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Journal: Psychotherapy (Chicago, Ill.)


Mentalizing-the capacity to understand others' and one’s own behavior in terms of mental states-is a defining human social and psychological achievement. It involves a complex and demanding spectrum of capacities that are susceptible to different strengths, weakness, and failings; personality disorders are often associated with severe and consistent mentalizing difficulties (Fonagy & Bateman, 2008). In this article, we will argue for the role of mentalizing in the therapeutic relationship, suggesting that although mentalization-based treatment may be a specific and particular form of practice, the “mentalizing therapist” is a universal constituent of effective psychotherapeutic interventions. (PsycINFO Database Record © 2014 APA, all rights reserved).

Concepts: Psychology, Therapy, Clinical psychology, Psychiatry, Psychotherapy, All rights reserved, Psychoanalysis, Carl Jung


Yalom and Leszcz (2005) indicated that interpersonal learning is a key therapeutic factor in group psychotherapy. In this study, we conceptualized interpersonal learning as the convergence over time between an individual’s and the group’s perception of the individual’s cohesion to the group. First, we developed parallel measures of: (a) an individual’s self-rated cohesion to the group (Cohesion Questionnaire-Individual Version [CQ-I]), and (b) the group’s rating of the individual’s cohesion to the group (CQ-G) based on the original Cohesion Questionnaire (CQ; Piper, Marache, Lacroix, Richardsen, & Jones, 1983). Second, we used these parallel scales to assess differences between an individual’s self-rating and the mean of the group’s ratings of the individual’s cohesion to the group. Women with binge eating disorder (N = 102) received Group Psychodynamic Interpersonal Psychotherapy. Participants were assigned to homogeneously composed groups of either high or low attachment anxiety. Outcomes were measured pre- and post-treatment, and the CQ-I and CQ-G were administered every fourth group session. We found significant convergence over time between the CQ-I and mean CQ-G scale scores in both attachment anxiety conditions. Participants with higher attachment anxiety had lower individual self-ratings of cohesion and had greater discrepancies between the CQ-I and CG-G compared with those with lower attachment anxiety. There was a significant relationship between greater convergence in cohesion ratings and improved self-esteem at post-treatment. More accurate self-perceptions through feedback from group members may be a key factor in facilitating increased self-esteem in group therapy. Group therapists may facilitate such interpersonal learning, especially for those higher in attachment anxiety, by noting discrepancies and then encouraging convergence between an individual and the group in their perceptions of cohesion to the group. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: Psychology, Eating disorders, Attachment theory, Bulimia nervosa, Family therapy, Binge eating disorder, Psychodynamic psychotherapy, Drama therapy


The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record


This article discusses how recent studies of the right brain, which is dominant for the implicit, nonverbal, intuitive, holistic processing of emotional information and social interactions, can elucidate the neurobiological mechanisms that underlie the relational foundations of psychotherapy. Utilizing the interpersonal neurobiological perspective of regulation theory, I describe the fundamental role of the early developing right brain in relational processes, throughout the life span. I present interdisciplinary evidence documenting right brain functions in early attachment processes, in emotional communications within the therapeutic alliance, in mutual therapeutic enactments, and in therapeutic change processes. This work highlights the fact that the current emphasis on relational processes is shared by, cross-fertilizing, and indeed transforming both psychology and neuroscience, with important consequences for clinical psychological models of psychotherapeutic change. (PsycINFO Database Record © 2014 APA, all rights reserved).

Concepts: Psychology, Neuroscience, Clinical psychology, Psychiatry, Psychotherapy, Family therapy, Psychoanalysis, Therapeutic relationship


An interpersonal model of Binge Eating Disorder (BED) posits that difficulties with social functioning precipitate negative affect, which in turn causes binge eating as a means of coping. Thus, long-term decreases in attachment insecurity may be important for women with BED. No research has assessed if long-term change in attachment insecurity is associated with sustained change in other outcomes. In the current study, we hypothesized that changes in attachment anxiety and avoidance will decrease at posttreatment and will be maintained up to 12 months after Group Psychodynamic Interpersonal Psychotherapy (GPIP). We further hypothesized that long-term stability of these changes in attachment insecurity will be related to other long-term outcomes. Women with BED (N = 102) attended 16 sessions of GPIP. Measures were completed pretreatment, posttreatment, at 6 and 12 months follow-up. Attachment anxiety, attachment avoidance, and the other outcome variables decreased significantly at 12 months posttreatment. Reductions in attachment anxiety and avoidance were significantly related to decreases in interpersonal problems up to 12 months posttreatment, and reduction in attachment anxiety was significantly related to decreases in depressive symptoms 12 months posttreatment. Further, the significant relationship between reduced attachment avoidance and decreased interpersonal problems strengthened over the long term. This is the first study to show an association between change in attachment insecurity and change in other outcomes in the long term, and to show an adaptive spiral in which greater reduction in attachment avoidance is increasingly associated with ongoing improvement of interpersonal problems. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: Time, Psychology, Eating disorders, Term, Attachment theory, Bulimia nervosa, Binge eating disorder, Attachment measures


