Objective Challenging therapy situations are interpersonally charged moments in therapy and can serve as a critical marker for assessing therapists’ interpersonal skills. This study aimed to investigate trainee therapists’ stress response during such situations. Method Trainees (n = 46) completed both the Facilitative Interpersonal Skills performance task to measure challenging therapy situations and an additional benign condition depicting interpersonally neutral moments in therapy. We assessed heart rate, heart rate variability, skin conductance level, fundamental frequency, speech rate, and self-reported distress to measure stress throughout the task. Results Analyses show differences on most outcome measures between the benign and challenging condition in the predicted direction (more arousal), although there was no alignment with self-reported distress. Conclusion These findings highlight the promising nature of considering trainees’ stress responses in different therapy situations in future research.

Objective Major depressive disorder (MDD) is associated with ineffective affect regulation. Vocal data can shed light on communication and expression during psychotherapy and provide high-resolution data for the study of affective arousal dynamics. Computerized vocal analyses were used to examine the extent to which intrapersonal and interpersonal vocal-arousal dynamics were linked to session outcomes and whether a session’s dampening as compared to an amplification arousal trajectory would moderate this association. Method: Data from 30 clients treated for MDD by nine therapists were analyzed. A total of 9,324 vocal arousal data points were extracted from the working phases of 137 therapy sessions. The clients reported their well-being levels before and after each session on the Outcome Rating Scale. Results Vocal-analysis revealed both intrapersonal regulation (towards one's baseline) and interpersonal regulation (towards the partner's arousal level). Only clients’ interpersonal regulation towards their therapist's arousal level was linked to better session outcomes. Notably, this positive link occurred more in sessions where the client's overall arousal decreased (dampening); no such link was observed when arousal increased (amplification). Conclusions These results suggest that interpersonal (i.e., therapist-client) affect regulation may contribute to therapeutic change in sessions characterized by overall dampening in patients diagnosed with MDD.

Objective To facilitate research on therapist factors that relate to treatment implementation and alliance building, the current study developed and validated a scale that measures therapist ambiguity intolerance. Method Using 870 sessions from 257 clients nested within 96 therapists in a Chinese master’s training program, the present study developed items for the Therapist Ambiguity Intolerance Scale (TAIS), explored its factor structure, and examined its structural and criterion validities. The analyses were conducted based on a multilevel framework. Results The results supported a unidimensional structure at the between-client level. Although technically a bifactor model with three specific factors was favored at the within-client level, the results revealed a dominant general factor. The score of the TAIS was positively associated with therapist anxiety and negatively associated with therapist self-efficacy at both the within- and between-client levels. The TAIS score was negatively associated with client-rated working alliance at the between-client level. Additionally, the TAIS score was negatively associated with client-rated session quality at both the within- and between-client levels. Conclusions This study offers a useful measure of therapist ambiguity intolerance for research and practice on therapy and training. It highlights the importance of handling inevitable ambiguity in therapy.

Objective Yalom (1985) believed that working in the here-and-now of the group is essential to facilitating the “therapeutic factors” necessary for a successful outcome. Yet, we currently lack research examining whether a here-and-now in-session focus predicts the therapeutic factors, as theorized. Methods This study used Linguistic Inquiry and Word Count (LIWC) analysis to assess group member and leader in-session here-and-now focus by analyzing words spoken in a session. Results The results suggest that when group leaders use more here-and-now words in a speaking turn, group members use more here-and-now words in the subsequent speaking turn. However, contrary to expectation, group leaders and group members “matching” on here-and-now language in a session did not predict more therapeutic factors in between sessions, but rather less social learning. Instead, how consistent or variable group members or leaders were in their here-and-now focus generally predicted more therapeutic factors. Conclusion These results suggest that LIWC may be a promising vehicle to assess here-and-now language in group therapy sessions and that a here-and-now in-session focus has a complex relationship with the therapeutic factors.

Objectives: Existing research suggests that a psychotherapist's physical attractiveness can shape patients’ initial evaluation. However, less is known about how facial attractiveness affects the decision to select one psychotherapist over another prior to therapy. In this study, conducted with a Spanish-speaking sample (N = 108, 63 females, M age = 32.08 years, SD = 17.50), we examined whether facial attractiveness influenced the likelihood of choosing a psychotherapist and whether this effect was moderated by sexual differences. Methods: The experimental design closely replicated an online professional therapist directory to enhance ecological validity. Participants were instructed to rate the likelihood of selecting each individual as their therapist. Results Results demonstrated that psychotherapists with attractive facial features were chosen more frequently, even when perceived trustworthiness and competence were controlled for. No significant differences were observed between profiles featuring unattractive faces and those with no profile picture. Crucially, neither the therapist's nor the patient's gender and sexual preferences (i.e., sexual attraction) moderated the observed effect. Conclusion: The findings suggest that the preference for attractiveness in therapist selection is not driven by mating intentions nor by a “halo effect” related to trustworthiness or competence. Practical implications for therapist selection and patient decision-making are discussed.

