Recovered memories in psychotherapy: a survey of practicing psychotherapists in Germany.

We report on a survey of 258 psychotherapists from Germany, focusing on their experiences with memory recovery in general, suggestive therapy procedures, evaluations of recovered memories, and memory recovery in training and guidelines. Most therapists (78%) reported instances of memory recovery encompassing negative and positive childhood experiences, but usually in a minority of patients. Also, most therapists (82%) reported to have held assumptions about unremembered trauma. Patients who held these beliefs were reported by 83% of the therapists. Both therapist and patient assumptions reportedly occurred in a minority of cases. Furthermore, 35% of participants had used therapeutic techniques at least once to recover presumed trauma memories. Only 10% reported assuming trauma in most patients and recovering purported memories in a majority of the attempts. A fifth believed memory recovery was a task of psychotherapy. This belief correlated with trauma assumptions, memory recovery attempts, and recovery frequency. Psychodynamic therapists more often reported to assume trauma behind symptoms and agreed more with problematic views on trauma and memory. No differences showed regarding suggestive behaviour in therapy. Most participants expressed interest in receiving support on dealing with memory recoveries. This interest should be taken up, ideally during therapist training.

Does a lack of emotions make chatbots unfit to be psychotherapists?

Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots.

"Me being myself isn't a barrier": Identity and praxis of nonbinary psychotherapists.

Experiences of nonbinary psychotherapists have largely gone unexamined in the present literature. Using critical-constructivist grounded theory, we explored the experiences of 13 nonbinary licensed psychotherapists through qualitative semistructured interviews. Interviews were an average of 1.36 hr, and participants were recruited via social media and professional listservs. We found that nonbinary therapists ground their professional praxis-the embodiment of professional theory, action, and practice-in identity across four interconnected areas: navigating minority stress, disclosing identity, utilizing identity, and centering anti-oppression ideologies. Findings add to the nascent examination of experiences of marginalized mental health professionals and note the value of identity integration into professional work. For this population, identity is used in praxis, as it permeates their entire professional sphere. We highlight how these clinicians use their identity in challenging binary understandings of the therapeutic profession. Furthermore, nonbinary therapists demonstrate resilience among systems of oppression and are empowered when challenging binary ways of thinking with clients, supervisors, and peers. Our results indicate the importance of supporting and training nonbinary clinicians in how to use themselves and identity disclosures as effective therapeutic tools and how to manage minority stress and microaggressions that occur in their professional practice. It also underscores the general need for increased training targeted to educators and binary mental health professions aimed at increasing competence in working with nonbinary people. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Rorschach Human Movement and Psychotherapy: Relationship with the Therapist's Emotional Responses.

The emotional responses of psychotherapists to their patients, known as countertransference, can yield valuable insights into the patient's psychological functioning. Albeit from a different perspective, the Rorschach test also provides information about the patient's psychological processes. In particular, the Rorschach human movement response (M) has been shown to be a useful measure of higher-level psychological functioning. In an attempt to bridge these two largely different perspectives, the aim of this study was to explore the association between M responses in the Rorschach protocols of psychotherapy patients and emotional responses exhibited by their therapists. To this end, a convenience sample of 149 outpatients were administered the Rorschach according to the Comprehensive System, and their therapists completed the Therapist Response Questionnaire. Through a series of regression models, controlling for response style, response complexity, and degree of psychopathology, M demonstrated a significant association with the therapists' emotional responses. A lower number of M responses was associated with the therapists' feelings of disengagement, and a higher number of M responses was associated with the therapists' feelings of being more involved with the patient. Taken together, these results suggest a potential relationship between the number of M responses the respondent gives in the Rorschach and the subsequent development of the therapeutic alliance between the respondent and their therapist.

Therapist's effect on children's therapeutic alliance: A naturalistic study.

OBJECTIVES: The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA. METHODS: The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q). RESULTS: Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients). CONCLUSION: We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.

Determining differences between therapists using an extended version of the facilitative interpersonal skills performance test.

