Research on psychotherapy integration: Building on the past, looking to the future

A systematic review of the nature and efficacy of Rational Emotive Behaviour Therapy interventions

In the absence of a single comprehensive systematic review of Rational Emotive Behaviour Therapy interventions across all settings, we reviewed the methodological quality, effectiveness and efficacy of Rational Emotive Behaviour Therapy interventions on irrational/rational beliefs. We explored the impact of Rational Emotive Behaviour Therapy on wider outcomes (e.g., mental health) and identified the characteristics of successful interventions. PsycARTICLES, PsycINFO, Scopus, SPORTDiscus, and PubMed were systematically searched up to December 2023 with 162 Rational Emotive Behaviour Therapy intervention studies identified which included a validated measure of irrational/rational beliefs. Where possible, effect size for irrational/rational belief change was reported and data was analysed through a qualitative approach. Using the Mixed Methods Appraisal tool, methodological quality within the Sport and Exercise domain was assessed as good, whilst all other domains were considered low in quality, with insufficient detail provided on intervention characteristics and delivery. Most studies were conducted in the United States, within the Education domain, and assessed irrational beliefs in non-clinical adult samples. Overall, studies reported significant reductions in irrational beliefs, increases in rational beliefs and improvements in mental health outcomes (e.g., depression). More successful interventions were delivered by trained Rational Emotive Behaviour Therapy practitioners, adopted the ABC framework and were longer in duration. We highlight the importance of designing and conducting rigorous future Rational Emotive Behaviour Therapy research to generate clearer insights as to its impact on irrational/rational beliefs and mental health outcomes.

Philosophy of psychiatry: theoretical advances and clinical implications

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

Development of the Psychotherapist Character Virtues (PCV) Interview

OBJECTIVE

To develop an interview-based rating method for assessing therapists' beneficial character traits and evaluate its reliability and validity.

METHOD

The semi-structured Psychotherapist Character Virtues (PCV) interview and evaluation method, based on Erik Erikson's and Heinz Kohut's writings on 16 virtues or abilities and achievements of an adult self, was administered to 68 psychodynamic and solution-focused therapists. Inter-rater reliability was assessed based on 20 videorecorded interviews, rated by two evaluators. In a mixed-methods design, validity was investigated against (i) therapist's questionnaire-based self-reported professional and personal background characteristics and (ii) a qualitative content analysis of emotional atmosphere in the interview.

RESULTS

Interrater reliability for individual 16 virtues was acceptable (median correlation .72). From individual virtues, three principal components (Creative Will, Empathy, and Love/Care) emerged with good/excellent internal consistency (component determinacies .95, .85, and .90, respectively) and criterion validity with self-reported professional and personal characteristics. Cluster analysis of therapists' component scores yielded six different therapist character profiles. In qualitative analysis, character profiles meaningfully differed in their impact on the interview's emotional atmosphere.

CONCLUSION

PCV appears promising for evaluating therapists' character virtues, posited to undergird therapists' sensitive attunement and responsiveness. Further research is needed on PCV's predictive validity for therapeutic relationships and outcomes.

CBT Meets Process: Assimilative Integration with Reference to Group Psychotherapy

This paper offers a brief overview of the historically predominant form of psychotherapy research both for individual and group psychotherapies, the randomized control trial (RCT), and its surrounding controversies and critiques as the backdrop from which new directions in both clinical theory building and research are being pursued, including efforts at building integrative models of treatment. The paper explores one promising integrative model, namely the incorporation of process and dynamic orientations into the province of group cognitive behavioral therapy (CBT) and identifies challenges in implementing this model.

Integrated focal psychotherapy: Results from a retrospective study

Background

The focus-based integrated model (FBIM) is a form of psychotherapy that integrates psychodynamic and cognitive psychotherapy and Erikson's life cycle model. Although there are many studies on the effectiveness of integrated models of psychotherapy, few have examined the efficacy of FBIM.

Objective

This pilot study explores clinical outcome measures concerning individual wellbeing, the presence/absence of symptoms, life functioning, and risk in a cohort of subjects after they received FBIM therapy.

Methods

A total of 71 participants were enrolled at the CRF Zapparoli Center in Milan, 66.2% of whom were women (N = 47). The mean age of the total sample was 35.2 years (SD = 12.8). We used the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) to test treatment efficacy.

