Integrating exploration and prediction in computational psychotherapy science: proof of concept.

Introduction: Psychotherapy research has long preferred explanatory over predictive models. As a result, psychotherapy research is currently limited in the variability that can be accounted for in the process and outcome of treatment. The present study is a proof-of-concept approach to psychotherapy science that uses a datadriven approach to achieve robust predictions of the process and outcome of treatment. Methods: A trial including 65 therapeutic dyads was designed to enable an adequate level of variability in therapist characteristics, overcoming the common problem of restricted range. A mixed-model, data-driven approach with cross-validation machine learning algorithms was used to predict treatment outcome and alliance (within- and between-clients; client- and therapist-rated alliance). Results and discussion: Based on baseline predictors only, the models explained 52.8% of the variance for out-of-sample prediction in treatment outcome, and 24.1-52.8% in therapeutic alliance. The identified predictors were consistent with previous findings and point to directions for future investigation. Although limited by its sample size, this study serves as proof of the great potential of the presented approach to produce robust predictions regarding the process and outcome of treatment, offering a potential solution to problems such as p-hacking and lack of replicability. Findings should be replicated using larger samples and distinct populations and settings.

Double trouble: Therapists with low facilitative interpersonal skills and without training have low in-session experiential processes.

Objectives: This study examined the combined effect of therapist Facilitative Interpersonal Skills (FIS) and Training Status on experiential processes within therapy sessions. In this randomized trial of FIS and Training Status, we predicted that in-session experiential processes would be highest for the high FIS and trained therapist group and lowest for the low FIS and untrained therapists. Methods: Forty-five clients were selected from 2,713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists were selected for their level of FIS (high vs. low) and Training (trainee vs. untrained) and each were assigned two clients for seven sessions each. Two different coder teams independently rated experiencing and narrative process from the third therapy session and computer analysis identified affect words from transcripts. Results: FIS×Training Status significantly interacted on the set of experiential process measures. Relative to all others, therapists who were in the low FIS / no training group had lower experiencing and reflexive content, but higher external content. Conclusions: The findings highlight the importance of therapist characteristics within therapy sessions. Therapists without training and with low interpersonal skills have sessions that are nearly devoid of content that focuses on client experiential processes and emotion.

Treating from Afar: Mental Health Providers' Challenges and Concerns During the COVID-19 Pandemic.

The outbreak of COVID-19 has resulted in increasing needs for mental health treatments and yet simultaneously posed great challenges to the delivery of in-person psychological services. The standard clinical practice suddenly shifted to the use of telepsychology. This study aimed to identify how therapists have been responding to the public health crisis and the rapid transition to telepsychology. We distributed a survey to 502 mental health providers to investigate the challenges and concerns of the delivery of clinical work during the pandemic. Our study found that most therapists (75.9%) transitioned to telepsychology without suspension of services. Therapists reported varied concerns regarding telepsychology, clinical practice, and their personal lives. The most common concerns identified were the use of therapeutic techniques in telepsychology, provision of remote services, and the practitioner's own health. Our findings also indicated that therapists who are students, female, sexual minorities, unpartnered, and working in public settings experienced relatively greater concerns. It may imperative to allocate more resources to those subgroups of therapists to facilitate their clinical work in telepsychology. This study contributed to our understanding of how the pandemic has impacted clinical work and may inform practitioners in coping with the current and any future public crises.

Zoom-in to zone-out: Therapists report less therapeutic skill in telepsychology versus face-to-face therapy during the COVID-19 pandemic.

The coronavirus disease (COVID-19) pandemic has resulted in a rapid transition from in-person therapy to teletherapy. This study examined mental health providers' perceptions of the differences between in-person therapy and teletherapy in common therapeutic attributes and identified therapist characteristics that predicted differences. A sample of 440 therapists and trainees completed an online survey that assessed their provision of clinical services since the outbreak of COVID-19. Therapists provided ratings for having used 28 therapeutic attributes (e.g., empathy, emotional expression) and skills for in-person therapy and teletherapy. Those attributes were clustered into three factors via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA): common therapeutic skills (e.g., warmth), extra-therapeutic influence (e.g., providing resources), and perceived outcome (e.g., symptom reductions). Therapists perceived poorer common therapeutic skills, decreased outcomes, and reduced extra-therapeutic influence when conducting teletherapy compared to in-person therapy. Therapists who reported poorer common therapeutic skills in teletherapy tended to be male, younger, utilize experience-based and relational therapies, have smaller caseloads, and had little training and no prior experience in teletherapy. Additionally, being male, utilizing experience-based and relational therapies, and having no training in teletherapy were associated with therapists' perception of reduced outcome in teletherapy. More intensive training and support in these attributes/skills are needed to improve therapists' confidence and ability to use therapeutic skills during teletherapy and ultimately improve the quality of psychological services in the era of teletherapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).