Journal of Psychotherapy Integration

Multidisciplinary and multimodal interventions for depressive and anxiety disorders: A single-arm meta-analysis.
While multidisciplinary multimodal interventions hold promise for the treatment of depressive and/or anxiety disorders, no meta-analysis has yet synthesized the findings from studies evaluating these interventions. Therefore, this study aims to examine changes in patient-reported and observer-rated outcomes over time among individuals undergoing such interventions, specifically focusing on changes from pre- to posttreatment and identify whether observed changes are sustained until follow-up. Cohorts from studies assessing the efficacy and effectiveness of these interventions for individuals with a diagnosed depressive and/or anxiety disorders were assessed for eligibility. Five electronic databases were systematically searched from inception to July 2022, resulting in inclusion of 22 cohorts (978 patients) from efficacy studies and 10 cohorts (1,520 patients) from effectiveness studies. Single-arm meta-analysis, utilizing pre–post effect sizes, was conducted separately for cohorts from efficacy and effectiveness studies. Changes over time for pre–post, postfollow-up, and prefollow-up contrasts were calculated for depressive symptoms, anxiety symptoms, overall psychiatric symptoms, global functioning, quality of life, and physical activity. The findings indicate that a favorable pre–post effect was observed in the majority of included cohorts, and these improvements were largely maintained until the end of follow-up across all outcome domains. However, caution is warranted in interpreting these results due to the use of single-arm meta-analysis with pre–post effect sizes. It is plausible that the observed results may not solely be attributed to the investigated interventions, as other uncontrolled factors likely influence the results. Moreover, substantial heterogeneity in participants and intervention characteristics were identified across the included study cohorts. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
A qualitative study of clients with chronic pain who participated in an integrative mind/body psychotherapy intervention.
The purpose of this qualitative study was to understand the experiences of 11 clients with chronic pain who participated in a 10-week, small group psychotherapy intervention that integrated emotional awareness and expression therapy and mindfulness. Qualitative interviews using constructivist grounded theory were conducted with participants to understand their experiences. The findings identify a set of conditions under which the approach is perceived as effective in alleviating chronic pain, as well as conditions under which participants perceived moderate or no benefit from the intervention. These findings provide the potential to inform future treatment protocols and interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Therapist ratings of technique and alliance among adults with eating disorders: Support for integrative treatment.
The prevalence of eating disorders (EDs) has persistently increased over time, yet research on ED treatment is scarce. This study is the first to explore the relationship between specific therapeutic techniques and therapist alliance in the treatment of adult ED patients. Data were collected in 2022 via an online survey from 126 licensed therapists treating an adult with an ED. Therapists averaged 15 years of clinical experience in various theoretical orientations (e.g., cognitive–behavioral [CB] = 50%, psychodynamic = 20.6%, interpersonal = 11.1%, family systems = 7.1%, humanistic–existential = 4.8%, other = 6.3%). Therapists rated the use of CB, psychodynamic–interpersonal (PI), and adjunctive (AT) ED interventions in their treatment of, as well as their alliance with, a randomly selected patient. Patients reported on had diagnoses of anorexia (n = 55), bulimia (n = 21), binge eating (n = 24), unspecified ED (n = 5), and other specified ED (n = 20). There was a significant, positive correlation between therapists’ reported use of CB interventions and rating of therapist alliance, r(124) = .182, p = .04. Furthermore, a forward stepwise regression yielded a three-step model predicting therapist alliance, R = .400, r² = .160, F(125) = 7.73, p <.001. This regression model revealed that psychoeducation (CB) and exploring uncomfortable emotions (PI) were positive predictors of therapist alliance, whereas simultaneous inpatient or day treatment (AT) was a negative predictor of therapist alliance. Findings highlight how specific integrative treatment interventions strengthen or weaken therapist alliance, with implications for improved treatment of adults with EDs. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Understanding self-forgiveness in emotion-focused therapy: An interpersonal process recall study with men in recovery from addiction.
