Religious/spiritual psychotherapy behaviors: Do we do what we believe to be important?

Professional psychologists have recently been encouraged to sensitively address religious/spiritual issues in psychotherapy. But how frequently do practitioners make religiously/spiritually informed interventions with their clients, and how important do they think it is to do so? Based on the existing literature, the authors identified 29 recommended religious/spiritual psychotherapy behaviors and surveyed 96 psychologists regarding perceived importance and use of these behaviors. The most and least frequently endorsed behaviors were identified. The greater the practitioners' religious/spiritual self-identification, the more likely they were to report using these behaviors in psychotherapy. However, overall, and for 90% of the individual items, clinicians engaged in these religious/spiritual psychotherapy behaviors less frequently than their importance ratings suggested they should. Practice implications and suggestions for educators are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical psychologists' religious and spiritual orientations and their practice of psychotherapy.

Examined the nature of 107 female and 299 male clinical psychologists' (aged 29–88 yrs) religiousness and spirituality, attitudes toward religiousness, use of interventions of a religious nature in psychotherapy, and training regarding religious and spiritual issues. Findings suggest that religious and spiritual orientation affects clinical psychologists' attitudes as well as their therapeutic interventions, which may in turn impact on the process and outcome of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy training and intervention use on session outcome.

Objective: This study was an investigation of the relationships among therapist training variables, psychotherapy process, and session outcome in a psychotherapy training clinic. The aims were to assess the relationship between “training as usual” and intervention use in individual psychotherapy, to investigate the relationship between therapist intervention use and session outcome, and to test whether training variables moderate this relationship. Method: Graduate student therapists (n = 19; mean age = 27 years; 79% women; 84% White) provided information about their training and completed a measure of intervention use (Multitheoretical List of Therapeutic Interventions; McCarthy & Barber, 2009) and clients (n = 42; mean age = 33 years; 64% women; 95% White) completed a measure of session outcome (Session Progress Scale; Kolden, 1991) after each session of individual psychotherapy. Results: With regard to intervention use and session outcome, no main effects were found for the training variables. Consequently, tests of moderation were not performed. The final model for intervention use and session outcome yielded main effects for time-varying interpersonal therapy and time-varying common factor use, and a 3-way interaction among time-varying cognitive–behavioral (CBT) intervention use, between-patient common factor use, and between-therapist common factor use. Patients who received more common factor interventions on average rated sessions as less helpful when more CBT interventions were employed; this finding was stronger for patients who were being treated by therapists with higher average levels of common factor use. Conclusions: Implications for training are discussed, with particular attention paid to the importance of clinical decision making and the complex interaction between common and unique technical factors in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concepts, processes and procedures: An introduction to the special issue on integration of concrete operating procedures.

Mahrer (1989b) described integration on the basis of concrete operating procedures as one of the more promising approaches to psychotherapy integration. In an attempt to examine this integrative approach, therapists from a variety of theoretical orientations were invited to share examples of how they had integrated into their preferred therapeutic approach interventions that were originally developed outside that framework. The articles in this special section provide illustrations of integration of specific procedures into four different theoretical frameworks. Although the articles discuss the incorporation of a wide variety of different types of interventions, as a group they suggest (a) that therapist operating procedures are understood more in terms of providing resources for an active collaborating client than as creating an impact upon the client, (b) that all therapist activities including procedures aimed at achieving problem resolution instantiate the therapeutic relationship, thus blurring the distinction between working on the relationship and working on client issues, and (c) that it is both possible and valuable for therapists to be flexible and creative in integrating new procedures into their therapeutic work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of therapeutic skills and techniques: Empirical identification, therapist correlates, and predictive utility.

Administered a 99-item questionnaire to 319 practicing psychotherapists (mean age 43.9 yrs) from 3 professional associations to assess their use of therapeutic techniques and skills as related to the variables of orientation, experience, sex, and personal psychotherapy. The predictive utility of reported interventions in classifying psychotherapists according to orientation was also examined. Principal component analyses yielded 13 scales. Reported therapy interventions varied as a function of the therapist's orientation and, to a lesser extent, as a function of experience, sex, and personal therapy. Eclectics had either the highest or 2nd-highest mean scores on each of the 13 scales, indicating a varied therapeutic arsenal. Across therapist variables, relationship-enhancing behaviors were reportedly most frequently used; flooding and frustration procedures least frequently used. On the basis of 11 scale scores, 90% of behavior therapists and 88% of psychodynamic therapists were correctly classified, but fewer than half of the eclectics were correctly classified. (62 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modification of depression risk factors: A solution-focused approach.

