Psychotherapists' Experience with In-Session Use of Routine Outcome Monitoring: A Qualitative Meta-analysis.

Routine outcome monitoring (ROM) has become an increasingly utilized tool in therapeutic practice that has the potential to improve therapy outcomes. This study aimed to synthesize the findings of existing qualitative studies investigating how clinicians use ROM in their work with clients. A systematic search of qualitative studies on clinicians' experience with the use of ROM in mental health services was conducted via PsycInfo, PsycArticles, Medline, Web of Science, and Scopus databases. Qualitative meta-analysis was used to synthesize the finding of the primary studies. Forty-seven studies met the inclusion criteria. The analysis resulted in 21 meta-categories organized into six clusters, namely (1) obtaining clinically relevant information, (2) adapting treatment, (3) facilitating communication, (4) enhancing the therapeutic relationship, (5) facilitating change in clients, and (6) personalized usage of ROM. The meta-analysis revealed that clinicians utilized ROM in diverse ways, including both informational and communicational functions. From the clinicians' perspective, ROM was an element that, on the one hand, introduced additional structure and standardization in treatment and, on the other hand, allowed for greater flexibility and tailoring of treatment.

Session Reactions Scale-3: Initial psychometric evidence.

Objective: This study aimed to develop an updated brief self-report post-session measure, suitable for collecting systematic feedback on clients' session reactions in the context of measurement-based care (MBC). Method: The Session Reactions Scale-3 (SRS-3; 33 items) was developed by extending and adjusting the Revised Session Reactions Scale. In Study 1, the psychometric properties of the SRS-3 were tested on N = 242 clients. In Study 2, a brief version of the SRS-3 (SRS-3-B; 15 items) was developed using a combination of conceptual, empirical, and pragmatic criteria. In Study 3, the psychometric properties of the SRS-3-B were tested on a new sample of N = 265 clients. Results: Exploratory factor analysis supported the use of the SRS-3-B as a two-factor (helpful reactions, hindering reactions) or unidimensional (overall session evaluation) instrument. The SRS-3-B was meaningfully related to another process measure (Individual Therapy Process Questionnaire) both on the item and factor levels. Conclusions: The SRS-3-B is a reliable process measure to elicit rich and clinically meaningful feedback from clients within the MBC context and as a research instrument to assess the helpful and hindering aspects of therapy sessions.

Negative experiences in psychotherapy from clients' perspective: A qualitative meta-analysis.

OBJECTIVE: A considerable number of clients report adverse or unwanted effects of psychological treatments. This study aimed to synthesize the findings of qualitative studies focused on what clients perceive as negative experiences in psychotherapy. METHOD: A database search was conducted to find primary studies, and a qualitative meta-analysis was used to aggregate the findings on the kinds of negative experiences psychotherapy clients reported. RESULTS: A total of 936 statements were extracted from 51 primary studies and categorized into 21 meta-categories, some of which were further divided into subcategories. These meta-categories covered clients' experiences, which fell into four broad clusters: therapists' misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment. CONCLUSION: Clients' negative experiences of psychotherapy are a vast and heterogeneous area, the breadth of which is not captured by any single study. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date.

The Cooper-Norcross Inventory of Preferences: Measurement invariance across & international datasets and languages.

OBJECTIVE: The Cooper-Norcross Inventory of Preferences (C-NIP) is a brief, multidimensional measure of clients' therapy preferences. This study aimed to examine the factor structure and measurement invariance of the C-NIP. METHOD: Fifteen datasets (N = 10,088 observations) representing the C-NIP in nine language versions were obtained from authors of psychometric studies. Confirmatory factor analysis and exploratory structural equation modeling were used to analyze the data. RESULTS: None of the proposed models adequately fit the data. Therefore, a new model was developed that sufficiently fit most of the C-NIP version 1.1 datasets. The new model was invariant up to the strict and means levels across genders, ages, and psychotherapy experience but only up to the metric level across translations. CONCLUSIONS: The C-NIP can be used to compare men and women, people of diverse ages, and people with some vs. no experience with psychotherapy. Lower reliabilities of the C-NIP scales are a limitation.