Results

The results revealed that participants improved in all four dimensions of CORE-OM (i.e., wellbeing, symptoms, life functioning, and risk), women improved more than men, and in most cases (64%), the change was clinically reliable.

Conclusion

The FBIM model seems to be effective for treating several patients. Most of the participants saw significant changes in symptoms, life functioning, and general wellbeing.

Narrative reconstruction therapy for prolonged grief disorder: Basic interventions and mechanisms of change

Narrative reconstruction is a time-limited integrative therapy, originally developed in the context of post-traumatic stress disorder and adjusted for the treatment of prolonged grief disorder (PGD). It consists of exposure to the loss memory and narrating a detailed written reconstruction of it. In this paper, we describe narrative reconstruction interventions and modifications for the treatment of PGD as well as the underlying mechanisms of change including integration of the loss episode into the life narrative. A case demonstration of narrative reconstruction with a patient with PGD presented for illustration and the integrative nature of narrative reconstruction for PGD is discussed.

Parent-Focused Psychotherapy for the Preventive Management of Chronicity in Anorexia Nervosa: A Case Series

Background: Anorexia nervosa (AN) is a complex eating disorder where involvement of family plays a central role in first line treatment in adolescents, but which is not so for adults where poor response to treatment is frequent. Given the reluctance of some patients to receive treatment, we set out to explore the hypothesis that certain family dynamics may be involved in the maintenance of the disorder. Methods: We aimed to understand what is underlying in the cases of patients who present clinical improvement with their parents, but not the ones who received a parent-focused psychotherapeutic intervention. We conducted a mixed methods study. On the one hand we performed a case series of 14 patients who dropped out of treatment while their parents actively attended the intervention, and on the other hand, we followed the evolution of the parents of those patients reluctant to continue treatment, through non-participant observation. Results: We present preliminary evidence where we found the parent-focused psychotherapeutic intervention was able to elicit a reflective function of the parents. We also observed that the intervention modified certain family dynamics that could be related to maintaining factors of the disorder. In patients, we found that in parallel to the assistance of their parents to psychotherapeutic treatment, and even when they were receiving no intervention, they showed significant clinical improvement of symptomatology and global functioning; we observed 9 of 14 of them who voluntarily decided to return to pharmacological treatment. Conclusions: This parent-focused intervention elicited changes in reflective functioning of participant parents; the intervention produced favorable changes in family dynamics, which we believe is probably related to improvement of global functioning, symptomatology, and insight of patients.

Dialectical Thinking: A Proposed Foundation for a Post-modern Psychology

For the authors, the way from a modern to a post-modern psychology requires dialectical thinking. Dialectical thinking recognizes the importance of contradiction, change, and synthesis; it also includes recognition of the value as well as limits of modern epistemological approaches. The article describes foundations for both ongoing efforts to understand and research the ontogeny of dialectical thinking and for appreciating the scope of dialectical thinking and its relevance for establishing a bridge from modern to post-modern psychology.

Conceptualising specialist supportive clinical management (SSCM): current evidence and future directions

BACKGROUND

Current evidence-based treatments for adult anorexia nervosa (AN) have limitations, with high attrition, very poor outcomes for 20% of people, and no clearly superior manualised therapy for adults with AN. Specialist Supportive Clinical Management (SSCM) was designed as a control treatment but has evolved as a valid first line treatment. The present paper aims to provide an overview of the evidence base for SSCM and a pedagogical reconceptualization with expansion by theoretical integration (TI). BODY: A secondary meta-analysis endorses SSCM as a promising treatment. This paper positions SSCM as a manualised therapy for adult AN with six unique features, namely (1) a philosophy which is person-centred, non-prescriptive, and informed by the person's strengths and values, (2) a focus on the person through inclusion of supportive psychotherapy and problem (clinical management), within target symptoms as defined in relation to AN, (3) a flexible and responsive therapy that could be delivered by a variety of clinicians with experience treating AN (4) a commitment to reversing starvation though a directional approach and a defined yet flexible stance on dietetic intervention (5) a commitment to the therapeutic relationship within all three phases of treatment, and (6) a therapy 'uncluttered' by specific mandates. In addition, this paper positions SSCM as a treatment that may be strengthened by other modalities and may also be adapted to the treatment of other eating disorders (ED), not just AN. The level of therapist sophistication to deliver upon the supportive psychotherapy component is explored and future directions are offered.

