Showing papers in "Psychotherapy Research in 2014"
TL;DR: Although the tripartite model appears to be empirically and theoretically viable, continued research and theoretical development will serve to refine the model further and the development and testing of additional models that unpack the global concept of the therapeutic relationship would be useful.
Abstract: The development and empirical examination of a tripartite model of the therapeutic relationship over nearly three decades are described. The model asserts that all therapeutic relationships, to varying degrees, consist of a real relationship, a working alliance, and a transference-countertransference configuration. Research testing propositions about how each of these components is related to treatment process and outcome, and to each other, is presented. Many propositions have been supported, but some have been disconfirmed. Although the tripartite, or perhaps a quadripartite, model appears to be empirically and theoretically viable, continued research and theoretical development will serve to refine the model further. The development and testing of additional models that unpack the global concept of the therapeutic relationship would also be useful.
149 citations
TL;DR: It is suggested that therapists should attend to attachment in order to foster alliance and have additional implications for theory and future research.
Abstract: This meta-analysis synthesizes research on the relation between patient adult attachment style and patient-rated working alliance. A random-effects model was used to calculate the mean weighted product-moment correlation (r) for 24 studies (12 published in peer-reviewed journals and 12 unpublished doctoral dissertations) of individual outpatient therapy with adults. The mean weighted r for attachment avoidance and alliance was -.137, p<.001, and the mean weighted r for attachment anxiety and alliance was -.121, p<.001. These findings suggest that therapists should attend to attachment in order to foster alliance and have additional implications for theory and future research.
113 citations
TL;DR: The alliance predicts outcome over and above the effect of prior symptom improvement, supporting a reciprocal influence model of the relationship between alliance and symptom change.
Abstract: Objective: Although the working alliance as been found to be a robust predictor of psychotherapy outcome, critics have questioned the causal status of this effect. Specifically, the effect of the alliance may be confounded with the effect of prior symptom improvement. The objective of the present study was to test this possibility. Method: A large dataset from primary care psychotherapy was used to study relationships between alliance and outcome using piecewise multilevel path analysis. Results: Initial symptom level and symptom change up to session three predicted the alliance at session three. Working alliance significantly predicted symptom change rate from session three to termination, even while controlling for several possible confounds. Conclusions: The alliance predicts outcome over and above the effect of prior symptom improvement, supporting a reciprocal influence model of the relationship between alliance and symptom change.
95 citations
TL;DR: The relational aspects of psychotherapy communication is emphasized by considering the prosodic features of the therapist's talk in relation to the prosody of the client.
Abstract: Objective: To investigate the prosodic aspects of therapists' empathic communication. Method: 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis were analysed using conversation analysis. Results: Two interactional trajectories where the therapists either validated the clients' emotions or challenged them were identified. The difference between these trajectories was not evident in the lexical composition of the therapists' formulations that initiated the trajectory. However, the prosodic features of the formulation already anticipated the direction of the trajectory. The formulations leading up to the validating trajectory were characterized by prosodic continuity and formulations leading up to the challenging trajectory by prosodic disjuncture. The choice between continuous and disjunctive prosody was a key resource for therapists in the construction of formulations as either validating or challenging. Conclusions: The present article emphasizes the relational aspects of ps...
87 citations
TL;DR: Benefits of feedback were strongest for cases that were not progressing well in short-term therapies when both the patient and therapist received feedback on the patients' progress, and there was a trend for FbTP to have fewer deteriorated cases.
Abstract: Objective. Outcome monitoring feedback has become popular, but its effect on treatment outcome has been mixed. Feedback seems most effective for patients who are not progressing well (“not on track” (NOT) cases). There are some indications that patient feedback has an additional effect and that feedback effects differentiate between short- and long-term therapy. This study aimed to evaluate the effect of outcome monitoring feedback to therapists and patients on outcome in short- and long-term psychotherapy. Methods. Patients (n = 475) were randomly assigned to three conditions: Feedback to therapist (FbT), feedback to therapist and patient (FbTP), and no feedback (NFb). Feedback consisted of progress charts based on the Outcome Questionnaire and a feedback message. Results. In short-term therapies (<35 weeks) FbT and FbTP was preventive of negative change for NOT cases. In long-term therapy only FbTP had a small positive effect on the rate of change. Feedback did not result in better outcomes at t...
