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Journal: Psychotherapy research : journal of the Society for Psychotherapy Research

28

Abstract One requirement for psychotherapy research is an accurate assessment of therapeutic interventions across studies. This study compared frequency and depth of therapist interventions from a dynamic perspective across four studies, conducted in four countries, including three treatment arms of psychodynamic psychotherapy, and one each of psychoanalysis and CBT. All studies used the Psychodynamic Intervention Rating Scales (PIRS) to identify 10 interventions from transcribed whole sessions early and later in treatment. The PIRS adequately categorized all interventions, except in CBT (only 91-93% categorized). As hypothesized, interpretations were present in all dynamic therapies and relatively absent in CBT. Proportions of interpretations increased over time. Defense interpretations were more common than transference interpretations, which were most prevalent in psychoanalysis. Depth of interpretations also increased over time. These data can serve as norms for measuring where on the supportive-interpretive continuum a dynamic treatment lies, as well as identify potentially mutative interventions for further process and outcome study.

Concepts: Therapy, Psychometrics, Cognitive behavioral therapy, Psychotherapy, Psychoanalysis, Sigmund Freud, Psychodynamic psychotherapy, Psychodynamics

27

Abstract The current study is the first to evaluate the effectiveness of a brief relational-cultural model of therapy in a community-based mental health center for women. The study was distinctive in its use of a hybrid model that employed elements of randomized control and naturalistic design. Results showed that the entire treatment group of 91 women improved significantly on all eight outcome measures. Therapeutic gains were maintained at 3- and 6-month follow-ups. The results lend support to the importance of including relational-cultural factors in the treatment of women. An adherence scale/manual was developed and implemented and will allow for replication.

Concepts: Medicine, Therapy, Classification of Pharmaco-Therapeutic Referrals, The Current

22

Although there is an established link between patients' early positive outcome expectation for and their actual improvement from therapy, there is little research on patients' change in outcome expectation across therapy and both patient and therapist correlates of early outcome expectation level and change. The present study examined: (i) the overall trajectory of change in patients' outcome expectation through cognitive-behavioral therapy (CBT) for depression; (ii) patient characteristics as predictors of both initial outcome expectation and change in outcome expectation; and (iii) between-therapist effects in outcome expectation change.

Concepts: Present, Time, Illness, Clinical psychology, Cognitive behavioral therapy, Major depressive disorder, Psychotherapy, Psychoanalysis

8

Although the past decade has witnessed growing research interest in positive psychological interventions (PPIs), their potential as adjunctive interventions for psychotherapy remains relatively unexplored. Therefore, this article expands the frontiers of PPI research by reporting the first randomized controlled trial to test a gratitude writing adjunctive intervention for psychotherapy clients. Participants were 293 adults seeking university-based psychotherapy services. Participants were randomly assigned to one of three conditions: (a) control (psychotherapy only), (b) a psychotherapy plus expressive writing, and © a psychotherapy plus gratitude writing. Participants in the gratitude condition wrote letters expressing gratitude to others, whereas those in the expressive writing condition wrote about their deepest thoughts and feelings about stressful experiences. About 4 weeks as well as 12 weeks after the conclusion of the writing intervention, participants in the gratitude condition reported significantly better mental health than those in the expressive and control conditions, whereas those in the expressive and control conditions did not differ significantly. Moreover, lower proportions of negative emotion words in participants' writing mediated the positive effect of condition (gratitude versus expressive writing) on mental health. These findings are discussed in light of the use of gratitude interventions as adjunctive interventions for psychotherapy clients.

Concepts: Psychology, Epidemiology, Randomized controlled trial, Linguistics, Writing, Clinical psychology, Psychiatry, Control

4

It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this.

Concepts: Experience, Knowledge

3

To identify psychotherapy clients' motives for concealing suicidal ideation from their therapist, and their perceptions of how their therapists could better elicit honest disclosure.

2

Aim: Socioeconomic deprivation is known to be associated with depression and anxiety symptoms. This study aimed to investigate the influence of several domains of neighbourhood deprivation on psychological treatment outcomes. Method: Healthcare records from 44805 patients who accessed psychological treatment were analyzed. Patient-level depression (PHQ-9) and anxiety (GAD-7) outcome measures were linked to their neighbourhood statistics, including area-level indices of income, unemployment, education, health and disability, crime, housing quality, and quality of the local environment. Linear regressions were applied to examine associations between these domains and post-treatment symptom severity after controlling for patient-level and service-level variables. Results: Neighbourhood income and crime rates were associated with depression and anxiety symptoms after controlling for covariates, explaining 4% to 5% of variability in treatment outcomes. Patients living in low-income areas required a higher number of treatment sessions to benefit from therapy. Conclusions: Patients living in economically deprived neighbourhoods tend to have poorer depression and anxiety treatment outcomes and require lengthier interventions.

2

The dose-response effect refers to the relationship between the dose (e.g., length, frequency) of treatment and the subsequent probability of improvement. This systematic review aimed to synthesize the literature on the dose-response effect in routine psychological therapies delivered to adult patients with mental health problems. Twenty-six studies were eligible for inclusion. Different methodological approaches have been used to examine the dose-response effect; including survival analysis, multilevel modelling and descriptive cluster analyses. Replicated and consistent support was found for a curvilinear (log-linear or cubic) relationship between treatment length and outcomes, with few exceptions such as eating disorders and severe psychiatric populations. Optimal doses of psychotherapy in routine settings range between 4 and 26 sessions (4-6 for low intensity guided self-help) and vary according to setting, clinical population and outcome measures. Weekly therapy appears to accelerate the rate of improvement compared to less frequent schedules. Most of the reviewed evidence is from university counselling centres and outpatient psychotherapy clinics for common mental health problems. There is scarce and inconclusive evidence in clinical samples with chronic and severe mental disorders.

2

A sense of disconnection for people who are suicidal seems to be a key construct of previous literature. Therapists' ways of encountering and understanding people who are suicidal have not been previously researched in depth using qualitative methodologies.

Concepts: Scientific method, Perception

2