CONCLUSION

SSCM is a unique and valid first line treatment for AN and would benefit from further expansion in line with emerging understandings of AN to strengthen it as a treatment. Speculation on aspects of potency would benefit from further testing. The proposed re-conceptualisation of SSCM in the context of its evidence may strengthen it as a treatment overall, position it as adaptable for treatment of other eating disorders and make it more accessible to clinicians.

Addiction Psychotherapy: Going Beyond Self-Medication

Scientific and clinical work concerning the etiology of substance use and addiction has come a long way in the past decades. Current theories highlight the notion that addiction is rooted in deficits in neurobiological and psychological reward mechanisms, but also as a coping-oriented effort to contend with, or "self-medicate," negative emotional experiences. As such, contemporary approaches in the dynamic psychotherapy of addiction highlight the compensatory nature of addiction, encouraging clinicians to detect the mental suffering underlying addiction and promote alternative coping behaviors. In this perspective article, the authors advocate for an integrative approach toward understanding and addressing addiction in psychotherapy, acknowledging its biological, psychological and social aspects. We propose that in addition to the regulatory process of self-medication, in which negative emotions are being suppressed, compulsive substance use may also reflect a substitutive function, in which negative emotions are being 'acted-out' through the use of drugs or alcohol. We suggest an integrative clinical approach which addresses these psychological aspects in a sequential manner and discuss consequent benefits for clinicians and patients working with and through addiction.

Validation and application of the Non-Verbal Behavior Analyzer: An automated tool to assess non-verbal emotional expressions in psychotherapy

BACKGROUND

Emotions play a key role in psychotherapy. However, a problem with examining emotional states via self-report questionnaires is that the assessment usually takes place after the actual emotion has been experienced which might lead to biases and continuous human ratings are time and cost intensive. Using the AI-based software package Non-Verbal Behavior Analyzer (NOVA), video-based emotion recognition of arousal and valence can be applied in naturalistic psychotherapeutic settings. In this study, four emotion recognition models (ERM) each based on specific feature sets (facial: OpenFace, OpenFace-Aureg; body: OpenPose-Activation, OpenPose-Energy) were developed and compared in their ability to predict arousal and valence scores correlated to PANAS emotion scores and processes of change (interpersonal experience, coping experience, affective experience) as well as symptoms (depression and anxiety in HSCL-11).

MATERIALS AND METHODS

A total of 183 patient therapy videos were divided into a training sample (55 patients), a test sample (50 patients), and a holdout sample (78 patients). The best ERM was selected for further analyses. Then, ERM based arousal and valence scores were correlated with patient and therapist estimates of emotions and processes of change. Furthermore, using regression models arousal and valence were examined as predictors of symptom severity in depression and anxiety.

RESULTS

The ERM based on OpenFace produced the best agreement to the human coder rating. Arousal and valence correlated significantly with therapists' ratings of sadness, shame, anxiety, and relaxation, but not with the patient ratings of their own emotions. Furthermore, a significant negative correlation indicates that negative valence was associated with higher affective experience. Negative valence was found to significantly predict higher anxiety but not depression scores.

CONCLUSION

This study shows that emotion recognition with NOVA can be used to generate ERMs associated with patient emotions, affective experiences and symptoms. Nevertheless, limitations were obvious. It seems necessary to improve the ERMs using larger databases of sessions and the validity of ERMs needs to be further investigated in different samples and different applications. Furthermore, future research should take ERMs to identify emotional synchrony between patient and therapists into account.

How to become a responsive therapist: A study of experiences of developing therapists

OBJECTIVE

: A growing body of empirical evidence suggests that psychotherapy is more effective when therapists tailor interventions to fit their specific clients' needs, a concept referred to as therapist responsiveness in the psychotherapy literature. However, the question of how therapists learn to become responsive rarely has been examined.

METHOD

: The central question of this study, put to eleven graduate student therapist trainees, was, "How did you learn to be responsive to clients as a novice therapist, and in what ways have you become responsive?" A critical-constructivist grounded theory method was employed to generate themes from trainees' replies.