The subject of therapist’s crying in therapy (TCIT) has been virtually ignored in the literature, with only 1 qualitative dissertation and 3 case studies devoted to the topic. This mixed-method survey study explored therapists' experiences with and attitude toward TCIT. Six hundred eighty-four U.S. psychologists and trainees filled out the survey online, revealing that 72% of therapists report having cried in therapy in their role as therapist. Data analysis indicated that the act of crying in therapy has less to do with personality or demographic factors (i.e., Big Five traits, sex, empathy) and more to do with the unique aspects of the therapy itself and the therapist’s identity in the therapeutic context (theoretical orientation, clinical experience, affective tone of the session). Clinicians with more experience, who are older, cried more in therapy than novice clinicians, despite lower crying frequency in daily life, suggesting that more experienced therapists feel more comfortable allowing themselves to experience and/or express such emotions in therapy sessions. Psychodynamic therapists reported slightly higher rates of TCIT than cognitive-behavioral therapists despite no difference in crying in daily life. Despite significant differences in crying rates in daily life, male and female clinicians report similar rates of TCIT. Data regarding the relationship between TCIT and Big Five personality traits, empathy, and perceived consequences of TCIT are reported. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: Psychology, Therapy, Clinical psychology, Cognitive behavioral therapy, Psychotherapy, Emotion, Big Five personality traits, Psychodynamic psychotherapy


What do patients prefer in their psychotherapy? Do laypersons and mental health professionals (as patients) want the same, or different, things? The authors systematically examined patients' psychotherapy preferences and quantitatively compared two samples of laypersons (N = 228, 1,305) with one sample of mental health professionals (N = 615) on the four dimensions of the Cooper-Norcross Inventory of Preferences: Therapist Directiveness Versus Client Directiveness, Emotional Intensity Versus Emotional Reserve, Past Orientation Versus Present Orientation, and Warm Support Versus Focused Challenge. On average, laypersons wanted therapist directiveness and emotional intensity. Robust differences were found between laypersons' and professionals' preferences on these two dimensions: Mental health professionals wanted less therapist directiveness than did laypersons (gs = 0.92 and 1.43 between groups) and more emotional intensity (gs = 0.49 and 1.33). Women also wanted more warm support than men (gs = 0.40 and 0.57). These findings suggest that psychotherapists should be mindful of their own treatment preferences and ensure that these are not inappropriately generalized to patients. (PsycINFO Database Record © 2019 APA, all rights reserved).


The therapeutic relationship and responsiveness/treatment adaptations rightfully occupy a prominent, evidence-based place in any guidelines for the psychological treatment of trauma. In this light, we critique the misguided efforts of the American Psychological Association’s (APA, 2017) Clinical Practice Guideline on Posttraumatic Stress Disorder in Adults to advance a biomedical model for psychotherapy and thus focus almost exclusively on treatment methods for particular disorders. Instead, the research evidence, clinical expertise, and patient preferences and culture (the necessary triumvirate of evidence-based practice) should converge on distinctive psychological guidelines that emphasize the therapy relationship, treatment adaptations, and individual therapist effects, all of which independently account for patient improvement more than the particular treatment method. Meta-analytic findings and several trauma-specific studies illustrate the thesis. Efforts to promulgate guidelines without including the relationship and responsiveness are seriously incomplete and potentially misleading. The net result is an APA Guideline that proves empirically dubious, clinically suspect, and marginally useful; moreover, it squanders a vital opportunity to identify what actually heals the scourge of trauma. We conclude with recommendations for moving forward with future APA practice guidelines. (PsycINFO Database Record © 2019 APA, all rights reserved).


Establishing a collaborative therapeutic relationship is an important research-supported goal for the initial sessions of psychotherapy. Fostering a collaborative relationship can occur through strategies such as recognizing the client’s expertise in treatment, involving the client in the treatment decision-making process, and discussing the possibility of therapist mistakes. In this article, we present theoretical and research support for establishing a collaborative relationship. We then provide a case example that illustrates different collaboration-building strategies. The article concludes with several clinical recommendations for how therapists can increase client collaboration in the initial sessions of treatment. (PsycINFO Database Record © 2019 APA, all rights reserved).


Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .28 (p < .001; 95% confidence interval [.23, .33]; equivalent of d = .58) for 82 independent samples and 6,138 clients. In general, the empathy-outcome relation held for different theoretical orientations and client presenting problems; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved).