To develop and validate a video rating instrument designed to assess transtheoretical clinical micro-skills within deliberate practice (DP) exercises.

The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a pantheoretical mental health assessment instrument that has been translated into over 50 languages. Despite its widespread international use in clinical practice and research, the psychometric properties of CORE-OM require further investigation.

A parallel randomized clinical trial evaluated the efficacy of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) for victims of terrorist attacks with long-term psychopathology. 120 adult Spanish victims, who met the criteria for current posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and/or anxiety disorders related to exposure to terrorist attacks that occurred 18 years ago, on average, were randomly assigned to 16 weekly sessions of TF-CBT ( = 60) or waiting list control conditions ( = 60). Participants who completed TF-CBT ( = 25) experienced significant pre-post decreases in diagnostic rates and in posttraumatic stress, depression, and anxiety symptoms. Pre/post effect sizes for the TF-CBT-treated participants were large ( = 1.25;  = 1.03;  = 1.16), and between-groups effect sizes were medium-large (=  0.94,  = 0.72,  = 0.95). Most TF-CBT completers (78.3% to 91.7%) achieved sub-syndromal symptom levels by post-treatment. The benefits persisted to the 6-month follow-up ( = 22). Modified intention-to-treat analyses ( = 35 vs.  = 50) confirmed the significance of the findings for PTSD and were significant but less robust for MDD and anxiety disorders. TF-CBT appears to be efficacious when applied to victims of terrorism with long-term psychopathology.

Exposure to family violence in childhood significantly increases the risk of developing severe psychiatric and physiological illnesses. Trauma-focused cognitive behavioural therapy (TF-CBT) effectively addresses trauma-related symptoms and improves overall well-being. However, knowledge of the persistence of these positive effects over time, facilitating factors, and why some children are not benefited remains limited. Furthermore, little attention has been paid to exploring children's subjective experiences. This study aimed to investigate long-term changes in trauma-related symptoms among children and youths who underwent TF-CBT due to family violence. Nine participants ( age = 16,6 years, range = 14-23; 7 girls and 2 boys) were assessed and interviewed four to five years after TF-CBT treatment.

Previous research has identified a complex relationship between client-therapist synchrony and therapy outcomes. We investigated the ways in which depression severity influences this relationship.

Despite growing interest in personalized psychotherapy research, little is known about therapists' current practice of personalizing psychotherapy. This study aimed to examine the extent to which psychotherapists engage in personalized treatment selection (PTS), i.e., recommending the presumably best-fitting treatment package to a patient, as one way of personalizing psychotherapy. This is a pre-registered study using open- and closed-ended questions in an online survey among German psychotherapists (= 557 started, = 392 (70.4%) completed). We applied logistic regression analyses to investigate predictors of PTS and qualitative analyses to investigate therapists' subjective reasoning for and against PTS. 78.7% (N = 437) of the therapists stated that they had practiced PTS in the past. Therapists trained in psychodynamic approaches were more likely to engage in PTS than cognitive-behavioral therapists. Therapists named a variety of patient characteristics that can lead to the recommendation of specific treatment approaches, most notably diagnostic factors and patient preferences. Therapists not engaging in PTS most often referred to the effectiveness of their own approach as explanation. The majority of psychotherapists provide personalized treatment recommendations to their patients. In light of our findings, we discuss challenges for the implementation of data-driven clinical support tools for PTS.

Internet-delivered cognitive behavior therapies (iCBT) are effective and scalable treatments for depression and anxiety. However, treatment adherence remains a major limitation that could be further understood by applying machine learning methods to during-treatment messages. We used machine learned topics to predict drop-out risk and symptom change in iCBT. We applied topic modeling to naturalistic messages from 18,117 patients of nationwide iCBT programs for depression and generalized anxiety disorder (GAD). We used elastic net regression for outcome predictions and cross-validation to aid in model selection. We left 10% of the data as a held-out test set to assess predictive performance. Compared to a set of reference covariates, inclusion of the topic variables resulted in significant decrease in drop-out risk prediction loss, both in between-patient and within-patient session-by-session models. Quantified as partial pseudo-R, the increase in variance explained was 2.1-6.8 percentage units. Topics did not improve symptom change predictions compared to the reference model. Message contents can be associated with both between-patients and session-by-session risk of drop-out. Our topic predictors were theoretically interpretable. Analysis of iCBT messages can have practical implications in improved drop-out risk assessment to aid in the allocation of additional supportive interventions.

