Decision making and psychotherapy integration: Theoretical considerations, preliminary data, and implications for future research.

In recent years, a number of publications have called for investigation of how psychotherapists make treatment decisions in clinical practice. This recommendation is particularly salient for psychotherapy integration, as studies have consistently shown that a plurality of American clinicians consider themselves to be either "eclectic" or "integrative" in theoretical orientation. Yet, the research on clinician decision making in psychotherapy is in its infancy. This article examines the need for decision-making research in psychotherapy integration, as well as aspects of psychotherapy integration that are targets for research and possible theoretical frameworks for understanding decision-making processes of integrative psychotherapists. A preliminary study provides data from practicing psychotherapists to illustrate these points. Finally, implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discovery-oriented psychotherapy research: Rationale, aims, and methods.

A critique of hypothesis-testing psychotherapy research holds that this traditional approach is unfeasible and unproductive for confirming or disconfirming theories of psychotherapy and also for contributing to a putative cumulative body of psychotherapeutic knowledge. Two approaches to discovery-oriented psychotherapy research are presented as alternatives to hypothesis-testing research, with their own rationales, aims, and methods. One consists of providing a closer, discovery-oriented look at psychotherapeutic events and phenomena, and the second consists of the discovery of the interconnections among psychotherapeutic conditions, operations, and consequences. Discovery-oriented research rationales, aims, and methods are described in sufficient detail to invite adoption by psychotherapy researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy: The humanistic (and effective) treatment.

Although it is well established that psychotherapy is remarkably effective, the change process in psychotherapy is not well understood. Psychotherapy is compared with medicine and cultural healing practices to argue that critical aspects of psychotherapy involve human processes that are used in religious, spiritual, and cultural healing practices. A model of psychotherapy is presented that stipulates various aspects that involve uniquely human characteristics. Central to this model is patient acquisition of an adaptive explanation of his or her difficulties. Finally, the research evidence for this model is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptual, methodological, and ethical problems of placebo groups in psychotherapy research.

Psychotherapy researchers have long recognized the need to control for expectancy effects, therapist contact, and therapist attention and have generally subsumed these therapeutic factors under the placebo effect rubric. The authors suggest that the need to control for such factors must be distinguished from the necessity for a placebo group. A psychotherapy placebo group that meets the classic criteria (i.e., a theoretically inert procedure without specific activity for the condition being treated) may be unethical, impractical, or methodologically unsound in psychotherapy research of moderate or greater length. The authors suggest that the term placebo group be abandoned and that alternatives, such as "best available" therapies, component control conditions, neutral expectancy controls, and counterdemand manipulations, be used. The necessity for wait-list controls in psychotherapy research is discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome assessment of psychotherapy.

ANovember, 1995 Consumer Reports (CR) magazine report and an article by M. E. P. Seligman (American Psychologist, 1995) on psychotherapy use follow in the tradition of federal efforts in 1957 and 1976 to document mental health services utilization. The 1995 reports represent a confirmation of the public's perception and valuing of psychotherapy that is consistent with the overall conclusion from empirical research that "psychotherapy, as a generic process, is demonstrably more effective than no treatment." Lifetime psychotherapy use increased from 14% in 1957 to 26% in 1976 (and is probably higher today). CR data, reconfigured to parallel earlier reports on overall utilization and by provider group, are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence process research in family therapy: A rationale and some practical guidelines.

Suggests that treatment adherence research has recently established a permanent niche in psychotherapy outcome research as a means for testing whether interventions have been implemented as intended. Advanced-level adherence methods allow investigators to move beyond treatment integrity questions regarding model fidelity and toward treatment process questions regarding therapeutic technique and intervention dosage. Though still in the developmental stage, treatment adherence process procedures appear to be congruent with the methods, goals, and theoretical framework that characterize contemporary psychotherapy process research. Because adherence process research is virtually absent from the family therapy research literature, practical guidelines are presented for conducting observational-based adherence research on family therapy models, using the example of Multidimensional Family Therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy supervision: Stages, Buber, and a theory of relationship.

