1
|
Cardoso C, Ferreira Â, Pinto D, Ribeiro E. Therapist's interventions immediately after exceeding the client's therapeutic zone of proximal development: A comparative case study. Psychother Res 2023; 33:70-83. [PMID: 36576080 DOI: 10.1080/10503307.2022.2153093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE When therapists' proposals are too demanding exceeding clients' readiness to move into change, clients may resist advancing. We aimed to understand how a therapist behaved immediately after the client resisted advancing into change within Cognitive-Behavioral Therapy. METHODS We analyzed a recovered and an unrecovered case, both with Major Depression, and followed by the same therapist. Through the Therapeutic Collaboration Coding System, we analyzed 407 exchanges of interest. RESULTS In both cases, clients resisted more in advancing at intermediate sessions, mainly by the therapist's challenges to raise insight and debate cognitive beliefs in the recovered case, and to seek experiential meanings in the unrecovered case. Immediately after clients resisted advancing, the therapist tended to insist on challenging them in the same direction. In the recovered case, the therapist did so continually throughout the therapy, sometimes balancing between insisting or stepping back. In the unrecovered case, the therapist insisted on challenging, but mostly at the final session. Occasionally, the therapist insisted on challenging, and clients resisted over consecutive exchanges. CONCLUSION Our results reinforce that to enact progress and change clients need to be pushed into change, however it requires therapists' skillful assessment of clients' tolerance to move in time.
Collapse
Affiliation(s)
- Cátia Cardoso
- School of Psychology, University of Minho, Braga, Portugal
| | | | - Dulce Pinto
- School of Psychology, University of Minho, Braga, Portugal
| | | |
Collapse
|
2
|
|
3
|
Luong HK, Drummond SPA, Norton PJ. Elements of the therapeutic relationship in CBT for anxiety disorders: A systematic review. J Anxiety Disord 2020; 76:102322. [PMID: 33035773 DOI: 10.1016/j.janxdis.2020.102322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/15/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Abstract
To optimise the effects of cognitive behaviour therapy (CBT) for anxiety disorders, research has increasingly focussed on understanding mechanisms of change. Specifically, the therapeutic relationship has been identified as a potential "active ingredient" of therapy. The evidence for the effects of eleven elements of the therapeutic relationship (alliance, collaboration, goal consensus, group cohesion, empathy, positive regard, feedback, emotional expression, outcome expectations, treatment credibility, alliance rupture-repair) on treatment outcomes in CBT for anxiety disorders was systematically reviewed. Fifty unique studies were included, and findings were qualitatively reviewed and summarised. Results revealed consistent and sizeable evidence for the cohesion-outcome and expectation-outcome relationships. There was emerging evidence for the effects of collaboration, empathy, and alliance rupture-repair on outcomes. However, the evidence for goal consensus and credibility on outcomes was limited. Notably, review of the alliance literature revealed substantial inconsistencies across studies. No studies were identified for positive regard, feedback, and emotional expression. Overall, further research is needed to clarify the role of the therapeutic relationship in CBT for anxiety disorders. These findings will contribute to the conceptual integration of therapeutic relationship constructs in cognitive behavioural models, and help to improve treatments and outcomes for individuals.
Collapse
Affiliation(s)
- Hoang K Luong
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Peter J Norton
- The Cairnmillar Institute, Hawthorn East, Victoria, Australia.
| |
Collapse
|
4
|
Constantino MJ, Coyne AE, Muir HJ. Evidence-Based Therapist Responsivity to Disruptive Clinical Process. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Kaluzeviciute G. The role of empathy in psychoanalytic psychotherapy: A historical exploration. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1748792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Greta Kaluzeviciute
- University of Essex, Department of Psychosocial and Psychoanalytic Studies, Colchester, UK
| |
Collapse
|
6
|
Muran JC. Confessions of a New York rupture researcher: An insider's guide and critique. Psychother Res 2019; 29:1-14. [PMID: 29254460 PMCID: PMC6092258 DOI: 10.1080/10503307.2017.1413261] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The study of alliance rupture has become quite prevalent since 1990 and especially in the past 10 years where we have seen a noticeable surge in empirical publications on the subject. This honorary paper attempts to provide a critical review of this literature from the perspective of someone who has contributed to it in his collaborative work on a research program designed to investigate ruptures and to develop intervention and training models to resolve them. METHOD This paper is organized into three topics or sections: (1) alliance rupture, (2) rupture resolution, and (3) alliance training; and it addresses definitions, findings, questions, and lessons with regard to each topic. RESULTS/CONCLUSIONS It suggests some clinical conceptualizations (concerning agency and communion as well as mutual recognition), training implications (regarding emotion regulation and deliberate practice), and methodological considerations (promoting pluralism and contextualism), along with future directions.
