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Background/objective: The present study leveraged the expertise of an international group of posttraumatic stress and substance use disorder (PTSD+SUD) intervention researchers to identify which methods of categorizing interventions which target SUD, PTSD, or PTSD+SUD for populations with both PTSD+SUD may be optimal for advancing future systematic reviews, meta-analyses, and comparative effectiveness studies which strive to compare effects across a broad variety of psychotherapy types., Method: A two-step process was used to evaluate the categorization terminology. First, we searched the literature for pre-existing categories of PTSD+SUD interventions from PTSD+SUD clinical trials, systematic and literature reviews. Then, we surveyed international trauma and substance use subject matter experts about their opinions on pre-existing intervention categorization and ideal categorization nomenclature., Results: Mixed method analyses revealed that a proliferation of PTSD+SUD treatment research over the last twenty years brought with it an abundance of ways to characterize the treatments that have been evaluated. Results from our survey of experts ( N  = 27) revealed that interventions for PTSD+SUD can be classified in many ways that appear to overlap highly with one another. Many experts (11/27; 41%) selected the categories of 'trauma-focused and non-trauma focused' as an optimal way to distinguish treatment types. Although several experts reinforced this point during the subsequent meeting, it became clear that no method of categorizing treatments is without flaws., Conclusion: One possible categorization (trauma-focused/non-trauma focused) was identified. Revised language and nomenclature for classification of PTSD+SUD treatments are needed in order to accommodate the needs of this advancing field., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objective: In seriously ill cardiac patients, several psychotherapy efficacy studies demonstrate little to no reduction in depression or improvement in quality of life, and little is known about how to improve psychotherapies to best address the range of patient needs. An interpersonal and behavioral activation psychotherapy was a key component of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) multisite randomized clinical trial. Although depressive symptoms did improve in the CASA trial, questions remain about how best to tailor psychotherapies to the needs of seriously ill patient populations. The study objective was to describe psychosocial needs emerging during a clinical trial of a palliative care and interpersonal and behavioral activation psychotherapy intervention that were not specifically addressed by the psychotherapy., Method: During the CASA trial, patient needs were prospectively tracked by the psychotherapist in each visit note using an a priori code list. Preplanned analysis of study data using directed content analysis was conducted analyzing the a priori code list, which were collapsed by team consensus into larger themes. The frequency of each code and theme were calculated into a percentage of visits., Result: A total of 150 patients received one or more visits from the therapist and were included in the analysis. Participants screened positive for depressive disorder (47%), had poor heart failure-specific health status (mean Kansas City Cardiomyopathy Questionnaire score = 48.6; SD = 17.4), and multiple comorbidities (median 4.3). Common needs that emerged during the therapy included difficulty coping with fatigue (48%), pain (28%), and satisfaction issues with medical care (43%). The following broader themes emerged: social support (77% of sessions), unmet symptom needs (67%), healthcare navigation (48%), housing, legal, safety, and transportation (32%), and end of life (12%)., Significance of Results: Coping with chronic symptoms and case management needs commonly emerged during psychotherapy visits. Future psychotherapy interventions in seriously ill populations should consider the importance of coping with chronic symptoms and case management.

This column reviews and updates "common factors" in psychotherapy, as originally described by Saul Rosenzweig in 1936. The author, a psychiatrist who has used multiple modalities of psychotherapeutic treatment over 4 decades, shares personal reflections concerning these "common factors" and introduces a model of integrated psychotherapies named for his grandfather's shaving brush.

Background and aims To date, no systematic approach to identifying the content and characteristics of psychological interventions used to reduce gambling or problem gambling has been developed. This study aimed to develop a reliable classification system capable of identifying intervention characteristics that could, potentially, account for greater or lesser effectiveness. Methods Intervention descriptions were content analyzed to identify common and differentiating characteristics. A coder manual was developed and applied by three independent coders to identify the presence or absence of defined characteristics in 46 psychological and self-help gambling interventions. Results The final classification taxonomy, entitled Gambling Intervention System of CharacTerization (GIST), included 35 categories of intervention characteristics. These were assigned to four groups: (a) types of change techniques (18 categories; e.g., cognitive restructuring and relapse prevention), (b) participant and study characteristics (6 categories; e.g., recruitment strategy and remuneration policy), and (c) characteristics of the delivery and conduct of interventions (11 categories; e.g., modality of delivery and therapist involvement), and (d) evaluation characteristics (e.g., type of control group). Interrater reliability of identification of defined characteristics was high (κ = 0.80-1.00). Discussion This research provides a tool that allows systematic identification of intervention characteristics, thereby enabling consideration, not only of whether interventions are effective or not, but also of which domain-relevant characteristics account for greater or lesser effectiveness. The taxonomy also facilitates standardized description of intervention content in a field in which many diverse interventions have been evaluated. Conclusion Application of this coding tool has the potential to accelerate the development of more efficient and effective therapist-delivered and self-directed interventions to reduce gambling problems.

