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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.
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Affiliation(s)
- Cátia Cardoso
- School of Psychology, University of Minho, Braga, Portugal
| | | | - Dulce Pinto
- School of Psychology, University of Minho, Braga, Portugal
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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.
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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.
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Song R, Sun N, Song X. The Efficacy of Psychological Capital Intervention (PCI) for Depression From the Perspective of Positive Psychology: A Pilot Study. Front Psychol 2019; 10:1816. [PMID: 31447745 PMCID: PMC6692487 DOI: 10.3389/fpsyg.2019.01816] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
Extensive psychological interventions primarily target the negative symptoms of depression and the deficits in positive resources have been systematically neglected. So far, little attention has been devoted to psychological capital (PsyCap) intervention from the perspective of developing positive resources. The aim of the present pilot study was to evaluate the efficacy of psychological capital intervention (PCI) for depression in a randomized controlled trial. A total of 56 patients were randomized to either care as usual (CAU) for normal medication or psychological capital intervention (PCI) group, where the normal medication was supplemented with the PCI. Participants were assessed at pre- and post-treatment, as well as 6-month follow-up, on measures of depressive symptoms and PsyCap. The PCI group displayed significantly larger improvements in PsyCap and larger reductions in depression symptoms from pre- to post treatment compared to control group. Improvements were sustained over the 6-month follow-up period. Targeting the positive resources intervention in the PCI may be effective against the treatment of depression.
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Affiliation(s)
- Ruijun Song
- School of Politics and Law, Shaoyang University, Shaoyang, China
- School of Psychology, Shandong Normal University, Jinan, China
| | - Nana Sun
- Department of Education, Luliang University, Luliang, China
| | - Xuhong Song
- Department of Medical Psychology, Shanxi Medical University, Taiyuan, China
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Conceptual Confusion in Psychological Therapy: Towards a Taxonomy of Therapies. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2019. [DOI: 10.1007/s10942-019-00313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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.
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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
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D'Iuso DA, Dobson KS, Watkins‐Martin K, Beaulieu L, Drapeau M. Bridging the gap between cognitive and interpersonal variables in depression. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018. [DOI: 10.1002/capr.12167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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8
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Yang D, Hur JW, Kwak YB, Choi SW. A Systematic Review and Meta-Analysis of Applicability of Web-Based Interventions for Individuals with Depression and Quality of Life Impairment. Psychiatry Investig 2018; 15:759-766. [PMID: 30048585 PMCID: PMC6111215 DOI: 10.30773/pi.2018.03.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/15/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this meta-analysis was to determine the applicability of web-based treatment programs for individuals with depression and quality of life impairments. METHODS We conducted database and manual searches using imprecise search-term strategy and inclusion criteria. Research published from 2005 to December 2015 was included in this study. Upon review, a total of 12 published papers on web-based intervention for individuals with depression were assessed eligible for this meta-analysis. Effect sizes were estimated for depression and quality of life. RESULTS The mean effect size of web-based treatment on depressive symptoms was 0.72. However, unlike the result showing medium to large effect size, the analysis on the quality of life did not yield adequate effects of web-based interventions. CONCLUSION Our results suggest robust benefits of employing web-based treatments for depressive symptoms. However, the adequacy of these relatively new intervention tools for individuals who suffer severe impairments of quality of life was found insufficient. The current study demonstrates the need to further develop web-based intervention techniques to improve overall functioning, as well as the clinical symptoms of patients with mental disorders.
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Affiliation(s)
- Danbi Yang
- Department of Psychology, Duksung Women's University, Seoul, Republic of Korea
| | - Ji-Won Hur
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Yoo Bin Kwak
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Sung-Won Choi
- Department of Psychology, Duksung Women's University, Seoul, Republic of Korea
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Lawton M, Sage K, Haddock G, Conroy P, Serrant L. Speech and language therapists' perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post-stroke. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:550-563. [PMID: 29349881 PMCID: PMC5969294 DOI: 10.1111/1460-6984.12368] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change. AIMS To explore speech and language therapists' perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post-stroke. METHODS & PROCEDURES Twenty-two, in-depth, semi-structured interviews were conducted with speech and language therapists working with people with aphasia post-stroke. Qualitative data were analysed using inductive thematic analysis. OUTCOMES & RESULTS Analysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists' responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patient's family, relational continuity and organizational drivers. CONCLUSIONS & IMPLICATIONS The findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non-verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in goal setting, relational strategies; and motivational enhancement techniques. The conceptualization of therapeutic alliance, however, is only provisional. Further research is essential to elucidate the experiences and perceptions of alliance development for people with aphasia undergoing rehabilitation.
