Psychotherapy does not work equally well for all clients. For research to support clinicians in helping more clients, we need to better understand the process of when therapy become particularly challenging. In this study, we investigated challenging change processes from the therapists' perspective when applying Emotion-Focused Therapy (EFT). We interviewed 14 therapists trained in EFT about their experiences of difficulties with applying EFT to clients with varying severity of mental health difficulties. Interviews were analyzed using reflexive thematic analysis. Five themes were constructed. Three describing what EFT therapist find challenging; (1) Challenges in the therapeutic relationship, (2) When feelings are too big, too small or difficult to experience, (3) Matching EFT with the client's challenges, and two describing therapist responses to the challenges: (4) Do I know EFT, and what would I have needed to know more? (5) What do I do when it becomes difficult? A total of 20 subthemes were identified. Reported experiences of applying EFT to a diverse population suggests a need for either model refinement or strengthening of the dissemination process to better enable EFT-therapists to help clients with more severe mental health difficulties.

Therapist responsiveness denotes that therapists provide therapeutic interventions within an emerging context of client manifestations and moment-by-moment internal and external changes. So far, psychotherapy research on explaining how therapy works falls short of operationalizing the sequence of events constituted by therapist responsiveness. The present special section of Psychotherapy Research addresses this conceptual and methodological gap and proposes six original contributions, using several validated assessment protocols, both from a quantitative and qualitative viewpoint, to study therapist responsiveness in psychotherapy. It aims at providing a rigorous conceptual and methodological basis for studying a core principle of change in psychotherapy for the future.

Therapists' emotional responses play a significant role in the therapeutic relationship and in the therapy process. The current study examined the associations between therapists' emotional responses and therapy sessions, and patients' experience of them as attuned and responsive.

To investigate the role of decentering as a mediator of the effect of mindfulness/mindfulness-based intervention (MBI) on emotional distress, we conducted cross-sectional and longitudinal designs.

Remote forms of psychotherapy became more common during the COVID-19 pandemic, increasing the importance of understanding how technological factors might affect remote treatment. Past research on other modes of communication suggests that perceptions can be influenced when the audiovisual quality of online communication is distorted. The aim of the current research was to examine the potential influence of visual or audio distortions during online therapy.

There is a pervasive underrepresentation of researchers and clinicians from diverse backgrounds in psychology. This is the first study to focus on diversity gaps in Psychotherapy Research. We examine a gap in the representation of research from low-income countries and summarize barriers and solutions to increase diversity in the field.

Research on nonverbal synchrony (NVS) as a core element in the therapeutic relationship has substantially increased and suggests that NVS influences therapeutic alliance and outcomes.

Negative effects of psychotherapy are a broad term that encompasses events such as non-response, deterioration, and novel symptoms. The aim of the present study was to explore experiences with negative effects among clinicians working within an intensive short-term dynamic psychotherapy (ISTDP) framework.

This study explores the experience of an individual and family therapy youth suicide intervention from the perspectives of seven psychotherapy triads (young people aged 12-18, their parents/caregivers and therapists).

To observe ruptures through clients' and therapists' experiences of closeness and distance in therapy. Sixty-six clients and their 29 therapists underwent RAP interviews that were rated with the Therapeutic-Distance-Scale- observer version (TDS-O) and completed the Post-Session-Questionnaire (PSQ) three times along therapy (early, mid and late therapy). Using a dyadic model, we associated client and therapist self-report of ruptures with TDS-O observer ratings. Clients' report of ruptures positively associated with clients' observed scores that the therapist was too distant, while therapists' report of ruptures related to their observed scores that the client was too close. Clients report that the rupture addressed related to their higher observed autonomy, but therapists report that the rupture addressed related to less client's autonomy. Resolution related to lower observed distance and higher observed engagement of both partners. In dyads in which the therapist was rated as experiencing distance, there was a higher level of resolution than in dyads in which the client observed as experiencing distance and the therapist did not. Clinical examples demonstrate how ruptures were manifested and understood through the therapeutic-distance prism. Observing the therapeutic-distance potentially improves therapists' ability to identify, negotiate, and resolve ruptures.