M. Seligman (1990) postulated that 3 meaning frames determine whether temporary sad feelings persist and eventually evolve into clinical depression: the permanence, pervasiveness, and personal causation of negative or stressful events. Successful treatment is thought to consist of interventions that modify these 3 meaning frames that contribute to depression. The authors combine Seligman's observations with 3 types of intervention questions used by therapists in solution-focused psychotherapy: exception, outcome, and coping and/or externalization questions. It is suggested that use of certain classes of intervention from solution-focused psychotherapy may shorten and potentiate treatment of depression. Solution-focused psychotherapy techniques are illustrated using a case study of a 69-yr-old man treated for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Larsson, Kaldo, and Broberg (2009).

Reports an error in "Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists" by Billy P. M. Larsson, Viktor Kaldo and Anders G. Broberg (Journal of Psychotherapy Integration, 2009[Mar], Vol 19[1], 34-66). The results of the post hoc tests were printed illegibly. In order to make it possible for the reader to understand which of the effect sizes belong to which of the comparisons, the tables are clarified in this erratum. (The following abstract of the original article appeared in record 2009-03150-003.) This study focuses on similarities and differences between Swedish psychotherapists of four orientations: psychodynamic, cognitive, cognitive–behavioral, and integrative therapy. The aim is to describe similarities and differences regarding (a) background factors, (b) focus in psychotherapy, (c) attitudes toward psychotherapy as art/craftsmanship, (d) scientific outlook, (e) what characterizes a good psychotherapist, and (f) how psychotherapy ought to be pursued. The therapists had very similar attitudes about the therapeutic relationship and rather similar attitudes about which effects psychotherapy ought to obtain. The greatest differences were related to psychotherapeutic techniques and science. The results are discussed with emphasis on the distance or proximity between the orientations. The conclusion is that there are differences between psychodynamic psychotherapy compared with cognitive and cognitive–behavioral therapies, which imply difficulties in integrating these orientations. However, the differences between the cognitive and cognitive–behavioral therapists are not of such a magnitude that they necessarily present an obstacle to integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency and type of confrontation over time within the first therapy interview.

Rated 1st psychotherapy interviews of 56 professional and graduate student therapists on empathy, positive regard, genuineness, and concreteness. On the basis of the notion of at least minimally facilitative conditions being necessary for client improvement, 13 therapists were designated as high- and 43 as low-facilitative therapists. Major findings were: (a) high- and low-facilitative graduate students differed significantly over time in their use of confrontations which focused on the ongoing therapist-client relationship; (b) high- and low-facilitative professionals differed significantly over time in their use of the same type of confrontation as well as confrontations which focused on client resources. In addition, they tended to differ significantly on confrontations which pressed for client action. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence tactics in psychotherapy.

Examined the process of psychotherapy within the context of social power theory. Therapist influence acts were classified in terms of the goals or reasons why therapists exercised influence and the strength of the influence attempt. The analysis was based on 22 tapes of psychotherapy sessions, provided by 5 female and 6 male therapists. Each therapist provided a tape of 1 male and 1 female client. Findings indicate that therapists were consistent in their use of tactics from one client to another. Male therapists, compared with female therapists, used significantly more influence tactics and interrupted their clients significantly more often. Therapists of both genders used significantly more passive forms of influence earlier in the session and more active forms later. Therapists of both genders told female clients what to do significantly more often than they did male clients, although they significantly more often explained thoughts, feelings, and behaviors to male clients than to female clients. Therapists used stronger influence attempts—those judged as demanding a response from the client—significantly more frequently with female clients than with male clients. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing Relationship Concerns in Individual Psychotherapy.

Many clients in individual psychotherapy present with relationship concerns but are not joined in psychotherapy by the partner in the problematic relationship. To increase clients' motivation for and satisfaction with individual psychotherapy, therapists must offer interventions that meet the clients' specific needs. This article presents an assimilative integration that uses L. Luborsky's (1984) core conflictual relationship theme approach to psychodynamic psychotherapy as its dominant theoretical orientation. Ideas and techniques from J. M. Gottman's (1998, 1999) sound marital house theory were integrated into the treatment to facilitate working through the client's core relationship conflicts. The integration proved useful in actively addressing relationship concerns within individual psychotherapy and in matching the client's readiness for change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unification beyond eclecticism and integration: Integral psychotherapy.

