Journal of Consulting & Clinical Psychology

Cultivating evidence-based clinical reasoning and action in youth mental health care: The Reaching Families multisite randomized trial.
Objective: Despite decades of policy emphasizing the role of evidence in guiding services, few studies have sought to improve the degree to which evidence is used in supervision and treatment. This study reports supervisor and therapist outcomes from the Reaching Families multisite cluster-randomized controlled trial, which tested the effects of a coordinated knowledge system (CKS) against practice guidelines (PG) on the use of evidence in supervision and treatment targeting low treatment engagement in publicly funded youth community mental health organizations located in two geographically distinct, underresourced communities where service inequities are common. Method: The sample included 121 mental health professionals (92.6% female; 81.0% Black, Indigenous, and people of color1) randomly assigned to a CKS or PG control condition. We recorded, transcribed, and coded 430 supervision and 208 treatment sessions involving 221 youth (Mage = 13.1 years, 46.2% female; 78.7% Black, Indigenous, and people of color) and/or their caregivers who reported engagement concerns during therapy. Results: CKS dyads showed uniformly greater use of evidence focused on specific client needs relative to dyads in the PG condition, with large effect sizes and no differences in the effect of condition across the sites. Secondary analyses showed that tools in the CKS condition were perceived significantly more positively than those in the PG condition in terms of effort and effectiveness, and supervisory workload was the same across both conditions. Conclusions: In routine clinical care delivered within highly representative community settings, a strategically designed knowledge resource can improve evidence-based reasoning and action and be perceived as easy to use and useful without negatively impacting workload. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Efficacy of facilitative interpersonal and relational skills training for teletherapy: A randomized controlled trial.
Objective: Therapists report a lack of confidence and competence in teletherapy compared to in-person therapy. Training focusing on teletherapy skills is scarce. This study reports on (a) the development of a training workshop for facilitative interpersonal skills (FIS) in teletherapy (tele-FIRST) and (b) a randomized controlled trial assessing the efficacy of tele-FIRST. Tele-FIRST is a 2-hr online synchronous training workshop that incorporates didactics, deliberate practice, simulation of teletherapy challenges, modeling, and discussion. Method: A set of tele-FIS stimulus clips that depict four types of teletherapy challenges (e.g., emotional disconnection, distraction) was used to evaluate and train therapists’ teletherapy skills. A total of 182 licensed therapists and trainees were randomized into either the tele-FIRST or a waitlist group. Of these, 153 participants completed baseline assessment and were included in the final analyses (tele-FIRST: n = 82; waitlist: n = 71). At baseline, posttraining, and follow-up, participants were assessed on their observer-rated FIS for teletherapy, self-reported FIS, teletherapy skills, acceptance of teletherapy, and self-efficacy. Results: Therapists demonstrated increased teletherapy skills following the tele-FIRST workshop. After controlling for baseline scores, the tele-FIRST group demonstrated significantly higher observer-rated tele-FIS (ηp² = .134), self-reported FIS (ηp² = .106), teletherapy skills (ηp² = .037), acceptance of teletherapy technology (ηp² = .082), and self-efficacy (ηp² = .036) compared to the waitlist group at posttraining. Conclusion: The tele-FIRST demonstrated significant short-term effects on enhancing therapists’ teletherapy skills as rated by both independent observers and therapists themselves. Tele-FIRST may improve the quality of teletherapy, though more research is needed to investigate its long-term effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Effects of a mobile mindfulness smartphone app on posttraumatic stress disorder symptoms and alcohol use problems for veterans: A pilot randomized controlled trial.