Persons with substance use disorders (SUDs) often act in ways that are harmful to others and incongruent with deeply held values and beliefs, which can result in painful thoughts and emotions related to critical self-evaluation (e.g., shame). In turn, substance misuse often serves as a maladaptive coping strategy that perpetuates a substance–shame cycle that further erodes meaningful connections and resources in life. Self-forgiveness and transformation of shame and related emotions might represent universal principles of psychotherapies for SUDs in such cases, in which clinicians help clients to move from avoidance-based coping and violation of cherished values into personal responsibility and values-consistent living. Focusing on Cornish’s (2016) emotion-focused therapy (EFT) intervention with men in early recovery from chronic SUDs, this study attempted to examine these principles in the context of a specific context intervention designed to promote self-forgiveness. In turn, an interpersonal process recall approach was used to illumine clients’ experiences and processes of self-forgiveness (or lack thereof) over the course of treatment. Drawing upon strategies from grounded theory and consensual qualitative research, three overarching thematic categories emerged from qualitative interviews at posttreatment: retreat (e.g., behaviors and related psychological processes involved in avoidance of painful emotion), reflection (e.g., owning regrettable actions/decisions associated with cycle of addiction), and rehabilitation (e.g., letting go of self-condemnation). Overall, these findings supported existing conceptions of self-forgiveness in cases of long-term addiction while offering possible mechanisms that could inform EFT and other evidence-based psychotherapies with clients who are seeking recovery from SUDs. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Men’s psychotherapy dropout is associated with conformity to traditional masculinity ideologies.
High conformity to traditional masculinity ideologies (TMI) is associated with lower use of psychotherapy, higher self-stigmatization, and poor mental health outcomes among men. However, the role of conformity to TMI in relation to psychotherapy dropout is still unclear. The present study aims to clarify the relationship between conformity to TMI and premature termination of psychotherapy (dropout) in men. Data were used from an anonymous online survey in German-speaking Europe. Participants with previous psychotherapy experience provided information on sociodemographics, mental health, TMI, and their past experiences with psychotherapy. Discontinuation of psychotherapy was assessed by self-report and further differentiated into discontinuation with or without consulting the therapist. Men with an unconsulted therapy ending were defined as psychotherapy dropouts. Conformity to TMI was assessed using the Conformity to Masculine Norms Inventory. Of the 266 men (Mage = 46.1, SD = 13.6) with psychotherapy experience, 30.5% (n = 81) reported having discontinued psychotherapy at least once, whereas 17.7% (n = 47) of the total sample reported dropout. These 47 men showed significantly higher conformity to TMI than men who did not report past dropout, while the subscales of self-reliance and playboy showed the strongest associations with psychotherapy dropout. Dropout from psychotherapy was significantly associated with higher conformity to TMI. Therapists should consider, and where necessary, work to flexibly adapt to TMI which may influence how men engage in mental health care. Such an approach would likely improve men’s ongoing engagement in psychotherapy, promoting opportunities to prevent avoidable psychotherapy dropout for men most at risk of deleterious mental health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Chronic couple conflictuality according to control-mastery theory.
This article aims to highlight how chronic couple conflictuality can be read from the control-mastery theory perspective. Some empirically grounded couple conflictuality models are reviewed and discussed, particularly regarding researchers’ tendency to focus on specific ways of dealing with conflicts, and the presence of a specific relational pattern, the demand/withdraw style, which seems to be particularly present among high-conflict couples. The article further presents an overview of the psychodynamic and systemic literature on couple conflictuality, in which three basic ways of reading conflict emerge: as an outcome of projective identification mechanisms; as a consequence of deficits in mentalization and affective regulation; and as a breakdown of dysfunctional communication strategies. The main control-mastery theory concepts also are presented, with a particular focus on its application to couple conflicts. According to this perspective, chronic couple conflictuality results from the repetition of vicious relational circles—that is, mutually failed tests by partners that give rise to negative escalations and couple dissatisfaction. A sample of clinical material from couple therapy is presented to exemplify this idea. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Revisiting the cognitive primacy hypothesis: Implications for psychotherapy.