OBJECTIVES: The therapist-facilitative interpersonal skills (FIS) has shown to predict therapy outcomes, demonstrating that high FIS therapists are more effective than low FIS therapists. There is a need for more insight into the variability in strengths and weaknesses in therapist skills. This study investigates whether a revised and extended FIS-scoring leads to more differentiation in measuring therapists' interpersonal skills. Furthermore, we explorative examine whether subgroups of therapists can be distinguished in terms of differences in their interpersonal responses. METHOD: Using secondary data analysis, 93 therapists were exposed to seven FIS-clips. Responses of therapists using the original and the extended FIS scoring were rated. RESULTS: Three factors were found on the extended FIS scoring distinguishing supportive, expressive, and persuasive interpersonal responses of therapists. A latent profile analysis enlightened the presence of six subgroups of therapists. CONCLUSION: Using the revised and extended FIS-scoring contributes to our understanding of the role of interpersonal skills in the therapeutic setting by unraveling the question what works for whom.

[The significance of educational biography for the professional self-image of GDR psychotherapists]. / Die Bedeutung der Bildungsbiografie für das professionelle Selbstverständnis von DDR-Psychotherapeut:innen.

OBJECTIVE: Since the reunification of Germany, a debate on the professional activities of GDR psychotherapists has rised up. This debate is partly conducted by the spirit of coming to terms with the past and partly by legitimizing therapeutic activities in the GDR. The aim of this work is to show in individual patterns the professional self-image of selected GDR psychotherapists. The study focused from a sociological perspective with the intention of differentiating this topic. In course of this, the range of political positioning of GDR psychotherapists will also be determined on a case-by-case basis and it will be shown how this was shaped in the often named "niche of psychotherapy". METHODS: Based on-biographical interviews, educational biographical trajectories of GDR psychotherapists were reconstructed. The interviews were analyzed using grounded theory in a circular process of material selection and theory development. According to the principle of maximum contrast (theoretical sampling), four women were selected for reconstruction from a sample of 39 interviews from the joint project Seelenarbeit im Sozialismus (Soul Work in Socialism) and analyzed using Teifel's (2005) coding guide based on educational theory. RESULTS: Within the four cases, extremely individual educational biographies emerge on the levels of the coding strategy (meaning/structure perspective and mode of action), each showing different characteristics with regard to their ability to adopt a reflexive stance and the adoption of professional agency. The cases also show different characteristics with regard to their different positions on the system of GDR. DISCUSSION: The results of the case reconstructions can be summarized in an overarching scheme. This shows that the role of each individual's educational access, their educational paths and their individual practice of action must be seen in relation to the influence of the political system and the ability to adopt a professional attitude. The psychotherapists of the GDR cannot be understood per se as a group acting subversively against the state.

[Dealing with Lived Crisis Experience During Self-Experience: A Standardized Survey in Psychiatric Hospitals in Berlin and Brandenburg]. / Umgang mit eigenen Krisenerfahrungen in der Selbsterfahrung: Eine standardisierte Befragung in psychiatrischen Einrichtungen in Berlin und Brandenburg.

OBJECTIVE: The current study follows the question if psychotherapists with lived experiences of crisis and treatment address these experiences during their processes of self-experience. Further, the conceptual differentiation between self-experience and psychotherapy of this group of staff is explored. METHODS: 108 professionals with psychotherapeutic qualification were surveyed on their training self-experience. Relationships between processing of crisis experiences, crises frequency, and experienced benefit were analyzed using correlation analyses. Conceptual differences between self-experience and psychotherapy were gauged via nine content categories whose importance for self-experience and psychotherapy were rated by the participants. The means of these ratings were compared via t-test. RESULTS: Most participants reported that they had used their self-experience to process lived crisis experiences, and that they benefited from their self-experience, with processing and benefit being correlated significantly and positively. Conceptual differentiation of the two formats appeared to be complex. Participants ascribed biographical and personal categories rather to psychotherapy, and professional categories to self-experience. DISCUSSION: Given the prevalence of stigmatization towards individuals with mental health problems, it was surprising that most of the participants were able to address and process their lived experiences during their self-experience. It was surprising too that personal factors were ascribed to psychotherapy rather than self-experience, as the major importance of the therapeutic relationship and, by extension, personality development is well-known. CONCLUSION: Training self-experience should be a stigma-free setting, where future therapists are able to address their biographical burdens freely and thereby develop their personalities.

