Search

Objectives: The effects of oxytocin (OT) administration on psychotherapeutic processes have thus far been elusive. This study explored the effect of OT administration on patient-therapist congruence of the working alliance., Method: Inpatients with mental disorders ( N  = 87) participating in a randomized controlled trial received OT ( n  = 44) or placebo ( n  = 43) intranasally twice a day, for four weeks. Patients and therapists rated the alliance after each session., Results: Oxytocin significantly moderated the level of agreement ( b  = -0.56, SE  = 0.25, t  = -2.30, p  = 0.02), such that patients receiving OT demonstrated lower discrepancy ( b  = -0.73, p  < 0.001) than did those receiving placebo ( b  = -1.30, p  < 0.001). On the other hand, the mutual covariance of patient-therapist ratings across sessions was positive and significant for patients receiving placebo ( b  = 0.26, p  = 0.01) but not for patients in the OT group ( b  = -0.06, p  = .56)., Conclusion: Oxytocin can reduce discrepancies of patient-therapist perceptions of the alliance, although additional studies are needed to explore OT's effect on alliance development over time. As alliance congruence is associated with therapy outcomes, such intervention may lead to enhancement of therapeutic gains.

Objective: Affective flexibility, the capacity to respond to life's varying environmental changes in a dynamic and adaptive manner, is considered a central aspect of psychological health in many psychotherapeutic approaches. The present study examined whether affective two-dimensional (i.e., arousal and valence) temporal variability extracted from voice and facial expressions would be associated with positive changes over the course of psychotherapy, at the session, client, and treatment levels., Method: A total of 22,741 mean vocal arousal and facial expression valence observations were extracted from 137 therapy sessions in a sample of 30 clients treated for major depressive disorder by nine therapists. Before and after each session, the clients self-reported their level of well-being on the outcome rating scale. Session-level affective temporal variability was assessed as the mean square of successive differences between consecutive two-dimensional affective measures., Results: Session outcome was positively associated with temporal variability at the session level (i.e., within clients, between sessions) and at the client level (i.e., between clients). Importantly, these associations held when controlling for average session- and client-level valence scores. In addition, the expansion of temporal variability throughout treatment was associated with steeper positive session outcome trajectories over the course of treatment., Conclusions: The continuous assessment of both vocal and facial affective expressions and the ability to extract measures of affective temporal variability from within-session data may enable therapists to better respond and modulate clients' affective flexibility; however, further research is necessary to determine whether there is a causal link between affective temporal variability and psychotherapy outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The literature on affective regulation in psychotherapy has traditionally relied on explicit client self-report measures. However, both clients' and therapists' affect fluctuate moment-to-moment during a session, highlighting the need for more implicit and continuous indices to better understand these dynamics. This study examined parasympathetic interpersonal and intrapersonal regulation dynamics between therapists and clients with Major Depressive Disorder during Supportive-Expressive Therapy., Method: Data were collected from 52 dyads across five preselected sessions, using the Respiratory Sinus Arrhythmia (RSA) index. We employed a longitudinal Actor-Partner Interdependence Model, with clients self-reporting their functioning level before and after each session, as the moderator., Results: Therapists' RSA at one time point negatively associated with clients' RSA at the next, and vice-versa, indicating interpersonal regulation. Clients' RSA at one time point was positively associated with their RSA at the next, indicating intrapersonal regulation. However, only interpersonal regulation was significantly moderated by clients' pre-to-post session functioning. Specifically, sessions where clients led positive dyadic RSA associations showed greater improvement in clients' functioning than those led by therapists., Conclusion: Physiological interpersonal regulation, measured by RSA, may be a catalyst for change in depression treatment. Therapists who are responsive to clients' arousal levels may help clients improve their functioning.

