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Worry is a phenomenon that is present in multiple psychopathologies. Given the widely accepted transdiagnostic role that worry plays in psychopathology, reliable measures for this construct are pivotal for clinical practice. The Penn State Worry Questionnaire (PSWQ) is one of the most widely used and established measures of worry in both clinical and non-clinical populations and it is accepted as a highly reliable measure. The present study aimed to examine the factor structure and psychometric properties of the PSWQ for the Portuguese population. The total sample consisted of 428 participants, 256 from the community, and 172 from the clinical population. Confirmatory factor analysis supported a model of one factor with a method factor containing the negatively worded items.

This case study of an undecided university student has two aims: to assess the effect of life design career counselling on autobiographical reasoning and career variables, and to analyse the client's narrative transformation using the innovative moments coding system. Results show improvement in career development and organization of autobiographical narrative. The client's narrative evolved from basic to complex levels of elaboration. The spontaneous emergence of re-conceptualization innovative moments differs from previous studies and suggests that counselling length and tasks can facilitate re-conceptualization. Among the implications, the use of narrative change markers to fit counselling tasks to clients' level of development is discussed.

According to the Dialogical Self Theory, the Self can move along the imaginal landscape of the mind and adopt different I-positions, endowing each position with a voice and enabling dialogical relationships (e.g., agreement, disagreement) among each other. Internal dialogues may have an important role regarding identity construction, self-regulation, and support, among others. However, if internal dialogues are not efficient or meaningful voices are suppressed, they may cause psychological problems. The current study aims to adapt and validate the Portuguese version of the Internal Dialogical Activity Scale - Revised (IDAS-R) and explore its correlations with personality dimensions and psychological indicators. The 397 participants, aged 15-73 years old, completed the IDAS-R and questionnaires to assess Well-Being, Satisfaction with Life, and the Big-Five Personality dimensions. Confirmatory factor analyses identified a factorial structure different than the one originally proposed. The CFA provided a best-fit model with four subscales – Identity Dialogues, Spontaneous Dialogues, Social and Supportive Dialogues, and Distressing Dialogues. All internal dialogues, except Identity Dialogues, correlated negatively with Well-Being and Satisfaction with Life and correlated positively with Neuroticism. We discuss these results, the possibility of assessing such dynamic processes by quantitative methods and point to new directions in the research of internal dialogicality. [ABSTRACT FROM AUTHOR]

This special section contains studies in which innovative moments are used as markers of changes in meaning in psychotherapy. Innovative moments, as an empirical operationalization of the concept of "unique outcomes" from narrative therapy, have been used as a strategy to evaluate changes in meaning in psychotherapy sessions and interviews. Innovative moments are defined as exceptions to the problematic pattern of meaning that is associated with clients' suffering. The emergence of these change markers indicates that flexibility is occurring in the meaning system. This special section contains five studies. Esposito et al. address innovative moments in group intervention by considering the idea that these events are not just individual but also interactional and collective events. Shimshi et al. study shifts between self-states and their relation to innovative moment production in therapy. These shifts are associated with the production of innovative moments, providing further support for the idea that flexibility and the emergence of these change markers are associated. Leeav et al. analyze the relationship between innovative moment production and the therapeutic alliance in a single case study. Fernandez-Navarro et al. interview therapists to understand whether coding innovative moments in sessions may help therapists become more attuned to these events in practice. Finally, Koustafa et al. analyze the evolution of innovative moments in a small sample of individuals with bulimia nervosa. Together, these studies illustrate the potential of this concept as well the domains in which it may be applicable. [ABSTRACT FROM AUTHOR]

Introduction: Innovative moments (IMs) pinpoint new and more adaptative meanings that emerge in clients' discourse during psychotherapy. Studies with adult clients have found a greater proportion of IMs in recovered compared to unchanged cases, but similar studies have yet to be conducted with adolescents. Aims: The paper aims (1) to study retrospectively the emergence of IMs in therapy, using a post‐therapy interview, in adolescents that underwent psychotherapy for depression, and (2) to characterize the themes present in IMs identified retrospectively in the interviews. Method: Semi‐structured post‐treatment interviews conducted with 24 adolescents on the experience of taking part in a clinical trial of youth depression, were coded using the Innovative Moments Coding System. After identifying IMs, a thematic analysis identified the prominent themes within them. Results: Higher presence of IMs were found in recovered compared to unchanged cases. Two main themes emerged in the IMs, changes that occurred with therapy and attributions of changes. Recovered cases presented more IMs centred on the self, whereas unchanged cases identified more non‐specific changes. Conclusion: This study suggests that it is possible to code IMs, identified retrospectively, based on post‐therapy interviews with adolescents. Meaningful differences were found between recovered compared to unchanged cases. Therapeutic recovery was associated with a higher focus on the self and more specificity in clients' representations of the change process. [ABSTRACT FROM AUTHOR]

