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Objective: There is a certain consensus in the psychotherapeutic literature that safety plays a central role in human development and psychotherapy and that lack of safety undermines mental health. However, the role of safety in psychotherapy has not yet been thoroughly examined. In this article, we identify and integrate the different functions of safety in psychotherapy on a theoretical basis. Method: We made a panoramic overview of the concept of safety across some of the main psychotherapeutic schools that represent major paradigms in contemporary psychotherapy (psychodynamic, cognitive-behavioral, humanistic). We then analyzed, compared, and synthetized the findings to identify the common functions that safety plays both in ontogenesis and in clinical practice across different therapeutic orientations. Results: Our analysis showed that safety is indeed rightly prioritized across psychotherapy schools because of its developmental value in promoting change and adaptation both in ontogenesis and clinical settings. The findings suggest that the main functions of safety are to secure survival, facilitate restoration, promote exploration, sustain risk-taking, and enable integration, with these functions being complementary and dependent on the context. However, safety seems to be in a dialectical and paradoxical relationship to psychotherapy and human development. Adequate ontogenetic development and treatment progress do not appear to require continuous maintenance of maximum possible safety. Rather, they seem to require enough safety, adequately and timely modulated according to developmental needs and treatment phases. Conclusions: Although safety provides the necessary basis that enables restoration, fuels exploration, and facilitates treatment progress, safety's misdosage (e.g., lack, excess), misconstruction (e.g., misattunement, misinterpretation), or misuse (exploitation, idealization) may hinder the healthy development of attachment, identity, autonomy, self/co-regulation as well as the ability to tolerate and cope with dangers, risks, insecurities, or frustrations. Future research is suggested to further explore the role of safety in psychotherapy. [ABSTRACT FROM AUTHOR]

Background: Research on dialectical behaviour therapy (DBT) or 12‐step programmes has shown inconclusive results; no systematic review has directly compared the two. Objectives: The goals of this meta‐analytic review were to assess if DBT is more effective than treatment as usual (TAU) and if DBT is more effective than 12‐step programmes (including twelve‐step facilitation [TSF] and self‐help groups like Alcoholics Anonymous) for substance use disorder (SUD). Methods: We searched for randomised controlled trials (RCTs) and extracted data on the following outcomes: reduction in substance use, retention in treatment, severity of substance dependence/abuse and severity of mental health symptoms. Studies involved adult (>18 years) women with SUD, according to DSM‐5 or the equivalent diagnoses in DSM‐IV. Three RCTs met the inclusion criteria and contained appropriate data for meta‐analysis (75 participants). Results: No significant effects of DBT have been found compared to 12‐step programmes. Comparing DBT with TAU, we found a beneficial short‐term (1 RCT, n = 12, SMD = −0.84; 95% CI [−1.64, −0.04]) and long‐term (2 RCTs, n = 29, SMD = −1.26; 95% CI [−2.13, −0.40]) effect of DBT on severity of substance use. Conclusions: Despite the limited evidence of the present review, contextual evidence supports DBT and 12‐step programmes. RCTs with larger sample sizes are needed to better elucidate the impact of both treatments on SUD and facilitate the comparison between DBT and 12 steps programmes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Therapist characteristics seem to be a key factor in clinical effectiveness. Trainees’ personal and professional background, motivation, and interpersonal style have been shown to deserve attention in previous research concerning therapist development and warrant further study due to their potential implications for psychotherapy training outcomes. Aim: To explore personal and professional background, motivation, and interpersonal style of psychotherapy trainees with different theoretical approaches. Findings: In the present study, 135 post‐graduate psychotherapy trainees with different theoretical approaches (psychodynamic, systemic, and cognitive‐behavioral) completed the Trainee Background Information Form (TBIF), reporting information concerning their background, style of relating, and motivations. Personal experiences of trainees were frequently reported as a motivation in undertaking psychotherapy training and were associated with negative experiences in childhood. Significant differences were found in the motivations and interpersonal style of trainees with different theoretical approach. Implications: Personal experiences, motivation and interpersonal styles should be taken into consideration in future studies on therapists’ development and in the implementation of psychotherapy programs. [ABSTRACT FROM AUTHOR]