Applying dynamic systems theory and complexity theory methods in psychotherapy research: A systematic literature review.

OBJECTIVE: Dynamic systems theory and complexity theory (DST/CT) is a framework explaining how complex systems change and adapt over time. In psychotherapy, DST/CT can be used to understand how a person's mental and emotional state changes during therapy incorporating higher levels of complexity. This study aimed to systematically review the variability of DST/CT methods applied in psychotherapy research. METHODS: A primary studies search was conducted in the EBSCO and Web of Knowledge databases, extracting information about the analyzed DST/CT phenomena, employed mathematical methods to investigate these phenomena, descriptions of specified dynamic models, psychotherapy phenomena, and other information regarding studies with empirical data (e.g., measurement granularity). RESULTS: After screening 38,216 abstracts and 4,194 full texts, N = 41 studies published from 1990 to 2021 were identified. The employed methods typically included measures of dynamic complexity or chaoticity. Computational and simulation studies most often employed first-order ordinary differential equations and typically focused on describing the time evolution of client-therapist dyadic influences. Eligible studies with empirical data were usually based on case studies and focused on data with high time intensity of within-session dynamics. CONCLUSION: This review provides a descriptive synthesis of the current state of the proliferation of DST/CT methods in the psychotherapy research field.

The associations between interoceptive awareness, emotion regulation, acceptance, and well-being in patients receiving multicomponent treatment: a dynamic panel network model.

Mechanisms of change represent the cornerstone of the therapeutic process. This study aimed to investigate how network models could be used to test mechanisms of change at a group level. A secondary aim was to investigate which of the several hypothesized mechanisms (emotion regulation, interoceptive awareness, and acceptance) are related to changes in psychological well-being. The sample comprised adult patients suffering from psychological disorders (N=444; 70% women) from 7 clinical sites in the Czech Republic who were undergoing groupbased multicomponent treatment composed mainly of psychodynamic psychotherapy (lasting from 4 to 12 weeks depending on the clinical site). Data were collected weekly using the multidimensional assessment of interoceptive awareness, emotion regulation skills questionnaire, chronic pain acceptance questionnaire-symptoms and outcome rating scale. A lag-1 longitudinal network model was employed for exploratory analysis of the panel data. The pruned final model demonstrated a satisfactory fit. Three networks were computed, i.e., temporal, contemporaneous, and between-person networks. The most central node was the modification of negative emotions. Mechanisms that were positively associated with well-being included modification, readiness to confront negative emotions, activity engagement, and trust in bodily signals. Acceptance of negative emotions showed a negative association with well-being. Moreover, noticing bodily sensations, not worrying, and self-regulation contributed indirectly to changes in well-being. In conclusion, the use of network methodology to model panel data helped generate novel hypotheses for future research and practice; for instance, well-being could be actively contributing to other mechanisms, not just a passive outcome.

Negative effects during multicomponent group-based treatment: A multisite study.

Objective Negative effects (NEs) in group treatments remain an under-researched area. This study aimed to explore the prevalence of various types of NEs in a multicomponent group-based treatment and to determine their predictors. Method: A total of 330 patients participating in a multicomponent group-based treatment were recruited across seven clinical sites. At the end of treatment, the Negative Effects Questionnaire (NEQ) was used to measure NEs. Item-level descriptive analysis was conducted to explore the prevalence of various types of NEs, and structural equation modeling was used to determine predictors of these NEs. Results: The most frequently reported type of NEs was the worsening of symptoms, and the single most frequently reported item was the resurfacing of unpleasant memories. Predictors of NEs included the overall distress level, alexithymia, attachment avoidance, low working alliance, problem actuation, and worse outcomes; psychological mindedness was a protective factor. Conclusion: Patients who experience higher levels of distress at the beginning of treatment, who perceive the group working alliance as problematic, and who experience high in-session emotional arousal related to their problem seem to be especially prone to reporting NEs. Furthermore, the findings do not support the assumption that NEs are a prerequisite for therapeutic change.Trial registration: ISRCTN.org identifier: ISRCTN13532466.

Psychometric Evaluation of the Cooper-Norcross Inventory of Preferences-Therapist Version.

The Cooper-Norcross Inventory of Preferences (C-NIP) is a commonly used and psychometrically validated measure of client preferences in therapy. However, the C-NIP version for therapists (C-NIP-T) has not yet been validated. This study aimed to develop a Chinese version of the C-NIP-T and test its factor structure, reliability, and concurrent validity. A national sample of 1,054 Chinese mental health professionals completed the C-NIP-T and provided relevant demographic information. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to examine the factor structure of the C-NIP-T. ESEM provided stronger evidence than CFA for the hypothesized four-factor model. Internal consistency coefficients (Cronbach's α) of the four subscales ranged between .60 and .76. Full or partial scalar invariance was established across therapists' therapeutic orientations, gender, personal therapy, and clinical experience. There were significant differences in subscale scores among therapists who identified as cognitive/cognitive-behavioral, psychoanalytic/psychodynamic, and humanistic/client-centered, supporting the concurrent validity of the C-NIP-T. The C-NIP-T is a psychometrically sound measure that can be used to assess therapists' preferences about therapy.

Czech version of the Emotion Regulation Skills Questionnaire (ERSQ): Psychometric evaluation and network model in an adult clinical sample.

The Emotion Regulation Skills Questionnaire (ERSQ, 27 items) is an instrument designed to measure nine emotion regulation skills. This study examined the psychometric properties and longitudinal network structure of the Czech translation of the ERSQ in the clinical sample (primarily mood or neurotic disorders). Czech patients N = 427 completed the ERSQ weekly during treatment. The data were analyzed using confirmatory factor analysis (CFA) and network modeling. The CFA supported an eight-dimensional factor solution (with merged Acceptance and Tolerance subscales). The subscales' internal consistency ranged from ωh = .669 (Bodily sensations) to ωh = .859 (Acceptance/Tolerance). The factor structure was invariant across genders, two age groups, and seven measurement waves (invariance tested as an assumption for network analysis). The longitudinal network model indicated the existence of perceptive and modulatory clusters of emotional regulation skills and revealed the central role of Modification, Bodily sensations, and Readiness for confrontation in emotional regulation. The Czech translation of the ERSQ is a psychometrically sound instrument comparable to the original version. Despite the high internal consistency of the total score (ωtot = .910), the ERSQ is not recommended for use as a unidimensional instrument. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mechanisms of change in multicomponent group-based treatment for patients suffering from medically unexplained physical symptoms.

Understanding psychological mechanisms of change is essential to advance treatments for patients suffering from medically unexplained physical symptoms (MUPS). This study aimed to test the role of selected change mechanisms (incl. interoceptive awareness, emotional regulation skills, symptom acceptance, relational needs satisfaction, clarification of meaning, working alliance, and group cohesion) in the modification of patients' somatic symptom intensity and well-being.N = 290 patients suffering from MUPS participated in a multi-component group-based treatment at seven clinical sites. Data were collected weekly. Multi-level modeling was used to test cross-lagged relationships between the hypothesized mechanisms and outcomes in terms of Granger causality (with lags of 1, 2, and 3 weeks).None of the mechanisms predicted a time-lagged change in outcomes in the expected direction. In fact, there was a consistent pattern of negative time-lagged relationships (i.e., an increase in a mechanism predicted worsening of the outcome). Findings consistent with the hypothesized role of the mechanisms were found only in concurrent relationships between mechanisms and outcomes.This study did not support time-lagged relationships under the condition of weekly measurement and many methodological factors remain to be considered (e.g., a finer time resolution).

What is it like to live with medically unexplained physical symptoms? A qualitative meta-summary.

