself as a therapist and my clients. I conclude with several general recommendations geared to enhance a positive therapeutic alliance and client outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathic relational bonds and personal agency in psychotherapy: Implications for psychotherapy supervision, practice, and research.

Although psychotherapy researchers have become increasingly interested in identifying common factors that contribute to effective therapeutic practices, across psycho-diagnostic categories and treatment approaches, relatively little attention to date has been focused on the impact of these research findings for psychotherapy supervision and training programs. To address this gap, in this article we describe key components of an integrative psychotherapy supervision and training program that focuses on the development of a strong therapeutic alliance as an empirically supported, common principle of change in psychotherapy. We review empirical research evidence that addresses the contributions of therapist empathic engagement for the development of secure, relational bonds, heightened client agency, and the development of strong therapeutic alliances, and we discuss the implications of these findings for therapy practice and supervision training. We conclude with specific recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group psychotherapy.

Insight into the therapeutic relationship in group psychotherapy requires an understanding of the treatment context. Cohesion is defined as the therapeutic relationship in group psychotherapy emerging from the aggregate of member leader, member-member, and member-group relationships. Using this definition, evidence for the relationship between cohesion, patient outcome, an treatment processes is reviewed. Six empirically supported principles that undergird the development and maintenance of cohesion are presented touching on pregroup preparation, ear group structure, leader interaction, feedback, leader modeling, and member emotional expression. The limitations the present research are discussed; leading to opportunities for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist immediacy in brief psychotherapy: Case study I.

The authors examined immediacy (i.e., discussions about the here-and-now therapeutic relationship) in a 12-session case of individual interpersonal psychotherapy. Therapist immediacy during immediacy events most often focused on parallels between external relationships and the therapy relationship, encouraging expression of immediate feelings, processing termination, therapist expressing disappointment/sadness/hurt and inquiring about the client's reactions. Client involvement was slightly higher before and after than during immediacy events. On the positive side, therapist immediacy seemed to help the client express her immediate feelings about the therapist more openly, feel closer to the therapist, and become less defended. On the negative side, the client felt somewhat awkward and pressured when the therapist used immediacy. Limitations and implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Reassessing psychotherapy research.

Reviews the book, Reassessing psychotherapy research edited by Robert L. Russell (see record 1994-98237-000). This book, with its international representation of contributors, attempts to address central issues in contemporary ("fourth generation") psychotherapy research. The main tenet is that much dominant psychotherapy research has focused on outcome, curative factors, and scientific rigor and overlooked the richness of therapeutic process. This book does as the title suggests: addresses content and process issues, balanced with methodological sophistication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p     

Research summary on the therapeutic relationship and psychotherapy outcome.

Factors that influence client outcome can be divided into four areas: extratherapeutic factors, expectancy effects, specific therapy techniques, and common factors. Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome than specialized treatment interventions. The common factors most frequently studied have been the person-centered facilitative conditions (empathy, warmth, congruence) and the therapeutic alliance. Decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is the nature of the therapeutic relationship. Clinicians must remember that this is the foundation of our efforts to help others. The improvement of psychotherapy may best be accomplished by learning to improve one's ability to relate to clients and tailoring that relationship to individual clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical explorations of mindfulness: Conceptual and methodological conundrums.

This commentary reflects on the articles in this Special Issue. The appearance of this group of articles underscores the important idea that a major target of mindfulness practice is on emotion. Transformation in trait affect is a key goal of all contemplative traditions. This commentary addresses several key methodological and conceptual issues in the empirical study of mindfulness. The many ways in which the term “mindfulness” is used in the articles in this Special Issue are noted, and they include its reference to states, traits, and independent variables that are manipulated in an experimental context. How the term “mindfulness” is conceptualized and operationalized is crucial, and for progress to be made it is essential that we qualify the use of this term by reference to how it is being operationalized in each context. Other methodological issues are considered, such as the duration of training and how it should be measured, and the nature of control and comparison groups in studies of mindfulness-based interventions. Finally, the commentary ends with a consideration of the targets within emotion processing that are likely to be impacted by mindfulness. This collection of articles underscores the substantial progress that has occurred in the empirical study of mindfulness and it is a harbinger of a very promising future in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sources of gain in psychotherapy.