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Affiliation(s)
- Michelle Lawton
- Department of Psychological SciencesUniversity of ManchesterManchesterUK
| | - Karen Sage
- Faculty of Health and WellbeingSheffield Hallam UniversitySheffieldUK
| | - Gillian Haddock
- Department of Psychological SciencesUniversity of ManchesterManchesterUK
| | - Paul Conroy
- Department of Psychological SciencesUniversity of ManchesterManchesterUK
| | - Laura Serrant
- Faculty of Health and WellbeingSheffield Hallam UniversitySheffieldUK
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Cameron SK, Rodgers J, Dagnan D. The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression: A meta-analytic review. Clin Psychol Psychother 2018; 25:446-456. [PMID: 29484770 DOI: 10.1002/cpp.2180] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/11/2022]
Abstract
Research consistently provides evidence for the relationship between the therapeutic alliance (TA) and outcome across various therapies and presenting problems. Depression is considered the leading cause of disability worldwide, and there is substantial evidence for the efficacy for Cognitive Behaviour Therapy (CBT) in its treatment. At present, there is lack of clarity specifically about the relationship between the TA and outcome in CBT for depression. The present review is the first meta-analytic review to explore this relationship and also considering moderators. Within a random-effects model, an overall mean effect size of r = 0.26 (95% CI [.19-.32]) was found, indicating that the TA was moderately related to outcome in CBT for depression. The mean TA-outcome correlation is consistent with existing meta-analysis that looked across a broad range of presenting problems and psychological therapies. A secondary exploratory analysis of moderators suggested the TA-outcome relationship varied according to the TA rater, where the relationship was weaker for therapist raters compared with clients and observer raters. Additionally, the results indicated that the TA-outcome relationship marginally increased over the course of CBT treatment. The results of the meta-analysis are discussed in reference to the wider body of research, methodological limitations, clinical implications, and future directions for research.
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Affiliation(s)
- Sarah Kate Cameron
- Psychological Services, NHS Lanarkshire, Lanarkshire, UK.,School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Jacqui Rodgers
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Dave Dagnan
- Department of Psychology, Cumbria Partnership NHS Foundation Trust, Penrith, UK
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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
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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]
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When is it Effective to Focus on the Alliance? Analysis of a Within-Client Moderator. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9867-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry 2016; 15:245-258. [PMID: 27717254 PMCID: PMC5032489 DOI: 10.1002/wps.20346] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of MDD, GAD, PAD or SAD, diagnosed on the basis of a structured interview. We found that the overall effects in the 144 included trials (184 comparisons) for all four disorders were large, ranging from g=0.75 for MDD to g=0.80 for GAD, g=0.81 for PAD, and g=0.88 for SAD. Publication bias mostly affected the outcomes of CBT in GAD (adjusted g=0.59) and MDD (adjusted g=0.65), but not those in PAD and SAD. Only 17.4% of the included trials were considered to be high-quality, and this mostly affected the outcomes for PAD (g=0.61) and SAD (g=0.76). More than 80% of trials in anxiety disorders used waiting list control groups, and the few studies using other control groups pointed at much smaller effect sizes for CBT. We conclude that CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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Waltman SH, Creed TA, Beck AT. Are the effects of cognitive behavior therapy for depression falling? Review and critique of the evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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.
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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
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A Comparative Study on the Efficacy of a Positive Psychology Intervention and a Cognitive Behavioral Therapy for Clinical Depression. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9778-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Beshai S, Wallace LM, Mcdougall KH, Waldmann K, Stea JN. Reduced Contact Cognitive-Behavioral Interventions for Adult Depression: A Review. THE JOURNAL OF PSYCHOLOGY 2015; 150:252-79. [PMID: 26606161 DOI: 10.1080/00223980.2015.1087376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Depression is a highly prevalent and debilitating mental health condition. Evidence suggests that there is a widening gap between the demand for and availability of effective treatments. As such, there is a vast need for the development and dissemination of accessible and affordable treatments for depression. In the past decade, there has been a proliferation of reduced client-therapist contact protocols for depression. In this article, the authors review and compare the efficacy of reduced contact cognitive-behavioral interventions for adult depression across two degrees of therapist-client contact (i.e., no therapist-client contact versus minimal therapist-client contact interventions). The authors also discuss the methodological and theoretical limitations of this research base. The present review suggests that a) reduced contact interventions for depression can be effective in remediating the symptoms of depression; b) the effect sizes of some reduced contact protocols may approximate those reported in traditional protocols involving significantly greater client-therapist contact; and c) protocols which employ some form of client-therapist contact, on average, generate higher effect sizes than those that are purely self-help in nature. A discussion of the theoretical and applied implications of such findings, as well as areas in need of further research, is provided.