In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression. [ABSTRACT FROM AUTHOR]

This study tests an add‐on procedure to foster change in Career Construction Counseling by eliciting reconceptualization innovative moments. After the career counseling intervention with 42 participants, 21 participants were allocated to the add‐on procedure, consisting of two additional sessions focused on eliciting reconceptualization innovative moments In turn, participants in the comparison group attended two extra intervention sessions in which the lifetime task was used. Outcome measures assessing vocational behavior and psychological distress were applied at the onset, at the end of counseling and after the two additional sessions. The findings show that Career Construction Counseling was effective, allowing a significant increase in vocational certainty, vocational identity, career decision‐making, and a decrease in psychological distress. After counseling, participants in the add‐on intervention fostering reconceptualization innovative moments revealed greater gains in vocational identity and psychological distress than those in the comparison group. The practical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

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Recently, Goldfried suggested that one main reason for the underdevelopment of psychotherapy as a scientific enterprise was the lack of acknowledgment of past contributions. In this article, this issue is illustrated by analysing the particular case of acceptance and commitment therapy (ACT). ACT has clear overlaps with therapies from the systemic tradition, such as strategic therapy in the line of the Mental Research Institute in Palo Alto and with the more recent models of solution‐focused therapy and narrative therapy. This article analyses theoretical overlaps with these models (e.g. the paradoxical nature of human problems and the nature of language) as well as examples of similarities in therapeutic strategies (externalization and the miracle question). It concludes by suggesting that this practice of inadvertently obliterating the past does not favour the development of the field or the creation of consensus but rather contributes to the ongoing proliferation of 'new' psychotherapy models. Trends that may contribute to circumventing this problem are discussed. [ABSTRACT FROM AUTHOR]

Patient ambivalence towards change is a central therapeutic target in the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). However, we do not know if and how patients resolve ambivalence across the sessions and modules of the UP. Previous studies have identified two types of ambivalence resolution—dominance and negotiation—and different patterns of resolution for recovered and unchanged cases. Objectives: This exploratory single case study aimed to describe the frequency of observed ambivalence resolution strategies across UP sessions and evaluate the impact of distinct ambivalence resolution strategies on ambivalence. Method: Sixteen sessions of a recovered case were coded with observational measures of ambivalence and ambivalence resolution. Results: Observed ambivalence significantly decreased; dominance remained highly frequent across sessions, and negotiation increased from the beginning to the middle phase of treatment but not from the middle to the final phase. Negotiation was significantly associated with ambivalence reduction. Conclusion: The progression of ambivalence resolution strategies differed from previous studies with distinct therapeutic approaches; promoting negotiation between the different parts of the client's inner conflict across the whole therapy may be valuable in dealing with patient ambivalence in UP treatment. [ABSTRACT FROM AUTHOR]

Copyright of Psico-USF is the property of Universidade Sao Francisco, Programa de Pos-Graduacao Stricto Sensu em Psicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This case study explores the collaboration that occurs between therapist and client when reconceptualization innovative moments emerge. Reconceptualization innovative moments are exceptions to the problematic self-narrative that brought the client to therapy and are associated with successful psychotherapy. Reconceptualization innovative moments have two main components: a contrast between a past problematic facet and a current, more adjusted one (e.g., before I did/thought/felt X..., now, I do/think/feel Y) and an attribution for what allowed this transformation to occur (e.g., this was possible because I realized Z). The collaboration between therapist and client was analyzed using the Therapeutic Collaboration Coding System, which conceptualizes the relationship as collaborative or as noncollaborative. The majority of interactions in this case were clearly collaborative, with the therapist and client working inside the therapeutic zone of proximal development, which is typical of successful psychotherapy cases. Reconceptualization innovative moments begin with collaborative exchanges in which the therapist supported the problem and the client elaborated on the change afterward. Implications of these findings for change in psychotherapy are discussed. [ABSTRACT FROM AUTHOR]

