Comments on the article by S. Zilcha-Mano et al. (see record 2023-80613-001). In this meta-analysis, Zilcha-Mano et al. ask a simple question, but one not easy to answer: Does a process variable ...(interpretation) improve outcome? They found that regardless of a variety of differences, the use of interpretations led to a positive outcome in the psychotherapeutic endeavor. Is the clinical observation that addressing painful emotions and trying to understand how a patient manages them demonstrable to be a common factor? This has to be systematically explored by evaluating the impact of experience-near interventions that address how patients protect themselves from painful affects at the moment it occurs in the session. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Reports the retraction of "Crying as communication in psychotherapy: The influence of client and therapist attachment dimensions and client attachment to therapist on amount and type of crying" by ...Noah Robinson, Clara E. Hill and Dennis M. Kivlighan Jr. ( Journal of Counseling Psychology, 2015Jul, Vol 623, 379-392). The following article is being retracted (https://doi.org/10.1037/cou0000090). This retraction is at the request of coauthors Kivlighan and Hill after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Robinson was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2015-23479-001.) Nelson (2005) associated 3 types of crying (inhibited, protest, despair) with 3 dimensions of attachment (avoidant, anxious, and secure). To test this theory, trained judges rated the intensity of inhibition, protest, and despair in 347 crying episodes for 40 clients and 14 therapists in 1,074 psychotherapy sessions. Crying occurred once out of every 7 sessions, and usually was characterized by protest or inhibition. Pre-therapy attachment dimensions of both therapist and client influenced crying. Therapists with high attachment avoidance had clients who cried frequently but less over time, whereas therapists with high attachment anxiety had clients who cried with more protest over time. Clients with high attachment anxiety initially cried with more protest and inhibition, but decreased over time, whereas clients with low attachment anxiety increased protest over time. Throughout the course of psychotherapy, therapists who were seen by their clients as establishing a secure attachment elicited more overall crying and a higher intensity of protest, whereas therapists who were seen by their clients as establishing insecure attachments had clients who cried less. Clients who established a secure or avoidant relationship with their therapists, relative to other clients of that therapist, cried infrequently and with inhibition, whereas clients who established a preoccupied relationship cried relatively often. Changes are suggested for Nelson’s (2005) typology. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Objective: Insight and affect awareness are correlated with outcome in a number of studies across different treatment orientations. In this study, we perform a full mediational analysis to examine ...whether improvement of both cognitive insight and affect awareness are mediators of the specific effects of transference work in dynamic psychotherapy. Method: This was a dismantling randomized controlled clinical trial specifically designed to study long-term effects of transference work (exploration of problematic patterns in the therapeutic relationship). One hundred outpatients were randomly assigned to 1 year of dynamic psychotherapy with and without transference work interventions. The outcome variables were the Interpersonal Functioning scale (clinician rated) and Inventory of Interpersonal Problems (patient self-report). Quality of Object Relations was moderator. Using structural equation modeling, we tested change during treatment (1 year) of Insight and Tolerance for Affects as mediators of long-term outcome (over the 1-year study period). Results: For both outcome measures, the best model supported a mediated moderation model where the effects of transference work, for patients with low Quality of Object Relations, were mediated via both change of Insight and Tolerance for Affects. The effect of Insight on outcome was significantly reduced due to an indirect effect via Tolerance for Affects. A number of alternative models allowed us to rule out alternative pathways with some confidence. Conclusions: Both improved insight and affect awareness seem to be mechanisms for long-term effects of transference work. Our results bridge the gap between mainstream clinical theory and empirical research.
What is the public health significance of this article?
Converging evidence has been published indicating that insight and affect awareness are predictors of outcome across treatment modalities. This study extends such findings and suggests that gain of both cognitive insight and affect awareness are key mechanisms of change in dynamic psychotherapy. Our findings may also have implications for different types of psychotherapy. Therapists, across theoretical orientations, should address problems in the therapeutic relationship and focus on both cognitions and affects.