Background: To make informed choices, patients need information about negative as well as positive effects of treatments. There is little information about negative effects of psychological interventions., Aims: To determine the prevalence of and risk factors for perceived negative effects of psychological treatment for common mental disorders., Method: Cross-sectional survey of people receiving psychological treatment from 184 services in England and Wales. Respondents were asked whether they had experienced lasting bad effects from the treatment they received., Results: Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad effects. People aged over 65 were less likely to report such effects and sexual and ethnic minorities were more likely to report them. People who were unsure what type of therapy they received were more likely to report negative effects (odds ratio (OR) = 1.51, 95% CI 1.22-1.87), and those that stated that they were given enough information about therapy before it started were less likely to report them (OR = 0.65, 95% CI 0.54-0.79)., Conclusions: One in 20 people responding to this survey reported lasting bad effects from psychological treatment. Clinicians should discuss the potential for both the positive and negative effects of therapy before it starts., (© The Royal College of Psychiatrists 2016.)

Objective: The present study investigates the relationships between therapists' value preferences and their beliefs in the efficacy of the four main therapeutic orientations (cognitive behavior, psychodynamic, client-centered, and eco-systemic)., Method: The study was conducted in Israel. Social workers practicing individual therapy in different psychosocial services participated in the study (n = 528)., Results: Personal value preferences explained a significant proportion of the variance in the social workers' beliefs in the efficacy of different therapeutic orientations. Each therapeutic orientation was associated with a specific pattern of value preferences, thus indicating that different therapeutic orientations promote or impede the attainment of the therapists' specific motivational goals., Conclusions: The study results' implications for understanding the motivational foundations of different therapeutic orientations are discussed, as well as their possible application for therapist training and practice.

Borderline personality disorder (BPD) is a highly prevalent disorder characterized by identity disturbance, emotion dysregulation, interpersonal difficulties and self-damaging behaviours. Mental health professionals most of the time encounter difficulties in the care of these hard-to-treat patients mainly due to the frequent crises often leading to drop-outs. In this perspective, technical and theoretical changes to traditional psychotherapeutic approaches were developed. We here give the major principles that should be considered when treating BPD patients in order not only to reduce the risk of being iatrogenic but also to apply the current psychotherapeutic and psychiatric modalities internationally recognized to be efficient.

Background: Nowadays, more and more mental health professionals manage patients who fail treatment for major psychiatric disorders. There is not a consensus on how to deal with treatment-resistance patients, but usually psychiatrists result to polypharmacy., Method: In reviewing the evidence based clinical research we will try to answer some questions about treatment-resistant psychiatric disorders. Treatment-resistant symptoms complicate the clinical course of all psychiatric disorders especially schizophrenia, causing the patients not to reach the therapeutical goal and enter remission. In consequence, polypharmacy is used to try to deal with the remaining symptoms, raising other issues., Summary: We will try to deal with this problematic issue through clinical studies and major research done to try and answer the question posed.