Background: There are a plethora of studies on expressive writing and positive writing interventions, but few have addressed the combination of both paradigms. Additionally, research on the role of ambivalence toward change in the context of writing-based interventions is lacking. Ambivalence toward change is a natural movement of approaching and avoiding change that may occur in various situations. In psychotherapy, its resolution is associated with successful outcomes. Aim: This study tested the efficacy of a combination of expressive and positive writing paradigms in an internet-based intervention to improve university students' mental health. Additionally, focusing participants on a current, unresolved problem allowed us to explore the possible role of ambivalence toward change as a mediator of the intervention's results. Methods: We recruited 172 participants who were randomly divided into experimental (n = 85) and control (n = 87) groups. The intervention consisted of the identification of a current problem and four writing tasks on consecutive days. Assessment was conducted at baseline and posttest in both groups and at follow-up in the experimental group. Participants in the experimental condition were also assessed after each task. Measures of anxiety, depression, rumination, ambivalence toward change, distress, and wellbeing (optimism, affect, and satisfaction with life) were collected. Results: Multivariate analysis of variance (MANOVA) showed that participants in the experimental group had a significant decrease from baseline to posttest in ambivalence toward change and rumination when compared with the control group. These results were maintained at follow-up. No differences were found in the remaining measures. Within the experimental group, ambivalence toward change, rumination, and distress significantly decreased throughout the intervention and the exploratory mediation analysis indicated that ambivalence toward change partially mediated the improvements in rumination and distress. Discussion: Considering different perspectives about a current problem and using a combination of expressive and positive writing fostered the reduction of ambivalence toward change and rumination. Ambivalence toward change reduction after the second writing task may have created optimal conditions for the subsequent decrease in rumination and distress. Future studies should replicate this finding and dismantle the components that are more adequate in changing these variables. [ABSTRACT FROM AUTHOR]

Innovative moments (IMs) are moments in which the previous problematic pattern of meaning is challenged. Studies have shown that IMs are associated with good psychotherapy outcomes. A three-level hierarchy of IMs was observed in recent studies, with level 1 IMs being more elementary and levels 2 and 3 being more complex and associated with treatment success. However, studies with manualized protocol treatments are thus far lacking. This study analyzed the longitudinal progression of IMs in the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) and explored its associations with changes in psychological distress. Data were collected from a Portuguese university-based outpatient clinic and included 18 cases with positive outcomes. Nine sessions of each case were coded with the IM coding system (N=162). Multilevel analyses showed a significant increase in all IM levels across treatments. The decrease in psychological distress predicted an increase in level 2 IMs in the same session. The evolution of IMs is similar to what was found previously in other studies. Contrary to what was found in previous studies, IMs did not predict outcomes in the following session, whereas the reduction in psychological distress predicted the emergence of level 2 IMs. [ABSTRACT FROM AUTHOR]

Objective: Prior research, mainly conducted on depression, observed that clients' improved capability to process their emotions predicted better therapeutic outcomes. The current comparative study aimed to investigate whether emotional processing was related to therapeutic change in complicated grief. Method: We analyzed two contrasting cases (good or poor outcome) treated with grief constructivist therapy. In both cases we investigated the association of emotional processing (Experiencing Scale) to (1) therapeutic outcome (Inventory of Complicated Grief), and (2) change in the type of grief-related emotions (Emotions Episodes). Results: The session-by-session growth of clients' emotional processing and the change of grief-related emotions were qualitatively explored throughout both cases. Compared with the poor outcome case, the good outcome case achieved more improvement in the ability to process emotions. Such improvement occurred alongside a deeper change in the type of grief-related emotions aroused, from maladaptive to more adaptive responses. Conclusion: Our findings suggest that a higher emotional processing capability may be associated with the transformation of grief-related maladaptive emotions and with the improvement of complicated grief condition. [ABSTRACT FROM AUTHOR]

Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good‐outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time‐backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university‐based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time‐backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p <.0001; R2adj =.29). Specifically, good‐outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor‐outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time × dropout; β11 =.64, p =.014). Additionally, poor‐outcome dropouts presented higher levels of ambivalence (β01 = 9.92, p <.0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed. [ABSTRACT FROM AUTHOR]