Several studies have identified therapist cultural humility as an important predictor of client psychotherapy outcomes, yet most have been conducted cross-sectionally, retrospectively, and/or with inconsistent assessment of other related therapy process constructs. Here, we bridge this gap by examining early treatment ratings of therapist cultural humility, multicultural competence, working alliance, and client-centered treatment approaches as prospective predictors of client functioning in an active community clinic.

We assessed a new methodological and analytical approach for examining how therapist moment-to-moment interpersonal flexibility and responsiveness influence subsequent client collaboration. Therapist interpersonal flexibility was conceptualized as one of the crucial components of interpersonal responsiveness and operationalized as adjustments in therapists' interpersonal behaviors between speaking turns. To uncover the context-dependent nature of the responsiveness, the study also explored how these turn-to-turn adjustments, in relation to previous client collaboration, influence subsequent client collaboration. This study involved 1107 speaking turns nested in 12 sessions nested within three therapist-client dyads. Three raters assessed therapist interpersonal behaviors in dominance-submission and approach-avoidance dimensions for each therapist speaking turn and the level of client collaboration for each client speaking turn. Distance scores and Dynamic Structural Equation Modeling (DSEM) were used to explore the hypothesized effects at a within-session level. We found when therapists adjusted their interpersonal styles to a moderately high degree, clients were more collaborative than usual. We also found therapist turn-to-turn adjustments had a significantly positive effect on subsequent client collaboration only when clients were not collaborative before such adjustments were made. Overall, this study offers a methodological advancement in the study of therapist responsiveness by demonstrating the nuanced clinical insights offered by use of sophisticated analyses (i.e., within-session moment-to-moments responsiveness, Euclidean distance scores, Dynamic Structural Equation Modeling [DSEM]). Findings suggest a moderate level of turn-to-turn interpersonal adjustment may benefit subsequent client collaboration. Findings also suggest that a therapist's turn-to-turn adjustment in response to previous low client collaboration may facilitate subsequent client collaboration. Strengths, methodological limitations, and clinical implications are discussed.

Patients with epistemic mistrust struggle to view others as trustworthy sources of knowledge and often default to negative appraisals in social communication. The three communication systems theory posits that resolving epistemic mistrust involves three systems: the epistemic match, improving mentalizing, and the re-emergence of social learning outside therapy. This study aimed to empirically examine the theory to understand how epistemic trust develops in psychotherapy.

Our primary aim was to assess the associations between outcomes and therapist interpersonal skills (TIS) of empathy, congruence, regard, and unconditionality, as rated by young people. We also aimed to compare these associations against outcome-alliance associations, and to assess whether these associations were specific to a TIS-prioritizing therapeutic practice.

Patients with Major depressive disorder (MDD) and a comorbid Borderline personality disorder (BPD) show a poorer prognosis for MDD compared to patients without BPD. Little is known about the therapeutic processes underlying this prognosis. The goal of the present study was to investigate whether patients with more severe BPD symptoms experience less strengthening in patient-therapist movement synchrony (MS) throughout treatment, and whether less strengthening in MS is associated with less effective sessions. Ninety-five patients participating in a randomized control trial were assessed for BPD ( = 9) using the Structured Interview for DSM-IV Personality. 1367 video-taped sessions were analyzed for MS using Motion Energy Analysis. Session effectiveness was evaluated following each session using a one-item scale taken from the Helping Skills Measure. Multilevel models were used to assess whether BPD severity predicted MS throughout treatment, and whether MS predicted session effectiveness. Patients with more severe BPD symptoms experienced greater strengthening in MS throughout treatment. Less MS strengthening was associated with less session effectiveness. These findings indicate unique therapeutic processes that characterize individuals with more severe BPD symptoms. Shedding light on these unique processes has the potential to contribute to the personalization of MDD treatment for patients with BPD.