Objective Several studies have identified therapist cultural humility as an important predictor of client psychotherapy outcomes, yet most have been conducted cross-sectionally, retrospectively, and/or with inconsistent assessment of other related therapy process constructs. Here, we bridge this gap by examining early treatment ratings of therapist cultural humility, multicultural competence, working alliance, and client-centered treatment approaches as prospective predictors of client functioning in an active community clinic. Method Fifty participants (56% women, 10% gender diverse; 44% ethnoracially diverse), aged 18–69, rated these factors within 12 weeks of intake in a community mental health clinic. Therapists assessed client functioning at pre-treatment screening, diagnostic feedback, and treatment termination. Results Multilevel modeling analyses indicated clients rating higher therapist cultural humility in early treatment had the largest improvements in therapist-rated functioning from pre-treatment to termination. Notably, the association between therapist cultural humility and client functioning at termination was moderated by ethnoracial status, with higher cultural humility ratings predicting better client functioning at termination solely for ethnoracially diverse clients. Conclusion These findings underscore the importance of integrating cultural humility instruction in training programs and therapeutic standards to promote mental health equity.

Objective Exposure to family violence in childhood significantly increases the risk of developing severe psychiatric and physiological illnesses. Trauma-focused cognitive behavioural therapy (TF-CBT) effectively addresses trauma-related symptoms and improves overall well-being. However, knowledge of the persistence of these positive effects over time, facilitating factors, and why some children are not benefited remains limited. Furthermore, little attention has been paid to exploring children’s subjective experiences. This study aimed to investigate long-term changes in trauma-related symptoms among children and youths who underwent TF-CBT due to family violence. Nine participants (M age = 16,6 years, range = 14–23; 7 girls and 2 boys) were assessed and interviewed four to five years after TF-CBT treatment. Methods The study adopted a mixed-method approach, integrating quantitative and qualitative methods. Results While most participants still reported being affected by the violence, most had benefited from treatment, with improvements lasting over the years. However, for those who did not report decreased symptoms, trauma symptoms persisted, accompanied by additional severe mental health problems. Conclusions The findings underscore the importance of providing effective trauma-focused treatments such as TF-CBT and highlight the need for enhanced safety measures and parental interventions for children who do not benefit from treatment.

Objective Routine Outcome Monitoring (ROM) in group psychotherapy has shown varied results, as personalizing therapy for multiple patients is challenging. This study explored the impact of ROM and individual Add-On Interventions (AOIs) for patients with depression who were not progressing during Group Cognitive Behavioral Therapy (GCBT). We followed the research question, “How can individual AOIs contribute to patients’ therapy courses?”. Method We interviewed patients and therapists involved in GCBT with ROM and individual AOIs prompted by Not-On-Track alerts. Thematic analysis was used to generate themes related to participants’ experiences. Three cases were selected to illustrate the structure of the themes. Results The main theme, “AOIs: Potential for active engagement,” was constituted by seven subthemes concerning the influence of ROM, therapeutic collaboration, shared decision-making, allowing for person-tailored interventions, and the dynamic between group and individual sessions. The potential for active engagement was nurtured through flexible awareness, as patients shifted between a first-person perspective and an external perspective on their therapy process. Conclusion Individual AOIs, prompted by patient feedback, could create opportunities for reflection and engagement. However, the impact was shaped by the therapeutic relationships, the shared decision-making process, and the extent to which the AOIs offered complementary approaches to group psychotherapy.

Background The Clinical Outcomes in Routine Evaluation (CORE) system was launched in 1998 intended to support the development of practice-based evidence and to reduce the research/practice gap. Since then, CORE instruments have been widely used. Aims To map the utilization of the CORE system as reflected in peer-reviewed literature. Methods We followed the guidelines for conducting a scoping review. Results We identified 721 papers from 1998 to 2021 citing the CORE system, with 636 of them referencing its use in clinical settings. There has been a marked increase in use of the system over that period. All CORE instruments were used at least once, spanning 39 countries and 24 languages. Papers had a broad spectrum of objectives and populations across diagnoses and settings, aligning with the authors’ planned versatility for the CORE system. Conclusions In the light of the findings, we present a guide to enhance the reporting of work utilizing the CORE system. This could be applied to all practice-based evidence data collection, CORE or otherwise.

Objective Maintaining relevance in a psychodynamic dialogue is a nuanced task, requiring therapists to balance between following patients’ free associations while avoiding less effective interventions. Identifying less effective sequences of talk is especially challenging given the diversity of psychodynamic approaches and methodological barriers to analyzing session discourse. This study introduces a novel approach using the MATRIX coding system, an evidence-based tool, to differentiate content correlated with better session outcomes. Method Transcripts of 367 sessions were coded using the MATRIX. Therapist Out-of-MATRIX utterances, indicating a deviation from core therapeutic focus, were examined for their predictive value. Outcome measures included the next-session alliance and patient functioning scores. Two machine-learning-based models, using the Random Forest algorithm, predicted session-by-session changes in clinical outcomes based on MATRIX codes, and interpreted using the SHapley Additive exPlanations. Results Therapist Out-of-MATRIX utterances accurately predicted next-session changes in alliance and patient functioning scores. Our model also identified an optimal dose-effect relationship for the number of Out-of-MATRIX interventions needed for effective therapy session. Conclusion This study demonstrates the potential of using contemporary research tools to analyze therapeutic discourse, revealing how psychotherapy produces its benefits. Its scope extends beyond prediction, providing practical recommendations on how to enhance therapists’ performance and outcomes.