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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
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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: 248] [Impact Index Per Article: 24.8] [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.
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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
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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.
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Barth J, Michlig N, Munder T. Unique and shared techniques in cognitive-behavioural and short-term psychodynamic psychotherapy: a content analysis of randomised trials on depression. Health Psychol Behav Med 2014; 2:929-950. [PMID: 25750827 PMCID: PMC4346076 DOI: 10.1080/21642850.2014.931231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 05/26/2014] [Indexed: 11/21/2022] Open
Abstract
Randomised controlled trials (RCTs) of psychotherapeutic interventions assume that specific techniques are used in treatments, which are responsible for changes in the client's symptoms. This assumption also holds true for meta-analyses, where evidence for specific interventions and techniques is compiled. However, it has also been argued that different treatments share important techniques and that an upcoming consensus about useful treatment strategies is leading to a greater integration of treatments. This makes assumptions about the effectiveness of specific interventions ingredients questionable if the shared (common) techniques are more often used in interventions than are the unique techniques. This study investigated the unique or shared techniques in RCTs of cognitive-behavioural therapy (CBT) and short-term psychodynamic psychotherapy (STPP). Psychotherapeutic techniques were coded from 42 masked treatment descriptions of RCTs in the field of depression (1979-2010). CBT techniques were often used in studies identified as either CBT or STPP. However, STPP techniques were only used in STPP-identified studies. Empirical clustering of treatment descriptions did not confirm the original distinction of CBT versus STPP, but instead showed substantial heterogeneity within both approaches. Extraction of psychotherapeutic techniques from the treatment descriptions is feasible and could be used as a content-based approach to classify treatments in systematic reviews and meta-analyses.
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Affiliation(s)
- Jürgen Barth
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute for Complementary and Integrative Medicine, University of Zürich, Zürich, Switzerland
| | - Nadja Michlig
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Thomas Munder
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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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
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Pascual-Leone A, Andreescu C. Repurposing process measures to train psychotherapists: Training outcomes using a new approach. COUNSELLING & PSYCHOTHERAPY RESEARCH 2013. [DOI: 10.1080/14733145.2012.739633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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How much psychotherapy is needed to treat depression? A metaregression analysis. J Affect Disord 2013; 149:1-13. [PMID: 23528438 DOI: 10.1016/j.jad.2013.02.030] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although psychotherapies are effective in the treatment of adult depression it is not clear how this treatment effect is related to amount, frequency and intensity of therapy. METHODS To fill this gap in knowledge, the present metaregression analysis examined the association between the effects of psychotherapy for adult depression and several indicators of amount, frequency and intensity of therapy. The analysis included 70 studies (92 comparisons) with 5403 patients, in which individual psychotherapy was compared with a control group (e.g. waiting list, care-as-usual). RESULTS There was only a small association between number of therapy sessions and effect size, and this association was no longer significant when the analysis adjusted for other characteristics of the studies. The multivariable analyses also found no significant association with the total contact time or duration of the therapy. However, there was a strong association between number of sessions per week and effect size. An increase from one to two sessions per week increased the effect size with g=0.45, while keeping the total number of treatment sessions constant. DISCUSSION More research is needed to establish the robustness of this finding. Based on these findings, it may be advisable to concentrate psychotherapy sessions within a brief time frame.