This study presents a pilot contribution to the new collaborative, multinational study of psychotherapy trainee development that was undertaken by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (see Orlinsky, Strauss, Rønnestad, et al., ). Although the main project is longitudinal in design, this preliminary study investigated cross‐sectional differences between trainees in different years of training and explored the influence of core training experiences—including supervision and personal therapy—on their perceived development as therapists. Using the trainee current‐progress report that was designed for the Society for Psychotherapy Research Interest Section on Therapist Training and Development project, 90 trainees at 4 different 4‐year training programs in Italy provided self‐evaluations of their development and of their therapeutic work experiences. Perceived development included overall change, progress, deterioration, overcoming past limitations, and realization of potential as a therapist. Therapeutic work experiences were assessed using scales of healing and stressful involvement (Orlinsky & Rønnestad, ). Year in training and support in supervision predicted perceived development and healing involvement, whereas experiencing criticism in supervision was associated with stressful involvement. Having had personal therapy, and especially ratings of benefit from personal therapy, was also associated with perceived development and healing involvement. Results are discussed with regard of their implications for psychotherapy training. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between a client's rate of speech (ROS) and emotional-cognitive regulation during a psychotherapy session. The ROS was measured in words per second on the timed transcript of a single session of psychodynamic psychotherapy. Emotional-cognitive regulation was assessed using the therapeutic cycles model on emotional tone (ET), abstraction (AB), and their combination in emotion-abstraction patterns (EAPs). The results were mostly consistent with our hypotheses and showed that: i) the ROS negatively correlated with the conjoined ET and AB; and ii) the ROS in the connecting EAP (high ET and high AB) was significantly lower than in other EAPs. The results support the hypothesis that a significant reduction in the client's ROS may be a reliable marker of in-session change processes. Clinical implications and future developments are discussed. [ABSTRACT FROM AUTHOR]

Objective: The significance of the psychotherapeutic relationship in promoting psychotherapeutic change is widely recognized. In this paper, we contribute to the relational orientation of psychotherapy through a transtheoretical exploration of safety. We aimed to identify and integrate those relational and change-promoting principles and aspects of safety that are school-independent., Method: We conducted an overview and synthesis of the clinical-theoretical and empirical literature that we believe has significantly addressed the role of safety in regulating change-promoting therapeutic relationships., Results: The relational and change-promoting aspects of safety form a dynamic system involving the therapist, the client, and the relationship. These interact, influence each other, and perform multiple homeostatic functions: they allow to resist change, assimilate small changes that do not disrupt the client's way of functioning, regulate major changes that disrupt and alter the client's way of functioning, and regulate adjustments in the way the therapist and client work together. From an integrative-relational perspective, a safe therapist is a precondition for co-creating a safe environment. This establishes trust and fosters an affective bond that provides additional sources of safety for the therapeutic relationship and the client. To promote change, however, the relational aspects of safety need to be fine-tuned (calibrated and personalized) for each therapy in terms of intensity, duration, timing, scope, and sources, accommodating developmental, individual, and situational differences. Crucially, the safety of the therapist, the client, and the relationship must be neither perfect, steady, or static, but rather safe enough, adaptive, and dynamic , leaving space not only for self-discovery and self-awareness but also for the co-regulation of tolerable frustrations, disappointments, and insecurities that facilitate the client's resilience and adaptation., Conclusions: Focusing on school-independent, safety-based relational principles and understanding how they evolve and adapt over time and across circumstances can make a significant contribution to the current relational orientation in psychotherapy. This has important implications for psychotherapy practice, training, and research., Competing Interests: Competing interests: None., (© 2024 Giovanni Fioriti Editore s.r.l.)