RESULTS

: The analysis showed that trainees learned to improve their responsiveness to clients by: (1) becoming more aware of cues that signaled the need to adapt interventions (as related to psychotherapy change processes, client-therapist relational dynamics, clients' identities and cultural contexts, and the maximizing of clients' agency); (2) developing attunement to their own emotions and engaging in self-care; and (3) adopting mindsets that facilitated their trying new relational or therapy approaches while also maintaining professionalism.

CONCLUSION

Based upon these findings, preliminary suggestions for responsiveness training are presented to guide programs that wish to train responsive psychotherapists .

On what do therapists agree? Assessing therapist evaluations of emotion regulation strategy effectiveness

OBJECTIVE

To develop more unified, process-based, and disseminable psychotherapy treatments, it is important to determine whether there is consensus among therapists regarding intervention strategies.

DESIGN

Because emotion regulation is a cornerstone of modern treatments and a thriving area of clinical research, we assessed therapists' ratings of the effectiveness of commonly studied emotion regulation strategies.

METHODS

Therapists (n = 582) read eleven vignettes describing stressful scenarios and rated the effectiveness of ten emotion regulation strategies in each scenario.

RESULTS

Across therapists, we found general consensus regarding the most (i.e., problem-solving) and least (i.e., concealing emotions) effective strategies. Cognitive/behavioural/third-wave therapists rated acceptance and distraction as more effective, and emotional expression and gathering information as less effective, than other therapists, Fs> 4.20, ps < .05, whereas hours of clinical experience were generally unrelated to strategy effectiveness ratings.

CONCLUSIONS

We discuss what these points of agreement and relative disagreement among therapists reveal about a more unified, process-based treatment approach and how these results can guide emotion regulation research.

PRACTITIONER POINTS

There is general consensus among practising therapists that problem-solving is the most effective emotion regulation strategy and expressive suppression is the least effective. However, CBT-oriented therapists rated acceptance and distraction as more effective than non-CBT-oriented therapists. Non-CBT-oriented therapists rated emotional expression and gathering information as more effective than CBT-oriented therapists. Years of experience were unrelated to ratings of emotion regulation strategy effectiveness.

Evaluation of Treatment Descriptions and Alignment With Clinical Guidance of Apps for Depression on App Stores: Systematic Search and Content Analysis

BACKGROUND

The use of apps for the treatment of depression shows great promise. However, there is uncertainty regarding the alignment of publicly available apps for depression with clinical guidance, their treatment fidelity and evidence base, and their overall safety.

OBJECTIVE

Built on previous analyses and reviews, this study aims to explore the treatment and safety issues of publicly available apps for depression.

METHODS

We conducted a content analysis of apps for depression in the 2 main UK app stores (Google Play and Apple App Store). App store listings were analyzed for intervention content, treatment fidelity, and fit with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of depression in adults.

RESULTS

A total of 353 apps for depression were included in the review. App descriptions reported the use of 20 treatment approaches and 37 treatment strategies. Many apps used transdiagnostic (155/353, 43.9%) and multitheoretical interventions to treat multiple disorders including depression. Although many interventions appeared to be evidence-informed, there were issues with treatment fidelity, research evidence, and fit with clinical guidelines. None of the apps fully aligned with the NICE guidelines for depression.

CONCLUSIONS

App developers have adopted many evidence-informed treatments in their interventions; however, more work is needed to improve clinical validity, treatment fidelity, and the safety of apps. We urge developers to consult relevant guidelines and standards, and to engage in reflective questioning on treatment and safety to address these issues and to improve treatment content and intervention design.

Using technology to understand how therapist variables are associated with clinical outcomes in IAPT

The UK’s Improving Access to Psychological Therapy Programme (IAPT) has improved transparency of primary mental health care in relation to the mandatory reporting of clinical outcomes. However, the data reveal a significant variance in outcomes. These findings have led to a growing body of research investigating to what extent therapist variables account for the difference in clinical outcomes. Previous studies have not had access to sufficient recordings or transcripts of therapy sessions in order to fully address this question. The purpose of this study was to use therapy transcripts derived from internet enabled cognitive behavioural therapy (CBT) treatment sessions in order to investigate whether and how therapist variables are associated with clinical outcome. A hierarchical log-linear analysis examined the relationship between therapist/patient variables and clinical outcome. Therapist fidelity to the CBT model and associated adherence to an evidence-based protocol were significantly related to clinical outcome. A graphical representation of the statistical model suggests that patient recovery is directly linked with fidelity and indirectly with adherence, after adjusting for patient attributes of age, gender and clinical presentation. Corroborating previous research, therapist competence and adherence to an evidence-based treatment protocol appear to be important in improving outcomes. These findings have implications for the continuing professional development of qualified therapists, potentially reinforcing the importance of reducing therapist drift.