Insight is not a cause of change but a possible result of change. "It is not a source of therapeutic gain but one among a number of possible consequences of gain." 5 "major sources of gain, five kinds of experiences that are the well-springs of personality reorganization" are specified. Psychotherapy is a unique life situation designed to maximize these sources of gain: (a) a sustaining experience of intimacy with another human without getting hurt; (b) divesting verbal and other symbols of their anxiety producing potential; (c) the transference relationship; (d) client opportunities to practice decision making, to learn to be responsible for himself, to develop an improved self-concept; and (e) insight which facilitates repression and symptom elimination, and involves cognitive structure modifications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist immediacy in brief psychotherapy: Case study II.

Immediacy was examined in a 17-session case of brief therapy with a bright, articulate, inner-city, African American female client seeing an interpersonally oriented, White, male therapist. The main types of therapist immediacy were reinforcing the client for in-session behavior, inviting the client to collaborate, inquiring about client reactions to therapy, and reminding the client that it was okay to disagree with him. An in-depth qualitative examination of the seven most extensive/salient immediacy events revealed that therapist immediacy enabled the therapist and client to negotiate the relationship, helped the client express her immediate feelings to the therapist, helped the client open up to deeper exploration of concerns, and provided the client with a corrective relational experience. Implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experienced therapists’ approach to psychotherapy for adults with attachment avoidance or attachment anxiety.

Interviews were conducted with therapists (N = 12) nominated by peers as especially effective in working with clients with adult interpersonal problems. Open-ended questions asked how these therapists would approach 2 adult clients described in brief vignettes as having high attachment avoidance or anxiety. A coding team used a grounded theory approach to identify 8 higher order themes in the interviews: Conceptualization, Client Defenses, Managing Boundaries, Markers of Progress, Therapist Reactions, Targeted Interventions, Corrective Relational Patterns, and Internal Representations and Models. These themes were integrated into an inclusive theoretical model based on the core concept of therapists’ strategic management of therapeutic distance. The distance necessary to engage clients initially is adjusted later in therapy to create a corrective attachment in the psychotherapy relationship that facilitates change. Therapists described how, after engagement, they gradually increase therapeutic distance for clients with attachment anxiety who must then manage resulting frustration while learning to function more autonomously. Therapists gradually insist on decreased therapeutic distance to help clients with attachment avoidance overcome their fears of intimacy. Therapists discussed the specific techniques they use to manage therapeutic distance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of psychotherapy integration: A roundtable.

This article provides a compilation of forecasts on the future of psychotherapy integration from 22 prominent figures in the integration movement. Contributors succinctly addressed questions on desirable practice, research, theoretical, and training directions for the movement. Contributors also responded to the question, What would you like the field of psychotherapy integration to look like in 25 years? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring psychotherapy process with the Adolescent Psychotherapy Q-set (APQ): Development and applications for training.

This study presents the initial findings from the development of an adolescent version of the Child Psychotherapy Q-set (CPQ, Schneider, 2003). The CPQ is a psychotherapy process measure that utilizes Q-methodology to define psychotherapy process in an empirical form suitable for quantitative analysis. This new instrument, the Adolescent Psychotherapy Process Q-set (APQ), was developed to be pantheoretical in assessing the process of psychotherapy with adolescents. Panels of "expert" psychodynamic (PD) and cognitive-behavioral (CB) theoreticians and practitioners (N = 22) rated the 100 APQ items, and these ratings were factor analyzed to develop general prototypes of ideally conducted therapy for each respective orientation. Agreement between and amongst the experts was examined; in order to determine the reliability of, and shared variance between, each prototype. Coefficient alpha reliabilities were high for both PD (.93) and CB (.94) orientations. A significant correlation between the factor scores of each prototype (r = .31; p ≤ .01) was found. In a second study, a case example is provided to demonstrate the applications of the APQ and the prototypes in psychotherapy training and supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintaining boundaries in psychotherapy: Covert narcissistic personality characteristics and psychotherapists.

