Which Methodological Practice(s) for Psychotherapy Science? A Systematic Review and a Proposal

Three main methodological practices have been employed in psychotherapy science: the empirical-quantitative, empirical-qualitative, and theoretical one. Some scholars have argued for a monopoly of the empirical-quantitative methodological practice, sustained by scientific monism. This systematic review aims at exploring the contribution of each methodological practice to the field. Fifteen journals were searched from 2003 to 2013. A total of 9796 publications and 9915 studies met inclusion criteria and were coded for the methodological practice employed. Empirical-quantitative studies were the most published overall, over time, and in most of the journals considered. This overwhelming prevalence increased when considering the citation rates of the publications. We argue that these results are indicative of a quantitative monopoly, which in turn is due to a lack of critical thinking sustaining scientific monism. We call for disciplinary critical thinking and the consequent scientific pluralism valuing the plurality, diversity, and multiplicity of all the existing methodological practices.

Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients

Suicide is the 10th leading cause of death in the United States and the second cause of death among those ages 15-24 years. The current standard of care for suicidality management often involves an involuntary hospitalization deemed necessary by the attending psychiatrist. The purpose of this article is to reexamine the ethical tradeoffs inherent in the current practice of involuntary psychiatric hospitalization for suicidal patients, calling attention to the often-neglected harms inherent in this practice and proposing a path for future research. With accumulating evidence of the harms inherent in civil commitment, we propose that the relative value of this intervention needs to be reevaluated and more efficacious alternatives researched. Three arguments are presented: (1) that inadequate attention has been given to the harms resulting from the use of coercion and the loss of autonomy, (2) that inadequate evidence exists that involuntary hospitalization is an effective method to reduce deaths by suicide, and (3) that some suicidal patients may benefit more from therapeutic interventions that maximize and support autonomy and personal responsibility. Considering this evidence, we argue for a policy that limits the coercive hospitalization of suicidal individuals to those who lack decision-making capacity.

Changes in Psychological Need Fulfillment Over the Course of Treatment for Major Depressive Disorder

Self-determination theory (Ryan & Deci, 2017) maintains that the psychological needs for autonomy, competence, and relatedness are essential qualities of experience that individuals require to thrive. The present research examined the role of psychological need fulfillment in a clinical sample undergoing treatment for major depressive disorder. Fifty-one patients with a SCID-IV diagnosis for major depressive disorder were randomly assigned to 16 weeks of cognitive behavioral therapy or antidepressant medication. Depressive symptoms, cognitive errors, dysfunctional attitudes, and psychological need fulfillment were assessed at four time points (pre-treatment, week 4, week 8, and week 16). Psychological need fulfillment increased over the course of treatment and did not differ significantly between treatment conditions. Furthermore, increases in psychological need fulfillment were associated with decreases in depression severity over and above the effects of time, cognitive errors, and dysfunctional attitudes. Given the incremental predictive validity of need fulfillment, a better understanding of its role in the treatment for depression may prove beneficial to mental health researchers and practitioners.

Beyond Cohesiveness

Despite a general consensus that cohesiveness promotes positive outcomes in group psychotherapy, the empirical evidence for this notion is limited. In this article the literature on group cohesiveness and its relation to clinical outcomes is reviewed. Three interrelated problems with this literature are highlighted: A lack of consensus as to how to conceptualize cohesiveness, inconsistent measurements of cohesiveness, and lack of attention to possible mediators of the cohesiveness-outcome relationship. The authors argue that the term cohesiveness is too vague and amorphous to be useful as a unitary construct and that the field could benefit by identifying more specific group processes that facilitate—or impede—clinical outcomes. They review social psychological research on group processes, and discuss how three constructs— group identification, independence, and homogeneity—might be applied to the clinical literature. Furthermore, in an attempt to stimulate a closer examination of mediational paths in the literature on group psychotherapy, they discuss possible mechanisms through which group processes affect clinical outcomes.