Collapse
Affiliation(s)
- J Christopher Muran
- a Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University , Garden City , NY , USA
- b Brief Psychotherapy Research Program, Mount Sinai Beth Israel , New York , NY , USA
| |
Collapse
|
7
|
Fulmer R, Joerin A, Gentile B, Lakerink L, Rauws M. Using Psychological Artificial Intelligence (Tess) to Relieve Symptoms of Depression and Anxiety: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e64. [PMID: 30545815 PMCID: PMC6315222 DOI: 10.2196/mental.9782] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Students in need of mental health care face many barriers including cost, location, availability, and stigma. Studies show that computer-assisted therapy and 1 conversational chatbot delivering cognitive behavioral therapy (CBT) offer a less-intensive and more cost-effective alternative for treating depression and anxiety. Although CBT is one of the most effective treatment methods, applying an integrative approach has been linked to equally effective posttreatment improvement. Integrative psychological artificial intelligence (AI) offers a scalable solution as the demand for affordable, convenient, lasting, and secure support grows. OBJECTIVE This study aimed to assess the feasibility and efficacy of using an integrative psychological AI, Tess, to reduce self-identified symptoms of depression and anxiety in college students. METHODS In this randomized controlled trial, 75 participants were recruited from 15 universities across the United States. All participants completed Web-based surveys, including the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Positive and Negative Affect Scale (PANAS) at baseline and 2 to 4 weeks later (T2). The 2 test groups consisted of 50 participants in total and were randomized to receive unlimited access to Tess for either 2 weeks (n=24) or 4 weeks (n=26). The information-only control group participants (n=24) received an electronic link to the National Institute of Mental Health's (NIMH) eBook on depression among college students and were only granted access to Tess after completion of the study. RESULTS A sample of 74 participants completed this study with 0% attrition from the test group and less than 1% attrition from the control group (1/24). The average age of participants was 22.9 years, with 70% of participants being female (52/74), mostly Asian (37/74, 51%), and white (32/74, 41%). Group 1 received unlimited access to Tess, with daily check-ins for 2 weeks. Group 2 received unlimited access to Tess with biweekly check-ins for 4 weeks. The information-only control group was provided with an electronic link to the NIMH's eBook. Multivariate analysis of covariance was conducted. We used an alpha level of .05 for all statistical tests. Results revealed a statistically significant difference between the control group and group 1, such that group 1 reported a significant reduction in symptoms of depression as measured by the PHQ-9 (P=.03), whereas those in the control group did not. A statistically significant difference was found between the control group and both test groups 1 and 2 for symptoms of anxiety as measured by the GAD-7. Group 1 (P=.045) and group 2 (P=.02) reported a significant reduction in symptoms of anxiety, whereas the control group did not. A statistically significant difference was found on the PANAS between the control group and group 1 (P=.03) and suggests that Tess did impact scores. CONCLUSIONS This study offers evidence that AI can serve as a cost-effective and accessible therapeutic agent. Although not designed to appropriate the role of a trained therapist, integrative psychological AI emerges as a feasible option for delivering support. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number: ISRCTN61214172; https://doi.org/10.1186/ISRCTN61214172.