84 citations
TL;DR: Pre- to post-treatment effect sizes for completers in both NT and CBT groups were superior to benchmarked waiting-list control groups.
Abstract: Background: Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse. Objective: To evaluate the efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT). Method: Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 (OQ-45.2) were used as outcome measures. Results: We found a significant symptomatic reduction in both treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2. Conclusions: Pre- to post-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups.
76 citations
TL;DR: Clients' perception of their therapists as empathic is an important mechanism of change in psychotherapy that warrants further investigation, and there was a significant direct relationship between therapists' empathy and outcome and a significant indirect effect.
Abstract: Since Rogers identified empathy as an important variable in therapy, it has been found to be a consistent predictor of client change; less clear is how this occurs. The objective in this study was to test a mediation model to determine whether clients' self-reported experience of therapists' empathy contributed to changes in their attachment styles and treatment of self, after 16 weeks of psychotherapy for depression. There was a significant direct relationship between therapists' empathy and outcome and a significant indirect effect, showing that clients' perceptions of therapists' empathy was associated with significant improvement in attachment insecurity and significant decreases in negative self-treatment at the end of therapy as well as reductions on BDI, IIP, DAS and SCL-90-R, GSI, and increases on RSE. The findings suggest that clients' perception of their therapists as empathic is an important mechanism of change in psychotherapy that warrants further investigation.
74 citations
TL;DR: The analysis of data simulations shows how the expected correlation between an excellent measure of therapy quality and outcome would be surprisingly small under conditions likely to be common in psychotherapy research.
Abstract: Objective: We identify difficulties researchers encounter in psychotherapy process-outcome investigations, and we describe several limitations of the popular “variance accounted for” approach to understanding the effects of psychotherapy. Methods & Results: Using data simulations, we show how the expected correlation between an excellent measure of therapy quality and outcome would be surprisingly small (approximately .25) under conditions likely to be common in psychotherapy research. Even when we modeled conditions designed to increase the likelihood that strong process-outcome relationships would be observed, we found that the expected correlations were still only in the modest range (.38–.51). Conclusions: We discuss the implications of our analysis for the interpretation of process-outcome findings as well as for design considerations in future investigations.
72 citations
TL;DR: Investigation of the use and perceived effects of immediacy in 16 cases of open-ended psychodynamic psychotherapy found amount of immediate was associated with therapists' but not clients' ratings of session process and outcome, and most typical observed consequences being clients expressing feelings about the therapist/therapy and opening up/gaining insight.
Abstract: The purpose of this study was to investigate the use and perceived effects of immediacy in 16 cases of open-ended psychodynamic psychotherapy. Of 234 immediacy events, most were initiated by therapists and involved exploration of unexpressed or covert feelings. Immediacy occurred during approximately 5% of time in therapy. Clients indicated in post-therapy interviews that they remembered and profited from immediacy, with the most typical observed consequences being clients expressing feelings about the therapist/therapy and opening up/gaining insight. Amount of immediacy was associated with therapists' but not clients' ratings of session process and outcome. Therapists focused more on feelings and less on ruptures, and initiated immediacy more often with fearfully than with securely attached clients. Implications for practice, training, and research are offered.
66 citations
TL;DR: A conceptual framework is presented which accounts for the participants' experiences and suggests a process through which they renegotiate their relationship with their mental health difficulties.