The move from inconsistent and problematic autobiographical narrative to a more coherent and reality-based narrative construction of the Self has been discussed as potential mechanism of change in psychotherapies for personality disorders. So far, little empirical evidence exists that demonstrates in a time-dependent design the role of narrative construction in the treatment of borderline personality disorder, in particular when it comes to understanding the integration of body-related information from the affective system with the autobiographical narrative. The present study aims at demonstrating change in emotion-based narrative markers over brief psychiatric treatment and to assess the impact of these changes on subsequent symptom change. A total of  = 57 clients with borderline personality disorder were assessed at three timepoint over the course of four months of brief psychiatric treatment, within the context of a secondary process-outcome analysis of a randomized controlled trial. Symptom change was assessed using the OQ-45.2 and emotion-narrative change was assessed using the Narrative-Emotion Process Coding System to code client's in-session speech in terms of problem, transition and change markers. All three emotion-based marker categories evidenced significant changes in the assumed direction. The reduction in problem emotion-based narrative markers (e.g., empty story telling) between session 1 and 5 into the treatment predicted the symptom reduction assessed between session 5 and 10. Emotion-based narrative construction may be a suitable method to study the pathway of change toward a more coherent and reality-based narrative construction of the Self-in-interaction-with-the-Other. Reduction of emotion-based problem-marker may be a promising candidate for a mechanism of change in treatments for personality disorders which should be tested in a time-dependent controlled design.

With meta-analytically estimated rates of about 25%, dropout in psychotherapies is a major concern for individuals, clinicians, and the healthcare system at large. To be able to counteract dropout in psychotherapy, accurate insights about its predictors are needed.

The purpose of this study was to assess the implementation of suicide-focused treatments delivered via a hybrid telemental health (TMH) and in-person format.

Predicting therapy responders can significantly improve clinical outcomes. This study aims to identify predictors of response to short-term dynamic therapy.

Certain client characteristics are associated with early working alliance difficulties in psychotherapy. However, there is limited quantitative evidence on whether combinations of these characteristics (e.g., intersectional identities, prior treatment experiences) are related to alliance development. The present study leveraged a person-centered research approach to examine profiles of early alliance development and differences in the latent class structure of client characteristics among alliance development profiles.

Research suggests that male-specific psychotherapy approaches for major depressive disorder (MDD) that consider traditional masculinity ideologies (TMI) may achieve improved treatment efficacy and reduced therapy dropout. However, studies examining male-specific psychotherapy for MDD or specific therapy aspects remain lacking. An anonymous online study on men's mental health examined 152 self-reporting mentally distressed cisgender men ( = 25.5 ± 9.1) from German-speaking countries of Europe. After completing baseline assessments (T1) of state self-esteem, state shame, positive/negative affect, depressive symptoms, and TMI, men were randomly assigned to read either a male-specific (MSP) or a cognitive behavioral therapy-oriented (CBT) psychoeducation text for MDD. Immediately afterwards, participants rated its usefulness and completed follow-up assessments (T2). Men in the MSP condition showed a stronger decrease in shame and negative affect as compared to men in the CBT-psychoeducation condition. Furthermore, in the MSP condition, prototypical depression symptoms tended to increase as compared to the CBT-psychoeducation, whereas male-typical externalizing depression symptoms tended to decrease. MSP for MDD may help depressed men feel less ashamed about their MDD and experience less negative affect about their condition than CBT-psychoeducation. Furthermore, MSP for MDD may elicit a shift from male-typical externalizing depression symptoms to prototypical depression symptoms.

To investigate the attitudes of mental health professionals towards Routine Outcome Monitoring (ROM) in Eastern and Western cultures.

Worldwide, the numbers of refugees and displaced people being exposed to traumatic and inhumane experiences are escalating, resulting in an enhanced need for appropriate psychological management of trauma in this at-risk group. This study explores therapists' perspectives on and preparedness for supporting adult refugees with trauma-related interventions.

Systemic Therapy conceives mental health symptoms in the context of social systems. Previous meta-analyses on Systemic Therapy focused on symptoms. This meta-analysis aims to focus on family system functioning while including all types of outcomes.

This umbrella review of systematic reviews and meta-analyses evaluates the effectiveness of Solution-Focused Brief Therapy (SFBT) across various populations and settings.

Informed by the person-environment fit theory, this preliminary study examined if a fit between a group member's treatment experience and their working therapy context (other group members' aggregated treatment experiences) were related to their level of motivation within a group treatment for healing from internalized weight stigma.

Therapeutic alliance has been little investigated in infant and toddler therapy, with no tools specifically adapted to this population. However, we have developed the Infant-Toddler Working Alliance Inventory-Short form (IT-WAI-S) which is based on the Working Alliance Inventory. The aim of this study was to assess the psychometric properties of this original French tool, in its two versions: for parent (IT-WAI-SP) and for therapist (IT-WAI-STh).