Reviews and synthesizes data on the major stage theories in psychotherapy supervision. Although attention has been directed to the supervisee and, to a lesser extent, the supervisor, the process of supervision has not been conceptualized per se. Typically, theories applied to supervision are overlays of theories of psychotherapy. Supervisory phenomena are distinguished from psychotherapy phenomena, and the nature of the relationship in psychotherapy supervision is described. A theory of psychotherapy supervision, based on M. Buber's (1955, 1970) work, is presented and applied to illustrative case materials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The real relationship: Schemas, stereotypes, and personal history.

A critique of the conventional view of "real" and transferential relationships in psychotherapy is presented. Semantic labels for fuzzy sets contribute to the confusion between what is experienced by therapists vis-á-vis clients. That analogous countertransferential processes occur in therapy in both therapists and clients is proposed, and a line of argument is presented to support this position. A symmetrical model of client-therapist interactions is proposed that affirms that both client and therapist infuse biasing schemas into the therapeutic process. The authors conclude that the real relationship is the so-called transferential relationship, which springs from the personal histories of both therapist and client. This principle enables clinical programs to prepare trainees to accommodate the inevitable dissonances that will be experienced by disparate and cross-cultural participants in this field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Award for Distinguished Professional Contributions: Hans H. Strupp.

Recognizing the diversity of roles and activities in which many professional psychologists are engaged, beginning in 1979, Professional Awards have been presented to individual members of the Association whose distinguished contributions have served to advance psychology as a profession in the areas of knowledge, public service, and professional practice. Hans Strupp was the recipient of the Distinguished Professional Contributions to Knowledge award. Strupp was cited for his numerous contributions to the knowledge and practice of professional psychology. A pioneer in the study of therapeutic process and change, he has forged rigorous research methods for studying psychotherapy. His stewardship of psychotherapy research has helped form it into a respected field of scientific inquiry, and his active leadership in the integration of clinical and research knowledge has been invaluable to the psychotherapy professions. In addition to the citation, a biography and selected bibliography of his works are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recipes for psychotherapy.

W. B. Stiles and D. A. Shapiro (see record 1995-10433-001) try to make a case for abandoning the model of drug research in exploring psychotherapy effectiveness, specifically, the idea that psychotherapy can be viewed in terms of effective "ingredients." Although provocative, their analysis can be challenged on methodological grounds involving failure to use multivariate analytic approaches, incomplete exploitation of advantages of growth curve analysis, and lack of attention to issues of statistical power. Acceptance of the conclusions proffered by Stiles and Shapiro would have negative effects on psychotherapy research and practice, and the case against the search for effective elements in psychotherapy process is not yet strongly made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The “Generic Model of Psychotherapy” after 25 years: Evolution of a research-based metatheory.

The “Generic Model of Psychotherapy” was initially presented 25 years ago (Orlinsky & Howard, 1984) and was conceived as a transtheoretical frame for integrating the varied empirical findings of hundreds of studies relating therapeutic process to outcome that had appeared during the previous 3 decades into a coherent body of knowledge (Orlinsky & Howard, 1986). This article briefly reviews the conceptual model as an integrative metatheory for research and practice and traces its continued growth based on subsequent innovations in process–outcome research, reflections on the human contexts of psychotherapy, and current limitations in the field of psychotherapy research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mending the gap: Introduction to the invited commentaries on Dinger, Strack, Sachsse, and Schauenburg (2009).

Introduces several commentaries on an article by U. Dinger et al (see record 200913603-002) entitled “Therapists’ attachment, patients’ interpersonal problems and alliance development over time in inpatient psychotherapy.” This article represents an ambitious effort on the part of the researchers to map a number of interrelated relational variables, over the course of treatment, in a relatively understudied patient population. “Attachment,” “interpersonal problems,” and “alliance” are variables that capture core components of the therapeutic relationship and psychotherapy process that have been reliably linked to patient improvement in many previous studies of mostly outpatient psychotherapy. Jeremy Holmes (see record 2009-13603-003) and George Silbershatz (see record 2009-13603-004) were invited to comment on this study while wearing their clinical hats. They were asked about how they made sense of the research results as practicing psychotherapists, the ways in which the findings were useful to them as clinicians, and where they considered the research to be of more limited value from a clinical point of view. Following the commentaries is a final word from the authors of the study (see record 2009-13603-005). It is hoped that this format of dialogue will have an impact on how clinical research is presented in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive emotions in psychotherapy theory, research, and practice: New kid on the block?