Mental health services are experiencing notable transformations as innovative technologies and artificial intelligence (AI) are increasingly utilized in a growing number of studies and services.These cutting-edge technologies carry the promise of substantial improvements in the field of mental health. Nevertheless, questions emerge about the alignment of novel technologies and AI systems with human needs, especially in the context of vulnerable populations receiving mental healthcare. The practice-oriented research (POR) model is pivotal in seamlessly integrating these emerging technologies into clinical research and practice. It underscores the importance of tight collaboration between clinicians and researchers, all driven by the central goal of ensuring and elevating client well-being. This paper focuses on how novel technologies can enhance the POR model and highlights its pivotal role in integrating these technologies into clinical research and practice. We discuss two key phases: pre-treatment, and during treatment. For each phase, we describe the challenges, present the major technological innovations, describe recent studies exemplifying technology use, and suggest future directions. Ethical concerns and the importance of aligning humans and technology are also considered, in addition to implications for practice and training., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aimed at understanding and improving psychological therapies as they are conducted in clinical routine, practice-oriented research (POR) is now a well-established approach to the scientific foundations of mental health care services. Resting on the accumulation of a wide range of practice-based evidence related to treatment outcome and process, as well as factors associated with the participants of psychotherapy and its context, POR is ripe for new developments - regarding what to investigate and how to investigate it. This paper is the introduction of a series devoted to recent advances and future directions of POR as their pertained to routine outcome monitoring, technologies and artificial intelligence, the integration of constructs and methods from program evaluation and implementation science, and the investigation of populations with limited financial resources across various regions of the world. The series also includes commentaries from two leaders of POR., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The association between emotional experience and expression, known as emotional coherence, is considered important for individual functioning. Recent advances in natural language processing (NLP) make it possible to automatically recognize verbally expressed emotions in psychotherapy dialogues and to explore emotional coherence with larger samples and finer granularity than previously. The present study used state-of-the-art emotion recognition models to automatically label clients' emotions at the utterance level, employed these labeled data to examine the coherence between verbally expressed emotions and self-reported emotions, and examined the associations between emotional coherence and clients' improvement in functioning throughout treatment. The data comprised 872 transcribed sessions from 68 clients. Clients self-reported their functioning before each session and their emotions after each. A subsample of 196 sessions were manually coded. A transformer-based approach was used to automatically label the remaining data for a total of 139,061 utterances. Multilevel modeling was used to assess emotional coherence and determine whether it was associated with changes in clients' functioning throughout treatment. The emotion recognition model demonstrated moderate performance. The findings indicated a significant association between verbally expressed emotions and self-reported emotions. Coherence in clients' negative emotions was associated with improvement in functioning. The results suggest an association between clients' subjective experience and their verbal expression of emotions and underscore the importance of this coherence to functioning. NLP may uncover crucial emotional processes in psychotherapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Despite the clinical significance of emotional diversity, also known as emodiversity, there has been limited investigation into the therapeutic interventions that influence this construct. In the current study we examined the association between immediate therapist self-disclosure (TSD) and emodiversity among two diagnostic groups who tend to experience emotional difficulties: people with schizophrenia and people with emotional disorders (i.e., depression and/or anxiety)., Method: The sample comprised 74 clients (37 diagnosed with schizophrenia and 37 with emotional disorders) treated by 45 therapists in a university clinic setting. Following each session, clients self-reported their emotions, and therapists completed a measure of frequency and centrality of their immediate TSD during the session., Results: Longitudinal multilevel models indicated that immediate TSD was positively associated with clients' global emodiversity, both at the within- and the between-client levels, as well as with clients' negative emodiversity at the between-client level. Moreover, clients with emotional disorders and clients with schizophrenia did not differ in the association between immediate TSD and emodiversity. In addition, across groups, clients treated by therapists who used more immediate TSD on average showed greater increases in global emodiversity during treatment., Conclusions: immediate TSD is associated with clients' ability to experience rich and diverse emotional experiences across different disorders. The theoretical and clinical implications of these findings are discussed., (© 2024 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objective: Although the clinical significance of the therapeutic alliance (TA) is well documented, the literature regarding the establishment of TA and the relation between client-therapist agreement on it to short-term outcome among various diagnostic groups-and specifically among clients diagnosed with serious mental illness (SMI)-is sparse. The aim of the present study was to examine the effect of client diagnosis on the abovementioned TA characteristics., Method: Dyadic analyses of session-by-session (SBS) data were used to compare clients diagnosed with schizophrenia and clients diagnosed with emotional disorders (based on a clinical interview) in their TA characteristics., Results: TA as initially rated by clients was stronger in the emotional disorders group than in the schizophrenia group. Higher TA ratings, regardless of whether these were provided by the therapist or the client, predicted better subsequent functioning in the emotional disorders group, whereas in the schizophrenia group, this association was observed only among good-outcome cases., Conclusions: Establishing TA, having client-therapist agreement on it, and having clients derive therapeutic benefit from it might be more challenging with clients with schizophrenia than with clients with emotional disorders. Special attention should be given to specific challenges and needs regarding clients' diagnosis in order to enhance favourable therapy outcomes., (© 2023 The British Psychological Society.)

Background: Progress feedback, also known as measurement-based care (MBC), is the routine collection of patient-reported measures to monitor treatment progress and inform clinical decision-making. Although a key ingredient to improving mental health care, sustained use of progress feedback is poor. Integration into everyday workflow is challenging, impacted by a complex interrelated set of factors across patient, clinician, organizational, and health system levels. This study describes the development of a qualitative coding scheme for progress feedback implementation that accounts for the dynamic nature of barriers and facilitators across multiple levels of use in mental health settings. Such a coding scheme may help promote a common language for researchers and implementers to better identify barriers that need to be addressed, as well as facilitators that could be supported in different settings and contexts., Methods: Clinical staff, managers, and leaders from two Dutch, three Norwegian, and four mental health organizations in the USA participated in semi-structured interviews on how intra- and extra-organizational characteristics interact to influence the use of progress feedback in clinical practice, supervision, and program improvement. Interviews were conducted in the local language, then translated to English prior to qualitative coding., Results: A team-based consensus coding approach was used to refine an a priori expert-informed and literature-based qualitative scheme to incorporate new understandings and constructs as they emerged. First, this hermeneutic approach resulted in a multi-level coding scheme with nine superordinate categories and 30 subcategories. Second-order axial coding established contextually sensitive categories for barriers and facilitators., Conclusions: The primary outcome is an empirically derived multi-level qualitative coding scheme that can be used in progress feedback implementation research and development. It can be applied across contexts and settings, with expectations for ongoing refinement. Suggestions for future research and application in practice settings are provided. Supplementary materials include the coding scheme and a detailed playbook., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Therapists' ability to accurately assess their clients' emotions is a critical clinical skill across various therapeutic approaches. However, little is understood about the contexts that facilitate or interfere with the effects of this accuracy on therapeutic outcomes. This study investigated the relationship between therapists' empathic accuracy (EA) concerning their clients' emotions and session outcomes, and whether this relationship is moderated by the therapists' use of different intervention types. A sample of 81 clients treated by 50 therapists in a university setting was used for the study. Following each session, clients rated the emotions they experienced during the session, as well as the quality of the session, while therapists rated their perception of their clients' emotions. Findings revealed that therapists' EA for negative emotions (but not positive ones) positively correlated with higher client evaluations of the session. Furthermore, the frequency of exploratory interventions (but not directive ones) moderated this relationship. The results highlight that merely being empathically accurate in assessing clients' negative emotions may not be sufficient; therapists who employ an exploratory approach while being empathically accurate can better facilitate emotional processing, potentially leading to improved outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. Method: We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Results: Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Conclusion: Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices.

Objective: Immediate therapist self-disclosure (Im-TSD) can be a powerful intervention. When engaged in judiciously, it can provide clients with a unique opportunity to explore their interpersonal relationship in real time. Relational theories suggest that for Im-TSD to be effective, both client and therapist must have temporally congruent perceptions of its occurrence. The present study examined (a) whether clients and therapists are temporally congruent in their session-by-session ratings of Im-TSD; and (b) whether this congruence is associated with therapy outcomes. Method: After each session, clients (n = 102) and therapists (n = 60) at a university-based clinic indicated whether Im-TSD was present during the session. Before each session, clients self-reported their functioning. They rated session quality after each session. Results: Therapists' ratings of their Im-TSD tended to be temporally congruent with their clients' Im-TSD ratings. Greater temporal congruvdence was associated with greater improvement over time in clients' experience of the session as helpful, but not with changes in clients' functioning. Conclusion: The findings highlight the importance of establishing a stronger temporal congruence of Im-TSD ratings between therapists and clients to further improve clients' experiences in treatment. The findings' implications are discussed as well as situations in which temporal congruence may not be beneficial.

