Test of the phase model of psychotherapy in a training clinic.

Recent publications suggest that psychotherapy models generated in outpatient settings do not fully generalize to the training clinic. A possible explanation for these findings is that the nature in which change occurs during psychotherapy may actually differ according to setting. To examine this possibility, the phase model of psychotherapy was tested in an outpatient training clinic. Results partially support the phase model, suggesting that the nature of change during effective psychotherapy within the training clinic setting does not differ from that in other outpatient settings. That is, clients who completed effective courses of treatment in the training clinic environment generally experience an improvement in subjective well-being before evidencing a reduction in symptom distress. Obtaining success in role performances (i.e., work or school) appears to emerge last. Practitioners may enhance treatment outcomes by targeting interventions that are congruent with the phase of the individual client presenting for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Negative outcome in psychotherapy and what to do about it.

Reviews the book, Negative outcome in psychotherapy and what to do about it edited by Daniel T. Mays and Cyril M. Franks (1985). Negative outcome in psychotherapy is a topic of great importance to the field. The treatment of this topic by Mays and Franks is a comprehensive and ambitious one. Their goals, as outlined in the Introduction, are to 1) generate a definition of negative outcome, 2) bring some preliminary closure to the negative outcome debate, 3) identify contributing variables and 4) offer suggestions for research and treatment application. They proceed to do this through an edited volume, consisting of 14 chapters, which fall into six sections and an Appendix. Of the goals that the editors set for themselves in the Introduction, the most important one, to this reviewer's mind, was not even mentioned--that is, the development of a theoretical framework from which future research can develop. It is this synthesis that makes the book particularly valuable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of psychotherapy and behavior change.

Reviews the book, Handbook of psychotherapy and behavior change by Sol L. Garfield and Allen E. Bergin (1986). The third edition of the Handbook is an 886-page volume, complete with author and subject indices. It contains 19 chapters divided into six parts; each chapter is written by established authorities. The six divisions into which the chapters have been separated include Historical, Methodological, and Conceptual Foundations; Evaluation of Process and Outcome in Psychotherapy and Behavior Change; Behavioral and Cognitive Therapies; Child and Family Therapies; Special Topics; and Evaluating the Training of Therapists. This volume represents "a critical appraisal of existing empirical research findings with an evenhanded or eclectic attitude toward divergent orientations in the area of psychotherapy and behavior change along with their implication for research and practice." Notably, the editors' critical but even-handed appraisal of the field now includes satisfaction with "an increased sophistication in the design of research on psychotherapy" as well as "the introduction of specific training manuals that allow for a greater specification and monitoring of the operations of specific therapies." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples psychotherapy: A psychodynamic model.

Psychoanalytic assumptions and goals need not be viewed or approached from a purely individual analytic perspective. Families and especially marriages offer a unique opportunity for systems-oriented intervention to add therapeutic depth by addressing psychodynamic interactions in vivo. Doing so requires integration in therapy, as well as in theory, of the manner in which individual psychodynamics manifest in primary interpersonal systems. A model is presented which aims at translating and instilling a useful degree of analytic insight in members of marital or family systems. Insight into transferential distortions and behavior is facilitated by introducing the metaphor of unconscious "hopes" and "expectations" in the interactive contexts of conjoint and individual sessions. It is suggested that such an expansion of systems-oriented approaches is a crucial step in adding depth and durability to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using clinically significant change to identify premature termination.

Research examining treatment dropout is hindered by the inconsistencies in the methods used to operationalize the construct. In this article an operationalization based on the criteria of attaining clinically significant change prior to treatment discontinuation is reintroduced and compared with other existing dropout classification systems. A dropout rate of 77% was found in a university-based training clinic sample by using the clinically significant change (CSC) definition. This classification showed little agreement to classifications made by other popularly used definitions of dropout (median split, intake only, missed appointment, and therapist judgment). Further analysis indicated that the other popularly used definitions frequently classified clients as treatment dropouts when recovery had occurred or as treatment completers when recovery had not occurred. Uses and limitations of the CSC method and other popular definitions of treatment dropout are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Towards a feminist empowerment model of forgiveness psychotherapy.

In recent years Enright and Fitzgibbon's (2000) process model of forgiveness therapy has received substantial theoretical and empirical attention. However, both the process model of forgiveness therapy and the social-cognitive developmental model on which it is based have received criticism from feminist theorists. The current paper considers feminist criticisms of forgiveness therapy and uses a feminist lens to identify potential areas for growth. Specifically, Worell and Remer's (2003) model of synthesizing feminist ideals into existing theory was consulted, areas of bias within the forgiveness model of psychotherapy were identified, and strategies for restructuring areas of potential bias were introduced. Further, the authors consider unique aspects of forgiveness therapy that can potentially strengthen existing models of feminist therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A qualitative investigation of eminent therapists' values within psychotherapy: Developing integrative principles for moment-to-moment psychotherapy practice.