Key learning aims

(1)

The capacity for psychotherapy process scale: development and psychometric validation of patient self-reports

Objective: Studies were conducted to develop and validate the Capacity for Psychotherapy Process Scale (CFPPS), a self-rating measure of capacity for the psychotherapy process from a trans-theoretical perspective. Method: In Study 1, a two-round Delphi methodology consulting 27 and 15 experts, respectively, was used to select items and identify content validity. In Study 2, 279 clients were recruited for exploratory factor analysis (EFA). In Study 3, confirmatory factor analysis and internal consistency analysis were conducted among 390 outpatients; the discriminant validity and predictive validity were studied in 270 outpatients and 82 psychotherapy outpatients, respectively. Results: The Delphi method resulted in 52 items. Through EFA, the CFPPS was reduced to 20 items, focusing on five factors: motivation, belief, self-revelation, persistence, and insight; the internal consistencies were good (0.92 for total scale and 0.82-0.91 for the factors). The CFPPS was not or was only weakly associated with symptoms. The Bonferroni-corrected partial correlation analyses revealed that the CFPPS was positively related to working alliance and session impact. Conclusions: The CFPPS is a preliminary step toward the self-report assessment of the capacity for psychotherapy process from a trans-theoretical perspective and may potentially be used to predict the working alliance and session impact.

Validity of the Czech Version of the Therapeutic Factors Inventory - Short Form (TFI-S)

This study's aim was to assess validity of the Czech translation of the Therapeutic Factors Inventory (TFI-S), which includes four factors: Instillation of Hope, Secure Emotional Expression, Awareness of Emotional Impact, and Social Learning. We assessed data from 220 patients who attended a daily three-month treatment program that used integrative group psychotherapy. TFI-S's reliability was satisfactory: at week 12, Cronbach's α was .93 and McDonald's ω was .95. Confirmatory factor analysis showed acceptable fit to our data: at week 12, χ2(146) = 262.5, p < 0.001, CFI = .994, TLI = .992, RMSEA = .071 (90% CI = .057-.084), and SRMR = .063. Predictive validity showed significant correlations between TFI-S factors and pre/post-treatment change. In the conclusion, we discuss possible future potential of cross-cultural research.

Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century

The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem-centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST's theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.

I’d Like to Have All the Characteristics of a Hero: A Case Study of Strength-Centered Therapy

Strength-centered therapy (ST) is a therapeutic model based on character strengths in positive psychology and social constructionist perspectives on psychotherapy. Although there is no documented empirical research on ST, research evidence indicates that interventions that identify and cultivate character strengths have consistently yielded positive outcomes in well-being. Some specific techniques adopted in ST have shown effectiveness in improving psychological outcomes. The present case study adds research evidence to the potential effectiveness of ST. This case study provides an analysis of ST with a 20-year-old White female client. The focus of this case study is to illustrate how ST techniques work with a real client. A total of 12 therapy sessions and pre- and post-therapy interviews and assessments with the client were recorded and transcribed for data analysis. The research team analyzed the data qualitatively, illustrated several ST therapeutic strategies, and explored the client’s experience of therapy in four phases of ST. Implications for practice and research are discussed.

Psychotherapy Termination Practices with Older Adults: Impact of Patient and Therapist Characteristics

OBJECTIVES

The aims of this study were to survey clinicians' opinions regarding psychotherapy practices in mutual termination with a specified population (depressed older adult outpatients) and to examine the patient and therapist characteristics that may influence such practices.

METHODS

We surveyed psychologists' (N = 96) psychotherapy termination practices, using a hypothetical depressed older adult as a referent, to assess consensus on the appropriateness of various guidelines to termination and to examine whether these differ as a function of patient and therapist characteristics.