Objective: Client-therapist physiological synchrony has recently attracted significant empirical attention. Recent theoretical accounts propose that physiological linkages should not be considered a stable dyadic virtue but rather a dynamic process that depends on the situational context in which they transpire. The present study adopted a "momentary" (vs. "global") approach that focuses on therapist-client physiological synchrony over relatively short periods of time. These temporal data served to examine the interplay between patterns of synchrony (in-phase vs. antiphase) and clients' momentary emotional experiences (inhibited/unproductive, productive, and positive). Synchrony was assessed by measuring respiratory sinus arrhythmia (RSA), an autonomic index that is known to be associated with interpersonal emotion regulation., Method: Data were drawn from 28 clients undergoing a 16-session supportive-expressive dynamic therapy for depression. Clients' and therapists' electrocardiography were recorded in five sessions; clients' emotional experiences were coded at the speech-turn level. After each session, the clients also completed the session evaluation scale., Results: Client-therapist dyads had greater momentary RSA synchrony than would be predicted by chance. Compared to moments of unproductive emotional experience, greater antiphase synchrony was observed during moments of productive emotional experiences. In addition, compared to moments of unproductive emotional experience, greater in-phase and antiphase synchrony were observed during moments of positive emotional experiences. These patterns of synchrony were associated with clients' favorable evaluations of the session., Conclusion: By considering the dynamic nature of synchrony, these findings provide a fine-grained picture of physiological synchrony and its potential effects on therapy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Depression is a major cause of disability worldwide. Recent data suggest that, in industrialised countries, the prevalence of depression peaks in middle age. Identifying factors predictive of future depressive episodes is crucial for developing prevention strategies for this age group., Aims: We aimed to identify future depression in middle-aged adults with no previous psychiatric history., Method: To predict a diagnosis of depression 1 year or more following a comprehensive baseline assessment, we used a data-driven, machine-learning methodology. Our data-set was the UK Biobank of middle-aged participants ( N = 245 036) with no psychiatric history., Results: Overall, 2.18% of the study population developed a depressive episode at least 1 year following baseline. Basing predictions on a single mental health questionnaire led to an area under the curve of the receiver operating characteristic of 0.66, and a predictive model leveraging the combined results of 100 UK Biobank questionnaires and measurements improved this to 0.79. Our findings were robust to demographic variations (place of birth, gender) and variations in methods of depression assessment. Thus, machine-learning-based models best predict diagnoses of depression when allowing the inclusion of multiple features., Conclusions: Machine-learning approaches show potential for being beneficial for the identification of clinically relevant predictors of depression. Specifically, we can identify, with moderate success, people with no recorded psychiatric history as at risk for depression by using a relatively small number of features. More work is required to improve these models and evaluate their cost-effectiveness before integrating them into the clinical workflow.

Background: Difficulties in emotion regulation (ER) abilities have been found to play a central role in different psychiatric disorders. However, researchers rarely compare ER across different diagnostic groups. In the current study, we examined ER and its relation to functional and symptomatic outcome among three distinct diagnostic groups: people with schizophrenia (SCZ), people with emotional disorders (EDs; i.e., depression and/or anxiety), and individuals without any psychiatric diagnosis (controls)., Methods: Participants in this study comprised 108 adults who requested psychotherapy at a community clinic in the year 2015 and between 2017 and 2019. Clients were interviewed and filled out questionnaires measuring depression, distress, and difficulties in ER abilities., Results: Results showed that individuals with psychiatric diagnoses reported higher levels of difficulties in ER abilities than did controls. Moreover, there were very few differences in levels of ER difficulty between SCZ and EDs. Further, the associations between maladaptive ER and psychological outcomes were significant in each diagnostic group, and especially for SCZ., Conclusion: Our study indicates that difficulties in ER abilities partially have a transdiagnostic nature, and that these difficulties are associated with psychological outcomes among both clinical populations and controls. There were very few differences in levels of ER ability difficulties between SCZ and EDs, suggesting that the two groups share difficulties in relating and responding to emotional distress. The associations between difficulties in ER abilities and outcome were more robust and stronger among SCZ than the other groups, highlighting the potential contribution of targeting ER abilities in the treatment of schizophrenia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Igra, Shilon, Kivity, Atzil-Slonim, Lavi-Rotenberg and Hasson-Ohayon.)

