Using 53 studies, comprising 52 separate data sets, published in refereed journals from 1985 through 2006, the authors conducted meta-analyses of the correlation and mean difference between client–therapist alliance ratings. Client and therapist alliance ratings were moderately correlated ( =.36, SD=.00); clients’ ratings were higher than ratings by their therapists ( =.63, SD=.42). Client disturbance was a significant moderator of client–therapist alliance rating discrepancies; clients with milder disturbances or with substance abuse problems tended to have larger rating discrepancies with their therapists than clients with more severe disturbances or moderate disturbance without substance abuse.

https://www.gc.cuny.edu/CUNY_GC/media/CUNY-Graduate-Center/PDF/Programs/Ed%20Psych/tryon,-blackwell,---Hammel.pdf

A meta-analytic examination of client-therapist perspectives of the working alliance.

This study entails the use of meta-analytic techniques to calculate and analyze 18 independent and 52 nonindependent effect sizes across 17 published studies of psychological assessment as a therapeutic intervention. In this sample of studies, which involves 1,496 participants, a significant overall Cohen's d effect size of 0.423 (95% CI [0.321, 0.525]) was found, whereby 66% of treatment group means fell above the control and comparison group means. When categorical variables were taken into account, significant treatment group effects were found for therapy process variables (d = 1.117, [0.679, 1.555]), therapy outcomes (d = 0.367, [0.256, 0.478]), and combined process/outcome variables (d = 0.547, [0.193, 0.901]). These findings appear to be robust on the basis of fail-safe N calculations. Taken together, they suggest that psychological assessment procedures-when combined with personalized, collaborative, and highly involving test feedback-have positive, clinically meaningful effects on treatment, especially regarding treatment processes. They also have important implications for assessment practice, training, and policy making, as well as future research, which are discussed in the conclusion of the article.

Meta-analysis of psychological assessment as a therapeutic intervention.

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The Working Alliance: Theory, Research, and Practice

Aim To identify possible reasons for the disappointingly negative results of methodologically rigorous controlled trials of psychological treatments in the addictions field.

Method  A selective overview of the literature on addictive behaviour change.

Findings  Eight failings of existing research are described: failing to account for the outcome equivalence paradox; neglecting relationships in favour of techniques; failing to integrate treatment research and research on unaided change; imposing an inappropriate time-scale on the change process; failing to take a systems or social network view; ignoring therapists' tacit theories; not including the patient's view; and displaying an ignorance of modern developments in the philosophy of science.

Conclusion  Treatment research has been asking the wrong questions in the wrong way. Three necessary shifts in ways of conducting research are proposed: (i) the field should stop studying named techniques and focus instead on change processes; (ii) change processes should be studied within the broader, longer-acting systems of which treatment is part; and (iii) science in the field should be brought up to date by acknowledging a variety of sources of useful knowledge.

Asking the right questions in the right way: the need for a shift in research on psychological treatments for addiction.

https://www.eqpartnersinc.com/wp-content/uploads/2012/12/ACT-and-FAP-for-Smoking-Cessation.pdf

Does Acceptance and Relationship Focused Behavior Therapy Contribute to Bupropion Outcomes? A Randomized Controlled Trial of Functional Analytic Psychotherapy and Acceptance and Commitment Therapy for Smoking Cessation.

Reliability generalization (RG) was used to study five versions of the Working Alliance Inventory (WAI), including scores from 12 different scales. Sixty-seven internal consistency estimates, six interrater reliability estimates, and four study characteristics were analyzed. In general, reliability estimates of WAI scale scores appear to be robust. Mean reliability estimates ranged, in this sample of studies, from .79 to .97, with a modal estimate of .92. Variability in reliability estimates was, based on simple bivariate correlations, associated with client and therapist sample size for WAI total scores (observer version). Implications for measuring alliance using the WAI and conducting future RG studies on psychotherapy process measures are discussed.