Career Construction Counseling fosters client change by evoking and elaborating innovative moments in client narratives. In this article, we describe four types of dialogues that counselors may use to prompt narrative novelty and foster client change: (a) identify and evaluate the effects of innovative moments, (b) highlight contrasting self-positions, (c) ask about changes achieved, (d) promote a meta-perspective on change. Vignettes from a case are used to illustrate how to use IM markers as a heuristic guide for when to engage in these four types of dialogues. [ABSTRACT FROM AUTHOR]

Portugal is one of the European countries that implemented early protective measures in the context of the COVID-19 pandemic. Portugal declared a state of emergency on 18 March, and a set of regional and national preventive public health measures was progressively implemented. Studies on the psychological impact of pandemics show evidence of the negative impact on mental health. Of particular concern are individuals with previous fragility (e.g. personal, family or occupational) and those undergoing life transitions. In this paper, we present a telephone-based psychological crisis intervention that was implemented to provide brief, appropriate, and timely psychological help. This intervention follows standard models of crisis intervention and is structured in five phases and five different intervention modules to take into account the impact of the pandemic on the mental health of specific risk groups. With these support services, we hope to help our community better cope with the immediate impact of the pandemic and to contribute to preventing serious mental health problems in the medium and long term. [ABSTRACT FROM AUTHOR]

Copyright of Análise Psicológica is the property of Instituto Superior de Psicologia Aplicada and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Emotional processing is an empirically established predictor of pre–post therapy improvement in depression. However, its relationship to symptom alleviation over time requires clarification. To clarify the contribution of emotional processing to gradual symptom improvement, we explored both (1) the effect of emotional processing on pre–post therapy changes in depressive symptoms (final outcome) and (2) its association with the intensity of clinical symptoms across sessions (session-by-session outcome). These relationships were estimated in a sample of 50 depressed clients treated with cognitive–behavioral therapy (CBT) or emotion-focused therapy (EFT). Emotional processing was measured by the Experiencing Scale during Emotion Episodes in five sessions taken across therapy. As expected, we found that a greater increase in emotional processing during treatment predicted a greater pre–post therapy improvement in depressive symptoms. Higher levels of emotional processing predicted next-session lower intensity on clinical symptoms, but the intensity of symptoms contributed to explaining the subsequent level of emotional processing achieved. Our observations suggest that clients' capabilities to process their emotions may both facilitate and be promoted by gradual improvement in symptoms. These results suggest the reciprocal predictive influence of emotional processing and symptoms on the therapeutic change in depression. [ABSTRACT FROM AUTHOR]

The FIND (Feedback Initiated Narrative Development) protocol was designed to foster the availability of clients' resources in psychotherapy. This protocol consists of two brief interviews and an observation of an early psychotherapy session, centered on the elicitation of the client's personal resources. The contents of both the interviews and the observed session are summarized for clients and therapists in the form of therapeutic letters. The theoretical background of this protocol is presented in this paper, which focuses on the first part of the protocol, illustrating it with clinical vignettes. The FIND protocol was developed after more than 10 years of research on innovative moments in psychotherapy and is based on narrative therapy practices and dialogical self theory tenets. Other research and models further contributed to the development of this protocol, such as the hypothesis of capitalization of resources; studies that emphasize clients´ active role in their own change; and research on autobiographical memories and narrative construction of identity. Drawing on these models, the FIND protocol attempts to prime and activate the client´s resources (i.e., potential innovative moments) from the beginning of therapy, with the aim of improving psychotherapy efficacy. [ABSTRACT FROM AUTHOR]

Objectives: Innovative moments (IMs) are exceptions to the maladaptive framework of meaning that causes distress. Dialogically, IMs can be seen as new, neglected or silenced I-positions that can prompt an alternative, more satisfying self-narrative to emerge. Research has suggested that IM production is associated with recovery in psychotherapy and is mediated by relational schemas. This exploratory research aims to study how relational I-positions are organized at the onset of treatment and how they evolve and reorganize along treatment. Method: A thematic analysis approach was used in a case study of a client diagnosed with major depressive disorder treated successfully with cognitive behavior therapy. Results: Three overarching themes (defending myself, being with me, and bonding with others) that encompassed the relational I-positions were expressed in more than half of the IMs. The themes were further divided into subthemes. The subthemes progressively displayed a more adaptive and integrated set of relational I-positions along treatment. Discussion: Relational I-positions are present in the IMs from the beginning of psychotherapy. IMs seem to include progressively more relational I-positions played out in clients' interpersonal encounters. In addition, the relational I-positions became more adaptive as psychotherapy progressed. This exploratory study suggests that the relational I-positions present in IMs are associated with increased flexibility along treatment. [ABSTRACT FROM AUTHOR]