Depression affects millions worldwide, thus underscoring the urgent need to optimize health care practices. To better understand the processes involved in psychotherapy gains, studies have emphasized the need to complement subjective reports with objective measures, in particular biological markers. Oxytocin (OT) has been proposed as a potential biomarker in the treatment of depression given its involvement in depression-related psychological and physiological functions and the formation of close relationships. Here, we assessed whether OT reactivity to therapeutic encounters (absolute and/or directional reactivity) is linked to improvements in depressive symptoms from session to session during psychotherapy. A total of 284 saliva samples were collected from 30 adult clients who underwent 16 sessions of manualized psychodynamic psychotherapy for depression in a university setting. Salivary OT was measured before and after five preselected sessions distributed evenly throughout the therapy. The Beck Depression Inventory-II (BDI-II) was administered at the beginning of each session. Multilevel growth models indicated that clients exhibiting greater absolute OT reactivity showed greater improvement in depressive symptoms throughout treatment. Directional reactivity was not associated with depressive symptom change. In addition, clients with higher baseline OT levels displayed less change in depressive symptoms. These findings highlight reactivity of the OT system, in either direction, as an important feature of the treatment response. Consistent with recent models of the neurobiology of resilience, OT reactivity appears to serve as an important biomarker of psychotherapy gain in the treatment of depression. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Most measures of psychotherapy outcome focus on symptomatic change. However, clients often report other changes through therapy, such as increased self-acceptance. This study reports on the development and validation of the Complementary Measure of Psychotherapy Outcome (COMPO) that assesses different areas of psychological functioning deemed important by clients and therapists. Items were written based on a literature review of client-reported change and feedback from experienced therapists. Exploratory factor analysis was conducted on the initial 42-item COMPO administered to 264 psychotherapy clients. Iterative item reduction resulted in the final 12-item, four-factor solution, with factors named self-acceptance, self-knowledge, relationship quality, and consideration of others. This factor structure, along with a bifactor model that contains a general factor and the four domain-specific factors, was replicated on a sample of 571 adults in the community. The 12-item COMPO exhibits convergent validity with measures of self-esteem, insight, social support, and empathy; demonstrates 2-week test-retest reliability; and predicts life satisfaction. The 12-item COMPO was further administered to 28 clients in short-term psychodynamic therapy for depression. Except for consideration of others, COMPO subscales and total scale scores improved from pre- to posttherapy. Posttherapy COMPO scores were also higher among clients who experienced clinically significant change compared to those who did not. The COMPO was negatively associated with depressive symptoms and impairments in functioning across the three samples. The brevity of the COMPO makes it a convenient tool to supplement symptom-based measures for a more comprehensive assessment of outcome in psychotherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: While previous studies have indicated that therapists' self-disclosure (TSD) can have curative effects, the contextual variables that may moderate the link between TSD and treatment outcome have not been sufficiently explored. Using session-by-session psychotherapy data, we examined the extent to which within-client distress and between-clients emotion regulation difficulties moderated the associations between TSD and session outcomes. Method: The sample comprised 68 clients treated according to the principles of psychodynamic psychotherapy by 47 therapists in a university clinic. Emotion regulation difficulties were assessed at the beginning of treatment, and functioning and distress levels as well as symptoms were assessed at the beginning of each session. After each session, therapists completed a measure of frequency and centrality of their immediate and non- immediate self-disclosure interventions during the session. Results: At the within-client level, in sessions marked by high pre-session client distress, immediate TSD was associated with a better next session outcome. At the between-clients level, for clients who had low emotion regulation difficulties, immediate TSD was marginally associated with better outcomes. Conclusion: These findings highlight the importance of considering within-client level as well as between-clients level variables when deciding upon self-disclosure.

Computerized natural language processing techniques can analyze psychotherapy sessions as texts, thus generating information about the therapy process and outcome and supporting the scaling-up of psychotherapy research. We used topic modeling to identify topics discussed in psychotherapy sessions and explored (a) which topics best identified clients' functioning and alliance ruptures and (b) whether changes in these topics were associated with changes in outcome. Transcripts of 873 sessions from 58 clients treated by 52 therapists were analyzed. Before each session, clients self-reported functioning and symptom level. After each session, therapists reported the extent of alliance rupture. Latent Dirichlet allocation was used to extract latent topics from psychotherapy textual data. Then a sparse multinomial logistic regression model was used to predict which topics best identified clients' functioning levels and the occurrence of alliance ruptures in psychotherapy sessions. Finally, we used multilevel growth models to explore the associations between changes in topics and changes in outcome. Session-based processing yielded a list of semantic topics. The model identified the labels above chance (65% to 75% accuracy). Change trajectories in topics were associated with change trajectories in outcome. The results suggest that topic models can exploit rich linguistic data within sessions to identify psychotherapy process and outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: The present study implements an automatic method of assessing arousal in vocal data as well as dynamic system models to explore intrapersonal and interpersonal affect dynamics within psychotherapy and to determine whether these dynamics are associated with treatment outcomes., Method: The data of 21,133 mean vocal arousal observations were extracted from 279 therapy sessions in a sample of 30 clients treated by 24 therapists. Before and after each session, clients self-reported their well-being level, using the Outcome Rating Scale., Results: Both clients' and therapists' vocal arousal showed intrapersonal dampening. Specifically, although both therapists and clients departed from their baseline, their vocal arousal levels were "pulled" back to these baselines. In addition, both clients and therapists exhibited interpersonal dampening. Specifically, both the clients' and the therapists' levels of arousal were "pulled" toward the other party's arousal level, and clients were "pulled" by their therapists' vocal arousal toward their own baseline. These dynamics exhibited a linear change over the course of treatment: whereas interpersonal dampening decreased over time, there was an increase in intrapersonal dampening over time. In addition, higher levels of interpersonal dampening were associated with better session outcomes., Conclusions: These findings demonstrate the advantages of using automatic vocal measures to capture nuanced intrapersonal and interpersonal affect dynamics in psychotherapy and demonstrate how these dynamics are associated with treatment gains. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Raw linguistic data within psychotherapy sessions may provide important information about clients' progress and well-being. In the current study, computerized text analytic techniques were applied to examine whether linguistic features were associated with clients' experiences of distress within and between clients and whether changes in linguistic features were associated with changes in treatment outcome. Transcripts of 729 psychotherapy sessions from 58 clients treated by 52 therapists were analyzed. Prior to each session, clients reported their distress level. Linguistic features were extracted automatically by using natural language parser for first-person singular identification and using positive and negative emotion words lexicon. The association between linguistic features and levels of distress was examined using multilevel models. At the within-client level, fewer first-person singular words, fewer negative emotional words and more positive emotional words were associated with lower distress in the same session; and fewer negative emotion words were associated with lower next session distress (rather small f2 effect sizes = 0.011 < f2 < 0.022). At the between-client level, only first session use of positive emotion words was associated with first session distress (ηp2 effect size = 0.08). A drop in the use of first-person singular words was associated with improved outcome from pre- to posttreatment (small ηp2 effect size = 0.05). The findings provide preliminary support for the association between clients' linguistic features and their fluctuating experience of distress. They point to the potential value of computerized linguistic measures to track therapeutic outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In this study, we used multilevel vector autoregressive network analysis to examine clients' intrapersonal and client-therapist interpersonal emotional dynamics from session to session. We expected to find differences in the network structure (i.e., the density) of responders versus nonresponders to treatment. The sample comprised 95 clients treated by 58 therapists in a university clinic. Clients and therapists self-reported their emotions after each session. The functioning level was assessed at the beginning of each session using clients' self-reports. The results indicated that higher intrapersonal density among clients' emotions within the temporal network (associations from session to session) was associated with less improvement in functioning, but higher intrapersonal density among clients' emotions within the contemporaneous network (same-session associations) was not associated with clients' functioning level. Additionally, higher interpersonal density among clients'-therapists' emotions within the contemporaneous network was associated with greater improvement in clients' functioning. These findings highlight the importance of recognizing the dynamic nature of emotions within the client, as well as between the client and the therapist and the contribution of such session-by-session emotional dynamics to the outcome of psychotherapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7., Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies., Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session., Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: The current investigation aimed to examine the possible association between therapists' flexibility in use of therapeutic techniques from different therapy orientations (i.e., therapeutic technique diversity; TTD) and subsequent improvement in client-reported (a) global functioning, as well as (b) quality of the working alliance, following sessions in which alliance ruptures occurred., Method: Clients ( n = 81) who received time-limited psychodynamic therapy in a community clinic, completed session-by-session reports of working alliance and global functioning. Therapists ( n = 56) completed session-by-session reports of working alliance and their use of therapeutic techniques across different therapeutic orientations, using the Multitheoretical List of Interventions (MULTI-30)., Results: We found a curvilinear association between TTD in rupture sessions and client-reported global functioning at the sessions subsequent to rupture sessions, such that moderate levels of TTD were associated with greater subsequent improvement in functioning, compared with low and high levels of TTD. However, TTD was not significantly associated with subsequent changes in the quality of working alliance., Conclusions: Our results suggest that moderate levels of TTD in the face of alliance ruptures are tied to clients' global functioning improvement during psychodynamic psychotherapy. These findings highlight the importance of further investigation of a varied delivery of therapeutic techniques, especially in the face of alliance ruptures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Aim : Self Compassion (SC) has been consistently linked to decreased emotional distress and is offered as a mechanism of change in several therapeutic approaches. The current study aimed to identify therapists' interventions that enhance clients' SC within individual psychodynamic psychotherapy. We examined a diverse set of interventions as predictors of clients' SC, on treatment and session levels. We hypothesized that improvement in SC will be associated with greater use of directive or common factor interventions. Method : Client/therapist ( N  = 89) dyads from a university-based community clinic participated in the study. Therapists' interventions and changes in clients' SC level were monitored at each psychotherapy session. Results: Clients' SC in a given session was not predicted by therapist use of interventions from any of the three clusters in the previous session. However, positive change in SC across treatment was predicted by greater use of directive interventions. Furthermore, among clients with low pretreatment SC, a positive change in SC across treatment was predicted by lesser use of common factor interventions. Discussion: The results highlight the importance of understanding clients' pretreatment characteristics when selecting therapeutic interventions and suggest that the integration of directive interventions into the psychodynamic therapeutic practice may be beneficial in enhancing clients' SC.