Collapse
|
8
|
Eubanks CF, Burckell LA, Goldfried MR. Clinical Consensus Strategies to Repair Ruptures in the Therapeutic Alliance. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2017; 28:60-76. [PMID: 29805243 DOI: 10.1037/int0000097] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective The alliance been recognized as an essential common factor and robust predictor of outcome. The present study sought to further our knowledge of the alliance and to promote the integration of research and practice by assessing consensus among peer-nominated expert therapists of varying theoretical orientations on the effectiveness of clinical strategies to repair alliance ruptures. Method This study drew on the behavioral-analytic model (Goldfried & D'Zurilla, 1969) and the methodology of the Expert Consensus Guideline Series (Frances, Docherty, & Kahn 1997). In Phase I, 69 therapists submitted clinical situations describing alliance ruptures. In Phase II, 177 therapists generated responses to the situations, and clinical strategies underlying the responses were identified. In Phase III, 134 peer-nominated experts (a mean of 22.3 therapists per situation) rated the effectiveness of these clinical strategies. Results The experts reached consensus on the use of strategies that validated the client's experience and explored the rupture during the rupture session. Change-oriented interventions (e.g., changing interpersonal interactions; highlighting patterns of behavior, thought, or emotions) were generally rated as less effective to use during the rupture, but effective for use in future sessions. Conclusions The findings are consistent with the growing literature on the value of using certain alliance-focused interventions during a rupture. The findings point to the importance of therapists' awareness of the state of the alliance so that they can identify when ruptures are occurring.
Collapse
|
9
|
Grosse Holtforth M, Krieger T, Zimmermann J, Altenstein-Yamanaka D, Dörig N, Meisch L, Hayes AM. A randomized-controlled trial of cognitive–behavioral therapy for depression with integrated techniques from emotion-focused and exposure therapies. Psychother Res 2017; 29:30-44. [DOI: 10.1080/10503307.2017.1397796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Martin Grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
- Department of Psychosomatic Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | | | | | - Nadja Dörig
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Laurence Meisch
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Adele M. Hayes
- Department of Psychology and Brain Sciences, University of Delaware, Newark, DE, USA
| |
Collapse
|
10
|
Not Just a Non-specific Factor: Moderators of the Effect of Within- and Between-Clients Alliance on Outcome in CBT. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9866-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Locati F, Rossi G, Parolin L. Interactive dynamics among therapist interventions, therapeutic alliance and metacognition in the early stages of the psychotherapeutic process. Psychother Res 2017; 29:112-122. [PMID: 28421880 DOI: 10.1080/10503307.2017.1314041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Several authors have identified a bidirectional link between patient metacognitive functioning and the therapeutic alliance. Specifically, metacognition might be enhanced by a positive alliance with the clinician, whereas metacognitive deficits might impede the alliance. Interestingly, the therapist's technical interventions might influence both therapeutic alliance and metacognitive functioning. However, little is known about the interactions between these dimensions. The aim of the present study is to explore these interactions more fully in the earliest phase of the therapeutic process. METHOD Participants included 24 patients and 12 therapists in training. The Metacognition Assessment Scale-Revised, Collaborative Interaction Scale, and Psychodynamic Intervention Rating Scale were employed in the first three sessions of psychotherapy. RESULTS Sequential analyses revealed that different therapist interventions co-occurred with three different levels of the therapeutic alliance: A first level characterized by a positive collaboration, a second characterized by a neutral collaboration, and a third characterized by ruptures. Importantly, the patient's metacognitive functioning was found to mediate the relationship between the therapeutic intervention and the therapeutic alliance in the positive and neutral levels of collaboration but not in the ruptures one. CONCLUSIONS These findings suggest that a specific interdependence exists among the therapeutic alliance, technical intervention, and metacognitive functioning.