Reasoning may help solving problems and understanding personal experiences. Ruminative reasoning, however, is inconclusive, repetitive, and usually regards negative thoughts. We asked how reasoning as manifested in oral autobiographical narratives might differ when it is ruminative versus when it is adaptive by comparing two constructs from the fields of psychotherapy research and narrative research that are potentially beneficial: innovative moments (IMs) and autobiographical reasoning (AR). IMs captures statements in that elaborate on changes regarding an earlier personal previous problem of the narrator, and AR capture the connecting of past events with other parts of the narrator's life or enduring aspects of the narrator. A total of N = 94 university students had been selected from 492 students to differ maximally on trait rumination and trait adaptive reflection, and were grouped as ruminators (N = 38), reflectors (N = 37), and a group with little ruminative and reflective tendencies ("unconcerned," N = 19). Participants narrated three negative personal experiences (disappointing oneself, harming someone, and being rejected) and two self-related experiences of more mixed valence (turning point and lesson learnt). Reflectors used more IMs and more negative than positive autobiographical arguments (AAs), but not more overall AAs than ruminators. Group differences were not moderated by the valence of memories, and groups did not differ in the positive effect of narrating on mood. Trait depression/anxiety was predicted negatively by IMs and positively by AAs. Thus, IMs are typical for reflectors but not ruminators, whereas the construct of AR appears to capture reasoning processes irrespective of their ruminative versus adaptive uses. [ABSTRACT FROM AUTHOR]

This paper aims to describe the Innovative Moments (IM) Coding System (IMCS), an idiographic and transtheoretical methodology that allows the identification of IMs—markers of changes in the client's initial maladaptive framework of meaning—throughout psychotherapy. The present study introduces the theoretical background underlying this methodology, along with the main empirical findings resulting from former studies that have applied this tool to clinical data. The IMCS application is also detailed: the coding phases, the training steps and inter‐rater agreement measures. In order to illustrate the application of IM coding, a case study is presented. Although a partial coding was used, the results are in line with previous research. Discussion is centred on the usefulness of the IMCS for the advance of process research in psychotherapy, and the potential use of this methodology in group format. [ABSTRACT FROM AUTHOR]

Research emphasizes that individuals' engagement with change process is a significant predictor of therapeutic outcomes. Ambivalence is a natural phenomenon in change processes, but when individuals cannot overcome it, their problems may intensify. Ambivalence towards change, a client variable characterized by an intrapersonal conflict between two positions of the self, one in favour of change and another one in favour of the status quo, is shown to play a determinant role in psychotherapy. Despite its importance, few empirical studies have examined this process, and the considerable methodological differences among existing studies make it difficult to generalize results. Therefore, instruments measuring ambivalence in an effective way can help broaden the understanding of the process. First, we performed a content analysis of ambivalence events identified in psychotherapy sessions from previous studies using an observational coding system. The factor structure, reliability and validity of the measure were tested using 91 and confirmed with 223 psychotherapy clients at any time during the therapeutic process. A two‐factor structure was found, suggesting two components of Ambivalence—Demoralization and Wavering. The results indicated that the Ambivalence in Psychotherapy Questionnaire exhibits good psychometric properties, including good convergent and divergent validity. The implications are discussed. [ABSTRACT FROM AUTHOR]

This article applies a dialogical analysis to the change processes involved in moving from engagement with to disengagement from an armed militant group, as well as from radicalization to deradicalization. The findings underline the interplay between different push and pull factors at individual, organizational, and societal levels that played a role in the already mentioned processes in three periods of time—engagement with, life within, and disengagement from an armed organization. The dialogical framework conceptualizes the development trajectory as relationships between a variety of positions of the self (I-positions), which generate different personal meanings involved in processes of disengagement and deradicalization. [ABSTRACT FROM AUTHOR]