Objective: The growth of videoconferencing psychotherapy (VP) requires a closer conceptualization of the therapeutic relationship in VP. Therefore, we investigated the therapeutic relationship in VP from the clinicians' perspective., Method: We conducted three focus groups with 27 Italian VP professional psychotherapists of different theoretical orientations, focusing on their experience of the therapeutic relationship in VP. Data analysis was conducted through inductive thematic analysis., Results: The following themes emerged: (a) construction and management of the online setting (regarding the complexity of the therapeutic boundaries in VP and the efforts to manage this); (b) meaning construction of the request for help and the therapeutic process (regarding how patients and therapist represent the meaning of the therapeutic space and work in VP); (c) patient and therapist involvement in the online relationship (addressing the depth of the therapeutic relationship in VP in terms of intimacy, openness/closure, distance/closeness, and involvement); (d) new elements of the therapeutic relationship introduced by VP (regarding the source and nature of information about the patient and the effects of the technical environment on the relationship); (e) nonverbal aspects and corporeality in VP (dealing with how different aspects of para- and extralinguistic communication may impact the therapeutic relationship in VP); (f) differences in the quality of the emotional and relational level of VP (regarding the emotional attitudes and reactions of patients and therapists and the overall quality of the therapeutic relationship); (g) treatment satisfaction and drop-out (regarding ease of leaving the session, patient satisfaction, and dificulties in terminating therapy); and (h) personal characteristics of patient and therapist that influence VP (regarding the impact of patients personality and therapists training/approach on the progress of VP)., Conclusions: Results suggest that the therapeutic relationship in VP has specific features that distinguish it from face-to-face psychotherapy. Implications for practice, training, and research are discussed., Competing Interests: Competing interests: None., (© 2024 Giovanni Fioriti Editore s.r.l.)

The COVID-19 pandemic represents an extraordinary challenge to clinicians, health care institutions and policymakers. The paper outlines a psychoanalytically grounded semiotic-cultural psychological interpretation of such a scenario. First, we underline how the actual emotional reaction (mainly of fear) of our society is a marker of how the mind functions in conditions of affective activation related to heightened uncertainty: it produces global, homogenizing and generalizing embodied interpretations of reality, at the cost of more fine-grained and differentiated analytical thought. Such a process, called affective semiosis, represents an adaptive response to the emergency in the short-term. Second, we argue that this adaptive value provided by affective semiosis will be reduced when we have to deal with the process of managing the transition to the post-crisis and the governance of the medium and longterm impact of the crisis. Third, we suggest that, in order to manage the pandemic crisis on a longer temporal frame, affective semiosis has to be integrated with less generalized and more domain-specific ways of interpreting reality. To this end, semiotic capital (i.e., culturally-mediated symbolic resources) should be promoted in order to enable people to interiorize the supra-individual and collective dimension of life. Accordingly, COVID-19 is proposed as a semiotic vaccine, a disruption in our everyday life routines which has the potential of opening the way to a semiotic reappropriation of the collective dimensions of our experience., Competing Interests: Competing interests: Authors have no disclosures, and they have no affiliation with or financial interest in any organization that might pose a conflict of interest., (© 2020 Giovanni Fioriti Editore s.r.l.)

The present work aims to empirically map what has been investigated and which issues ( i.e . topics) characterize the debates of psychotherapy research, using a computer-assisted, bottom-up method of content analysis. The abstract of papers (N=13,499), published between 2000-2016 and retrieved from a sample of 10 journals selected as representing the field of psychotherapy research, were subjected to a method of automated content analysis. Five different research topics were identified (clinical relationship, clinical efficacy, clinical practice and research, psychopathology, and neuroscientific approaches to mental disorders) and each abstract was labeled according to the retrieved research topic. Two different Chi-square analyses investigated the distributions of research topics over time and among the selected journals. Results concerning the distribution over time highlighted an increase in the clinical relationship and clinical efficacy topics and a decrease in the others. An examination of the distribution among journals showed that psychopathology and neuroscientific approaches to mental disorders were associated with psychiatric journals, while the others were associated with non-psychiatric journals. The findings are discussed in light of the theoretical, methodological, and practical implications offering pointers for a critical understanding of the current psychotherapy research domain., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest., (©Copyright: the Author(s).)