Background: Against the background of the continuously growing incidence rates of gerontopsychiatric disorders, their economic dimen-sions, and the effects on persons affected as well as their social environments, the present study focuses on an analysis of the services provided in acute psychiatric care settings for patients with dementia. RESULTS are based on secondary data., Aim of the Study: We aim to compare therapeutic service units of different clusters of occupational groups (physicians/psychologists, nurses/special therapists) for the ICD-10 diagnostic groups F00-F03 and G30 in the years 2010 (starting with July) and 2011. Main research question is how many patients are mappable with 'therapeutic units' (Therapieeinheiten, TE) of the operation and procedures catalogue (OPS)., Methods: The present study is based on an analysis of the §21 KHEntgG data record of 35 acute psychiatric facilities. Data collection took place within the project "Versorgungsindikatoren für die Psychiatrie und Psychosomatik (VIPP)", "Supply indicators for psychiatric and psychosomatic settings". The data record implies statewide data of specialised hospitals, university hospitals and departments of psychiatry of the Federal Republic of Germany., Results: In total, 5 111 cases were included in the analysis. Nurses and special therapists carried out significantly more therapeutic units in the main diagnoses groups (F01, F03 and G30) and the care groups (regular vs. intensive) than physicians and psychologists (p<0.05). It was not possible to map all patients with the use of therapeutic units (G30 78.8%, F01 83.4%, F03 81.2%). Mapping of patients was significantly higher in the intensive care compared to regular care in both occupational clusters (p<0.05)., Conclusions: We demonstrated that the "therapeutic units" of the OPS codes are now used in the routine data (§21 KHEntgG), and that they are able to portray relevant aspects of non-medication therapeutic service. The present study provides a preliminary/exploratory overview on the services provided, mapped by therapeutic units. Future research should focus on the overlap between the category "therapeutic" units and the services actually provided., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: How change comes about is hotly debated in psychotherapy research. One camp considers 'non-specific' or 'common factors', shared by different therapy approaches, as essential, whereas researchers of the other camp consider specific techniques as the essential ingredients of change. This controversy, however, suffers from unclear terminology and logical inconsistencies. The Taxonomy Project therefore aims at contributing to the definition and conceptualization of common factors of psychotherapy by analyzing their differential associations to standard techniques., Methods: A review identified 22 common factors discussed in psychotherapy research literature. We conducted a survey, in which 68 psychotherapy experts assessed how common factors are implemented by specific techniques. Using hierarchical linear models, we predicted each common factor by techniques and by experts' age, gender and allegiance to a therapy orientation., Results: Common factors differed largely in their relevance for technique implementation. Patient engagement, Affective experiencing and Therapeutic alliance were judged most relevant. Common factors also differed with respect to how well they could be explained by the set of techniques. We present detailed profiles of all common factors by the (positively or negatively) associated techniques. There were indications of a biased taxonomy not covering the embodiment of psychotherapy (expressed by body-centred techniques such as progressive muscle relaxation, biofeedback training and hypnosis). Likewise, common factors did not adequately represent effective psychodynamic and systemic techniques., Conclusion: This taxonomic endeavour is a step towards a clarification of important core constructs of psychotherapy., Key Practitioner Message: This article relates standard techniques of psychotherapy (well known to practising therapists) to the change factors/change mechanisms discussed in psychotherapy theory. It gives a short review of the current debate on the mechanisms by which psychotherapy works. We provide detailed profiles of change mechanisms and how they may be generated by practice techniques., (Copyright © 2012 John Wiley & Sons, Ltd.)

Background: Although several adjunctive psychological interventions are effective in the maintenance of bipolar disorders (BD), no attempt has been made to classify them according to their ability to prevent manic versus depressive episodes. Our study aims to rank the adjunctive psychotherapies for the prophylaxis of BD by means of their polarity index (PI)., Methods: Randomized controlled trials comparing the efficacy of a psychological intervention with a comparator in BD maintenance treatment in patients aged over 18 were systematically reviewed. Exclusion criteria were a small sample size, a study sample not exclusively composed of bipolar patients and the absence of a control group. PI is a novel metric indicating the relative antimanic versus antidepressive preventive efficacy of treatments. PI was retrieved by calculating the ratio of the number needed to treat (NNT) for prevention of depression and the NNT for prevention of mania. PI >1.0 indicates a relatively higher antimanic prophylactic efficacy and PI <1.0 a greater antidepressive efficacy., Results: A total of 9 studies were included. PI was 0.33, 0.63 and 0.89 for cognitive-behavioral therapy, 0.42 for family-focused therapy, 0.73 and 0.78 for psychoeducation, 1 for enhanced relapse prevention, 1.78 for caregiver group psychoeducation and 3.36 for brief technique-driven interventions. With regard to the PI for 1 cognitive-behavioral study, enhanced relapse prevention and brief technique-driven interventions may not be reliable since those trials were negative., Conclusions: The PI provides a measure of how much depression-preventive or (hypo) mania-preventive an intervention is and may guide the choice of adjunctive psychotherapy in the context of individualized long-term treatment of BD., (Copyright © 2013 S. Karger AG, Basel.)

This study describes the psychological interventions used for eating disorders (EDs) by community practitioners. Of 573 clinicians we screened across Alberta, 130 (22.7%) had treated EDs; 118 (90.8%) were interviewed. Clinicians reported varied reasons for psychotherapy choice and diverse training experiences; the primary approaches used varied by education and field. The most common primary approach was eclectic (43.2%), followed by cognitive-behavior therapy (CBT; 22.9%). However, self-reported CBT clinicians used specific CBT techniques infrequently. Half of clinicians incorporated addictions-based techniques. These results indicate that ED treatment provided by community clinicians is varied and generally does not align with evidence-based practice guidelines.

