Journal of Psychotherapy Integration

Brief transactional analysis psychotherapy for depression: The systematic development of a treatment manual.
Since the birth of transactional analysis (TA) in the 1950s, many psychotherapists have provided and tested TA psychotherapy (TAP) in clinical trials. However, most descriptions of TA therapy within these trials offered a general guide rather than a systematic treatment manual. This makes it difficult to attribute their outcomes directly to TAP as the variations in the therapists’ ways of working have not been sufficiently accounted for. The existing manuals are based on particular schools of TA and research-informed personal best practice, rather than systematic reviews and meta-analyses, which would ensure that they could be replicated. This article addresses that apparent gap by describing the systematic development of a semistructured treatment manual for Brief Transactional Analysis Psychotherapy for depression, in order to enable its use in practice and research. The manual was based on an international survey of TA therapists, a systematic literature review of TA psychometric instruments, and meta-analyses of TAP clinical trials, which fed into the development of the evidence-based integrated conceptual model. This model formed an operational definition of TAP and the basis of a 16-session treatment manual for mild to moderate depression. The manual consists of four stages: initial assessment and therapeutic agreement (“contract”), systematic assessment, experiential processing, decision-making and applying script changes. Two new instruments were also developed: Transactional Analysis Goal Attainment Form (TAGAF) and Transactional Analysis Psychotherapeutic Self Report Competencies Scale (TAP-SRCS). (PsycInfo Database Record (c) 2024 APA, all rights reserved)
New skills for distance regulation: Therapists’ experiences of remote psychotherapy following the COVID-19 pandemic.
Social distancing during the COVID-19 pandemic forced many therapists to shift from in-person sessions to the use of communication technology. This shift actualizes the issue of for whom and when remote therapy is suitable and how the therapeutic technique should be adjusted. Our study explored therapists’ long-term experiences of remote psychotherapy after this transition. Data were collected about 2 years after World Health Organization’s (WHO’s) declaration of the COVID-19 pandemic. Semistructured interviews with 10 therapists with different treatment orientations were analyzed, applying the qualitative method of inductive experiential thematic analysis. The therapists said that the use of communication technology implied a new and different in-session interaction, inclusive of changed relational dynamics and the need to adjust their way of working. All therapists experienced possibilities and advantages as well as difficulties and challenges with remote psychotherapy. As time went on, they gained both positive and negative new experiences of the distinctive features of remote therapy and became more comfortable with remote communication. Above all, they acquired new technical and relational skills. Taken together, the therapists’ experiences illustrate the need to develop new skills for negotiating setting alternations and distance regulation and to adapt therapeutic interventions when shifting between in-person settings and remote sessions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Clinician reports of the motivation to change and the therapeutic alliance in patients with anorexia nervosa: Countertransference as a mediator.
Objective: The motivation to change in patients with anorexia nervosa (AN) predicts both treatment outcomes and the therapeutic alliance (TA). In addition, different countertransference patterns have previously been related to the patient’s motivation to change and the TA. However, the mechanisms through which these relationships occur are unclear. In this study, we examine the therapists’ perspectives on the relationships between all three variables and whether countertransference patterns mediate the relationship between the stage of change and the TA. Method: One hundred and fifty-six AN therapists were recruited from eating disorders recovery centers, conferences, and associations. The participants completed a motivation to change questionnaire (the staging algorithm questionnaire), a countertransference questionnaire, and a TA questionnaire (working alliance inventory short revised), regarding the last patient with AN they had a session with. Results: Motivation to change, as rated by therapists, was strongly related to the TA and to countertransference patterns of hostility, helplessness, and positivity. Countertransference patterns that were hostile, helpless, positive, disengaged, or overwhelmed were related to the TA as rated by therapists. Additionally, three countertransference patterns (positive, hostile, and helpless) mediated the relationship between the motivation to change and the TA. Conclusions: Increasing patients’ motivation to change might facilitate alliance development. Furthermore, more attention should be given to therapists’ countertransference to account for the motivation to change–TA relationship as perceived by therapists. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
The effectiveness of psychotherapy for anxiety in private practice: Benchmarking outcomes and examining predictors.