This article introduces the Special Section, which explores the potential importance of positive emotions in our theory, research, and practice. The authors propose that the peripheral role that psychotherapy theory, research, and practice has allotted to the variable "positive emotion" can be understood in terms of the foundational axioms of our discipline. The authors argue that psychotherapy has implicitly adopted an attitude of caution and suspicion toward the potential therapeutic value of experiencing positive emotions, an all embracing attitude toward the therapeutic value of experiencing negative emotions, and an identity focused on healing psychological wounds at the expense of promoting psychological well-being. The authors trace the adoption of these axioms to Judeo-Christian ideas of human nature and to the identity formation process of psychotherapy, and the authors speculate on the sociopolitical forces that have promoted a shift in our theorizing in the last few decades. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cookbooks, manuals, and paint-by-numbers: Psychotherapy in the 90's.

Critically reviews the Division 12 Task Force Report on Promotion and Dissemination of Psychological Procedures and its update report and uses these reports as illustrative of flaws in contemporary psychotherapy research. The Task Force makes sweeping generalizations based on a paucity of research evidence. It does not address the issue of validation of manualization, nor the controversy over using manuals in psychotherapy. The complexities associated with measuring and assessing outcome are also ignored. Flaws common in contemporary psychotherapy displayed in the Task Force Report include the Type III Error, the exclusivity myth, "methodolatry," and oversimplification of the concept of outcome. While so flawed as to be of dubious value for researchers or practitioners, the Report and its accompaniments are worrisome in their potential appeal to those who might want to limit the use of psychotherapies only to those "validated" by the Task Force. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparatory techniques in initiating expressive psychotherapy with lower-class, unsophisticated patients.

Reviews theoretical and research evidence suggesting the usefulness of preparatory techniques in facilitating expressive psychotherapy with lower-class unsophisticated patients. The issue of mutuality of patient-therapist role expectations is presented as an essential part of an adequate working alliance. Common difficulties encountered in expressive psychotherapy with lower-class, unsophisticated patients are then reviewed, focusing on the part played by widely discrepant patient-therapist role expectations. Finally, research on socializing techniques in psychotherapy is reviewed to survey one possible parameter in dealing with these difficulties. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protection, Dissociation, and Internal Roles: Modeling and Treating the Effects of Child Abuse.

This article presents a theory of the long-term effects of child abuse that emphasizes the development of internal working models of protection. The theory proposes that abused children do not receive adequate caregiver protection and do not form internal representations of an effective protector. As a result, they have ongoing difficulty defending themselves against interpersonal aggression and internal self-criticism. The model integrates current research and theory in attachment behavior, developmental psychopathology, trauma, dissociation, and experiential psychotherapy. It accounts for many of the clinical symptoms presented by adult survivors of child abuse and suggests specific strategies for treatment. The author provides 3 examples of psychotherapy interventions derived from the model, distinguishes protection and "rescuing", and suggests directions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiation matching in psychotherapy.

A cognitive process conceptualization of psychotherapy suggests far-reaching implications as to the form and objectives of psychotherapy. A review of research in the areas of clinical judgment, information processing, conceptual systems, and social psychology reveals common themes in support of a differentiation taxonomy. Recent research indicates that the matching of conceptual levels of the patient and therapist significantly improves the probability of successful therapeutic process and outcome. Similarly, matching of the therapist's conceptual level to a certain type of group or to members of the group would appear to improve the group process and therapeutic outcome. This review examines the contribution of the differentiation literature and proposes future research considerations for both individual and group psychotherapy. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and the placebo effect.

The theoretical and methodological problems involved in studies concerned with the "placebo effect" are presented. There is a need for more theoretically oriented research and for "a greater emphasis upon control factors and other methodological considerations." Future research should be directed towards a further understanding of the influence of non-specific factors in psychotherapy. 39 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deny nothing, doubt everything: A comment on Westen and Morrison (2001).

It is remarkable that so many important issues in psychotherapy research are touched on and, in some cases, more thoroughly explored in D. Westen and K. Morrison's (2001) meta-analysis (see record 2001-05666-001) and its discussion. Although no previously unanswered questions are resolved on the basis of their findings, original approaches to familiar questions are attempted and intriguing data are presented. Westen and Morrison's capacity to "think outside the box" while they seek to answer very familiar questions is most impressive. In the final analysis, the most significant outcome of Westen and Morrison's laudable effort can be that it might lead other psychotherapy researchers to do important things differently in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)