This article suggests that a unifying meta-paradigm of psychotherapy may be presently available in integral psychotherapy. Integral theory's "all-quadrant, all-level" (AQAL) model systematically, coherently, and comprehensively includes and unifies the existing "single-theories" and their associated interventions in such a way that they complement, rather than contradict, one another. An integrally informed approach to psychotherapy continually reminds us to conceptualize patients and utilize practices from multiple perspectives. The AQAL model thus operates like self-scanning software that readily alerts us as to whether we are engaging the methods and techniques that will make our treatment approaches comprehensive and optimally therapeutic for each individual. Recognizing that multiple theories and techniques are important in the "integral forest" of psychotherapeutic practice, integral therapists do not devalue any of the existing approaches, but rather emphasize the need to acknowledge and attend to as many dimensions of patients' being-in-the-world as possible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating substance-abuse patients with histories of violence: Reactions, perspectives, and interventions.

One of the more troubling experiences that occurs in the psychotherapy of addicted persons is when they relate stories concerning their involvements with past acts of violence. Whether these events are regretted or not, they often arouse strong feelings in therapists and can present both patients and clinicians with questions about how to proceed. Attribution theory can be a useful tool for understanding the feelings and countertransference that arises, and a combination of insights from the field of posttraumatic stress disorder (PTSD) treatment and existential therapy, along with a focus on the question of character, are a potential foundation for the development of therapeutic interventions. The relationship between substance abuse and violence, the importance of treatment context, and the interdependence of identity and action are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of verbal reinforcement with information feedback in analogue psychotherapy

Thirty Ss were assigned randomly to one of the two experimental analogue psychotherapy groups and a control group. In the experimental psychotherapy groups two different psychotherapy techniques were used for eight sessions. The two psychotherapy techniques employed were one-word verbal reinforcement (VR) and lengthy verbal information feedback (IF). Three therapists each demonstrated significant differences (P less than .001) in their verbal interactions with the Ss when they used the two different psychotherapy techniques. The results indicated that both treatment techniques were significantly effective (p less than .05) in improving self-ratings of self-concept. However, the two psychotherapy techniques were differentially effective in improving social skills as measured by behavioral ratings.     

Psychotherapist orientation and expectations for liked and disliked patients.

Two fictional intake summaries were presented to either psychodynamically (n?=?32) or cognitive-behaviorally oriented (n?=?22) psychotherapists. Therapists rated the personality attributes of and expectations for the course of therapy with these potential patients. Therapists were less inclined to treat hypothetical patients whom they did not like, even though they believed these individuals to be in greater need of psychotherapy. When imagining themselves working with less liked patients, therapists expected to feel less confident of their skills and were more concerned that such patients would engage in countertherapeutic activities. Cognitive-behavioral therapists were somewhat more likely to differentiate between liked and less liked patients in their expectations for the course of therapy than were psychodynamic therapists. Implications for the provision of psychotherapy services are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lifestyle and mental health.

Mental health professionals have significantly underestimated the importance of lifestyle factors (a) as contributors to and treatments for multiple psychopathologies, (b) for fostering individual and social well-being, and (c) for preserving and optimizing cognitive function. Consequently, therapeutic lifestyle changes (TLCs) are underutilized despite considerable evidence of their effectiveness in both clinical and normal populations. TLCs are sometimes as effective as either psychotherapy or pharmacotherapy and can offer significant therapeutic advantages. Important TLCs include exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement, and service to others. This article reviews research on their effects and effectiveness; the principles, advantages, and challenges involved in implementing them; and the forces (economic, institutional, and professional) hindering their use. Where possible, therapeutic recommendations are distilled into easily communicable principles, because such ease of communication strongly influences whether therapists recommend and patients adopt interventions. Finally, the article explores the many implications of contemporary lifestyles and TLCs for individuals, society, and health professionals. In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical, and public health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Therapeutic relationships and iatrogenic outcomes: The blame-and-change maneuver in psychotherapy.

Examined all the articles published in Psychotherapy for 1990 to assess what kinds of inferences therapists make about the significant others in their clients' lives. Data indicate that when reporting therapists make inferences about these significant others, they predominantly couch them in critical terms. These results also suggest that blame-and-change maneuvers are alive and well in psychotherapy. When therapists disregard the strengths and resources of their clients' significant others, they may resort to the therapeutic relationship as their primary vehicle for treatment. It is concluded that the time has come for psychotherapy to extend empathy, congruence, and warmth to the significant others in their clients' lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-therapist interdependence: Cognitive and behavioral.

Each of 7 patients saw each of 4 therapists twice. After each session, therapists rated how they thought the patient and therapists should behave during psychotherapy. In addition, these patient and therapist behaviors were independently rated from tapes of the meetings. A balanced 4 * 7 design was utilized. Behavior rating data indicate that therapists are more influenced by patients than patients are by therapists. Comparisons of questionnaire and behavior rating data indicate that differences among therapists are more evident in how therapists think than in how they or patients behave. Implications for understanding the different roles of the psychotherapist are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)