Objective: Veterans returning from deployment have high rates of posttraumatic stress disorder (PTSD) and co-occurring alcohol use disorder (AUD). Current treatments for PTSD and AUD report high dropout rates, and many veterans report alcohol misuse to cope with symptoms of PTSD. The present study is a pilot randomized controlled trial in which veterans (N = 201) were randomized to receive a mobile mindfulness-based intervention enhanced with brief alcohol intervention content (Mind Guide) or an active stress management program. Method: To be eligible for the study, veterans had to have served after September 11, 2001 (post-9/11 veteran) and screen positive for PTSD and AUD. All participants were asked to complete a baseline and four monthly follow-up assessments (two during treatment phase and two posttreatment phase). Primary outcomes were PTSD symptoms, frequency of alcohol use, and alcohol use consequences. Results: Engagement with Mind Guide was excellent (averages of over 31 logins and 5 hr of app usage). Those assigned to Mind Guide showed significant reductions in PTSD symptoms (d = −0.36; 16-week follow-up). No differences emerged for frequency of alcohol use (d = −0.12; 16-week follow-up) or consequences (d = −0.12; 16-week follow-up). Conclusions: Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. Further development of Mind Guide may enhance efficacy at reducing alcohol use and consequences. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Association of machine-learning-rated supportive counseling skills with psychotherapy outcome.
Objective: This study applied a machine-learning-based skill assessment system to investigate the association between supportive counseling skills (empathy, open questions, and reflections) and treatment outcomes. We hypothesized that higher empathy and higher use of open questions and reflections would be associated with greater symptom reduction. Method: We used a data set with 2,974 sessions, 610 clients, and 48 therapists collected from a university counseling center, which included 845,953 rated therapist statements. Client outcome was routinely monitored by the Counseling Center Assessment of Psychological Symptoms Instruments. Therapists’ skills were measured via computer by a bidirectional-long-short-term-memory-based system that rated use of supportive counseling skills. We used multilevel modeling to separate the between-therapist and the within-therapist associations of the skills and outcome. Results: Use of open questions and reflections was associated with client symptom reduction between therapists but not within therapists. We did not find significant associations between therapist empathy and client symptom reduction but found that empathy was negatively associated with clients’ baseline symptom level within therapists. Conclusions: Therapist exploration of clients’ experience and expression of understanding may be important skills that are associated with clients’ better outcomes. This study highlights the importance of support counseling skills, as well as the potential of machine-learning-based measures in psychotherapy research. We discuss the limitations of the study, including the limitations related to the speaker recognition system and potential reasons for the lack of association between empathy and client outcome. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
A theoretically based experimental manipulation of the processing of sudden gains: Considering reasons, meaning, and opportunities to leverage the gain.
Objective: Sudden gains in psychotherapy have been found to predict outcome, but the conditions under which this occurs remain understudied. In the present study, we experimentally examined the effects of processing sudden gains on treatment outcome. Method: As part of a large randomized controlled trial of internet-delivered cognitive behavior therapy for social anxiety disorder (n = 182), we experimentally manipulated therapists’ responses to sudden gains. Specifically, we randomized individuals who experienced a sudden gain (n = 52) to either receive (n = 26) or not receive (n = 26) processing of the gain. Results: We found that processed sudden gains were significantly less likely to be reversed compared to unprocessed sudden gains. We also found that individuals with processed sudden gains had lower symptom levels at posttreatment/follow-up compared to individuals with unprocessed sudden gains (Mdifference = 15.65, SE = 5.87, p = .023, Cohen’s d = 0.84; Mdifference = 16.68, SE = 6.36, p = .026, Cohen’s d = 1.05; respectively). In addition, individuals with unprocessed sudden gains did not have significantly different symptom levels at posttreatment/follow-up compared to individuals who did not experience a sudden gain during treatment. Conclusions: Our findings suggest that in internet-delivered cognitive behavior therapy for social anxiety disorder, the processing of sudden gains (rather than the gains themselves) leads to upward spirals of improvement that affect long-term outcomes. Replication of these findings in additional studies is needed, and, if replicated, such findings could provide the basis for adding processing of sudden gains to existing therapeutic protocols. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

Journal of Consulting and Clinical Psychology - Vol 93, Iss 2