Collapse
Affiliation(s)
- Francesca Locati
- a Department of Psychology , University of Milano-Bicocca , Milano , Italy
| | - Germano Rossi
- a Department of Psychology , University of Milano-Bicocca , Milano , Italy
| | - Laura Parolin
- a Department of Psychology , University of Milano-Bicocca , Milano , Italy
| |
Collapse
|
12
|
When Words are not Enough: Psychotherapy with Clients Who are Living Below the Poverty Level. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-015-9313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Schattner E, Tishby O, Wiseman H. Relational Patterns and the Development of the Alliance: A Systematic Comparison of two Cases. Clin Psychol Psychother 2016; 24:555-568. [PMID: 27189795 DOI: 10.1002/cpp.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/10/2016] [Accepted: 04/15/2016] [Indexed: 11/11/2022]
Abstract
A systematic case study approach was taken to explore the impact of client and therapist relational patterns on the development of the therapeutic alliance and symptom reduction in two cases of psychodynamic psychotherapy treated by the same therapist. The cases were selected from a larger sample and represent two distinct trajectories of alliance development: improvement versus deterioration. The comparison was based on participants' ongoing narratives about each other and about significant others, using the Relationship Anecdote Paradigm (RAP) interview. The qualitative findings were triangulated with process and outcome measures assessed at four time points during the year of treatment. We hypothesized that different therapeutic processes, including different handling by the therapist of interpersonal difficulties as they arose in treatment, could explain the two distinct trajectories of alliance development and symptom change within the caseload of one therapist. Results indicate two linked elements that may explain a steady increase in alliance and decrease in symptoms in one case, compared with the second case that started with an increase in alliance and symptom improvement, but gradually reached an impasse and a setback in symptoms. One element was the extent to which client's and therapist's relational patterns clashed, impacting each other negatively. The second was the extent to which differences and disagreements were stated openly and negotiated so that the therapist could flexibly adapt to meet the client's relational patterns in one case versus inability to do so in the other. Implications for training and other psychotherapy orientations are discussed. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE The interaction of client and therapist relational patterns may be a key factor in the development of the therapeutic alliance and might potentially impact client outcome. Therapeutic practice will likely be improved if therapists are more aware of their own relational patterns and the ways these interact with their clients' relational patterns. Striving for this awareness should probably be a main focal point for therapists throughout their careers, in their training, supervisions and personal therapies.
Collapse
Affiliation(s)
| | - Orya Tishby
- School of Social Work, Hebrew University of Jerusalem, Israel.,Department of Psychology, Hebrew University of Jerusalem, Israel
| | - Hadas Wiseman
- Department of Counseling and Human Development, University of Haifa, Israel
| |
Collapse
|
14
|
Olin SS, Shen S, Rodriguez J, Radigan M, Burton G, Hoagwood KE. Parent Depression and Anger in Peer-Delivered Parent Support Services. JOURNAL OF CHILD AND FAMILY STUDIES 2015; 24:3383-3395. [PMID: 28775660 PMCID: PMC5538779 DOI: 10.1007/s10826-015-0140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Knowledge about parents who seek peer-delivered parent support services in children's mental health is limited. In this prospective study, characteristics of 124 parents who sought peer parent advocate services related to their children's behavioral difficulties are described. This urban sample consisted primarily of low-income mothers of color, 80% of whom were caring for children with clinically significant behavioral problems. Of these parents, 64% endorsed clinically significant levels of depressive symptoms at baseline. Linear mixed effects models were used to examine associations between parent depression and anger expression with working alliances with peer advocates. No independent or combined effects of parent depression or anger expression on working alliance were found. However, adjusting for family demographic factors, caregiver strain and child symptoms, parent depression interacted with anger expression to influence working alliances, primarily around agreement and mutual engagement on goals. Among parents who endorsed clinically significant depressive symptoms, anger expression did not influence working alliance but among non-depressed parents, anger expression was negatively associated with working alliance. Implications for training peer parent advocates to more effectively engage low income parents are discussed.