We reviewed the techniques and evidence base of four psychotherapeutic adjuncts to the pharmacological treatment of schizophrenia: Personal therapy, cognitive behavioral therapy, cognitive enhancement therapy, and psychodynamic psychotherapy. While there is a significant evidence base for the first three of these modalities, there is a paucity of research on psychodynamic treatments for schizophrenia. We review the history of psychodynamic treatment for schizophrenia and the ways in which it informs current treatment. In light of the limited efficacy of antipsychotic medications in the treatment of schizophrenic persons, there is increasing interest in the role of social and psychological approaches.

Objective: Actual codes for operations and procedures (OPS) in psychiatry and psychosomatics should map cost separating therapeutic activities so far defined in Germany by the normative specifications of the psychiatry staff enactment (PsychPV). OPS codes should also allow re-estimating underlying therapy times., Method: Therapeutic activities of the PsychPV fulfilling the minimal criteria of the OPS definition were classified as multiples of a therapeutic 25 minute unit., Results: Therapeutic activities of the PsychPV are mapped to OPS complex codes in a variable degree (psychiatrists 35 %, psychologists 42 %, nurses 43 %, special therapists 59 %)., Conclusion: Actual OPS codes are inappropriate for identifying relevant cost-separating factors in the therapy of psychiatric in-patients. They cannot assure in their actual form the standards given by the PsychPV and need substantial revision., (© Georg Thieme Verlag KG Stuttgart · New York.)

Many different psychosocial treatments for pain have been described in the literature. All of these treatments have at least some evidence supporting their efficacy. However, each treatment is based on a theory or model that is most useful only for that particular intervention. An overarching model or framework that includes all of the factors hypothesized to play a role in the effects of these treatments would be useful for (1) understanding the similarities and differences between existing and future psychosocial pain treatments, (2) guiding the psychosocial evaluation of patients with chronic pain, and (3) giving clinicians greater flexibility for including psychosocial interventions that have proven efficacy, but that may not be explained by their preferred (but perhaps limited) model. This article proposes an initial version of such a framework, with the hope that it will increase our understanding of the role that psychosocial factors play in the experience of pain and its negative effects on functioning, and informs future research seeking to identify the common and specific factors associated with psychosocial pain treatments., (Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

The current development of structured psychotherapy has brought gradual improvements to the treatment provided to bipolar patients. This psychotherapy may be either carried out individually or in a group. In this context, psychotherapeutic meditation seems beneficial.

Over 2,200 North American psychotherapists completed a Web-based survey concerning their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques. Psychotherapeutic integration was common, with the majority of respondents identifying with more than one theoretical orientation or as having an eclectic orientation. The modal patient was a White female adult suffering from a mood or anxiety disorder and interpersonal problems. Individual psychotherapy was the preferred treatment modality. The most frequently endorsed techniques were relationship-oriented such as conveying warmth, acceptance, understanding, and empathy. The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy. Efforts to disseminate empirically based therapies require understanding and accommodating clinicians' tendencies to integrate techniques., (PsycINFO Database Record (c) 2010 APA, all rights reserved.)

The purpose of this meta-analytic review was to quantify the effects of psychological therapies for the management of chronic pain in youth. Specifically, in this review we updated previous systematic reviews of randomized controlled trials by including new trials, and by adding disability and emotional functioning to pain as treatment outcomes. Electronic searches of the Cochrane Register of Randomised Controlled Trials, MEDLINE, PsycLIT, EMBASE, and the Social Sciences Citation Index were conducted from inception through August 2008. Methodological quality of the studies was assessed, and data extracted on the three primary outcomes of interest. Twenty-five trials including 1247 young people met inclusion criteria and were included in the meta-analysis. Meta-analytic findings demonstrated a large positive effect of psychological intervention on pain reduction at immediate post-treatment and follow-up in youth with headache, abdominal pain, and fibromyalgia. Small and non-significant effects were found for improvements in disability and emotional functioning, although there were limited data on these outcomes available in the included studies. Omnibus cognitive-behavioral therapy, relaxation therapy, and biofeedback all produced significant and positive effects on pain reduction. Studies directly comparing the effects of self-administered versus therapist-administered interventions found similar effects on pain reduction. Psychological therapies result in improvement in pain relief across several different pain conditions in children. Future trials are needed that incorporate non-pain outcome domains, that focus significant therapeutic content on reductions in disability, and that include extended follow-up to better understand maintenance of treatment effects.

Psychology requires new heuristics for intervention research and reporting. There are problems with evidence-based practice (EBP) and with publications reporting intervention studies in Psychology. These issues are connected. EBP is associated with unsustainable levels of Waste, Inertia, Invalidity, Simplisticity and Opacity. Eleven domains of behaviour change are defined which encompass a vast array of programmes, interventions and techniques. These procedures are delivered in a multitude of combinations enabling millions of different interventions in Psychology. Reporting an intervention study in Psychology is a complex operation. A taxonomy for intervention reports is described.