Abstract: Objective: The aim of this paper was to synthesize the findings of qualitative studies examining the experience of individuals with mental health difficulties attending mindfulness-based interventions. Method: A meta-synthesis of 15 qualitative studies was carried out, using a thematic synthesis approach. Results: The meta-synthesis identified eight analytical themes: ‘prior experiences and expectations’, ‘normalising and supportive process of the group’, ‘relating differently to thoughts and feelings’, ‘acceptance’, ‘a sense of control and choice’, ‘relationship with self and others’, ‘struggles’, and ‘awareness’. Conclusions: A conceptual framework is presented which accounts for the participants' experiences and suggests a process through which they renegotiate their relationship with their mental health difficulties.
64 citations
TL;DR: Preliminary findings from a research program designed to investigate the value of alliance-focused training (AFT), a supervision approach designed to enhance therapists' ability to work constructively with negative therapeutic process are presented.
Abstract: Objective: In this article we present preliminary findings from a research program designed to investigate the value of alliance-focused training (AFT), a supervision approach designed to enhance therapists’ ability to work constructively with negative therapeutic process. Method: In the context of a multiple baseline design, all therapists began treating their patients using cognitive therapy and then joined AFT supervision groups at either session 8 or 16 of a 30 session protocol. Study I investigated the impact of AFT on patient and therapist interpersonal process as assessed through the Structural Analysis of Social Behavior (SASB). Study 2 investigated the impact of AFT on therapists’ tendency to reflect on their relationships with their patients in an experientially grounded fashion, as assessed via the Experiencing Scale (EXP). Since one of the goals of AFT is to train therapists to use their own emerging feelings as important clues regarding what may be taking place in the therapeutic relationship, we hypothesized that they would show increased levels of EXP after undergoing AFT. Results and Conclusion: The results of both studies 1 and 2 were for the most part consistent with hypotheses. Implications and future research directions are discussed.
TL;DR: It is shown how disaffiliation is interactionally realized in different ways and how this is followed by more or less successful attempts at repair.
Abstract: Over the past three decades a great deal of energy has been invested in examining the consequences of relational stresses and their repair. Less work has been done to examine how therapists and clients actually achieve re-affiliation through verbal and non-verbal resources, how such affiliation becomes vulnerable and at risk, and how therapists attempt to re-establish affiliative ties with the client-or fail to do so. We utilize the method of Conversation Analysis (CA) to examine clinical cases that involve extended episodes of disaffiliation. Clients with different styles of disaffiliation-confrontation and withdrawal-are compared. We show how disaffiliation is interactionally realized in different ways and how this is followed by more or less successful attempts at repair.
TL;DR: Expectations of alliance and of treatment outcome/improvement, measured prior to treatment onset, predicted subsequent alliance.
Abstract: Objective: To examine the associations between treatment/outcome expectations, alliance before and during treatment, and the impact of alliance on symptomatic improvement. Methods: One hundred and fifty-three depressed patients randomized to dynamic supportive-expressive psychotherapy (SET), antidepressant medication (ADM) or placebo (PBO) + clinical management completed ratings of treatment expectations, therapeutic alliance (CALPAS, WAI-S), and depressive symptoms (HAM-D). Results: Pretreatment expectations of the therapeutic alliance were significantly related to alliance later in therapy but did not differ across treatments and did not predict outcome. Alliance development over time differed between treatments; it increased more in SET than in PBO. After controlling for prior symptom improvement, early alliance predicted subsequent depression change. Conclusions: Expectations of alliance and of treatment outcome/improvement, measured prior to treatment onset, predicted subsequent alliance.
TL;DR: The findings suggest the importance of considering client-therapist attachment matching and the need to pay attention to the special challenges involved in treating avoidant clients in order to facilitate progress in psychotherapy.