While emotions, thoughts, and behaviors are considered to each impact one another, cognitive interventions have come to dominate most forms of psychotherapy practiced today. This assumes the cognitive primacy hypothesis, which is often considered to be in opposition to the affective primacy hypothesis. These two hypotheses are examined in conjunction with recent advances in psychological research along with the neuroscience of evaluative processing models. Research is investigated to determine if cognitive models like the A–B–C model are the most applicable to psychotherapy. Research does not find support for either the cognitive or affective primacy hypotheses. Neuroscience research indicates that cognition and emotion interact dynamically, unlike previously proposed linear models of therapeutic change (A–B–C model, insight for therapeutic change). Given such, emotional interventions in psychotherapy should be applied in tandem with cognitive interventions. Emotional interventions should be considered as relevant as cognitive interventions in the practice of psychotherapy, given there is no single linear model starting with cognitive or affective primacy. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
When psychotherapy runs into shame: A scoping review of empirical findings.
Shame may be a transdiagnostic marker of psychopathology and might potentially have a negative impact on treatment outcome. This scoping review maps the empirical literature on shame and psychotherapy, with a focus on individual therapy. Searching the terms shame and psychotherapy in PubMed and PsycInfo, we identified 2,520 unique records. After screening and selection, 46 empirical studies were included in the review and three themes were extracted from them: the impact of psychotherapy on shame, the impact of shame on psychotherapy, and additional shame-related themes. Narrative synthesis suggested that shame decreases after psychotherapy. In a subset of quantitative treatment evaluation studies, a preliminary meta-analysis indicated a medium size decrease in shame. The impact of shame on individual psychotherapy was more nuanced. Additional themes included but were not limited to shame-appropriate versus nonappropriate therapeutic interventions or investigations of therapists’ reactions to patients’ shame. Research gaps and recommendations for future investigations are outlined. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Depression symptom changes in triphasic trauma therapy: Initial findings from a community-based observational study.
This observational naturalistic study examined depression symptom change over the course of trauma-focused therapy. Understanding the impact of depression on trauma treatment and recovery as well as how to integrate therapeutic techniques for the treatment of concurrent depression and trauma, can assist with recovery from both conditions. Using naturalistic observations, depression symptom change was measured in 39 participants over the course of a triphasic trauma therapy called trauma practice (TP). Self-report measures were administered upon therapy initiation, following each therapy phase, and then at follow-up. Results demonstrated statistically and clinically significant improvements in depression symptoms following treatment. On average, clients shifted from clinically elevated depression symptoms at baseline to nonclinical symptoms at the conclusion of therapy. Notable effect sizes, clinically significant reliable change indices, and maintenance of treatment gains at follow-up were all present in this study, with the caveat that the sample size at follow-up was small. A strong, positive linear correlation was also found between depression symptom change and trauma symptom change over the course of treatment. TP appears to be a promising intervention for individuals with comorbid depression and trauma symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
An empirical analysis of corrective experiences in psychotherapy supervision.
The corrective emotional experience (CEE) has been found to be a key change agent in psychotherapy (Castonguay & Hill, 2012). Is the same true for supervision? This study examines the occurrence and correlates of corrective experiences in psychotherapy supervision through observation of 11 videotaped supervision sessions with expert supervisors using various supervision models (American Psychological Association’s Clinical Supervision Essentials series DVDs). Each minute of the videotaped sessions was coded using adapted versions (for both supervisor and supervisee) of the Narrative Emotion Process Coding System (NEPCS; Angus et al., 2017), which has been used to detect CEEs in psychotherapy sessions. In addition, subjective experiences of CEEs were collected by self-report data from all 11 supervisees. Analyses indicate that CEEs are significant learning events that occur across different approaches to supervision, and that trainees can reliably distinguish between CEEs and educationally corrective experiences (Watkins, 2018). Results also indicate that trainee-identified CEEs parallel the CEEs identified by the NEPCS markers. Supervisees reported that their CEEs led to profound shifts in understanding of themselves as therapists, their relationship to clients, and expanded clinical consciousness. Implications of patterns that emerged in coding the 11 supervision sessions with the adapted NEPCS and the supervisees’ reflections are discussed. The findings provide promising empirical evidence of transformative learning experiences in supervision. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Feasibility and acceptability of integrating repertory grids into reformulation and termination during cognitive analytic therapy.