/pdf/reliability-generalization-of-working-alliance-inventory-260h8xp9s0.pdf

Reliability generalization of working alliance inventory scale scores

IMPORTANCE Posttraumatic stress disorder (PTSD) is a prevalent and serious mental health problem. Although there are effective psychotherapies for PTSD, there is little information about their comparative effectiveness. OBJECTIVE To compare the effectiveness of prolonged exposure (PE) vs cognitive processing therapy (CPT) for treating PTSD in veterans. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial assessed the comparative effectiveness of PE vs CPT among veterans with military-related PTSD recruited from outpatient mental health clinics at 17 Department of Veterans Affairs medical centers across the US from October 31, 2014, to February 1, 2018, with follow-up through February 1, 2019. The primary outcome was assessed using centralized masking. Tested hypotheses were prespecified before trial initiation. Data were analyzed from October 5, 2020, to May 5, 2021. INTERVENTIONS Participants were randomized to 1 of 2 individual cognitive-behavioral therapies, PE or CPT, delivered according to a flexible protocol of 10 to 14 sessions. MAIN OUTCOMES AND MEASURES The primary outcome was change in PTSD symptom severity on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) from before treatment to the mean after treatment across posttreatment and 3- and 6-month follow-ups. Secondary outcomes included other symptoms, functioning, and quality of life. RESULTS Analyses were based on all 916 randomized participants (730 [79.7%] men and 186 [20.3%] women; mean [range] age 45.2 [21–80] years), with 455 participants randomized to PE (mean CAPS-5 score at baseline, 39.9 [95% CI, 39.1–40.7] points) and 461 participants randomized to CPT (mean CAPS-5 score at baseline, 40.3 [95% CI, 39.5–41.1] points). PTSD severity on the CAPS-5 improved substantially in both PE (standardized mean difference [SMD], 0.99 [95% CI, 0.89–1.08]) and CPT (SMD, 0.71 [95% CI, 0.61–0.80]) groups from before to after treatment. Mean improvement was greater in PE than CPT (least square mean, 2.42 [95% CI, 0.53–4.31]; P = .01), but the difference was not clinically significant (SMD, 0.17). Results for self-reported PTSD symptoms were comparable with CAPS-5 findings. The PE group had higher odds of response (odds ratio [OR], 1.32 [95% CI, 1.00–1.65]; P < .001), loss of diagnosis (OR, 1.43 [95% CI, 1.12–1.74]; P < .001), and remission (OR, 1.62 [95% CI, 1.24–2.00]; P < .001) compared with the CPT group. Groups did not differ on other outcomes. Treatment dropout was higher in PE (254 participants [55.8%]) than in CPT (215 participants [46.6%]; P < .01). Three participants in the PE group and 1 participant in the CPT group were withdrawn from treatment, and 3 participants in each treatment dropped out owing to serious adverse events. CONCLUSIONS AND RELEVANCE This randomized clinical trial found that although PE was statistically more effective than CPT, the difference was not clinically significant, and improvements in PTSD were meaningful in both treatment groups. These findings highlight the importance of shared decision-making to help patients understand the evidence and select their preferred treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01928732

/pdf/comparison-of-prolonged-exposure-vs-cognitive-processing-maa4l8kf.pdf

Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans A Randomized Clinical Trial

In this empirical, mixed methods study, we explored test feedback training, supervision, and practice among psychologists, focusing specifically on how feedback is provided to clients and whether feedback skills are taught in graduate programs. Based on a 48.5% return rate, this national survey of clinical, counseling, and school psychologists' suggests psychologists provide test feedback to clients but inconsistently. Most respondents, 91.7%, indicated they give verbal feedback at least some of the time, whereas 35% do so every time. However, 2.8% indicated they never give feedback. A negative correlation exists for clinical psychologists between years since graduation and providing verbal feedback. Of particular interest, approximately one third of respondents indicated predoctoral coursework, practica, and internship were of little-to-no help in preparing them to provide feedback. Also, feedback training in predoctoral coursework, practica, and internship was not correlated to actually providing feedback. There was, however, a significant correlation between postdoctoral training and providing feedback. Consistent with existing ethical exceptions, the most frequent reason for not providing feedback was using assessments in forensic settings. Individuals who indicated their training was not helpful cited "trial and error" and self-instruction as ways in which they learned feedback skills. We discuss implications and suggestions for feedback training, research, and practice.

Kyle T. Curry

Papers

Reliability generalization of working alliance inventory scale scores

Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans A Randomized Clinical Trial

National survey of psychologists' test feedback training, supervision, and practice: a mixed methods study.