The effects of Dialectical Behavioral Therapy for Adolescents (DBT-A) on emotional and interpersonal instability were explored in adolescents exhibiting Borderline Personality Disorder (BPD) features, using ecological momentary assessment (EMA) to reduce recall bias.  = 28 help-seeking female adolescents were enrolled, meeting ≥ 3 DSM-IV BPD criteria. BPD criteria, non-suicidal self-injury (NSSI), and depressive symptoms were examined pre- and post-DBT-A treatment ( duration: 42.74 weeks,  = 7.46). Participants maintained e-diaries pre- and post-treatment, hourly rating momentary affect, attachment to mother and best friend, and self-injury urges. Interview-rated BPD symptoms decreased (χ²(1) = 5.66,  = .017), alongside reduced self-rated depression severity (χ²(1) = 9.61,  = .002). EMA data showed decreased NSSI urges (χ²(1) = 9.05,  = .003) and increased mother attachment (χ²(1) = 6.03,  = .014). However, mean affect, affective instability, mean attachment to the best friend, and attachment instability showed no significant change over time. DBT-A yielded limited evidence for altering momentary affective states and instability in adolescents based on EMA. Nevertheless, significant effects were observed in reducing NSSI urges and enhancing interpersonal dynamics during treatment, as assessed via EMA.

: Although therapists are encouraged to balance emotionally involving work on the patient's problems with need satisfaction in therapy sessions, effects of this balance have rarely been studied empirically. Hence, we examined congruence effects between problem-related affective and need-satisfying experiences in cognitive-behavioral therapy (CBT). : 165 distressed family caregivers rated problem-related affective experiences, need-satisfying experiences comprising self-esteem, positive interpersonal, and control experiences, as well as coping experiences after 12 CBT sessions. We examined within-person congruence effects of problem-related affective and need-satisfying experiences on subsequent coping in multilevel response surface analysis. Further, we included between-person problem-related affective and need-satisfying experiences and pretreatment depression and anxiety as moderators of within-person effects. : A slight predominance of self-esteem over problem-related affective experiences as well as exact correspondence between problem-related affective and both interpersonal and control experiences was most predictive of coping. Between-person moderators supported a cross-level balance heuristic of problem-related affective and self-esteem experiences. Finally, a stronger emphasis on self-esteem and interpersonal over problem-related affective experiences proved more beneficial for patients with high anxiety and low depression. : The findings highlight the importance of balancing problem-related affective and need-satisfying experiences in CBT and provide insights into how balancing may be tailored to specific patients.

The Therapist Work Involvement Scales (TWIS) is a self-report research instrument that enables a multilayered description of psychotherapists' experiences when treating clients. The TWIS was created in a comprehensive study of close to 5,000 psychotherapists, and has been used in multiple studies. The aim of the current paper is to clarify the organization and statistical characteristics of the TWIS, and to present an updated version for longitudinal and cross-sectional research.

Although psychotherapy research suggests that clients' resources are related to positive outcomes, there is a lack of clinical tools available to consider their integration into psychotherapy. In this exploratory research, we studied the feasibility of a semi-structured interview to identify resources reported by clients at the onset of therapy and the relationship between resources and therapy outcomes.

We used longitudinal youth- and caregiver-reports of adolescent psychological symptoms from three samples of youth receiving mental health services in routine treatment settings to derive expected change trajectories and identify cases at risk for treatment failure.

Stepped care models are frameworks for mental health care systems in several countries. According to Norwegian guidelines, individuals with mental health problems of mild severity should be treated in community mental health services, moderate severity in specialist mental health services, while complex/severe problems are often a shared responsibility. This study investigated whether patients are allocated as intended.

This study explored the extent to which within-patient changes in processes targeted in Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) are associated with changes within-patient in pain intensity and depressed mood and evaluated the extent that process-outcome relationships differed between patients.

Previous meta-analyses have shown that client-rated working alliance is negatively correlated with attachment anxiety and attachment avoidance. The purpose of this study is to provide an updated meta-analysis of the relation between alliance and the two dimensions of attachment insecurity. Random effects models were used to examine the relation between the working alliance and attachment anxiety and the relation between the working alliance and attachment avoidance. The overall relation between alliance and attachment anxiety was  = -.09 (= .01,  = 33,  = 43.7%). The overall relation between alliance and attachment avoidance was  = -.13 ( .001,  = 33,  = 44.7%). There was no evidence that these relations varied across study characteristics such as client race or the number of therapists in the study. The results support the negative relations between client-rated alliance and both dimensions of client-rated attachment insecurity. Further research is needed to identify the factors that moderate this relationship, using a more diverse sample of study characteristics and a wider range of measures.