Maintaining relevance in a psychodynamic dialogue is a nuanced task, requiring therapists to balance between following patients' free associations while avoiding less effective interventions. Identifying less effective sequences of talk is especially challenging given the diversity of psychodynamic approaches and methodological barriers to analyzing session discourse. This study introduces a novel approach using the MATRIX coding system, an evidence-based tool, to differentiate content correlated with better session outcomes.

The Clinical Outcomes in Routine Evaluation (CORE) system was launched in 1998 intended to support the development of practice-based evidence and to reduce the research/practice gap. Since then, CORE instruments have been widely used.

Routine Outcome Monitoring (ROM) in group psychotherapy has shown varied results, as personalizing therapy for multiple patients is challenging. This study explored the impact of ROM and individual Add-On Interventions (AOIs) for patients with depression who were not progressing during Group Cognitive Behavioral Therapy (GCBT). We followed the research question, "How can individual AOIs contribute to patients' therapy courses?".

This study examines if experiencing the sequence of primary maladaptive emotions followed by primary adaptive emotions in-session predicts therapeutic change and whether this sequence mediates the impact of therapist emotional reflections on outcomes at post-treatment and follow-up.

This qualitative study explored changes described by individuals with complex dissociative disorders (CDDs) 2 years after participating in a psychoeducative group. Few recent studies have examined the early changes from incomprehensible reactions to the integration of traumatic events.

This study aims to evaluate the factor structure, reliability, and validity of the Clinician Affective REsponse (CARE) scales, a 15-item self-report measure designed for practical use in psychotherapy settings. Validation data were gathered from 151 mental health clinicians. These clinicians completed the CARE scales alongside measures capturing sociodemographic and professional details, patient demographics and clinical details, therapeutic intervention characteristics, therapeutic relationship elements, and session outcomes. The CARE scales had a three-factor structure: positive engagement (= 5, = .78), enmeshed (= 5, = .72), and stuck (= 5, = .71). Confirmatory factor analysis (CFA) yielded the following fit indices for the three-factor model: = 120.41, CFI = .94; TLI = .93, RMSEA = .05, and SRMR = .08. Multigroup CFA (which pooled two samples for a total of 607 subjects) showed that the CARE scales were invariant across remote and in-person session formats. The scales showed meaningful correlations with concurrent measures of working alliance, real relationship, countertransference, patient's experience of the therapeutic relationship, and session outcome. The CARE scales are a valuable instrument in clinical, training, and research contexts, adept at capturing clinicians' session-level affective responses and perceptions of the therapeutic relationship. Quantifying these reactions facilitates statistical analysis and empirical research, while their monitoring can guide therapeutic interventions and inform clinical supervision.

Dropout is a major factor undermining the effectiveness of psychotherapy, however, it remains poorly anticipated in clinical practice. Classification trees may offer simple, accessible, and practical solutions to identifying patients at-risk of dropout by synthesizing potentially complex patterns of relationships among intake measures.

: This special section underscores the potential of multimodal measurement approaches to transform psychotherapy research. A multimodal approach provides a more comprehensive understanding than any single modality (type of collected information) can provide on its own. Traditionally, clinicians and researchers have relied on their intuition, experience, and training to integrate different types of information in a psychotherapy session/treatment. Increasingly, however, computational methods offer a complementary alternative, enabling more automated, data-driven, and reproducible solutions.: The six empirical examples in this special section illustrate the emerging-and often interdisciplinary-methodologies, including text, audio, video, and physiological measures, that are relevant in the psychotherapy setting. While each study addressed distinct research questions and employed unique methodologies, they all demonstrated a commitment to leveraging multimodal measurement and tackling the challenges of integrating diverse data sources.