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Locke BD, Bieschke KJ, Castonguay LG, Hayes JA. The center for collegiate mental health: studying college student mental health through an innovative research infrastructure that brings science and practice together. Harv Rev Psychiatry 2012; 20:233-45. [PMID: 22894732 DOI: 10.3109/10673229.2012.712837] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Available information about college student mental health has largely been anecdotal or based on information drawn from a single institution. This review examines ten studies published within the past 20 years that focused on college student mental health using data collected from multisite college or university counseling center clients or staff. This subset of research on college student mental health is important in view of the increased demands on counseling centers and the increased emphasis on evidence-based practice. Collectively, these studies suggest that the presenting concerns of college students are changing, that those in treatment are more distressed than those who are not, that clients who identify as ethnic minorities appear to evidence slightly more distress than their white counterparts, that matching client and counselors relative to ethnicity does not appear to improve outcome, and that counseling services seem to improve outcome. While each study makes a unique contribution to the literature, this body of literature suffers from a common set of limitations that stem from the difficulties associated with multisite research, research taking place in active clinical work, and the time-limited nature of data sets. Through our review and critique of these studies, we discuss the importance of establishing an infrastructure that helps researchers to elucidate trends, effective treatments, and risk factors that will be useful to clinicians treating this population. The Center for Collegiate Mental Health, a practice-research network focused on college student mental health, is described and preliminary findings from this entity are presented.
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Affiliation(s)
- Benjamin D Locke
- Center for Counseling and Psychological Services, Pennsylvania State University, University Park, PA 16801, USA
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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
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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.
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Affiliation(s)
- Louis G Castonguay
- Department of Psychology, Penn State University, University Park, PA 16802, USA.
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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
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Castonguay LG, Locke BD, Hayes JA. The Center for Collegiate Mental Health: An Example of a Practice-Research Network in University Counseling Centers. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2011. [DOI: 10.1080/87568225.2011.556929] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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.
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Affiliation(s)
- Giancarlo Dimaggio
- Third Center of Cognitive Psychotherapy - Training School Associazione di Psicologia Cognitiva (APC), Rome, Italy
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Cuijpers P, Smit F, Hollon SD, Andersson G. Continuous and dichotomous outcomes in studies of psychotherapy for adult depression: a meta-analytic comparison. J Affect Disord 2010; 126:349-57. [PMID: 20149928 DOI: 10.1016/j.jad.2010.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/13/2010] [Accepted: 01/14/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND In treatment research on depressive disorders, outcomes can be based on continuous outcomes but also on dichotomous outcomes. Although it is possible to convert the two types of outcomes to each other, it has not been tested whether this results in systematic differences. METHOD We selected studies on psychotherapy for adult depression from an existing database, in which both continuous and dichotomous outcomes were presented. We calculated effect sizes using both types of outcomes, and compared the results. RESULTS Although there were considerable differences between the two types of outcomes in individual studies, both types of outcomes resulted in very similar pooled effect sizes. The pooled effect size based on the continuous outcome were somewhat more conservative (d=0.59; OR=2.92) than the one based on the dichotomous outcome (d=0.64; OR=3.17). Heterogeneity was higher in the analyses based on the continuous outcomes than in those based on the dichotomous outcomes. Sensitivity analyses and subgroup analyses confirmed that the pooled effect sizes were very similar, that the effect sizes were somewhat smaller when the continuous outcomes are used, and that heterogeneity was higher in the analyses based on the continuous outcomes. CONCLUSION Overall, the two types of outcomes result in comparable pooled effect sizes and can both be used in meta-analyses. However, the results of the two types of outcomes should not be used interchangeably, because there may be systematic differences in heterogeneity and subgroup analyses.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology and EMGO Institute, VU University Amsterdam, The Netherlands.
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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.
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Affiliation(s)
- Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee 37203, USA.
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35
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Daly AM, Llewelyn S, McDougall E, Chanen AM. Rupture resolution in cognitive analytic therapy for adolescents with borderline personality disorder. Psychol Psychother 2010; 83:273-88. [PMID: 20109279 DOI: 10.1348/147608309x481036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Ruptures are potential change events in therapy that might result in positive or negative consequences for the therapeutic alliance and outcome. Alliance ruptures and premature drop-out are common with clients diagnosed with borderline personality disorder, limiting treatment effectiveness. OBJECTIVE To test a nine stage model of rupture resolution in cognitive analytic therapy (CAT) with adolescents. METHOD The validation phase of task analysis was employed to test the rupture resolution model and to relate handling of ruptures to outcome using quantitative and qualitative analysis of transcripts. Eighteen ruptures and resolution attempts were intensively examined across three good and two poor outcome sessions, as rated by clients. The number of model stages employed by therapists was related to outcome. RESULTS Sessions evaluated as poor or good by clients could be distinguished according to the extent to which therapists used model stages. Treatment outcome was significantly associated with number of model stages included by therapists. CONCLUSION Competent resolution of ruptures in CAT is dependent on therapists' inclusion of stages of the model, providing validation for the model, and demonstrating that effective rupture resolution might be related to treatment outcome. Ruptures and their resolution are likely to be key events in psychotherapy process.