Many attempts have been made to discover and characterize the mechanisms of change in psychotherapies for depression, yet no clear, evidence-based account of the relationship between therapeutic ...procedures, psychological mechanisms, and symptom improvement has emerged. Negatively-biased thinking plays an important role in the phenomenology of depression, and most theorists acknowledge that cognitive changes occur during successful treatments. However, the causal role of cognitive change procedures in promoting cognitive change and alleviating depressive symptoms has been questioned. We describe the methodological and inferential limitations of the relevant empirical investigations and provide recommendations for addressing them. We then develop a framework within which the possible links between cognitive procedures, cognitive change, and symptom change can be considered. We conclude that cognitive procedures are effective in alleviating symptoms of depression and that cognitive change, regardless of how it is achieved, contributes to symptom change, a pattern of findings that lends support to the cognitive theory of depression.
•Various therapeutic procedures produce both cognitive and symptom change.•Cognitive change appears to be a general mechanism of change.•Cognitive mediation studies often violate temporality assumptions.•A framework for research on cognitive mediation is proposed.
Reports the retraction of "Working alliance, real relationship, session quality, and client improvement in psychodynamic psychotherapy: A longitudinal actor partner interdependence model" by Dennis ...M. Kivlighan Jr., Clara E. Hill, Charles J. Gelso and Ellen Baumann ( Journal of Counseling Psychology, 2016Mar, Vol 632, 149-161). The following article is being retracted (https://doi.org/10.1037/cou0000134). This retraction is at the request of coauthors Kivlighan, Hill, and Gelso after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Baumann was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2015-57048-001.) We used the Actor Partner Interdependence Model (APIM; Kashy & Kenny, 2000) to examine the dyadic associations of 74 clients and 23 therapists in their evaluations of working alliance, real relationship, session quality, and client improvement over time in ongoing psychodynamic or interpersonal psychotherapy. There were significant actor effects for both therapists and clients, with the participant’s own ratings of working alliance and real relationship independently predicting their own evaluations of session quality. There were significant client partner effects, with clients’ working alliance and real relationship independently predicting their therapists’ evaluations of session quality. The client partner real relationship effect was stronger in later sessions than in earlier sessions. Therapists’ real relationship ratings (partner effect) were a stronger predictor of clients’ session quality ratings in later sessions than in earlier sessions. Therapists’ working alliance ratings (partner effect) were a stronger predictor of clients’ session quality ratings when clients made greater improvement than when clients made lesser improvement. For clients’ session outcome ratings, there were complex three-way interactions, such that both Client real relationship and working alliance interacted with client improvement and time in treatment to predict clients’ session quality. These findings strongly suggest both individual and partner effects when clients and therapists evaluate psychotherapy process and outcome. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
The therapeutic value of alliance is a contested supposition. Although many theorists and researchers believe that alliance is therapeutic in itself, others see it as a byproduct of effective ...treatment or as a common nonspecific factor enabling the truly effective ingredients of treatment to work. For many years, the debate was confined mainly to the domain of theory, and no studies were available to confirm which of these approaches is correct. The only empirical evidence that existed was studies showing a correlation between alliance and outcome, and advocates of the above conflicting opinions used the same correlation to prove the validity of their position. Over the last few years, however, a revolution has taken place in alliance research, which brings this theoretical debate into the realm of the empirical. Several recent alliance studies have applied advanced methodologies to achieve this aim. Based on an integration of these studies, the present article proposes a new model for understanding the potential therapeutic role of alliance as sufficient to induce change by itself. The model stresses the importance of differentiating between patients' general tendencies to form satisfying relationships with others, which affect also the relationship with the therapist ("trait-like" component of alliance), and the process of the development of changes in such tendencies through interaction with the therapist ("state-like" component of alliance). The former enables treatment to be effective; the latter makes alliance therapeutic. Based on the literature, this article attempts to determine which of these components is the predictor of treatment outcome.