Abstract: Objective: We examined the associations between client attachment, client attachment to the therapist, and symptom change, as well as the effects of client-therapist attachment match on outcome. Clients (n = 67) and their therapists (n = 27) completed the ECR to assess attachment. Method: Clients completed also the Client Attachment to Therapist scale three times (early, middle, and late sessions) and the OQ-45 at intake and four times over the course of a year of psychodynamic psychotherapy. Results: Clients characterized by avoidant attachment and by avoidant attachment to their therapist showed the least improvement. A low-avoidant client-therapist attachment match led to a greater decrease in symptom distress than when a low-avoidant therapist treated a high-avoidant client. Conclusions: These findings suggest the importance of considering client-therapist attachment matching and the need to pay attention to the special challenges involved in treating avoidant clients in order to facilitate pr...
TL;DR: Analysis of the therapeutic collaboration in episodes in which a relatively poor-outcome client in narrative therapy expressed ambivalence suggests that in such ambivalenced episodes the therapist did not match the client's developmental level, and by working outside the TZPD unintentionally contributed to the maintaining the Client's ambivalences.
Abstract: Objectives: We understand ambivalence as a cyclical movement between two opposing parts of the self. The emergence of a novel part produces an innovative moment, challenging the current maladaptive self-narrative. However, the novel part is subsequently attenuated by a return to the maladaptive self-narrative. This study focused on the analysis of the therapeutic collaboration in episodes in which a relatively poor-outcome client in narrative therapy expressed ambivalence. Method: For our analysis we used the Therapeutic Collaboration Coding System, developed to assess whether and how the therapeutic dyad is working within the therapeutic zone of proximal development (TZPD). Results: Results showed that when the therapist challenged the client after the emergence of ambivalence, the client tended to invalidate (reject or ignore) the therapist's intervention. Conclusions: This suggests that in such ambivalence episodes the therapist did not match the client's developmental level, and by working out...
TL;DR: The study provides data that suggest that mindfulness training significantly improves measures of trait anger and attentional control, and further research is needed to replicate these findings.
Abstract: Objectives: Little empirical literature focuses on psychotherapists' cultivation of internal states of mind necessary for controlling attention and responding empathically to the client. We explore the effects of mindfulness training on emotional and attentional measures in Spanish resident intern psychiatrists and clinical psychologists. Method: One hundred and three residents were assigned to an experimental group (n = 60) that completed an 8-week mindfulness training versus a wait-list control group (n = 43). We evaluated emotional variables (sadness, anxiety, and anger, using standard instruments), state of mindfulness (using the Mindfulness Awareness Attention Scale), and attentional control variables using objective measures such as a continuous performance task and the Stroop task before and after mindfulness training. Results: Our study provides data that suggest that mindfulness training significantly improves measures of trait anger and attentional control. Conclusions: Further research ...
TL;DR: Testing the hypothesis that therapist responsiveness in the first two sessions of therapy relates to three measures of early patient engagement in treatment found a factor measuring positive therapeutic atmosphere, as well as a global item of therapist responsiveness, predicted both the patient's positive perception of the therapeutic relationship after the second session and the patients' remaining in therapy for more than four sessions.
Abstract: This study tests the hypothesis that therapist responsiveness in the first two sessions of therapy relates to three measures of early patient engagement in treatment. Using videotapes and data from the NIMH Treatment of Depression Collaborative Research Program (TDCRP), an instrument was developed to measure therapist responsiveness in the first two sessions of Cognitive Behavior Therapy and Interpersonal Psychotherapy. A factor measuring positive therapeutic atmosphere, as well as a global item of therapist responsiveness, predicted both the patient's positive perception of the therapeutic relationship after the second session and the patient's remaining in therapy for more than four sessions. A negative therapist behavior factor also predicted early termination. Factors measuring therapist attentiveness and early empathic responding did not predict the engagement variables.
TL;DR: The results indicate that cognitive-behavioral group therapy for depressive rumination is effective and well accepted by patients suffering from residual depression.