The Multitheoretical List of Therapeutic Interventions (MULTI) assesses interventions from eight different psychotherapy orientations (behavioral, cognitive, dialectical-behavioral, interpersonal, person centered, psychodynamic, process-experiential, and common factors) and from the perspective of clients, therapists, and observers. The internal consistency for the subscales was moderate to high. Split-half reliability was moderate for clients and low to moderate for therapists and untrained observers. Interrater reliability for the subscales was low for untrained raters but moderate for psychotherapy-knowledgeable raters. A model of the MULTI subscales representing different psychotherapy orientations fit the data adequately but not parsimoniously in a confirmatory factor analysis. MULTI subscale levels successfully predicted sessions of different psychotherapy orientations. The MULTI seems to be a promising tool to investigate the interventions that occur in different psychotherapies.

Psychosocial care is increasingly recognized as an essential component of the comprehensive care of the individual with cancer. Improving patients' access to psychosocial care is important; however, ensuring that the care made available has been shown to be effective is just as important. Accordingly, the goal of this review is to describe an evidence-based approach to the psychosocial care of adults with cancer. The focus is on anxiety and depression because a considerable body of research has examined the impact of psychosocial interventions on these outcomes. After describing the sources, assessment, and prevalence of anxiety and depression in adults with cancer and presenting existing clinical practice guidelines for their management, previous publications that systematically reviewed evidence of the efficacy of psychosocial interventions are summarized. The use of these publications to derive specific recommendations for the use of psychosocial interventions in the management of anxiety and depression is then illustrated. In addition, examples are provided of interventions that are effective against anxiety and depression and have good potential for dissemination in routine clinical practice. The review concludes with a discussion of future directions for the continued development of an evidence-based approach to the psychosocial care of people with cancer.

Objective: Without standardized definitions of the techniques included in behavior change interventions, it is difficult to faithfully replicate effective interventions and challenging to identify techniques contributing to effectiveness across interventions. This research aimed to develop and test a theory-linked taxonomy of generally applicable behavior change techniques (BCTs)., Design: Twenty-six BCTs were defined. Two psychologists used a 5-page coding manual to independently judge the presence or absence of each technique in published intervention descriptions and in intervention manuals., Results: Three systematic reviews yielded 195 published descriptions. Across 78 reliability tests (i.e., 26 techniques applied to 3 reviews), the average kappa per technique was 0.79, with 93% of judgments being agreements. Interventions were found to vary widely in the range and type of techniques used, even when targeting the same behavior among similar participants. The average agreement for intervention manuals was 85%, and a comparison of BCTs identified in 13 manuals and 13 published articles describing the same interventions generated a technique correspondence rate of 74%, with most mismatches (73%) arising from identification of a technique in the manual but not in the article., Conclusions: These findings demonstrate the feasibility of developing standardized definitions of BCTs included in behavioral interventions and highlight problematic variability in the reporting of intervention content.

This study involved a content analysis of 261 unique advertisements for psychotherapy workshops that appeared in two bimonthly clinical magazines, Psychotherapy Networker and Counselor, during a 2-year period. Two independent judges coded each advertisement and documented the type and prevalence of advertising appeals used. From the seminal diffusion of innovations model, Rogers' (2003) five perceived characteristics of innovations found to influence adoption in diverse fields were not well represented in these workshops appeals, appearing less than 10% each. Few advertisements cited specific empirically supported treatments or presented any evidence of treatment effectiveness beyond expert testimonials. The most frequently noted appeals were to benefit the clinician (e.g., earning education credit or developing skills), characteristics that enhance credibility of the workshop (e.g., reference to storied history or mention of faculty), and features of the advertisements itself (e.g., use of superlatives and exclamation points). Promotional strategies to advertise psychotherapy workshops can be used to inform the dissemination of empirically supported treatments.