This study applied a mixed-methods approach to investigate rater effects that might affect case report evaluation in China. In the quantitative phase, we randomly assigned 210 mental health professionals to the experienced or novice ratee condition to rate the same structured case report on assessment and formulation, intervention strategy, relationship, and self-reflection. The qualitative phase was subsequently conducted to help make sense of the results. We interviewed twelve supervisors about how they would rate a case report and factors they thought would influence their evaluation. Linear model with non-constant variances revealed that the manipulation of ratee experience did not significantly bias ratings. Raters whose self-identified theoretical orientation aligned with that of the report provided higher and less dispersed ratings for intervention strategy and therapeutic relationship competencies. As their years of experience increased, theoretically congruent raters tended to give lower and more dispersed ratings. Thematic analysis revealed highly variable cognitive processes, and identified rater theoretical expertise, evaluation context, rater subjectivity and dual relationships as important factors to consider. This study indicate that theoretically congruent raters would be desirable, but raters with more years of experience should be cautioned against giving stringent ratings for theoretically familiar cases.

There is a growing consensus that interpersonal processes are key to understanding psychotherapy. How might that be reflected in the brain? Recent research proposes that inter-brain synchrony is a crucial neural component of interpersonal interaction. The current proof-of-concept study examines, for the first time, therapist-patient inter-brain synchrony measurement during multiple sessions. To guide the design of future studies, we performed a precursory test in a small sample of the association between inter-brain synchrony and therapeutic change, hypothesizing that it would gradually increase over therapy, reflecting inter-brain plasticity.

High levels of change are linked to the flexibility between immersion and distancing, as well as to higher levels of therapeutic alliance. This study aims to explore the evolution of flexibility between immersion and distancing throughout the entire therapeutic process and its relationship with therapeutic alliance and depressive symptoms in a clinical case.

Cognitive behavioral therapy (CBT) and Emotion-focused therapy (EFT) are empirically supported models for treating depression. Comparisons of the models regarding outcome exist, but no comparison of the clients' experiences of change. This study explored and compared experiences of change in CBT and EFT for major depression.

Teletherapy via videoconferencing has become common practice but has unique challenges. We aimed to develop and validate the first performance-based observer-rated measure of teletherapy skills: The Teletherapy Facilitative Interpersonal Skills Performance Task (Tele-FIS). We developed a set of 12 Tele-FIS video stimulus clips as simulations of four research-informed common therapeutic challenges in teletherapy: technology, distraction, boundaries and privacy, and emotional disconnection. A total of 153 therapists recorded interventions to the clips which were later rated on interpersonal skills. The Tele-FIS performance task demonstrated good interrater reliability, internal consistency, test-retest reliability, and convergent validity. The Tele-FIS was positively associated with self-reported facilitative interpersonal skills, self-efficacy, attitudes towards technology, and observer-rated skills on a version of the FIS task that simulates in-person therapy. Therapists performed similarly on teletherapy clips of emotional disconnection and privacy issues compared to clips of in-person therapy. Therapists performed worse on Tele-FIS clips of technology and distraction challenges than in-person therapy clips. The Tele-FIS has potential as an assessment tool in skills training for trainees and licensed clinicians as well as future research about therapeutic work via teletherapy. Results are discussed to consider therapist skill and the use of practice-relevant materials in training.

Emotion-Focused Therapy is one of the evidence-based psychotherapies for a range of psychological problems. While most evidence was gained from randomized controlled studies or process research at university settings, there is a need for more outcome research conducted within practitioner-researcher networks assessing the effectiveness of Emotion-Focused Therapy in private practice.

Countertransference (CT) has been shown to interfere with therapy goals, and its management is crucial to desired treatment outcomes. As a first step, a clinician's awareness of their covert and overt CT reactions is critical to successfully managing CT. Research on CT awareness is scarce, however, mainly because of difficulties in empirically investigating and measuring this construct. In this study, we sought to develop and validate two instruments: one to measure CT feelings and one to measure CT behaviors.