Ample empirical research on values has demonstrated that clients' values tend to become increasingly like those of their therapist during therapy. There is little research, however, on how therapists negotiate value conflicts and the role of values in therapy. In order to better understand this process, 14 expert psychotherapists from four major psychotherapy orientations were interviewed about their use of values in the psychotherapeutic change process. A grounded theory analysis was conducted leading to an integrative understanding of how expert therapists from different orientations conceptualize the relationship of values and change in therapy and how they work with values in sessions. Based on this analysis, four transtheoretical principles were generated that can be applied to training and practice and used to inform research on psychotherapy process and integration. (PsycINFO Database Record (c) 2011 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)     

Beyond brand names of psychotherapy: Identifying empirically supported change processes.

There is considerable debate about which empirical research methods best advance clinical outcomes in psychotherapy. The prevailing tendency has been to test treatment packages using randomized, controlled clinical trials. Recently, focus has shifted to considering how studying the process of change in naturalistic treatments can be a useful complement to controlled trials. Clinicians self-identifying as psychodynamic treated 17 panic disorder patients in naturalistic psychotherapy for an average of 21 sessions. Patients achieved statistically significant reductions in symptoms across all domains. Rates of remission and clinically significant change as well as effect sizes were commensurate with those of empirically supported therapies for panic disorder. Treatment gains were maintained at 6-month follow-up. Intensive analysis of the process of the treatments revealed that integrative elements characterized the treatments: Adherence to cognitive-behavioral process was most characteristic, adherence to interpersonal and psychodynamic process, however, was most predictive of positive outcome. Specific process predictors of outcome were identified using the Psychotherapy Process Q-Set. These findings demonstrate how process research can be used to empirically validate change processes in naturalistic treatments as opposed to treatment packages in controlled trials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond the illusion of structural change: A process priming approach to psychotherapy outcome research.

Psychoanalytically oriented psychotherapy outcome research has yet to differentiate between a psychological structure that is present but temporarily inactive and genuine change in that underlying structure. Thus, a decrease in maladaptive responding following treatment may sometimes reflect illusory structural change, with the patient remaining vulnerable to relapse in situations that activate the underlying pathogenic structure. Genuine structural change would be better assessed by deliberately seeking and failing to find evidence of the enduring presence of a pathogenic structure under conditions that typically activate that structure, using both implicit (e.g., free response) and explicit (self-report) outcome measures. Because implicit and explicit measures are differentially affected by situational variables (e.g., mood, mindset priming), rigorous psychotherapy research must use experimental techniques and multimodal assessments to assess outcome under the conditions most likely to evoke a pathological reaction in a seemingly recovered individual. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Some implicit common factors in diverse methods of psychotherapy.

This article is a republication of a classic paper in which Rosenzweig introduced the concept of common factors in psychotherapy. This seminal idea-which refers to the finding that all forms of psychotherapy seem to share, to some degree, a small number of effective change ingredients-remains highly influential in psychotherapy integration today. Rosenzweig reviewed the data presented by then current forms of psychotherapy and argued that the theories that describe the change principles in each psychotherapy are inadequate to capture those deeper common factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward the unification of psychotherapy: An introduction to the journal symposium.

This article introduces the papers that compose this special issue, a journal symposium designed to explore the unification of psychotherapy from multiple perspectives. The authors briefly discuss both the historical background and contemporary developments that contextualize this project, which is an expansion of a symposium on psychotherapy unification presented by the authors at the 2003 Annual Conference of the Society for the Exploration of Psychotherapy Integration (SEPI). The present special issue comprises articles by four of the individuals who presented papers at that SEPI symposium and four commentaries that were subsequently invited specifically for this project. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of psychotherapy.

This "article" contains two blank pages, as an indication of G. W. Albee's concerns about the future of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in clients' attachment styles over the course of time-limited dynamic psychotherapy.

This study utilized a theory-specific measure to examine client relational change over the course of time-limited dynamic psychotherapy in 84 Ss (aged 26–64 yrs). Specifically, this study examined change and stability in clients' attachment style. Categorical and dimensional ratings attachment styles were obtained. Pretreatment and posttreatment measures of attachment styles were then examined in association with Global Assessment Scale (GAS) scores and symptoms. Results show that at posttreatment, a significant number of clients were evaluated as having changed from an insecure to a secure attachment style. Additionally, the sample as a whole demonstrated significant changes toward increased secure attachment. Significant relationships were also found among changes in attachment style, GAS scores, and symptom levels. Implications for psychodynamic/interpersonal psychotherapy research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Leading researchers' consensus on psychotherapy research findings: Implications for the teaching and conduct of psychotherapy.