[Discrimination-Sensitive Psychotherapy: How High Is The Privilege Awareness Among Psychotherapists?] / Diskriminierungssensible Psychotherapie: Wie hoch ist das Privilegienbewusstsein von Psychotherapeut*innen in Deutschland?

OBJECTIVE: Discrimination can have a negative impact on mental health and thus can play a crucial role in the context of psychotherapy. This paper outlines the potentials and the relevance of an (intersectional) privilege awareness of psychotherapists for a discrimination-sensitive psychotherapy. The aim of this study was to assess the privilege awareness of psychotherapists in Germany for the first time as well as its thematization in the training of psychotherapists. In addition, the connection between belonging to a marginalized group and the privilege awareness was investigated. METHODS: 270 psychotherapists (in training) based in Germany participated in an online survey (2022). Privilege awareness was assessed with an adapted version of the Awareness of Privilege and Oppression Scale-2, translated into German, regarding the following axes of discrimination: heterosexism, classism, and racism. Three self-written items additionally surveyed the thematization of discrimination and privilege in psychotherapy training. The relationship between belonging to a marginalized group and privilege awareness was examined using linear regression analysis. RESULTS: Nearly 65% (N=270) of participants felt unprepared or somewhat unprepared to deal with patients' experiences of discrimination, with approximately 40% (N=270) indicating that discrimination was not addressed in training. Privilege was addressed much less frequently. Belonging to a marginalized group was associated with higher privilege awareness (B=0,47, 95%-confidence interval: 0,27-0,67, F(2, 267)=15,41, p<0,001). CONCLUSION: There is a need to include the impact of discrimination and privilege on mental health and the therapeutic relationship as an integral part of psychotherapy training to enhance its quality as well as the quality of future psychotherapies.

[Clinical Judgement and Relational Competence in the Psychotherapy of Older Patients]. / Klinische Urteilsbildung und Beziehungskompetenz in der Psychotherapie älterer PatientInnen.

The negative attitude of psychotherapists towards the treatment of older patients in the past has weakened in the recent past. Nevertheless, the question remains as to how therapists perceive older patients in comparison to younger patients, what clinical judgements they arrive at and how they perceive the relationship with them. In the present study, which was conducted as part of the ÄPP study (Older Patients in Psychotherapy), therapists were asked to assess a self-selected younger (<40 years) or an older patient (>65) with regard to various variables. A total of 527 completed questionnaires were available. Two-factor analyses of variance were used to show, among other things, that younger therapists (compared to their older colleagues) rate older patients more negatively in terms of suitability for psychotherapy, the patient's ability to establish a therapeutic working relationship and other parameters. In comparison with their older colleagues, younger therapists perceive themselves as less competent in their relationships with older patients. There are only slight differences with younger patients.

Dispositional Empathy Among Psychotherapists: A Latent Profile Analysis.

OBJECTIVE: This study examined therapists' dispositional empathy profiles and how they differ based on professional and personal characteristics. METHOD: A total of 376 clinicians was recruited for this study. Dispositional empathy was assessed with the Interpersonal Reactivity Index (IRI). Profiles were generated using latent profile analysis. Predictors of profiles were assessed with multiple self-report questionnaires measuring demographic and professional characteristics, romantic attachment styles, five-factor personality traits and vulnerable narcissism. RESULTS: A four-profile solution was retained with the following proportions: rational empathic (20%), disengaged/detached (10%), empathic immersion (35%) and insecure/self-absorbed (35%). Overall, few relationships were found regarding demographic and professional characteristics. In contrast, significant relationships were found between profile membership and personal characteristics, including avoidant and anxious attachment, agreeableness, conscientiousness, neuroticism, intellect/imagination and vulnerable narcissism. CONCLUSION: The findings show that differences in therapists' empathic dispositions are linked to personality dimensions. Implications for psychotherapy research, practice and training are discussed.

Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels.

Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.

Validation of the Italian Version of the Telepresence in Videoconference Scale (TVS) in a Sample of Psychologists and Psychotherapists During the COVID-19 Pandemic.

OBJECTIVE: Telepresence may play a fundamental role in establishing authentic interactions and relationships in online psychological interventions and can be measured by the Telepresence in Videoconference Scale (TVS), which was validated only with patients to date. This post hoc study aimed to validate the Italian version of the TVS with mental health professionals. METHOD: The Italian TVS was included in an online survey, whose primary aim was to assess the experiences of Italian psychologists and psychotherapists with online interventions during the first wave of the COVID-19 pandemic and was filled in by 296 participants (83.4% females, mean age = 42 years old). RESULTS: Exploratory factor analysis supported the original factor structure only partially because the scale 'Absorption' (i.e., the feeling of losing track of time), as it was formulated, did not measure telepresence. Correlations were also explored between the TVS scales and some survey items pertaining to intimacy and emotional closeness to patients, comfort and positive as well as negative experiences with online interventions. CONCLUSION: The TVS may be a useful tool to measure physical and social telepresence in online interventions, both in patients and in professionals.

[Participation-oriented psychotherapy for patients with mental disorders who are able or unable to work : Results of a survey of practicing psychotherapists]. / Teilhabeorientierte Psychotherapie bei arbeitsfähigen und arbeitsunfähigen Patienten mit psychischen Erkrankungen : Ergebnisse einer Befragung niedergelassener Psychotherapeuten.

BACKGROUND: Treatment of (chronic) mental disorders must focus on both reducing symptoms and improving social and work participation by social medicine treatments and counselling. The objective of this study was to compare psychotherapy patients who are fit or unfit for work to describe similarities and differences regarding patient status and interventions. METHODS: Interviews were performed with 73 cognitive behavior therapists and 58 psychodynamic psychotherapists about 188 and 134 recent cases they had seen, respectively. The case reports referred to patients who were on average 42 years old (65% females). RESULTS: There were no differences between patients with no or short-term sick leave (up to 6 weeks, n = 156) and patients with longer sick leave (7 weeks or more, n = 140) with respect to basic characteristics of treatment (side effects, therapeutic alliance). Patients with a longer sick leave duration had more severe capacity and participation impairments and received more specific work participation-oriented treatments, whereas general saluto-therapeutic activities (sports-club, counselling, family-support) were similarly undertaken in patients with shorter or longer sick leave. DISCUSSION: Therapists chose intervention options according to indication: in patients with work participation problems, more work-related treatments are undertaken, whereas interventions for general mental health improvement are distributed independent of specific work participation problems.

A qualitative study of women of color group psychotherapists: The wellspring of collective healing.

Understanding the psychological health of women of color (WOC) in a racialized and gendered society requires accessing, validating, and processing the lived experiences and emotions that stem from interlocking systems of oppression. Despite the importance of responding to the psychological health needs of this population, the group therapy literature on how to design and facilitate group therapy for women of color remains limited. For this reason, the present research aims to identify group therapy-oriented experiences based on data provided by ten women of color group psychotherapists practicing in the United States. Findings from the consensual qualitative research (Hill, 2012) revealed six domains: (a) group development, (b) personal and professional significance, (c) group facilitation behaviors, (d) perceived healing factors, (e) challenges, and (f) advice. Suggestions for future research and recommendations for women of color groups positioned as a wellspring of empowerment, liberation, and psychological health are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychotherapists' experiences providing at-home psychotherapy for home-living older adults with long-term care needs and depression.