Innovative moments are alternative meanings to the problems expressed by clients and are organized into three levels. This study analyzes if these levels are not only change markers related to symptomatology outcomes, but also gradual steps in meaning development. A thematic analysis was carried out in a case of depression treated with narrative therapy. Results revealed three themes that evolved from level 1 to level 3. Levels 1 and 2 corresponded to one specific theme and almost all level 3 integrated different themes (polythematic). Level 3 innovative moments might be an integrative bridge allowing the construction of a more adaptive meaning framework. [ABSTRACT FROM AUTHOR]

Previous studies have found an association between therapeutic alliance and treatment outcome, but only recently have researchers begun to analyse time‐lagged relationships between session‐to‐session measures of alliance and outcomes with hierarchical linear modelling (HLM). HLM assumes simple correlation structures between any two measurements from the same client. In this paper, we suggest that this assumption might be problematic. Session‐to‐session measurements of outcomes (Outcome Questionnaire‐10.2) and alliance (Working Alliance Inventory) in a sample (N = 63) were used to perform HLM analyses to test time‐lagged (lag +1) relations between outcomes and alliance in both directions. A first set of analyses replicated the models consistently used in the literature, whereas a second set of models considered a correlation structure as a function of time. A correlation independent of time distance resulted in a bidirectional influence between alliance and outcomes (the model commonly used in the literature), but when considering a correlation structure as a function of time, only the outcomes were predictive of alliance. Considering a more complex correlation structure as a function of time seems to be an important analytical strategy for addressing the issue of variability in within‐client measurements over time. This study highlights how the misspecification of a statistical model, namely, not considering a time‐dependent correlation structure of the response variable, may lead to misleading findings in HLM studies. This is particularly relevant in process–outcome research, such as studies analysing the impact of therapeutic alliance on clinical outcomes. [ABSTRACT FROM AUTHOR]

This article advances understanding of career construction counseling (CCC) by viewing it through the lens of the innovative moments model (IMM) of how clients construct change. The IMM conceives clients' narrative transformations as resulting from counselors prompting and clients reflecting on exceptions to a problematic self‐narrative (i.e., innovative moments; IMs) that emerges in counseling dialogues. On the basis of intensive IMM analysis of CCC case studies, the authors propose an integration of the 2 models that describes the sequence of client change in IMs across the 3 phases of CCC. This proposal provides both conceptual and assessment tools that make it possible to describe and analyze the process of client change through life‐designing dialogues. The authors illustrate the integrated framework with vignettes from case studies and conclude by suggesting research to examine the validity and usefulness of the client change sequence and interventions for using this pattern of change to foster client transformation. [ABSTRACT FROM AUTHOR]

Background: The identification of poor outcome predictors is essential if we are to prevent therapeutic failure. Ambivalence – defined as a conflictual relationship between two positions of the self: one favoring change and another one favoring problematic stability – has been consistently associated with poor outcomes. However, the precise relationship between ambivalence and clients' symptomatology remains unclear. Objective: This study aims at assessing ambivalence's power to predict symptomatology, using a longitudinal design. Methods: The complete 305 sessions of 16 narrative and cognitive-behavioral cases have been analyzed with the Ambivalence Coding System and outcome measures have been used for each session. Results: Ambivalence emerged as a significant predictor of subsequent symptomatology suggesting that ambivalence is not only related to treatment outcomes, but that it represents a strong predictor of subsequent symptomatology. Discussion: The implications of ambivalence's power to predict outcomes for research and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Innovative moments (IMs) are exceptions to the maladaptive framework of meaning that typically motivates clients to seek psychotherapy, and previous studies have shown that IMs are associated with psychotherapy outcomes. While IMs are exceptions that occur at the level of the therapeutic conversation, relational schemas are more stable patterns, and their increased flexibility may facilitate change during psychotherapy. With this in mind, we tested the hypothesis that IMs contribute to outcomes by improving the flexibility of relational schemas. Method: The Core Conflictual Relationship Theme (CCRT) was used to assess relational schemas. IMs were evaluated using the Innovative Moments Coding System. The sample included 22 clients diagnosed with major depressive disorder. The flexibility of the three components of the CCRT (Wishes, responses of the self (RS), and responses of others (RO)) were tested as mediators between IMs and outcomes. Results: The flexibility of the RS was a mediator between IMs and outcomes, but Wishes and RO were not. Conclusion: These findings align with previous research showing that RS is the component most open to change, whereas the other components seem less sensitive to change during brief therapy. [ABSTRACT FROM AUTHOR]