Latent trajectories of change for clients at a psychodynamic training clinic

A practice-based study of relational virtues and alliance correspondence in psychodynamic psychotherapy

OBJECTIVE

Treatment outcome monitoring typically emphasizes pathology. In contrast, we responded to the need to establish psychodynamic psychotherapy as evidence-based by modeling changes in gratitude and forgiveness.

METHOD

We utilized a practice-based research design involving non-manualized outpatient treatment. We employed a longitudinal mixture modeling approach to evaluate treatment effectiveness. We did so by testing the theorized role for relational virtues (i.e., gratitude, forgiveness) as signs of progress in psychodynamic treatment, with relational virtues referring to the application of character strengths to specific situations. We modeled clients' self-reported level on the virtues as a joint process over five time points, and examined the influence of early treatment alliance correspondence on patterns of change using a sample of outpatient clients (N = 185; Mage = 40.12; 60% female; 74.1% White).

RESULTS

A 3-class solution best fit the data, with one class exhibiting growth in gratitude and forgiveness, improved symptoms, and a greater likelihood of symptom improvement relative to well-being gains. Alliance correspondence predicted the classes of change patterns, with greater similarity between clinicians' and clients' perceptions about the alliance predicting greater likelihood of belonging to the subgroup showing highest levels of virtues and well-being, lowest symptoms, and improved well-being.

CONCLUSION

Clinical implications involve monitoring gratitude and forgiveness as signs of progress and navigating the dialectic between implicit alliance processes and explicit virtue interventions. The former involves nurturing a strong alliance and repairing ruptures, whereas the latter involves direct in-session conversation and/or the practice of virtue interventions in and/or outside of session.

The Moderating Influence of Religiousness/Spirituality on COVID-19 Impact and Change in Psychotherapy

The COVID-19 pandemic has spurred a global surge in empirical research examining the influence of the pandemic on individuals’ mental health symptoms and well-being. Within this larger literature is a rapidly growing literature on the associations among religiousness/spirituality, COVID-19 impact, symptoms and well-being. Largely absent from this literature is a specific research focus on psychotherapy clients, and the influence of religiousness/spirituality and COVID-19 impact on change during treatment. One prominent theory in the existing literature centers on the notion that religiousness/spirituality is a coping resource for individuals during times of adversity. Yet, existing empirical findings present mixed evidence for the religious/spiritual coping hypothesis. We expanded upon these emerging research trends to examine the influence of religious/spiritual struggles, religious/spiritual commitment, religious/spiritual exploration, and COVID-19 impact ratings on psychotherapy change in a sample of adult clients (N = 185; Mage = 38.06; SD = 15.78; range = 19–81; 61.1% female; 69.7% White). The results of latent trajectory analysis identified three subgroups that differed on initial levels of symptoms and well-being and the nature of change over three time points. The COVID-19 impact ratings predicted change trajectories. As more positive ratings of COVID-19 impact increased, membership in the no change trajectory was more likely relative to the deterioration trajectory at high levels of both religious/spiritual commitment and exploration. The implications emphasize the need for judicious assessment of religiousness/spirituality and COVID-19 impact before integrating religiousness/spirituality into treatment.

Trajectories of depression in psychotherapy: How client characteristics predict clinical improvement

OBJECTIVE

The current study aims to ascertain the trajectories of psychotherapy clients' symptom change and identify client factors that predict treatment outcome.

METHOD

We conducted a latent growth mixture model (LGMM) to identify the change trajectories of 44 clients' depression scores during psychotherapy. Client characteristics were then explored to determine whether any were associated with change trajectories. We examined whether the number of physician visits and/or client self-concealment scores predict 63 clients' improvement after controlling for initial symptom severity.

RESULTS

Two trajectories of clients' symptom change were identified: nonimprovers (52.3%) and improvers (47.7%). Nonimprovers had higher levels of self-concealment and baseline depression than improvers. The number of physician visits was associated with higher depression scores at baseline and greater clinical improvement during psychotherapy.

CONCLUSION

Clients showed distinct trajectories of symptom change in psychotherapy. Early identification of clients at risk for treatment failure may increase the probability of therapeutic success.