We examined leading international psychotherapy researchers' views on psychotherapy outcome research. Participants completed a questionnaire on which they rated level of research evidence for or against various assertions about psychotherapy processes and outcomes. Participants rated how confident they were that the assertions were supported by psychotherapy research. Strong, or relatively strong, consensus was achieved on several of the questionnaire items. Areas for which relative uniformity of opinion does or does not exist have potential implications for the teaching and conduct of psychotherapy and for the science-practice interface in psychotherapy. Additionally, consensus about psychotherapy findings can be used as a yardstick by which to measure practicing clinicians' knowledge of the research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a unified conceptual framework of psychotherapy.

The increase in theoretical redundancy and the fact that all theories of psychotherapy possess weaknesses as well as strengths suggest that the time may be ripe for the emergence of a unified theory of psychotherapy. Three questions are addressed that are prerequisite to the development of a unified conceptual framework in psychotherapy: (1) What is the current state of the field of psychotherapy integration? (2) How do we move toward a unified theory of psychotherapy? and (3) What must a unified psychotherapy theory include? Unification is merely the next step in the evolution of psychotherapy theory, which is expected to oscillate between stages of unification and differentiation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapy processes and outcomes of psychological interventions for women diagnosed with gynecological cancers: A test of the generic process model of psychotherapy.

Objective: Little attention has been paid to the role of nonspecific therapy processes in the efficacy of psychological interventions for individuals diagnosed with cancer. The goal of the current study was to examine the three constructs from the generic model of psychotherapy (GMP): therapeutic alliance, therapeutic realizations, and therapeutic openness/involvement in the treatment outcome of women with gynecological cancers attending either a 7-session supportive counseling intervention or a coping and communication skills intervention. Method: Two hundred and three women completed measures of alliance, realizations, and openness after Intervention Sessions 2, 3, and 6, as well as measures of depressive symptoms after these sessions and 6 months after the pre-intervention assessment (posttreatment). Results: Consistent with the GMP, in early sessions, therapeutic bond predicted openness in terms of positive affect experienced during sessions, and both aspects of openness (positive and negative affect), in turn, predicted more therapeutic realizations. Therapeutic realizations predicted perceptions of greater session progress, and greater therapeutic bond predicted more therapeutic realizations. When early session GMP variables were used to predict later GMP processes and outcomes and posttreatment outcomes, early therapeutic bond predicted later session therapeutic realizations directly and indirectly via emotional arousal, emotional arousal predicted session progress, session progress predicted lower postsession depressive symptoms, and depressive symptoms as rated after Session 6 predicted depressive symptoms 3 months posttreatment. However, a number of additional associations among GMP processes were found. Conclusions: Our results suggest that therapy processes played a role in predicting both short- and long-term treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model for teaching psychotherapy theory through an integrative structure.

This article discusses a model for teaching psychotherapy theory through an integrative structure from the start of graduate students' training. This model articulates an ordering structure for the reputed 400+ so-called "theories" of psychotherapy. The rationale for such a structure highlights one dimension among several--that is, the recognition that a vast majority of mental health practitioners describe their orientation as eclectic or integrative. Professionals in training are encouraged to use this structure as an organizing principle to create the underpinnings for future professional development. The structure informs all aspects of a graduate-level course, including its syllabus, the textbooks selected, the reader, learning objectives, and tools for learning outcome assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary study of an attraction-barrier model of patients' commitment and responses to dissatisfaction in psychotherapy.

In a cross-sectional study, 168 psychotherapy patients (mean age 24.57 yrs) reported on how they dealt with problems pertaining to the therapist or the therapy process. Ss were asked to think about a session in therapy when they experienced a problem or dissatisfying event pertaining to the therapist or the therapy process. It was found that commitment to therapy mediated the effect of level of Ss' disclosure in therapy in endorsing constructive accommodation (voice and loyalty as opposed to exit and neglect) to deal with the dissatisfying events. Severity of the dissatisfying event with the therapist had direct effects on increasing the use of voice and exit and decreasing loyalty; it also had indirect effects on accommodation via the mediating variable of commitment. The results are explained jointly in terms of G. Levinger's (1999) attraction-barrier model of commitment and C. E. Rusbult et al.'s (1991) model of accommodation processes. It is concluded that the proposed conceptual framework, derived from theory and research on the social psychology of personal relationships, may be useful in understanding when interpersonal problems between patients and therapists encourage patients to withdraw or drop out of therapy before it is therapeutically appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)