Collapse
Affiliation(s)
- S Serene Olin
- The Child Study Center at NYU Langone Medical Center, Department of Child and Adolescent Psychiatry, New York, NY, 10016
| | - Sa Shen
- The Center on Health, Aging, and Disability at University of Illinois, College of Applied Health Sciences, Urbana-Champaign, Champaign, Illinois 61820
| | - James Rodriguez
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY 10003
| | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, NY, 12229
| | - Geraldine Burton
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, 10962
| | - Kimberly E Hoagwood
- The Child Study Center at NYU Langone Medical Center, Department of Child and Adolescent Psychiatry, New York, NY, 10016
| |
Collapse
|
15
|
Castonguay LG, Eubanks CF, Goldfried MR, Muran JC, Lutz W. Research on psychotherapy integration: Building on the past, looking to the future. Psychother Res 2015; 25:365-82. [DOI: 10.1080/10503307.2015.1014010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
16
|
Lingiardi V, Colli A. Therapeutic Alliance and Alliance Ruptures and Resolutions: Theoretical Definitions, Assessment Issues, and Research Findings. Psychother Res 2015. [DOI: 10.1007/978-3-7091-1382-0_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
17
|
van Ballegooijen W, Cuijpers P, van Straten A, Karyotaki E, Andersson G, Smit JH, Riper H. Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLoS One 2014; 9:e100674. [PMID: 25029507 PMCID: PMC4100736 DOI: 10.1371/journal.pone.0100674] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/30/2014] [Indexed: 11/19/2022] Open
Abstract
Background Internet-based cognitive behavioural therapy (iCBT) is an effective and acceptable treatment for depression, especially when it includes guidance, but its treatment adherence has not yet been systematically studied. We conducted a meta-analysis, comparing the adherence to guided iCBT with the adherence to individual face-to-face CBT. Methods Studies were selected from a database of trials that investigate treatment for adult depression (see www.evidencebasedpsychotherapies.org), updated to January 2013. We identified 24 studies describing 26 treatment conditions (14 face-to-face CBT, 12 guided iCBT), by means of these inclusion criteria: targeting depressed adults, no comorbid somatic disorder or substance abuse, community recruitment, published in the year 2000 or later. The main outcome measure was the percentage of completed sessions. We also coded the percentage of treatment completers (separately coding for 100% or at least 80% of treatment completed). Results We did not find studies that compared guided iCBT and face-to-face CBT in a single trial that met our inclusion criteria. Face-to-face CBT treatments ranged from 12 to 28 sessions, guided iCBT interventions consisted of 5 to 9 sessions. Participants in face-to-face CBT completed on average 83.9% of their treatment, which did not differ significantly from participants in guided iCBT (80.8%, P = .59). The percentage of completers (total intervention) was significantly higher in face-to-face CBT (84.7%) than in guided iCBT (65.1%, P < .001), as was the percentage of completers of 80% or more of the intervention (face-to-face CBT: 85.2%, guided iCBT: 67.5%, P = .003). Non-completers of face-to-face CBT completed on average 24.5% of their treatment, while non-completers of guided iCBT completed on average 42.1% of their treatment. Conclusion We did not find studies that compared guided iCBT and face-to-face CBT in a single trial. Adherence to guided iCBT appears to be adequate and could be equal to adherence to face-to-face CBT.
Collapse
Affiliation(s)
- Wouter van Ballegooijen
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan H Smit
- Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Leuphana University, Lüneburg, Germany
| |
Collapse
|
18
|
McAleavey AA, Castonguay LG, Goldfried MR. Clinical experiences in conducting cognitive-behavioral therapy for social phobia. Behav Ther 2014; 45:21-35. [PMID: 24411111 DOI: 10.1016/j.beth.2013.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/16/2013] [Accepted: 09/26/2013] [Indexed: 11/28/2022]
Abstract
Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.