Abstract: The maintenance of residual symptoms following acute treatment is common and is associated with poor long-term prognosis. This study investigates whether a cognitive-behavioral group treatment is effective in reducing residual depression by targeting depressive rumination. Participants (N=60) were randomly assigned to either the group treatment or a wait-list control condition. Treatment significantly improved depressed mood, rumination, perceived control over rumination and dysfunctional metacognitive beliefs compared with the wait condition. Treatment gains were maintained over the follow-up period of 1 year. Attrition was low and treatment satisfaction was high. Eight individuals suffered from a depressive relapse/recurrence in the year following treatment. The results indicate that cognitive-behavioral group therapy for depressive rumination is effective and well accepted by patients suffering from residual depression.
TL;DR: A generalized linear model analysis showed a significant association between the emergence of IMs and the interaction between time and symptomatic improvement, indicating a higher rate of IM production over time in cases with better clinical outcomes.
Abstract: Several studies have proposed that self-narrative transformation occurs through the elaboration of “Innovative Moments” (IMs), which are alternative experiences to the problematic self-narrative. This study aimed to analyze the emergence of IMs among 6 complicated grief women undergoing grief therapy according to the meaning reconstruction approach and to examine associations of IMs to the severity of grief symptomatology, assessed by the “Inventory of Complicated Grief.” Eighty-three sessions were analyzed using the “Innovative Moments Coding System” (IMCS). A generalized linear model analysis (GLM) showed a significant association between the emergence of IMs and the interaction between time and symptomatic improvement, indicating a higher rate of IM production over time in cases with better clinical outcomes. These results reinforce IMs' relevance in studying narrative change among cases with distinct clinical progressions.
TL;DR: Return-to-the-Problem Markers signaling moments of devaluation of IMs were coded in passages containing IMs in six clients with major depression treated with emotion-focused therapy, consistent with the theoretical suggestion that therapeutic failure may be associated with this form of ambivalence.
Abstract: Objective: Ambivalence can be understood as a cyclical movement between an emerging narrative novelty—an Innovative Moment (IM)—and a return to a problematically dominant self-narrative. The return implies that the IM, with its potential for change is devalued right after its emergence. Our goal is to test the hypothesis that the probability of the client expressing such form of ambivalence decreases across treatment in good-outcome cases but not in poor-outcome cases. Method: Return-to-the-Problem Markers (RPMs) signaling moments of devaluation of IMs were coded in passages containing IMs in six clients with major depression treated with emotion-focused therapy: three good-outcome cases and three poor-outcome cases. Results: The percentage of IMs with RPMs decreased across therapy in good-outcome cases, whereas it remained unchanged and high in the poor-outcome cases. Conclusions: These results were consistent with the theoretical suggestion that therapeutic failure may be associated with this fo...
TL;DR: The findings indicate that negative symptoms might be a barrier to the development of therapeutic alliance in cognitive behavioral therapy for psychosis.
Abstract: Objective: The strength of therapeutic alliance is consistently associated with therapy outcome. The aim of this study was to identify relevant predictors for early therapeutic alliance in cognitive behavioral therapy for psychosis. Method: Fifty-six patients with schizophrenia spectrum disorders were included in the analysis. Possible predictors (positive and negative symptoms, depression, insight, social functioning, theory of mind, and medication adherence) were assessed at baseline. Alliance was assessed after each therapy session. Results: Lower negative symptoms significantly predicted higher patient and therapist rated alliance. Conclusions: The findings indicate that negative symptoms might be a barrier to the development of therapeutic alliance. Assumed underlying processes and practical implications are discussed.
TL;DR: The sample of depressive patients reported higher levels of interpersonal problems than the normative sample and the sample of outpatients without a principal diagnosis of depression.