Early change is an increasing area of investigation in psychotherapy research. In this study, we analyzed patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multiple outcome measures for the first time. We used growth mixture modeling to identify different latent classes of early change in interpersonal problems with 212 patients who underwent cognitive-behavioral treatment including interpersonal and emotion-focused elements. Furthermore, videotaped sessions were analyzed using motion energy analysis, providing values for the calculation of nonverbal synchrony to predict early change in interpersonal problems. The relationship between early change patterns and symptoms as well as overall change in interpersonal problems was also investigated. Three latent subgroups were identified: 1 class with slow improvement (n = 145), 1 class with fast improvement (n = 12), and 1 early deterioration class (n = 55). Lower levels of early nonverbal synchrony were significantly related to fast improvement in interpersonal change patterns. Furthermore, such patterns predicted treatment outcome in symptoms and interpersonal problems. The results suggest that nonverbal synchrony is associated with early change patterns in interpersonal problems, which are also predictive of treatment outcome. Limitations of the applied methods as well as possible applications in routine care are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients' and therapists' estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument., Method: We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size., Results: Heterogeneity analyses (k = 22, Cohen's d = -.46, 95% confidence interval = .31-1.1) produced a significant Q-statistic (Q = 94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate., Conclusions: Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client's diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients' and therapists' estimations than do more general instruments that are applied to assess TA.

There is a growing consensus among psychotherapy theoreticians and researchers that psychotherapy processes are an interpersonal phenomenon that can be studied as a dynamic system. The aim of this special section is to highlight the importance of exploring the complex processes that emerge over time from interactions and feedback loops amongst sub-components (e.g., emotions, non-verbal behavior, physiology, voice, subjective experience) within and between clients and therapists. The articles featured in this special section discuss multiple methods and angles to study dynamic dyadic processes in psychotherapy that can better capture the complexity of the therapeutic process and the ways it can lead to favorable outcomes. Future research that focuses on dynamic dyadic processes in psychotherapy is outlined.

Clients' emotional experience (EE) and self-understanding (SU) are two clients' processes thought to play a key role in many therapeutic approaches, especially psychodynamic (PD) psychotherapy. Previous studies exploring client processes and the interventions assumed to promote them have found that both processes and interventions are related to a reduction in symptoms. However, the complex associations between the use of specific interventions, clients' processes and symptomatic outcomes have rarely been investigated. Using data collected on a session-by-session basis, we explored (a) the temporal associations between clients' processes (EE and SU) and treatment outcomes (clients' level of functioning), (b) the associations between therapists' AF and PD interventions and clients' processes, and (c) the direct and indirect associations among therapists' interventions, clients' processes, and clients' functioning. Clients ( N = 115) undergoing PD psychotherapy reported their general functioning presession using the Outcome Rating Scale, and their EE and SU postsession using the Emotional Experience Self-Report and Self-Understanding Scale, respectively. Therapists reported their use of interventions postsession using the Multitheoretical List of Interventions. Longitudinal multilevel models indicated that higher EE and SU scores predicted subsequent change in functioning. Moderate (vs. high or low) use of AF interventions predicted an increase in clients' EE. Greater use of PD interventions predicted an increase in clients' SU, which also mediated improvement in functioning. These findings highlight the importance of adjusting therapists' use of interventions to promote clients' therapeutic processes and outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Deficits in metacognition have often been identified as a central feature in various forms of psychopathology. The current study explores changes in metacognition and symptoms during the process of psychodynamic-oriented psychotherapy conducted in a community setting among people with diverse psychological challenges. We examined the associations between metacognition and symptoms at both the within-client and the between-clients level. Nine good-outcome and nine poor-outcome cases of psychodynamic treatment were analyzed. In terms of metacognitive abilities, results showed that clients who were part of the good-outcome group had higher levels of decentration than did clients who were part of the poor-outcome group. In addition, clients' ability to understand the other's mind improved significantly only for clients in the good-outcome group. Furthermore, sessions in which clients' self-reflectivity was higher were followed by increased symptom levels (in the next session) beyond group (poor or good outcome group). Clinical implications regarding the improvement of metacognitive abilities and their associations with outcome measures are discussed.