Collapse
|
19
|
Weiss M, Kivity Y, Huppert JD. How does the therapeutic alliance develop throughout cognitive behavioral therapy for panic disorder? Sawtooth patterns, sudden gains, and stabilization. Psychother Res 2013; 24:407-18. [DOI: 10.1080/10503307.2013.868947] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
20
|
Arnow BA, Steidtmann D, Blasey C, Manber R, Constantino MJ, Klein DN, Markowitz JC, Rothbaum BO, Thase ME, Fisher AJ, Kocsis JH. The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression. J Consult Clin Psychol 2013; 81:627-38. [PMID: 23339536 PMCID: PMC3742444 DOI: 10.1037/a0031530] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study tested whether the quality of the patient-rated working alliance, measured early in treatment, predicted subsequent symptom reduction in chronically depressed patients. Secondarily, the study assessed whether the relationship between early alliance and response to treatment differed between patients receiving cognitive behavioral analysis system of psychotherapy (CBASP) vs. brief supportive psychotherapy (BSP). METHOD 395 adults (57% female; Mage = 46; 91% Caucasian) who met criteria for chronic depression and did not fully remit during a 12-week algorithm-based, open-label pharmacotherapy trial were randomized to receive either 16-20 sessions of CBASP or BSP in addition to continued, algorithm-based antidepressant medication. Of these, 224 patients completed the Working Alliance Inventory-Short Form at Weeks 2 or 4 of treatment. Blind raters assessed depressive symptoms at 2-week intervals across treatment using the Hamilton Rating Scale for Depression. Linear mixed models tested the association between early alliance and subsequent symptom ratings while accounting for early symptom change. RESULTS A more positive early working alliance was associated with lower subsequent symptom ratings in both the CBASP and BSP, F(1, 1236) = 62.48, p < .001. In addition, the interaction between alliance and psychotherapy type was significant, such that alliance quality was more strongly associated with symptom ratings among those in the CBASP treatment group, F(1, 1234) = 8.31, p = .004. CONCLUSIONS The results support the role of the therapeutic alliance as a predictor of outcome across dissimilar treatments for chronic depression. Contrary to expectations, the therapeutic alliance was more strongly related to outcome in CBASP, the more directive of the 2 therapies.
Collapse
Affiliation(s)
- Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5722,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Constantino MJ. Believing is seeing: An evolving research program on patients' psychotherapy expectations. Psychother Res 2012; 22:127-38. [DOI: 10.1080/10503307.2012.663512] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
22
|
Castonguay LG. Psychotherapy, psychopathology, research and practice: pathways of connections and integration. Psychother Res 2011; 21:125-40. [PMID: 21491345 DOI: 10.1080/10503307.2011.563250] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This paper describes three pathways of connections between different communities of knowledge seekers: integration of psychotherapeutic approaches, integration of psychotherapy and psychopathology, and integration of science and practice. Some of the issues discussed involve the delineation and investigation of common factors (e.g., principles of change), improvement of major forms of psychotherapy, clinical implications of psychopathology research, as well as current and future directions related to practice-research networks. The aim of this paper is to suggest that building bridges across theoretical orientations, scientific fields, professional experiences, and epistemological views may be a fruitful strategy to improve our understanding and the impact of psychotherapy.
Collapse
Affiliation(s)
- Louis G Castonguay
- Department of Psychology, Penn State University, University Park, PA 16802, USA.
| |
Collapse
|
23
|
Treating Depression During a Recession: Psychotherapy with Indigent Clients. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2011. [DOI: 10.1007/s10879-011-9193-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
24
|
Westra HA, Constantino MJ, Aviram A. The impact of alliance ruptures on client outcome expectations in cognitive behavioral therapy. Psychother Res 2011; 21:472-81. [DOI: 10.1080/10503307.2011.581708] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
25
|
Kuutmann K, Hilsenroth MJ. Exploring In-Session Focus on the Patient-Therapist Relationship: Patient Characteristics, Process and Outcome. Clin Psychol Psychother 2011; 19:187-202. [DOI: 10.1002/cpp.743] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 01/11/2011] [Accepted: 01/12/2011] [Indexed: 11/06/2022]
Affiliation(s)
- Klara Kuutmann
- Department of Psychology; Uppsala University; Uppsala; Sweden
| | | |
Collapse
|
26
|
Dimaggio G, Carcione A, Salvatore G, Semerari A, Nicolò G. A rational model for maximizing the effects of therapeutic relationship regulation in personality disorders with poor metacognition and over-regulation of affects. Psychol Psychother 2010; 83:363-84. [PMID: 25268484 DOI: 10.1348/147608310x485256] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The therapeutic relationship plays a key role in personality disorder (PD) psychotherapy. Some aspects of therapeutic relationship regulation appear important for treatment of PD clients, including those with constricted relational schemas, poor metacognition, and over-regulation of affects described here. AIM.: To propose a rational model for how and when to work on the therapeutic relationship by treating the underlying personality pathology. METHOD Formalize a step-by-step procedure for performing operations such as validation of clients' experiences, creating a sense of sharedness, assessing the quality of the therapeutic relationship in order to prevent and repair ruptures in the alliance, self-disclosing by the therapist, and metacommunication on the basis of clients' responses to treatment. CONCLUSION We discuss the implications of this model for further research into the PD therapy process.