Abstract: We examined interpersonal problems in psychotherapy outpatients with a principal diagnosis of a depressive disorder in routine care (n=361). These patients were compared to a normative non-clinical sample and to outpatients with other principal diagnoses (n=959). Furthermore, these patients were statistically assigned to interpersonally defined subgroups that were compared regarding symptoms and the quality of the early alliance. The sample of depressive patients reported higher levels of interpersonal problems than the normative sample and the sample of outpatients without a principal diagnosis of depression. Latent Class Analysis identified eight distinct interpersonal subgroups, which differed regarding self-reported symptom load and the quality of the early alliance. However, therapists' alliance ratings did not differentiate between the groups. This interpersonal differentiation within the group of patients with a principal diagnosis of depression may add to a personalized psychotherapy based on interpersonal profiles.
TL;DR: It is suggested that client disclosure is a marker of early engagement in experiential therapy, as well as support this model's mandate to form interpersonally safe therapeutic environments from the first moments of therapy.
Abstract: This study examined the effects of in-session interpersonal process and pre-therapy interpersonal problems on session-one alliance formation for 32 clients who received short-term experiential therapy for depression. Interpersonal behavior measured by the Structural Analysis of Social Behavior, as well as clients' pre-therapy reports of interpersonal problems significantly related to session-one alliance scores. Greater client disclosure independently predicted a stronger session-one bond with the therapist. Both greater client disclosure (positively) and pre-therapy Social Inhibition (negatively) independently predicted early goal agreement. Findings suggest that client disclosure is a marker of early engagement in experiential therapy, as well as support this model's mandate to form interpersonally safe therapeutic environments from the first moments of therapy.
TL;DR: Results suggest that intensive data collection is likely to yield understanding of the relationship between therapy processes and outcomes.
Abstract: Objective: There has been little research on the development of the therapeutic alliance in cognitive behavioral therapy (CBT). This study aims to examine the development of therapeutic alliance in CBT for panic disorder. Method: Nineteen patients were treated with CBT for panic disorder. Pre- and post-session data of the therapeutic alliance and panic symptoms and cognitions were collected. Results: Several patterns were observed, including a sawtooth pattern (within-session improvements followed by decline between sessions; 63% of the patients), sudden gains in the alliance (58%), and late stabilization (89%). The sawtooth pattern was related to less symptom reduction between sessions (explained variance = 20–48%). Though not statistically significant, there were moderate effect sizes for the relationships between outcomes and early alliance and sudden gains (explained variance = 13–17%). Conclusions: Overall, results suggest that intensive data collection is likely to yield understanding of the...
TL;DR: Preliminary support is provided for the importance of assessing the contribution of narrative-emotion processes to efficacious treatment outcomes in EFT, CCT, and CT treatments of depression.
Abstract: Objective: While the individual contributions of narrative and emotion processes to psychotherapy outcome have been the focus of recent interest in psychotherapy research literature, the empirical analysis of narrative and emotion integration has rarely been addressed. The Narrative-Emotion Processes Coding System (NEPCS) was developed to provide researchers with a systematic method for identifying specific narrative and emotion process markers, for application to therapy session videos. Method: The present study examined the relationship between NEPCS-derived problem markers (same old storytelling, empty storytelling, unstoried emotion, abstract storytelling) and change markers (competing plotlines storytelling, inchoate storytelling, unexpected outcome storytelling, and discovery storytelling), and treatment outcome (recovered versus unchanged at therapy termination) and stage of therapy (early, middle, late) in brief emotion-focused (EFT), client-centred (CCT), and cognitive (CT) therapies for ...
TL;DR: This study examines the compassionate self-soothing task of emotion-focused therapy involving two-chair work, with seven clients, and offers therapists a specific account of how to respond to clients at specific junctures in self-Soothing dialogues and how to structure and accomplish the self- soothing task.
Abstract: Objective: Despite an increasing recognition of the relevance and significance of self-compassion processes, little research has explored interventions that seek to enhance these in therapy. In this study, we examined the compassionate self-soothing task of emotion-focused therapy involving two-chair work, with seven clients. Method: Conversation analysis was used to examine client-therapst interaction. Results: The analysis yielded a detailed description of interactional practices and processes involved in the accomplishment of self-soothing, drawing on Goffman's concept of the participation frame. We show how therapists and clients collaborate to move from the ordinary frame of therapeutic conversation to a self-soothing frame and back again by using various interactional practices: Therapists' instructions to clients, specific ways of sequencing actions in interaction, explanations and justification of the importance of the self-soothing task, pronouns as a way to distinguish among addressees (...