Objective : The present study aimed to examine the association between patient-therapist micro-level congruence/incongruence ratio and psychotherapeutic outcome. Method : Nine good- and nine poor-outcome psychodynamic treatments (segregated by comparing pre- and post-treatment BDI-II) were analyzed ( N  = 18) moment by moment using the MATRIX (total number of MATRIX codes analyzed = 11,125). MATRIX congruence was defined as similar adjacent MATRIX codes. Results : the congruence/incongruence ratio tended to increase as the treatment progressed only in good-outcome treatments. Conclusion : Progression of MATRIX codes' congruence/incongruence ratio is associated with good outcome of psychotherapy.

Objective: According to the Assimilation Model, the self is consisted of multiple internal voices which are sometimes conflicted, or even dissociated, from one another. Thus, a key therapeutic goal is to create awareness and dialogue between a patient's various internal voices, in order to facilitate positive change. A recent development of this theoretical line suggests that clinically addressing both the patients' and therapists' internal voices, and their mutual influences, contributes significantly to the treatment outcome. Current study aims to examine: (a) Patients' progression throughout treatment in their quality of movement of self-states, from lower levels of dissociation to higher ones of dialectics, and whether this pattern is associated with positive outcomes; (b) temporal congruence in patient-therapist quality of movement of self-states and its association with session outcome. Method: Nine good and nine poor-outcome cases of psychodynamic treatment were analyzed ( N  = 18) for both the patient and the therapist using the TPA, an expansion of the assimilation of problematic experiences scale (APES). Patients completed the Outcome Rating Scale (i.e., ORS), a session-by-session measure that assesses overall functioning, and symptomatic pre-and-post treatment measures (BDI). Results: A quadratic pattern of change was observed on the TPA of patients from the good-outcome cases: Patients showed more conflict in the beginning, avoidance between self-states in the middle phase, and dialectics towards the end. Additionally, the patient-therapist TPA temporal congruence was significantly related to session outcome of the good-outcome group. Conclusion: These findings emphasize the importance of combining an intra-psychic and inter-psychic set of lenses when inquiring therapeutic processes.

Client-therapist synchrony in various channels (e.g., self-reported affect or physical movement) has been shown as a key process in the construction and development of therapeutic alliance. However, psychophysiological synchrony between clients and therapists has been understudied, with the few extant studies typically relying on single-session data, and no studies examining it within the context of emotion-focused techniques. The main aim of the current paper is to examine the role of client-therapist physiological synchrony during segments of one emotion-focused technique-namely, imagery (IM) work-in predicting therapeutic alliance, and to compare it to the role of synchrony during segments of more traditional cognitive-behavioral (CB) techniques. We conducted an open-trial study in which 31 clients with test anxiety received a 6-session protocol-based treatment. Both clients' and therapists' electrodermal activity (EDA) were continuously assessed during sessions. The physiological measures for 5 sessions each (N = 128) were used to compute client-therapist synchrony in IM and CB segments. Therapeutic alliance was assessed using the Session Alliance Inventory. Client-therapist dyads' synchrony during IM and CB segments was, on average, greater than chance. Synchrony varied mostly at the session (vs. the dyad) level. Multilevel analyses revealed that the synchrony within IM segments (but not within CB segments) was significantly associated with the therapeutic bond aspect (but not the task/goal aspects) of alliance. Physiological synchrony during emotion-focused IM is tied to the bond component of the therapeutic alliance at the session level. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: Emotional experience during psychotherapy is considered a core mechanism of change. Yet the sheer experience itself may not necessarily be beneficial; instead, the trajectories of emotional experience need to be explored as possible predictors of treatment outcomes. This study investigated whether clients' pre-treatment levels of emotion regulation and symptoms predicted patterns of session-to-session change in emotional experience. We also explored which patterns better predict clients' improvement in emotion regulation and symptoms from pre- to post treatment., Method: One-hundred and seven clients undergoing psychodynamic psychotherapy completed questionnaires on their symptoms and emotion regulation at pre- and post- treatment. They also reported their level of emotional experience at the end of each session., Results: Pre-treatment symptoms and difficulties in emotion regulation predicted greater instability in emotional experience. Higher mean levels of emotional experience during treatment were associated with an improvement in emotion regulation, and greater stability during treatment was associated with improvement in emotion regulation and symptoms., Conclusions: These findings lend weight to the idea that experiencing emotion in the therapeutic environment has significant implications for clients' ability to manage their emotions outside the session. However, emotions experienced in an unstable manner within therapy are associated with poorer outcomes. Clinical and methodological significance of this article: Therapists can benefit from observing the patterns and not only the level of their clients' emotional experiences. The identification of clients' difficulties early in treatment may help therapists guide clients through the delicate process of carefully attending to their emotions.

Objective: Therapists' empathic accuracy (EA) toward their clients' fluctuating emotions is a crucial clinical skill that underlies many therapeutic interventions. In contrast to the subjective components of empathy, limited empirical work has addressed EA or its effect on the outcomes of psychotherapy. Here, we differentiate between the components of EA (tracking accuracy, directional discrepancy) as well as the valence of the target emotions (positive vs. negative). We also investigated the relative contribution of cognitive and emotional processes to therapists' EA and examined the associations between EA and treatment outcomes., Method: The sample comprised 93 clients treated by 62 therapists in a university setting. Prior to each session, clients self-reported their symptoms. Following each session, clients rated their positive (PE) and negative (NE) emotions during the session and therapists rated their own emotions, as well as their assessment of their clients' emotions., Results: Therapists accurately tracked their clients' PE and NE and were more accurate for NE. Therapists tended to overestimate their clients' NE and underestimate their clients' PE. Therapists' emotions were associated with their clients' emotions (real similarity). Therapists' emotions were also associated with their assessments of their clients' emotions (assumed similarity). Therapists' own emotions partially mediated the association between clients' emotions and therapists' assessments. Therapists' inaccuracy in assessing their clients' PE was associated with higher reported symptoms in the next session., Conclusion: These findings help provide a better understanding of the specific characteristics associated with more EA and underscore the importance of EA in facilitating clients' emotional well-being. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Clients' emotions often serve as a major focus for therapists' attention. Interestingly, little is known about the factors that facilitate or hinder therapists' accurate assessment of these emotions. We hypothesized that therapists' accuracy would be negatively tied to their clients' emotional fluctuation (i.e., instability) and positively tied to the therapists' own inferential fluctuation (i.e., flexibility) as well as to the clients' emotional intensity. Clients ( N = 98/ N = 76) received weekly psychodynamic psychotherapy at a university-based clinic. Following each session, clients reported their within-session emotions, and therapists provided their own assessment of their clients' emotions. As expected, when clients' emotions were more unstable, therapists were less accurate in tracking these emotions. Additionally, when therapists' assessments of their clients' emotions were more flexible, they were more accurate in tracking them. Our results help identify factors that predict accurate emotion perception within psychotherapy and may translate into actionable ideas for enhancing this accuracy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