This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American ...Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome. The expert consensus deemed 9 of the relationship elements as demonstrably effective, 7 as probably effective, and 1 as promising but with insufficient research to judge. What works-and what does not-in the therapy relationship is emphasized throughout. The limitations of the task force work are also addressed. The article closes with the Task Force's formal conclusions and 28 recommendations. The authors conclude that decades of research evidence and clinical experience converge: The psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment.
Clinical Impact Statement
Question: What, specifically, is effective in the powerful psychotherapy relationship? Findings: Clinicians can use these meta-analytic conclusions and the practice recommendations of the Task Force on Evidence-Based Relationships and Responsiveness to provide what works in the relationship and simultaneously to avoid what does not work. Meaning: Based on original meta-analyses, experts deemed nine of the relationship elements as demonstrably effective, seven as probably effective, and one as promising. Next Steps: Future directions are to disseminate these findings to practice communities, to implement them in training programs, and to examine the interrelations of the effective elements of the relationship.
Comments on the article by J. J. Allen et al. (see record 2024-18546-001), a review of the facilitative interpersonal skills (FIS) performance task and rating method. Research on the FIS remains ...ongoing. The systematic search by Allen et al. was conducted in December 2022. Since then, a few new empirical studies have already been published since then (e.g., Gumz et al., 2023). Notably, several of these studies report on new analyses based on relatively older data collections of FIS responses. Thus, although the interest in the FIS appears to grow among researchers in different countries, the creation of new datasets of clinicians’ responses that have been coded on the FIS is relatively slow. In this comment the authors will be highlighting its current limitations, future directions for research, and its potential for real-world application. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Comments on the article by J. J. Allen et al. (see record 2024-18546-001), a review of the facilitative interpersonal skills (FIS) performance task and rating method. In this comment the author ...discusses some of the issues the review by Allen et al. raises, and that will be important to address moving forward. One issue is measuring therapist effects in the FIS performance task. Another issue is the inherent tension between training and personal qualities in the FIS performance task, and whether clinical training is needed. The present author believes that the FIS performance task has great potential in studying the effect of clinical training on the development of interpersonal skills in challenging interpersonal situations. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Cohesion in Group Therapy: A Meta-Analysis Burlingame, Gary M; McClendon, Debra Theobald; Yang, Chongming
Psychotherapy (Chicago, Ill.),
12/2018, Volume:
55, Issue:
4
Journal Article
Peer reviewed
Cohesion is the most popular of the relationship constructs in the group therapy literature. This article reviews common definitions of cohesion, the most frequently studied measures, and a measure ...that may clarify group relations using two latent factors (quality and structure) to explain common variance among frequently used group relationship instruments. We present the results of a meta-analysis examining the relation between group cohesion and treatment outcome in 55 studies. Results indicate that the weighted aggregate correlation between cohesion and treatment outcome was statistically significant, r = .26, z = 6.54 (p < .01), reflecting a moderate effect size (d = .56). Heterogeneity of effect sizes was significant (Q = 260.84, df = 54, p < .001) and high (I2 = 79.3%), supporting moderator analyses. Six moderator variables were found to significantly predict the magnitude of the cohesion-outcome association (type of outcome measure, leader interventions to increase cohesion, theoretical orientation, type of group, emphasis on group interaction, and dose or number of group sessions). Patient contributions, diversity considerations, and evidence-based therapeutic practices are highlighted.
Clinical Impact Statement
Question: Does the quality of the group therapeutic relationship predict patient improvement? Findings: Clinical efforts to enhance the therapeutic relationship in group optimize patient outcome irrespective of theoretical orientation. Meaning: Group cohesion improves outcomes in both inpatient and outpatient settings and across a variety of patient diagnoses. Next Steps: Test cohesion measure-informed care in group on failing states of relationship.