Anxiety disorders are highly prevalent conditions that can be successfully treated with psychotherapy. This effectiveness, however, has rarely been examined in private practice. Thus, this is an important gap in the literature. The present study was designed to address this omission by examining treatment outcomes from a sample of 2,826 clients receiving psychotherapy for an anxiety disorder. The average age of clients was 32.91 years (SD = 11.77 years, range = 18–86 years) and most identified as women (74.0%). Treatment was delivered by private practitioners (n = 1,141) who were part of a practice research group. We conducted benchmarking and multilevel analyses to examine predictors of outcomes, including access to care and comorbidity. The whole sample displayed medium improvements, while clients with moderate and severe baseline presentations exhibited large improvements. A benchmarking analysis found these outcomes to be equivalent to those reported in active treatments from randomized controlled trials, and superior to those observed in untreated individuals. Multilevel analyses indicated that therapists who had a shorter time from case assignment to first session across their caseloads achieved better client outcomes. However, for these therapists when their clients do wait longer, they have worse therapy outcomes. Therapists who had longer wait times for the clients, on average had worse outcomes, regardless of clients’ actual wait times. Comorbid baseline depressive symptoms were found to hinder anxiety outcomes, irrespective of baseline anxiety severity. Therapists should be mindful of their responsiveness to clients during the onboarding phase and develop ways to improve engagement with clients. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Using values interventions to improve exposure therapy engagement in specific phobias.
Exposure therapy is the gold standard for treating specific phobias (SPs). However, most individuals never seek treatment, refuse treatment, or prematurely drop out. This integrative review brings together literature from the fields of SPs, other anxiety and related disorders, exposure therapy, and acceptance and commitment therapy (ACT) to identify reasons for limited engagement and to provide a potential solution. Operant processes involved in maintaining SPs are first discussed as drivers of limited willingness to engage with treatment. Individuals with SPs are more motivated to avoid contact with phobic stimuli—a requirement of exposure therapy—regardless of possible approach benefits. Following, a novel solution based on ACT values components, which directly targets the operant processes involved in SPs, is proposed. Values interventions aim to clarify what is important in one’s life and promote behavior consistent with stated values even in the presence of difficult thoughts and emotions. Such work can provide meaning and reinforcement for approaching phobic stimuli. Therefore, values interventions have the potential to enhance willingness to pursue and persist in exposure, enabling individuals to augment treatment benefits and reduce costs. To guide this endeavor, recommendations to clinicians and researchers are presented. Clinical vignettes from real patients are also provided to illustrate the proposed methods. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Assessing interpersonal impact of veterans with posttraumatic stress disorder and moral injury: A case study of how significant others perceive veterans undergoing a positive psychology intervention.
Given the risk for posttraumatic stress disorder (PTSD) and moral injury to negatively impact relationships of veterans, researchers have increasingly focused on social functioning assessment. However, extant studies have often relied on self-report methods and relatively broad relational measures. To better understand the dynamic process of social functioning, it is important to determine how others perceive those veterans and their interactions. Interpersonal circumplex assessments, such as the Impact Message Inventory-Circumplex (IMI-C), may provide that perspective by asking others to rate observations of veterans’ social behaviors on a circular pattern of eight octants representing unique blends of two orthogonal dimensions: affiliation (cold–warm) and control (dominant–submissive). This case study demonstrated how the IMI-C can be used to examine significant others’ perceptions of veterans with PTSD and moral injury in the context of a novel positive psychology treatment focused on inducing moral elevation. Using a fine-grained analysis of interpersonal behaviors, this study described two cases of veterans who demonstrated notable pre–post changes in how they were perceived by others, providing contextual information including quantitative changes in PTSD symptoms, moral injury, and quality of life, as well as qualitative reports of interpersonal changes. Clinical and research implications are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Considerations in adapting cognitive-behavioral conjoint therapy for posttraumatic stress disorder to a family setting.
Cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) is a manualized therapy for couples designed to simultaneously decrease PTSD symptoms and improve relationship functioning. CBCT has only been tested in couples, not families of three or more members. Family therapy for PTSD may have merit given that there is a bidirectional relationship between PTSD symptoms and poor family adjustment. Adapting CBCT for families has the potential to broaden the impact of CBCT on multiple family members. We review the current evidence for CBCT, the familial impact of PTSD, and presently available family-focused treatments for PTSD. Next, we provide an overview of considerations for adapting CBCT to a family context, as informed by an initial effort to administer this intervention to a family of three. Considerations include lengthening the number and duration of sessions to accommodate hearing from more family members, replacing couple-specific content, tweaking instructions for worksheets, and ensuring that all members are included in the in-session and out-of-session practice. Logistical considerations when seeking to deliver family therapy during COVID-19 or virtual treatment are also described. Future research is needed to determine the efficacy of CBCT for treating PTSD within families. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Journal of Psychotherapy Integration - Vol 34, Iss 1