People with schizophrenia spectrum disorder face a major challenge in the ability to reflect on their own and others' mental activities and about specific psychological problems in their lives. These deficits are associated with increased symptoms and lower functioning. Specific interventions have been designed to enhance these abilities, one of which is metacognitive reflection and insight therapy (MERIT). Several case studies and a recent pilot study have shown increased metacognitive abilities and a decrease in symptoms among clients after MERIT. This article presents two case studies of clients diagnosed with schizoaffective disorder whose psychotherapy, conducted in Israel, incorporated the MERIT protocol. Outcome measures were taken before and after treatment, and metacognitive abilities were assessed at five time points throughout treatment. Clinical implications and limitations are discussed.

Congruence between therapists' and their clients' alliance ratings was found to be beneficial to therapeutic processes and outcomes. To date, however, less is known about the possible moderators of such congruence. The current study adapted Funder's (1995) realistic accuracy model to identify a judge characteristic (therapists' affiliative tendencies), a target characteristic (clients' affiliative tendencies), information (time elapsed in therapy), and traits (bond vs. task/goal aspects of the alliance) that may moderate this congruence. These were examined using the innovative truth-and-bias model (West & Kenny, 2011), which allows the simultaneous estimation of two different congruence indices within repeatedly measured data: therapist/client temporal congruence (i.e., the correlation over time between therapists' and their clients' alliance ratings) and directional discrepancy (i.e., the average difference between therapists' and their clients' alliance ratings across sessions). Clients ( n = 109) and therapists ( n = 62) at a university-based clinic rated their affiliation tendencies at the beginning of treatment and rated their alliance perception after each session. Time elapsed in therapy, as well as therapists' (but not clients') affiliative tendencies were linked to higher therapist/client temporal congruence and to lower therapist directional discrepancy. In addition, congruence was higher for the bond aspect of the therapeutic alliance than for goals/tasks. Consistent with Funder's model, multiple factors (including judge, information, and trait) were associated with therapist/client congruence in alliance. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objective: Sudden gains are robust predictors of outcome in psychotherapy. However, previous attempts at predicting sudden gains have yielded inconclusive findings. The aim of the present study was to examine a novel, transdiagnostic, transtherapeutic predictor of sudden gains that would replicate in different settings and populations. Specifically, we examined intraindividual variability in symptoms., Method: We examined data from a randomized controlled trial (RCT) of prolonged exposure therapy for posttraumatic stress disorder (PTSD) in children and adolescents (n = 63), an RCT of cognitive and behavioral therapies for obsessive-compulsive disorder (OCD) in adults (n = 91), and psychodynamic therapy delivered under routine clinical conditions in a naturalistic setting for diverse disorders (n = 106). In all 3 data sets, we examined whether a measure of variability in symptoms occurring during the first sessions could predict sudden gains., Results: Variability in symptoms was found to be independent of total change during treatment. Variability in symptoms significantly predicted sudden gains in all 3 data sets and correctly classified 81.0%, 69.2%, and 76.9% of individuals to sudden gain or nonsudden gain status, respectively., Conclusions: The present study represents the first examination of variability in symptoms as a predictor of sudden gains. Findings indicated that sudden gains are significantly predicted by intraindividual variability in symptoms, in diverse settings, contexts, and populations. Advantages of this predictor, as well as clinical and research implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Therapists' awareness of ruptures in the alliance may determine whether such ruptures will prove beneficial or obstructive to the therapy process., Objective: This study investigated the associations between therapists' recognition of these ruptures, and changes in clients' alliance ratings and symptom reports, using time-series data in a naturalistic treatment setting., Method: Eighty-four clients treated by 56 therapists completed alliance measures after each session, and the clients also completed symptom measures at the beginning of each session., Results: Therapists' recognition of alliance rupture in non-rupture sessions was positively associated with clients' alliance ratings in the next session and this effect was significantly higher when rupture did occur. There was also a significant interaction effect for functioning ratings: Therapists' recognition of alliance ruptures abolished the negative effect of ruptures on clients' symptom ratings in the following session., Conclusion: These results highlight the importance of therapists' recognition of deterioration in the alliance for a repair process to take place that may eventually lead to an improved relationship and outcome.

Objective: Self-compassion (SC) has been consistently linked to less psychopathology; however, the link between changes in client's SC levels and psychotherapy outcomes has yet to be explored., Method: Clients at a university-based community clinic completed SC and outcome measures session by session (N = 112) as well as pre- to posttreatment (N = 70)., Results: Increases in clients' SC levels across the entire therapeutic process were associated with improvement in all posttreatment outcomes. Additionally, session-to-session increases in SC levels predicted improved symptoms and functioning at the session level; these effects were significant above and beyond the effects of the therapeutic alliance., Conclusion: The results of the current study highlight SC as a possible process variable in psychotherapy., (© 2017 Wiley Periodicals, Inc.)