The psychological literature to date has identified more than one form of narcissism: the more well-known grandiose form, and the less familiar and recognized covert form. Although the distinction between these two narcissistic types has been identified with regard to better conceptualizing client dynamics, there has been much less written about how covert narcissistic tendencies and traits may affect psychotherapists and psychotherapy. This paper uses psychodynamic theory to highlight the role that covert narcissistic characteristics may have on the psychotherapists' ability to maintain boundaries, potentially leading to boundary transgressions (existing along a continuum from therapeutically useful to maladaptive and anti-therapeutic). Specific therapeutic situations have been delineated to increase therapists' recognition and awareness of themes that may emerge and compromise the boundaries between themselves and their clients. Areas of focus include narcissism and its forms, the possible connection between covert narcissism in psychotherapists and the impact on managing boundaries, the potential therapeutic implications of covert narcissistic tendencies in psychotherapists, and the implications of covert narcissistic personality characteristics on treatment, supervision, and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning psychotherapy in the digital age.

There is substantial literature documenting the process factors that lead to effective psychotherapy. Similarly, there is now a wealth of data attesting to the effectiveness of several psychotherapy brands. Little is known about the elements that facilitate learning how to be an effective clinician. One important step, after reading about a treatment model and seeing techniques demonstrated, is having the chance to practice the approach and receiving feedback and coaching from an experienced, knowledgeable supervisor. To accomplish this efficiently, most programs rely not only on trainee accounts of what went on in their therapy sessions, but also on recordings and videos of therapeutic encounters. This article describes our experience over a 5-year period in developing the use of Webcams for training psychology interns and psychiatric residents in the delivery of psychotherapy services. Pragmatic and technical details are given about how we went about establishing a recording system that is easy to use and provides secure, confidential storage of information at a reasonable cost. Discussion addresses both the weighing of choices that need to be made and overcoming the hesitation of trainees to reveal their work during treatment sessions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mindfulness and psychological process.

The author reviews the articles in the Special Section on Mindfulness, starting from the assumption that emotions evolved as signaling systems that need to be sensitive to environmental contingencies. Failure to switch off emotion is due to the activation of mental representations of present, past, and future that are created independently of external contingencies. Mindfulness training can be seen as one way to teach people to discriminate such “simulations” from objects and contingencies as they actually are. The articles in this Special Section show how even brief laboratory training can have effects on processing affective stimuli; that long-term meditation practitioners show distinct reactions to pain; that longer meditation training is associated with differences in brain structure; that 8 weeks’ mindfulness practice brings about changes in the way emotion is processed showing that participants can learn to uncouple the sensory, directly experienced self from the “narrative” self; that mindfulness training can affect working memory capacity, and enhance the ability of participants to talk about past crises in a way that enables them to remain specific and yet not be overwhelmed. The implications of these findings for understanding emotion and for further research is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived support and relational effects in psychotherapy process constructs.

Recent research has indicated that only a small portion of supportiveness reflects the objective properties of providers. Instead, supportiveness primarily reflects the unique relationships among specific recipients and providers (i.e., relational effects), thus suggesting new approaches to support interventions. The authors investigated the possibility that similar relational effects occur for therapy process constructs (e.g., working alliance). Isolating relational effects in psychotherapy requires that each client receive treatment from more than one therapist during the same period of time. Therefore, we conducted analog studies in which therapy clients and students viewed videos of therapists and then rated expected therapist supportiveness and expected therapy process constructs for each therapist. Two studies indicated very strong relational effects in therapist supportiveness and therapy process constructs. In addition, process constructs were correlated strongly with supportiveness (Study 1) and favorable affect (Study 2) for relational effects specifically. Implications for integrating research on perceived support and therapy process were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder.

This study investigated the quality and development of the therapeutic alliance as a mediator of change in schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder. Seventy-eight patients were randomly allocated to 3 years of biweekly SFT or TFP. Scores of both therapists and patients for the therapeutic alliance were higher in SFT than in TFP. Negative ratings of therapists and patients at early treatment were predictive of dropout, whereas increasingly positive ratings of patients in the 1st half of treatment predicted subsequent clinical improvement. Dissimilarity between therapist and patients in pathological personality characteristics had a direct effect on growth of the therapeutic alliance but showed no relationship with clinical improvement. The authors conclude that the therapeutic alliance and specific techniques interact with and influence one another and may serve to facilitate change processes underlying clinical improvement in patients with borderline personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)