RESULTS

Several practices were generally agreed to be "extremely appropriate" when terminating psychotherapy with older adults, including collaborating to determine the end date of treatment and discussing patient growth. Data also indicate that patient factors, such as personality pathology, and therapist factors, such as having an Integrative theoretical orientation were associated with differential endorsement of termination practices. Identification as a geropsychologist or working regularly with older adults were associated with a more cautious approach to termination.

CONCLUSIONS

There is substantial consensus regarding many approaches to termination, but modifications might be appropriate depending on patient characteristics.

CLINICAL IMPLICATIONS

Clinicians agree on a set of fundamental termination practices when working with older adults, but modify these based on orientation and diagnosis.

Clinical Consensus Strategies to Repair Ruptures in the Therapeutic Alliance

Objective

The alliance been recognized as an essential common factor and robust predictor of outcome. The present study sought to further our knowledge of the alliance and to promote the integration of research and practice by assessing consensus among peer-nominated expert therapists of varying theoretical orientations on the effectiveness of clinical strategies to repair alliance ruptures.

Method

This study drew on the behavioral-analytic model (Goldfried & D'Zurilla, 1969) and the methodology of the Expert Consensus Guideline Series (Frances, Docherty, & Kahn 1997). In Phase I, 69 therapists submitted clinical situations describing alliance ruptures. In Phase II, 177 therapists generated responses to the situations, and clinical strategies underlying the responses were identified. In Phase III, 134 peer-nominated experts (a mean of 22.3 therapists per situation) rated the effectiveness of these clinical strategies.

Results

The experts reached consensus on the use of strategies that validated the client's experience and explored the rupture during the rupture session. Change-oriented interventions (e.g., changing interpersonal interactions; highlighting patterns of behavior, thought, or emotions) were generally rated as less effective to use during the rupture, but effective for use in future sessions.

Conclusions

The findings are consistent with the growing literature on the value of using certain alliance-focused interventions during a rupture. The findings point to the importance of therapists' awareness of the state of the alliance so that they can identify when ruptures are occurring.

Towards mHealth Systems for Support of Psychotherapeutic Practice: A Qualitative Study of Researcher-Clinician Collaboration in System Design and Evaluation

We examined clinicians' and researchers' experiences from participation in collaborative research on the introduction of Internet and mobile information systems (mHealth systems) in psychotherapeutic routines. The study used grounded theory methodology and was set in a collaboration that aimed to develop and evaluate mHealth support of psychotherapy provided to young people. Soundness of the central objects developed in the design phase (the collaboration contract, the trial protocol, and the system technology) was a necessary foundation for successful collaborative mHealth research; neglect of unanticipated organizational influences during the trial phase was a factor in collaboration failure. The experiences gained in this study can be used in settings where collaborative research on mHealth systems in mental health is planned.

A train of thought: 25 years of Psychotherapy research

This paper serves as an introduction to the 25th anniversary issue of Psychotherapy research. It includes a consideration of the original aims of the journal in light of the most cited articles, various developments in research orientation and methodology, and most recent publications. It demonstrates both diversity and consistency in content over time, as well as the international reach of the journal.

[How timely are the methods taught in psychotherapy training and practice?]

ISSUES

Even though many psychotherapists consider themselves to be eclectic or integrative, training and reimbursement in the modern healthcare system are clearly oriented toward the model of distinct psychotherapy approaches. Prompted by the proposition to favor general, disorder-oriented psychotherapy, we investigate how timely distinctive methods are that are taught in training and practice.

METHODS

We reviewed the pertinent literature regarding general and specific factors, the effectiveness of integrative and eclectic treatments, orientation toward specific disorders, manualization and psychotherapeutic training.

RESULTS

There is a lack of systematic studies on the efficacy of combining therapy methods from different approaches. The first empirical findings reveal that a superiority of combined versus single treatmentmethods has yet to be demonstrated. The development of transnosological manuals shows the limits of disorder-specific treatment.General factors such as therapeutic alliance or education about the model of disease and treatment rationale require specific definitions.

CONCLUSION

Taking reference to a specific treatment approach provides important consistency of theory, training therapy and supervision, though this does not preclude an openness toward other therapy concepts. Current manualized examples show that methods and techniques can indeed be integrated from other approaches. Integrating different methods can also be seen as a developmental task for practitioners and researchers which may be mastered increasingly better with more experience.