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Abstract
The authors propose that if therapists and clients process their therapeutic relationship (i.e., directly address in the here and now feelings about each other and about the inevitable problems that emerge in the therapy relationship), feelings will be expressed and accepted, problems will be resolved, the relationship will be enhanced, and clients will transfer their learning to other relationships outside of therapy. The authors review theories supporting the idea of processing the therapeutic relationship, discuss the relevant empirical literature in this area, and provide their conceptualization of the construct of processing the therapeutic relationship based on the theory and empirical findings. Finally, they discuss methodological concerns and suggest implications for clinical practice, training, and further research.
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Affiliation(s)
- Clara E Hill
- Department of Psychology, University of Maryland, College Park, MD 20742, USA.
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37
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Aspland H, Llewelyn S, Hardy GE, Barkham M, Stiles W. Alliance ruptures and rupture resolution in cognitive-behavior therapy: a preliminary task analysis. Psychother Res 2009; 18:699-710. [PMID: 18815951 DOI: 10.1080/10503300802291463] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive-behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Results indicated differences between what therapists think they should do to resolve ruptures and what they actually do and suggested that the rational model should be expanded to emphasize client validation and empowerment. Therapists' ability to attend to ruptures emerged as an important clinical skill.
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Affiliation(s)
- Helen Aspland
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Zack SE, Castonguay LG, Boswell JF. Youth working alliance: a core clinical construct in need of empirical maturity. Harv Rev Psychiatry 2007; 15:278-88. [PMID: 18097838 DOI: 10.1080/10673220701803867] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The therapeutic alliance has long been recognized as an important component of successful psychotherapy for adults; research has established robust links to outcome. Until recently, however, research on the alliance between youth and their therapists has been sparse. The present review synthesizes the existing findings regarding the youth alliance and utilizes the adult alliance literature and the child and adolescent developmental literatures to suggest future avenues of research. Weak alliance was found to predict premature termination, and strong alliance predicted symptom reduction, with some support for differential effects of the youth-therapist and parent-therapist alliances. In addition, the youth alliance is moderated by several patient and therapist characteristics, including the particular problems of patients and the interpersonal skills of therapists. The field has yet to coalesce around a single definition of the youth alliance, however, making it difficult to assess research results. Adult models of the alliance continue to be used heuristically despite some evidence that the alliance operates differently for youth. Tightening the operational definition of the youth alliance and addressing methodological issues will be essential in future efforts to understand how the alliance develops and what role it may play in the treatment process for youth.
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Affiliation(s)
- Sanno Elena Zack
- Department of Psychology, Pennsylvania State University, University Park, PA 16802, USA.
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Castonguay LG. Training issues in psychotherapy integration: A commentary. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2005. [DOI: 10.1037/1053-0479.15.4.384] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Constantino MJ, Arnow BA, Blasey C, Agras WS. The Association Between Patient Characteristics and the Therapeutic Alliance in Cognitive-Behavioral and Interpersonal Therapy for Bulimia Nervosa. J Consult Clin Psychol 2005; 73:203-11. [PMID: 15796627 DOI: 10.1037/0022-006x.73.2.203] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The therapeutic alliance is an established predictor of psychotherapy outcome. However, alliance research in the treatment of eating disorders has been scant, with even less attention paid to correlates of alliance development. The goal of this study was to examine the relation between specific patient characteristics and the development of the alliance in 2 different treatments for bulimia nervosa (BN). Data derive from a large, randomized clinical trial comparing cognitive- behavioral therapy (CBT) and interpersonal therapy (IPT) for BN. Across both treatments, patient expectation of improvement was positively associated with early- and middle-treatment alliance quality. In CBT, baseline symptom severity was negatively related to middle alliance. In IPT, more baseline interpersonal problems were associated with poorer alliance quality at midtreatment.
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Affiliation(s)
- Michael J Constantino
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA.
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