Depression and anxiety disorders frequently co-occur. This type of co-morbidity is associated with higher severity, suicidality, chronicity and treatment resistance. However, available treatment guidelines mainly focus on treatment for singular disorders. The current paper describes diagnostic and treatment issues relevant for adequately addressing patients with depression and an anxiety disorder, using information from both guidelines and a search of recent literature. Apart from differential diagnosis, the diagnostic evaluation should include a thorough assessment of the symptoms of both disorders, preferably by using a structured clinical interview, and an assessment of depression severity in terms of suicidality, psychotic symptoms and impairment. Treatment should first address the primary disorder in terms of severity and risk. As a rule, severe depression should be treated before the anxiety disorder, using antidepressant medication or combined treatment (plus psychotherapy). In less severe pathology, the primary focus may be determined by examining the temporal pattern and the subjective burden of each disorder as experienced by the patient. Treatment is often sequential. Treatment of the primary disorder may or may not relieve the co-morbid disorder as well. If the primary disorder is an anxiety disorder, co-morbid depression generally implies earlier use of an antidepressant. Co-morbid mild depression may also react favourably to psychotherapeutic treatment of the anxiety disorder. Recent literature on concurrent treatment of both depression and anxiety shows that modern antidepressants such as sertraline, paroxetine, fluoxetine, venlafaxine, nefazodone and bupropion have demonstrated efficacy in relieving both depressive and anxiety symptoms compared with placebo. Head-to-head comparisons, although relatively scarce, tend to show superiority over tricyclic antidepressants. Venlafaxine was found to be more effective than fluoxetine in some studies. However, these results should be interpreted with caution because studies vary considerably in terms of patient selection, assessment of anxiety and primary outcome measures. Only one randomized controlled trial compared atypical antipsychotics with placebo. Psychotherapy was generally shown to have a beneficial effect on the co-morbid conditions, and available evidence appears to favour combined treatment. The results should be interpreted with caution because the number of studies on this issue was relatively small, with considerable clinical and methodological heterogeneity.

Background: The study examined the influence of experience with psychiatric treatment on the perceived credibility of psychodynamic (PDT), cognitive (CT) and cognitive-behavioural psychotherapy (CBT)., Methods: Written descriptions of the three forms of psychotherapy were rated by three groups of subjects with different levels of experience of psychiatric treatment, a random community sample with the normal level of psychiatric treatment (N=121), psychiatric out-patients with limited previous experience of psychiatric care (N=118), and a group of psychiatric veterans with long experience of psychiatric care (N=48)., Results: Besides a significant main effect of psychotherapy form on credibility, the interaction between psychotherapy form and level of previous experience of psychiatric care was highly significant. When respondents ranked the three forms of psychotherapy, there was an overrepresentation of preferences for CBT (and 'don't know' responses) among the general public, whereas the two patient samples were less indecisive and more often preferred PDT and, in particular, CT., Conclusions: Different forms of psychotherapy appear to have their own market segments, the size of which varies depending on previous experiences of psychological distress and psychiatric treatment.

Experiential psychotherapy is generally accepted as one of the major families of psychotherapy. One of the main purposes of this introduction to the theme issue is to invite leading proponents and exponents to provide their own answers to the question of how to do experiential psychotherapy, with the emphasis on what would be helpful to students, trainees, and practitioners somewhat familiar with the approach. A second main purpose is to make a case that the very idea of an "experiential family" is a myth. There is no such thing as an "experiential family" of psychotherapies. There are not distinctively common family characteristics.

This article offers an overview of prominent general trends in the field of psychotherapy research. We consider 3 areas of the literature: metaanalytic reviews addressing the effectiveness of psychotherapy, the movement to identify empirically supported treatments (EST), and research on the "common factor" or "contextual" models of psychotherapy. We present narrative reviews of selected literature associated with each area. The reviews highlight several issues currently confronting the field. Metaanalytic reviews underscore 2 conclusions: psychotherapy is superior to the absence of treatment, and different approaches to psychotherapy yield equivalent effects. In counterpoint to these findings, the EST movement emphasizes the empirical demonstration that specific psychotherapies have efficacy for specific disorders. Misinterpretation of EST findings has led to considerable controversy. Although EST research can identify causal effects of therapy, it has less capacity to explain how these effects come about. We suggest an appropriate perspective on EST findings. Considerable evidence supports the importance of common factors as mechanisms of change; at present, however, this evidence is predominantly correlational. We conclude that a blending of EST studies and research on the common factors represents the greatest potential for advancing the field. Studies to identify specific ESTs are key to validating the efficacy of psychotherapy approaches and need to be undertaken with the psychodynamic and experiential therapies. Greater emphasis on common factors in research, training, and practice can advance understanding about change processes in efficacious therapies, facilitate the development of sensitive clinicians, and increase the effectiveness of mental health services.