Collapse
Affiliation(s)
- Giancarlo Dimaggio
- Third Center of Cognitive Psychotherapy - Training School Associazione di Psicologia Cognitiva (APC), Rome, Italy
| | | | | | | | | |
Collapse
|
27
|
Hollon SD, Ponniah K. A review of empirically supported psychological therapies for mood disorders in adults. Depress Anxiety 2010; 27:891-932. [PMID: 20830696 PMCID: PMC2948609 DOI: 10.1002/da.20741] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The mood disorders are prevalent and problematic. We review randomized controlled psychotherapy trials to find those that are empirically supported with respect to acute symptom reduction and the prevention of subsequent relapse and recurrence. METHODS We searched the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to identify appropriate articles. RESULTS One hundred twenty-five studies were found evaluating treatment efficacy for the various mood disorders. With respect to the treatment of major depressive disorder (MDD), interpersonal psychotherapy (IPT), cognitive behavior therapy (CBT), and behavior therapy (BT) are efficacious and specific and brief dynamic therapy (BDT) and emotion-focused therapy (EFT) are possibly efficacious. CBT is efficacious and specific, mindfulness-based cognitive therapy (MBCT) efficacious, and BDT and EFT possibly efficacious in the prevention of relapse/recurrence following treatment termination and IPT and CBT are each possibly efficacious in the prevention of relapse/recurrence if continued or maintained. IPT is possibly efficacious in the treatment of dysthymic disorder. With respect to bipolar disorder (BD), CBT and family-focused therapy (FFT) are efficacious and interpersonal social rhythm therapy (IPSRT) possibly efficacious as adjuncts to medication in the treatment of depression. Psychoeducation (PE) is efficacious in the prevention of mania/hypomania (and possibly depression) and FFT is efficacious and IPSRT and CBT possibly efficacious in preventing bipolar episodes. CONCLUSIONS The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD.
Collapse
Affiliation(s)
- Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee 37203, USA.
| | | |
Collapse
|
28
|
Colli A, Lingiardi V. The Collaborative Interactions Scale: A new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in psychotherapy. Psychother Res 2009; 19:718-34. [DOI: 10.1080/10503300903121098] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
29
|
Lambert MJ, Ogles BM. Using clinical significance in psychotherapy outcome research: The need for a common procedure and validity data. Psychother Res 2009; 19:493-501. [DOI: 10.1080/10503300902849483] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Michael J. Lambert
- a Department of Psychology , Brigham Young University , Provo, Utah
- b Department of Psychology , Ohio University , Athens, Ohio, USA
| | - Benjamin M. Ogles
- a Department of Psychology , Brigham Young University , Provo, Utah
- b Department of Psychology , Ohio University , Athens, Ohio, USA
| |
Collapse
|
30
|
Kanter JW, Rusch LC, Landes SJ, Holman GI, Whiteside U, Sedivy SK. The Use and Nature of Present-Focused Interventions in Cognitive and Behavioral Therapies for Depression. Psychotherapy (Chic) 2009; 46:220-232. [PMID: 20383284 PMCID: PMC2851097 DOI: 10.1037/a0016083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To improve cognitive and behavioral therapies (CBT) for depression, several approaches recommend an increased focus on the occurrence of problems as they occur in the therapeutic relationship or in relation to the live therapy process, referred to as present-focused. A lingering question has been the degree to which CBT therapists already engage in present-focused work. This study utilized sessions from recent trials of CBT for depression and, in Phase I, raters identified present-focused interventions on a turn-by-turn basis. Phase II raters used a qualitative analysis to determine categories of present-focused interventions. Results indicated that therapists rarely focused on the therapeutic relationship; when they did it was often transient and lacking in the elaborations suggested by newer approaches. Therapists more often performed therapy process and emotion focused interventions, but these also tended to lack elaboration.
Collapse
|