Objective: The present study investigates the association between congruence of patients' and therapists' perceptions of the therapeutic bond and symptom improvement., Method: Bond congruence-outcome associations were examined on the within- and between-dyad level for 580 patients (mainly depression and anxiety) receiving cognitive-behavioral therapy. Symptom change was assessed on a session-to-session level as well as from pre- to posttreatment. For the between-dyad analyses, the truth and bias model was applied. For the within-dyad analyses, polynomial regression and response surface analysis were conducted., Results: On the between-dyad level, higher temporal congruence between patients' and therapists' bond ratings (i.e., their correlation) was associated with better treatment outcomes. Additionally, the average discrepancy between therapists' and patients' bond ratings showed a significant quadratic association with treatment outcome. A tendency for therapists to moderately rate the bond lower than their patients' showed lowest posttreatment symptom scores. On the within-dyad level, we found that when patients' and therapists' ratings were in "agreement," higher bond scores were associated with fewer next-session symptoms. For "disagreement," the results showed that if therapists rated the bond as weak, whereas their patients rated it as strong, higher subsequent symptom distress was observed than if patients rated the bond as weak and their therapists rated it as strong., Conclusions: The present study highlights the importance of therapists being vigilant to session-to-session changes in the therapeutic bond to adjust their interventions accordingly. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

The present study aimed to (a) explore 2 indices of emotional congruence-temporal similarity and directional discrepancy-between clients' and therapists' ratings of their emotions as they cofluctuate session-by-session; and (b) examine whether client/therapist emotional congruence predicts clients' symptom relief and improved functioning. The sample comprised 109 clients treated by 62 therapists in a university setting. Clients and therapists self-reported their negative (NE) and positive emotions (PE) after each session. Symptom severity and functioning level were assessed at the beginning of each session using the clients' self-reports. To assess emotional congruence, an adaptation of West and Kenny's (2011) Truth and Bias model was applied. To examine the consequences of emotional congruence, polynomial regression, and response surface analyses were conducted (Edwards & Parry, 1993). Clients and therapists were temporally similar in both PE and NE. Therapists experienced less intense PE on average, but did not experience more or less intense NE than their clients. Those therapists who experienced more intense NE than their clients were more temporally similar in their emotions to their clients. Therapist/client incongruence in both PE and NE predicted poorer next-session symptomatology; incongruence in PE was also associated with lower client next-session functioning. Session-level symptoms were better when therapists experienced more intense emotions (both PE and NE) than their clients. The findings highlight the importance of recognizing the dynamic nature of emotions in client-therapist interactions and the contribution of session-by-session emotional dynamics to outcomes. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Most measures in the field of psychodynamic psychotherapy are bound to a specific theory, and usually focus only on patient processes or therapist interventions. The MATRIX is a newly developed research tool that focuses on events within both the patient and the therapist individually, as well as on dyadic events, and provides the simple and meaningful coding of content for therapy session transcripts in psychotherapy. The present study describes the inter-rater reliability and construct validity of the MATRIX. Reliability of the MATRIX was assessed by applying it to 805 fragments of psychodynamic-oriented psychotherapy sessions. Three independent experts coded fragments, and the tool was examined for reliability. Validity in identifying the theoretical inclinations was assessed by applying the MATRIX to 30 segments (containing 1309 fragments) of sessions that reflect different theoretical orientations. Findings evinced high inter-rater reliability for all dimensions. The MATRIX was found to have high degree of validity for differentiating the theoretical inclinations of segments of sessions. The MATRIX is a reliable and valid measure that may enable moment-to-moment, quantitative, analysis of psychodynamic psychotherapy., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: We aimed to assess the extent to which therapists' reports of client functioning track their clients' changing experience of their own functioning from session to session (temporal congruence) as well as the extent to which they over- or underestimate their clients' functioning (level or directional bias) and to examine whether these indices predict treatment outcomes., Method: The participants included 384 clients who were treated by 77 therapists. Both clients and therapists rated the clients' functioning each session. The clients also completed pre- and posttreatment outcome measures., Results: Using multilevel modeling, we found that therapists' reports regarding their clients' functioning tended to be temporally congruent from session to session with their clients' reported functioning. In addition, on average, therapists did not show a level bias (i.e., did not over- or underestimate their clients' functioning). Finally, temporal congruence (but not level bias) predicted better treatment outcomes., Conclusion: These findings highlight the importance of tracking clients' fluctuating symptoms over time. Thus, we discuss their implication for the policy and practice of providing session-by-session feedback to therapists. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Accumulating evidence suggests that the therapeutic alliance and clients' contact with emotions during therapy sessions can be effective in reducing their suffering outside of sessions. However, the complex associations among these determinants are not yet clear. Using data collected in therapy on a session-by-session basis, this study explored (a) the temporal associations between emotional experience and the therapeutic alliance; (b) the temporal associations between emotional experience and clients' level of functioning; and (c) the direct and indirect associations among emotional experience, the therapeutic alliance, and functioning. Clients (N = 101) undergoing psychodynamic therapy completed a functioning and distress measure prior to each session, and reported on their emotional experience and perceived alliance strength following each session. Longitudinal multilevel models indicated that higher therapeutic alliance scores at the end of 1 session predicted a greater emotional experience in the next session but that emotional experience did not predict subsequent levels of alliance. The results provided evidence of reciprocal prediction in which a previous emotional experience predicted a subsequent change in functioning and vice versa. Finally, the alliance predicted emotional experience, which, in turn, predicted functioning; hence, alliance strength indirectly predicted clients' level of functioning. Findings indicate that emotional experience and the therapeutic alliance are important determinants of the therapeutic process, which contribute to predict clients' improvement in functioning within psychodynamic treatment., ((c) 2016 APA, all rights reserved).)

Objective: Two groups of clients at sequential developmental stages, adolescents and emerging adults, were compared regarding their presenting problems, psychological distress, and relationship representations over one year of psychotherapy., Method: Thirty adolescents aged 14-18 years and 30 emerging adults aged 22-28 years, with similar demographic background, completed outcome measures and interviews according to the Core Conflictual Relationship Theme (CCRT) method., Results: The groups differed significantly in the presenting problems but did not differ in their initial levels of distress; their symptoms improved to a similar extent after one year of psychotherapy; differences between the groups in the representations of others were consistent with age-specific developmental challenges; levels of representations were associated with levels of symptoms at the end-point of treatment., Conclusion: Clinicians need to be attuned to the specific difficulties and challenges of these continuous yet distinct developmental stages.