Completing repertory grids to enable reformulation has fallen out of practice in cognitive analytic therapy (CAT). This study therefore sought to explore the acceptability and feasibility of integrating dyad grids back into CAT practice. A mixed-methods design was used. Seven patients with complex emotional difficulties were treated by four CAT therapists in a tertiary psychotherapy service using the 24-session CAT model. Dyad grids were intended to inform narrative reformulation letters and goodbye letters. Patients completed the Clinical Outcomes in Routine Evaluation-10 (CORE-10) and the helpful aspects of therapy (HAT) measures at each session. Patients and therapists were interviewed regarding their experiences of using grids. Nine out of 14 planned dyad grids were completed, a grid took 4.9 hr to produce, and 2 weeks elapsed between grid completion and grid feedback. No grids were integrated into reformulation letters. Grids were integrated into goodbye letters for three out of the four patients. Grid analysis for the four participants completing both grids found that all made positive changes in relationships with both self and others. Grids were not a factor in dropout. Five qualitative themes were found: validation, perspective, facilitating reflection, patient suitability, and managing the dyad grid process. Grids were mentioned in three HATs: two as helpful and one as hindering. Nonoverlap analysis of CORE-10 outcomes found CAT to be effective for three out of five completers. Due to the amount of time and technical support needed, grids appear a more specialist aspect of CAT work. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Therapists’ responses to cultural ruptures: A pilot study of external ratings of multicultural orientation.
In the field of counseling and clinical psychology, the last several decades have been characterized by a strengthened recognition of the importance of cultural factors in psychotherapy. While this has been impactful, there is evidence that racial/ethnic disparities in psychotherapy outcomes persist. Cultural ruptures, defined as subtle misattunements impacting the therapeutic alliance, may play a role in maintaining these outcome disparities. The present study sought to pilot a practice-oriented method for defining and measuring cultural ruptures, specifically related to race and racism. Four mock counseling videos were created depicting different types of cultural ruptures related to race. In total, 88 white counseling trainees were recruited. Participants recorded themselves responding to cultural rupture videos, and they were asked to self-rate their level of understanding and effectiveness. Coders were trained to rate participants’ levels of cultural comfort, cultural humility (CH), cultural opportunities, and overall effectiveness. Results revealed that cultural ruptures could be reliably coded and measured in this practice-oriented way. Secondly, results suggested that white therapists tend to overestimate their effectiveness in responding to cultural ruptures in comparison to coders. Implications, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A critical comparison between cultural comfort and countertransference.
In this article, we compare the concepts of cultural comfort and countertransference. Cultural comfort refers to the therapist’s ease and nondefensiveness when discussing social or cultural topics with clients, whereas countertransference refers to the therapist’s reactions to clients rooted in the therapist’s unresolved conflicts or vulnerabilities. Although some scholars have suggested that these concepts overlap, we argue that they have meaningful theoretical differences that merit close attention. Both cultural comfort and countertransference may have similar triggers, manifestations, and effects in psychotherapy, but conceptually, the critical distinction is whether the therapist’s conflicts or vulnerabilities related to culture are implicated in their reactions. When this occurs, then the therapist’s experience of cultural comfort or discomfort can be viewed as a form of cultural countertransference, requiring careful management. To that end, we review a theoretical framework for considering important factors that can help therapists manage their cultural discomfort and cultural countertransference, and ultimately enhance their cultural comfort. These factors include the therapist’s understanding of themselves and their clients, their capacity for self-integration and emotion regulation during sessions, and the practice of cultural humility. To support our arguments and illustrate key points, we provide case examples from the literature and our own experiences as psychotherapists. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Journal of Psychotherapy Integration - Vol 34, Iss 4