This study used qualitative methods to explore psychotherapists' experiences conducting at-home psychotherapy with older adults (60 + years) with long-term care needs and depression. We conducted semistructured interviews with 16 female psychotherapists (26-70 years old) who delivered at-home cognitive behavioral therapy to home-living older adults with long-term care needs and depression. We additionally conducted 10 patient case studies. Using an adaption of the methodology of grounded theory, we iteratively developed a hierarchical model. Results showed that psychotherapists experienced three dilemmas: (a) pushing for change versus acknowledging limitations, (b) providing help versus maintaining boundaries, and (c) being a guest in the patient's home versus the host of a psychotherapy session. The absence of a shared understanding of therapy and confrontation with patients' existential suffering intensified the experience of the dilemmas. The dilemmas generated professional self-doubt and negative emotions, which in turn triggered a reflexive process and ultimately participants' professional development. Participants found a way to integrate drives initially perceived as mutually exclusive, and further developed their professional self-image and therapeutic techniques. We interpret the dilemmas as reflecting difficulty reconciling the "curing" and "caring" treatment paradigms. Practice and support managing the three dilemmas along with reflection on the curing paradigm, views on old age, and fear of existential suffering should be part of qualifications for psychotherapists working with older adults in need of care. Cooperating with other care providers may relieve the pressure on psychotherapists to provide forms of support that could lead to overburden and impede therapeutic progress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Teamwork for complex clinical situations in psychotherapy: Introduction to the issue.

This in-session issue is focused on psychotherapists involved in and performing teamwork practices. Specifically, five teamwork-based psychotherapy interventions are illustrated as solutions for complex clinical situations drawing from multiple theoretical approaches (narrative, systemic, cognitive behavioral, and integrative) and applied in different health care provision settings, ranging from psychotherapy private office to a multidisciplinary oncological service. The contributions try to cover a diversity of presenting problems: separating couples, gang involvement, schizophrenia, cancer and suicidal ideation, bipolar disorder; and formats of delivery such as couple therapy supervision, family therapy, multidisciplinary team formulation and interprofessional health psychology. Three main shared coordinates underlie the diversity of interventions: (1) Considering that psychotherapy is just a piece of a broader network of interactions and meanings generated around a given problem/solution and, thus, it is part of an ecology of ideas (ecological dimension), (2) Assuming interdependence and collaboration as the best strategies to interact with professionals and significant others involved with a given problem or solution (collaborative dimension), and (3) fostering a strengths-based case formulation (epistemological dimension). The issue aims at enriching practitioners' toolbox willing to incorporate team-based interventions as part of their range of professional competences.

Long-term psychodynamic psychotherapy in a face-to-face versus videoconferencing setting: A single case study.

OBJECTIVE: Due to the coronavirus pandemic and crisis, psychotherapists around the world were forced to switch to video- or tele-based treatments overnight. To date, only a few studies on the effectiveness of video-based psychodynamic psychotherapy via the Internet exist. Therefore, the goal of the present study was to examine symptom improvement, therapeutic relationship, nonverbal synchrony processes, and intersession processes within a systematic single case design and compare face-to-face to video-based approaches in long-term psychodynamic-oriented psychotherapy. METHODS: We examined 85 sessions of a client with major depression whose psychodynamic psychotherapy changed from a face-to-face setting to a video-based setting. Video recordings were analyzed using motion energy analysis, and nonverbal synchrony was computed using a surrogate synchrony approach. Time series analyses were performed to analyze changes in symptom severity, therapeutic relationship, and intersession processes. RESULTS: The results showed that symptom severity improved descriptively, but not significantly, across the entire course of psychotherapy. There were significant differences, however, in the therapeutic relationship, intersession experiences, and synchronous behavior between the face-to-face and video-based settings. CONCLUSION: The results indicate that the presented methodology is well situated to investigate the question whether psychodynamic psychotherapy in video-based setting works in the sameway as in a face-to-face setting.

Adjusting to a new reality: Consensual qualitative research on therapists' experiences with teletherapy.

OBJECTIVE: In the wake of the COVID-19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process. METHODS: Thirty-one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method. RESULTS: Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in-person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process. CONCLUSION: Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process-level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities.