The Impact of Providing Therapy on the Therapist: A Student's Reflection

Providing psychotherapy changes the therapist in a variety of ways. This article discusses one doctoral student's perceptions of these changes, such as increasing her patience, gratitude, and reliance on faith; stretching her ability to tolerate ambiguity; and influencing her interpersonal relationships.     

Limitations of Manualized Psychotherapy for Everyday Clinical Practice

Outcome research is important to improving psycho-therapeutic procedures. Empirical evaluation of "manu-alized" clinical procedures, both broad and narrow, is a valuable current research trend. However, the conditions of such research are far removed from the conditions that exist in everyday clinical practice. The limitations of present data on so-called "validated treatments" preclude conclusions about what forms of treatment to reimburse or include/exclude in graduate training programs. Future research should emphasize commonly used forms of treatment and more typical patient populations.     

Implicit and Untested Assumptions About the Role of Psychotherapy Treatment Manuals in Evidence- Based Mental Health Practice

We consider Carroll and Nuro's (this issue) model of treatment manual development in the broader context of attempts to bring accountability and evidence- based practice to clinical services. The current Zeitgeist surrounding treatment manual dissemination is guided by several implicit and largely untested assumptions. We describe each assumption, consider how it guides current thinking about dissemination of empirically supported treatments, and briefly summarize relevant research. We conclude that treatment manual development and dissemination, while clearly a worthwhile pursuit, is only one way to merge science and practice.     

Achieving Evidence-Based Psychotherapy Practice: A Psychodynamic Perspective on the General Acceptance of Treatment Manuals

This commentary strongly applauds the initiative to implement manualiied treatments into clinic settings. It argues that manualization is the most effective method currently available, limiting the countertherapeutic components of the relationship between client and psychotherapist that inevitably arise as part of treatment.     

Manual-Based Treatment and Clinical Practice: Hangman of Life or Promising Development?

Wilson (this issue) argues for the advantages of manual-based treatments for enhancing therapeutic outcomes. While largely agreeing with Wilson about the advantages of manuals, I argue here that manuals have been with us since the early 1960s, that their use has done little to enhance patient outcome, and that the field would be best served by tracking patient progress on a routine basis, a task that does not require manual development. Empirical science has much to contribute to positive patient outcome; its greatest direct effect will be felt when clinicians monitor outcome and connect this outcome to the behaviors and attitudes of a particular therapist.     

What to Do When Manuals Fail? The Dual Model of Psychotherapy

Although multicenter clinical trials have impressively attested to the efficacy of psychological interventions for common psychological disorders, some individual patients still do not profit from treatment. In this article, we present a theoretical model and some supportive results to explain this unsatisfactory state. Apart from early treatment dropout, some patients are not engaged in treatment and lack the prerequisite behavior ("patient basic behavior") for successfully applying protocol-specified intervention techniques. According to the dual model of therapy, therapists have two tasks: to apply treatment techniques/procedures and to motivate patients for treatment by strengthening patient basic behavior if necessary. Our results show that therapists attend and react to therapeutic process problems by changing from a method-oriented treatment strategy to a process- or patient-oriented strategy. This change, however, occurs too soon, too often, and occasionally for the wrong reason. We must therefore develop empirically based criteria to inform therapists when to react, what to look for, and what to do to motivate the patient. We conclude that treatment outcome research and process research are both valuable and complementary aspects of psychotherapy research.     

Treatment Manuals for the Real World: Where Do We Build Them?

Carroll and Nuro (this issue) outline a model for development of psychotherapy manuals that parallels the recently articulated stage model of psychotherapy research. The authors outline excellent considerations for treatment manuals in early, middle, and late stages of development. As manual testing moves from pilot studies and efficacy tests in university settings to transportability studies in clinical settings, the complexity of the manuals increases. These considerations also raise the broader question, however, of whether the stages of psychotherapy research as commonly implemented are best suited for developing treatments appropriate for "real-world" clinical settings. I suggest that all stages of research are perhaps better conducted in clinical as opposed to university settings. A change in research infrastructure would be challenging at first but could ultimately accelerate development of psychotherapy technologies.     

系统式家庭治疗过程中的若干观察和思考

目的 :探讨系统式家庭治疗。方法 :通过对 2 9例家庭实施系统式家庭治疗 ,总结了治疗过程中治疗师的观察和感受。结果 :治疗师要尊重咨客的就诊习惯和思维方式 ,以实际生活中的事件作为治疗资源促进咨客的变化 ,将家庭对自己命运的焦虑转化成重新自我组织的动力淡化未解决的问题 ,注重积极变化 ;同时治疗师要对会谈进程保持高度意识 ,注意控制会谈的节奏和时间。结论 :引进的治疗方法应结合我们的国情     

Witnessing Clients’ Emotional Transformation: An Emotion‐Focused Therapist's Experience of Providing Therapy

Emotion‐focused therapy (EFT) is an integrative–humanistic, research‐informed, psychological intervention characterized by sustained focus on the client's emotional pain and its transformation. This article discusses the impacts on the therapist when encountering and transforming the client's vulnerability. It is organized around the different phases of the therapy process: meeting a new client, accessing the client's core emotional pain, transforming the client's emotional pain, and ending the therapeutic work. The article also contains personal experiences of the author and provides illustrations of impactful events from therapy sessions. The work, it is suggested, provides significant learning for the therapist on both a personal and a professional level, leading, for example, to the therapist's maturation, better connection with personal hurts and vulnerabilities, greater courage in regard to sharing such feelings, greater kindness toward others and the self, and greater determination to be braver when facing adversity or injustice.     

In Defense of Dissemination of Empirically Supported Psychological Interventions

Misconceptions apparent in Garfield's comments on the report of the Division 12 Task Force on Promotion and Dissemination of Psychological Procedures are corrected. Issues concerning the use of manuals in psychotherapy training and practice and the value of specific treatments for specific problems are discussed.     

住院森田疗法在治疗强迫症中的改进及疗效分析

探讨适合我国强迫症患者的有效心理疗法 ,方法 :在应用日本森田疗法基础上 ,结合临床实践 ,对治疗强迫症过程中的治疗原则、实施过程等进行了改进。对 80例强迫症患者进行了治疗 ,同时采用SCL -90 ,SDS ,SAS和EPQ在治疗前后进行评定。结果 :平均疗程 64 3± 19 7天 ,痊愈 32例 ,显著好转2 8例 ,好转 12例 ,无效 8例 ,显著好转率 75% ;量表测查结果表明 ,患者治疗后心理健康水平明显提高 ,一些人格特征得到改善。患者有无强迫行为对疗效无明显影响。结论 :改进后的住院森田疗法是治疗强迫症的有效心理疗法强     

It Isn't the Size, but the Fit

The very structure and control that formed the reason for developing treatment manuals have now become their most frequently criticized characteristic. Carroll and Nuro (this issue) continue this critique and rightly call for ways to increase the flexibility in the processes used to develop treatment manuals. But it is insufficient to be flexible during the process of developing the manual. It is also necessary to find ways to increase the flexibility of selecting and applying the treatment procedures themselves. Offering therapists options in the selection and use of techniques can be accomplished by focusing more on the principles of therapeutic change than on theories of psychotherapy or the applications of techniques. This paper announces a Presidential Initiative from the Society for Clinical Psychology (Division 1 2) of the American Psychological Association (APA), which is designed to identify integrative and crosscutting principles of therapeutic change. It is hoped that this initiative will further foster the development of flexibility without sacrificing the basis of sound empirical support.     