TL;DR: A preliminary analysis of two psychodynamic therapies, one with good outcome and one with poor outcome, showed that CT types could be reliably rated.
Abstract: Objective: The purpose of this study was to develop a typology of countertransference (CT) based on therapists' narratives about their parents and their clients. Method: Data are based on interviews conducted in the early, middle and late phases of ongoing psychodynamic psychotherapy with five therapists who treated 12 clients. Narratives were analyzed using the Core Conflictual Relationship Theme Method (CCRT). CT was defined as repetition of CCRT components from therapists' relationship with their parents in their narratives with their clients. Results: Raters identified five types of CT in the narratives: Wish from parent transferred to client, Projection of the parent Response from Other (RO) to client, Repetition of the Response of Self (RS), Repeating the negative parent RO, and Repair of the parent RO. Conclusions: A preliminary analysis of two psychodynamic therapies, one with good outcome and one with poor outcome, showed that CT types could be reliably rated.
TL;DR: It is suggested that age and education, in addition to expectations of improvement and the amount of early symptom improvement, may influence the patient's perceptions of the credibility of a treatment rationale early in the treatment process and that credibility ratings predict subsequent symptom change.
Abstract: Objective: The current investigation examined the relation between credibility ratings for adult psychotherapies and a variety of patient factors as well as the relation between credibility ratings and subsequent symptom change. Method: A pooled study database that included studies evaluating the efficacy of cognitive and psychodynamic therapies for a variety of disorders was used. For all studies, a three-item credibility scale was administered at session 2. Patient variables at baseline were used to predict early treatment credibility. Results: Early symptom improvement, age, education, and expectation of improvement were all significantly predictive of credibility scores at session 2. In one combined multiple regression model controlling for treatment, study, and early symptom change, age, education, and expectation of improvement remained significantly predictive of credibility scores. Credibility was predictive of subsequent symptom change even when controlling for age, education, expectation...
TL;DR: Three methods for calculating effect sizes are recommended for moderating differences, including two equations that show promise as valid and practical methods for use by clinicians in professional practice.
Abstract: Objective: The measurement of clinical change via single-group pre-post effect size has become increasingly common in psychotherapy settings that collect practice-based evidence and engage in feedback-informed treatment Different methods of calculating effect size for the same sample of clients and the same measure can lead to wide-ranging results, reducing interpretability Method: Effect sizes from therapists—including those drawn from a large web-based database of practicing clinicians—were calculated using nine different methods Results: The resulting effect sizes varied significantly depending on the method employed Differences between measurement methods routinely exceeded 040 for individual therapists Conclusions: Three methods for calculating effect sizes are recommended for moderating these differences, including two equations that show promise as valid and practical methods for use by clinicians in professional practice
TL;DR: The final theoretical rupture resolution model may be a useful tool when working with BPD clients in CBT, however it is recognized that further research on data from larger samples is needed.
Abstract: Objective: To explore the process of rupture resolution in cognitive behaviour therapy (CBT) with two good outcome clients with borderline personality disorder (BPD). Method: This study employed task-analytic methods to investigate whether the existing CBT rupture resolution model for depression could be validated. Quantitative analyses identified rupture-repair sequences and 41 rupture resolution attempts were systematically analysed. Results: The final model shared similarities with the existing model although additional components, including an “external observer” were identified. Focus on affective experience was also hypothesized to be important. Conclusions: The final theoretical rupture resolution model may be a useful tool when working with BPD clients in CBT. It is however recognized that further research on data from larger samples is needed. Clinical implications for managing alliance ruptures with BPD clients are discussed.