Objective: Little is known about the psychotherapies delivered to eating-disordered clients by community therapists. We sought to describe the education and training of psychotherapists working with eating-disordered clients, the psychotherapeutic approaches used, and the reasons for use., Method: Eligible Calgary clinicians were identified and asked to complete a 25-item telephone interview., Results: The response rate was 74%. Educational backgrounds and fields of specialization of clinicians who completed the survey (n = 52) varied widely, as did the psychotherapies used. The most common primary therapeutic orientations of respondents were eclectic therapy (50%), cognitive-behavioral therapy (CBT; 33%), and addiction-based therapy (6%). Most clinicians (87%) reported frequently using CBT techniques with eating-disordered clients. The reasons given for using primary therapeutic approaches varied by clinicians' preferred therapeutic approach and education level., Conclusion: Clinicians generally choose to tailor treatment to individual needs rather than base decisions on the level of empirical support. These findings have implications for dissemination of empirically supported psychotherapies., (2005 by Wiley Periodicals, Inc.)

Background: Project MATCH was the largest and most expensive alcoholism treatment trial ever conducted. The results were disappointing. There were essentially no patient-treatment matches, and three very different treatments produced nearly identical outcomes. These results were interpreted post hoc as evidence that all three treatments were quite effective. We re-analyzed the data in order to estimate effectiveness in relation to quantity of treatment., Methods: This was a secondary analysis of data from a multisite clinical trial of alcohol dependent volunteers (N = 1726) who received outpatient psychosocial therapy. Analyses were confined to the primary outcome variables, percent days abstinent (PDA) and drinks per drinking day (DDD). Overall tests between treatment outcome and treatment quantity were conducted. Next, three specific groups were highlighted. One group consisted of those who dropped out immediately; the second were those who dropped out after receiving only one therapy session, and the third were those who attended 12 therapy sessions., Results: Overall, a median of only 3% of the drinking outcome at follow-up could be attributed to treatment. However this effect appeared to be present at week one before most of the treatment had been delivered. The zero treatment dropout group showed great improvement, achieving a mean of 72 percent days abstinent at follow-up. Effect size estimates showed that two-thirds to three-fourths of the improvement in the full treatment group was duplicated in the zero treatment group. Outcomes for the one session treatment group were worse than for the zero treatment group, suggesting a patient self selection effect. Nearly all the improvement in all groups had occurred by week one. The full treatment group had improved in PDA by 62% at week one, and the additional 11 therapy sessions added only another 4% improvement., Conclusion: The results suggest that current psychosocial treatments for alcoholism are not particularly effective. Untreated alcoholics in clinical trials show significant improvement. Most of the improvement which is interpreted as treatment effect is not due to treatment. Part of the remainder appears to be due to selection effects.

Risk covariates of neuropsychological ability (NA) at treatment entry and neuropsychological recovery (NR) across 15 months were examined and replicated in 2 samples (Ns = 952 and 774) from Project MATCH, a multisite study of alcoholism treatments. NA at treatment entry was associated with age, education, and other covariates. Statistically significant mean increases in NA over time had small effect sizes, suggesting limited clinical significance of NR in the samples as a whole. However, initial NA and a combination of risk factors in direct and mediated pathways predicted a large proportion of individual differences in NR. Statistically significant but modest differential treatment effects on NR suggest that addiction treatments may need to be modified or developed to facilitate this important aspect of recovery., (Copyright 2004 APA.)

Objective: Recent research on predictors of resource use in inpatient psychotherapy indicates that various patient characteristics as well as therapeutic factors may influence resource use. The aim of our study was to examine the relationship between patient attributes and psychotherapeutic costs in German inpatient psychotherapy. The amount of variance explained in resource use was calculated., Method: The existing sample used in this study consists of sociodemographic and clinical variables of 2375 patients treated in various inpatient psychosomatic clinics. Resource use was measured on the basis of clinical staff activities (Klassifikation Therapeutischer Leistungen, KTL, BfA 2000). Regression Tree Analysis was performed to classify patient attributes based on resource use., Results: The model assigns patients to 20 classes, accounting for 17.5 % of variance. Those patients with single status and personality or eating disorder consume more resources than those patients with non-single status, low motivation for psychotherapy, comorbidity of physical illness and lower levels on symptom severity., Conclusions: Implications of the results for the development of a patient classification system in inpatient psychotherapy will be discussed.

This paper gives a brief outline of the Conversational Model which is among the best validated of currently employed psychotherapies. The theory is built around the idea that the central task of psychotherapy is to potentiate the emergence and amplification of that dualistic form of consciousness that William James called self. However, this state of mind cannot be acted upon as if it existed in isolation. Rather, it is part of an ecology that includes the form of relatedness that underpins it. No element of the ecology can change unless the other elements also change. Seen in this way, the form of relatedness is transformational. It is necessarily mediated by conversation consisting of more than its content, the simple transmission of information. The main point of the paper is that the form of the conversation manifests and constitutes not only a form of consciousness but also a form of relatedness. This conception provides a means of testing hypotheses of therapeutic action since it suggests that syntactical structuring, together with the other major elements of language, lexicon, and phonology, allow us to chart the waxings and wanings of personal being in the therapeutic conversation.

The process of learning to conduct psychotherapy is extremely challenging, especially in the initial stages. It is not inappropriate for the novice to seek concrete guidance as to how to proceed in the initial work with the patient. Unfortunately, however, the therapist in training may be daunted by the psychodynamic/psychoanalytic literature, which is highly theoretical and bewildering in its diversity. The following material is a compilation of psychotherapy "pearls" that the authors have distilled from the psychotherapy literature, supervision with senior colleagues, and their own clinical experience. This article is intended as a primer of some technical aspects of psychodynamic work. An attempt has been made to select facets of technique that seem surprising to the inexperienced, as they are different from other types of conventional discourse. The authors have chosen to use "he" instead of "he/she" or "them" to make the paper stylistically more palatable. A bibliography is presented at the end as a guide for the beginning reader.

Diagnosis related groups (DRGs) will be introduced in Germany in 2003 as a basis for hospital funding in all areas except for psychiatry and psychotherapeutic medicine. The following article provides an overview of the use of alternative casemix-systems in the treatment of patients with mental disorders. Overall, DRGs and alternative systems have proven to be poor predictors of resource consumption due to the high variation in the length of stay and the variable treatment opportunities. Therefore, a DRG-system must include the possibility of coded therapeutic treatments, analogous to the procedures used in surgical DRGs, in order to integrate psychiatry and psychotherapeutic medicine into a DRG-based payment system.

Psychotherapy has shifted from long-term to short-term approaches, which have been found to be effective for the treatment of specific psychiatric disorders. These psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been found useful in presenting an educational framework for disorders and the treatment rationale for intervention programs. Short-term and maintenance empirical data support the effectiveness of using behavior therapy and CBT as adjunctive interventions with medications for bipolar I disorder and schizophrenia. In major randomized clinical trials, psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been shown to be effective as primary treatments (treatments of choice) for the major psychiatric problems of obsessive-compulsive disorder, panic disorder, and major depression as well as several other psychiatric disorders. The combination of psychotherapy and psychotropic medications is not always additive for acute treatment effects or especially for the maintenance of treatment effects so that the combination of psychotherapy and medications is not the most effective treatment for all psychiatric disorders. Badly needed, additional randomized controlled trials of psychotherapy, medications, and their combinations are under way in large, NIMH-supported studies of the treatment of several psychiatric disorders.

A cross-cultural view of psychopathology is proposed, contending that there are two basic systems of self-organization. These two systems of self-organization, labeled autonomy and relatedness, are essential to a person's well-being regardless of the culture or society to which the person belongs. The degree of autonomy and relatedness required to maintain mental health in a specific society is affected by cultural mores. People in collectivistic (primarily non-Western) cultures require high levels of relatedness and moderate levels of autonomy to maintain mental health. People in individualistic (primarily Western) cultures require high levels of autonomy and moderate levels of relatedness to maintain mental health. This view, based on a review of past work in various areas of psychology, is discussed in the context of various forms of psychotherapy existing in individualistic and collectivistic cultures.

An ideological and scientific struggle spanning decades has borne fruit with the development and documentation of psychological interventions for a variety of disorders and problems with proven efficacy. Termed variously 'empirically supported treatments' or 'evidence-based psychological practice' highly regarded scientific methods have established these interventions as effective as, and often more effective than, pharmacological treatments, particularly in the long run. In some cases, combined efficacious psychological and pharmacological treatments are most effective. Despite these developments, evidence exists that these psychological treatments are not readily available to the public who requires them, because they have not been effectively disseminated to the mental health professionals who deliver them. The variety of barriers to successful dissemination are outlined, and recent developments in clinical research and public health policy are described that may facilitate the advancement of evidence-based psychological practice.

The field of psychotherapies has in general widely evolved for these ten last years in France and more in depressive disorders treatment, namely owing to short structured therapies development and especially cognitive-behaviour therapies well fitted for controlled studies assessment. Pyschoanalytically oriented psychotherapies have also changed but not so much and they still remain less efficacious in this area. Henceforth the numerous technicals of this kind of therapy will be modified in the eclective and integrative approach; they must not be compared in opposition one another but used in a collaborative way on the basis of scientific data in order to make them more effective. So some very exciting prospects are open in the future of that field of research. Practically, nowadays the best outcomes are obtained in the association of both antidepressant drugs and cognitive-behavior psychotherapy.