Progression of Therapy Research and Clinical Application of Treatment Require Better Understanding of the Change Process

The stage model of therapy research focuses on the development of treatment from pilot work, through randomized controlled clinical trials, to tests in clinic settings. A goal of the model is to develop effective treatments that can be used clinically. The present comments begin with a similar goal but emphasize the importance of a broader agenda designed to understand therapy. A central thesis is that developing effective treatments depends heavily on investigations that address critical scientific questions; particularly, what are the mechanisms through which therapy operates and under what conditions is therapy likely to be effective and why? The comments argue for a portfolio of research that addresses a broader range of questions and encompasses more diverse methods of evaluating treatment. Breadth and diversity are not ends in themselves but will be essential to obtain the requisite knowledge to effect optimal changes in clinical applications of treatment.     

Between‐therapist and within‐therapist differences in the quality of the therapeutic relationship: effects on maladjustment and self‐critical perfectionism

The relationship between therapeutic outcome and a patient‐reported measure of the Rogerian conditions of positive regard, empathy, and genuineness was decomposed into between‐therapist effects and within‐therapist effects using multilevel modeling. Data were available for 157 depressed outpatients treated by 27 therapists in the cognitive‐behavioral therapy, interpersonal therapy, or placebo with clinical management conditions of the Treatment of Depression Collaborative Research Program (Elkin, 1994 ). Consistent with prior findings of significant between‐therapist variability in outcome (e.g., Baldwin, Wampold, & Imel, 2007 ), patients whose therapists provided high average levels of the perceived Rogerian conditions across the patients in their caseloads experienced more rapid reductions in both overall maladjustment and depressive vulnerability (self‐critical perfectionism). Within each therapist's caseload, differences between patients in perceived Rogerian conditions had weaker effects. The results underline the importance of differences between therapists as determinants of outcome in the treatment of depression. © 2010 Wiley Periodicals, Inc. J Clin Psychol: 66:1–17, 2010.     

A Tool to Advance the Effectiveness and Dissemination of Empirically Supported Psychotherapies and the NIMH Public Health Research Agenda

Carroll and Nuro's (this issue) stage model will likely hasten the availability of more educationally effective and clinically complete therapy manuals for both research and practice. The model is an important and concise tool for broadly disseminating knowledge about psychotherapy manual development that has accrued over the 20 years since manuals became required for federally funded therapy outcome research. The current paradigm shift to a public health research agenda, spearheaded by the National Institute of Mental Health (NIMH), is evident in the model's specifications for stage III manuals. The immense challenge for researchers to truly meet the scientific demands of stage III manuals (and the NIMH's research charge) is briefly discussed. An autobiographical case report is also presented to illustrate that manuals for empirically supported therapies are not, in all cases, as "unfriendly" to practice and practitioners as much contemporary literature suggests, and as the stage model is intended to remedy.     

在HIV/AIDS小组心理治疗的实践

目的：在HIV／AIDS患者中开展小组心理治疗。探索经验和方法。方法：采用支持、认知为导向的集体心理治疗方法，对三位HIV／AIDS个体进行心理治疗。结果：三位患者在小组治疗后认同HIV身份之时，接纳自己，面对现实、减轻了孤独感。结论：在HIV／AIDS人员中实施集体心理治疗将有利于提高其生活质量。     

住院森田疗法对神经症治疗的研究

本文应用住院森田疗法治疗41例神经症病人,平均疗程45天。经临床疗效评定,痊愈28例,显好10例,显效率达92.68%。SCL-90、SAS、SDS 量表测查提示各项因子疗程前后均有显著性差异(P<0.01)。平均随访7.84±4.73月证实远期疗效较稳定。说明住院森田疗法是治疗神经症的有效方法。     

The Effects of the Individual Psychotherapist and Implications for Future Research

A body of research concerning psychotherapy outcome is reviewed with the intent of establishing the importance of the individual psychotherapist to treatment process and outcome. Although particular therapy techniques have not been shown to be especially important in therapy process and outcome, they have been the focus of most research and training for the past two decades. In the past, extensive study of the individual therapist was difficult, but the rising trend of managed health care organizations has created opportunities to conduct research on this topic. Hypothetical outcome data for individual clinicians are presented in graphical form. An attempt is made to show how patient typing can be used to adjust outcome by case-mix methods. Suggestions for future research are made.