Medically unexplained physical symptoms (MUPS) are a frequent phenomenon. Understanding adults and adolescents' lived experience with MUPS is essential for providing adequate care, yet a rigorous synthesis of existing studies is missing. Objective: This study aimed to summarize findings from primary qualitative studies focused on adults' and adolescents' experience of living with MUPS. Design: Qualitative studies were searched in the PsycINFO, PsycARTICLES, and Medline databases and manually. A total of 23 resources met the inclusion criteria and were subjected to a qualitative meta-summary. Results: Eight themes were found across the set of primary studies, namely, the need to feel understood, struggling with isolation, 'sense of self' in strain, facing uncertainty, searching for explanations, ambivalence about diagnosis, disappointed by healthcare, and active coping. Conclusion: The eight themes represent the core struggles adults' and adolescents' with MUPS face in their lives, psychologically and socially. Although these themes appear to be universal, the analysis also revealed considerable variability of experience in terms of expectations from healthcare professionals, attitude towards formal diagnoses, ability to cope with the illness, or potential to transform the illness experience into personal growth. Addressing this diversity of needs represents a significant challenge for the healthcare system.

Client-Identified Impacts of Helpful and Hindering Events in Psychotherapy: A Qualitative Meta-analysis.

OBJECTIVE: Understanding the client perspective is important for the provision of psychotherapy. The significant events paradigm, within which clients report on the most significant events of a therapy session immediately after the session, represents a useful means to explore clients' in-session experience. METHOD: The aim of this study was to investigate what types of client-identified impacts are reported in qualitative studies on helpful and hindering events in psychotherapy. Seventeen primary studies focusing on client-identified helpful and hindering events were identified through database searches and subsequent manual searches. The data were subjected to qualitative meta-analysis. RESULTS: The descriptions of event impacts were classified into 12 helpful (e.g., gaining a new perspective on the self; feeling heard, understood, and accepted; and feeling engaged in the therapeutic process) and eight hindering (e.g., lacking guidance from the therapist and feeling emotionally overwhelmed) impact meta-categories. CONCLUSION: The findings provide an update to a previous meta-analysis by identifying several new categories of helpful event impacts and by categorizing hindering event impacts.

Corrigendum: Validation of the Czech Version of the Relational Needs Satisfaction Scale.

[This corrects the article DOI: 10.3389/fpsyg.2020.00359.].

Personal therapeutic approach in Gestalt therapists working with clients suffering from medically unexplained psychosomatic symptoms.

Treatment specificity and adherence to treatment manuals represent essential components of the medical model in psychotherapy. The model assumes that psychotherapists who work with the same type of clients and who identify with the same theoretical approach work very similarly. This study illustrates the shortcomings of that assumption and explores how therapists' individuality forms and shapes their unique approaches that resonate with their own personalities, inclinations, and worldviews. Semi-structured interviews with eight Gestalt therapists working with clients who experienced medically unexplained physical symptoms were analysed using the grounded theory method. Considerable differences were found among the therapists within four domains of the personal therapeutic approach, namely Case Conceptualization, Therapeutic Task, Therapist's Position, and Alternative Strategy. However, regardless of the differences, all the therapists endeavoured, either implicitly or explicitly, to convey to the clients what they considered to be healthy functioning. There is considerable diversity in the way therapists work even when they subscribe to the same psychotherapeutic approach and work with the same type of clients. The exploration of psychotherapists' usual strategies, as well as the alternative strategies they use when their usual strategies do not work, appears helpful for capturing their personal therapeutic approaches.

Psychometric Evaluation of the Czech Version of Group Cohesiveness Scale (GCS) in a Clinical Sample: A Two-Dimensional Model.

The Group Cohesiveness Scale (GCS, 7 items) measures patient-rated group cohesiveness. The English version of the scale has demonstrated good psychometric properties. This study describes the validation of the Czech version of the GCS. A total of 369 patients participated in the study. Unlike the original study, the ordinal confirmatory factor analysis (CFA) supported a two-dimensional solution (RMSEA = 0.075; TLI = 0.986). The analysis demonstrated the existence of two moderately to highly associated (r = 0.79) domains of group cohesiveness-affective and behavioral. The two-dimensional model was invariant across genders, age, education, and time (retest after 6 weeks) up to factor means level. Internal consistency reached satisfactory values for both domains (affective, ω = 0.86; behavioral, ω = 0.81). In terms of convergent validity, only weak association was found between the GCS domains and the group working alliance measured by the Group Outcome Rating Scale (GSRS). This is the first revision of the factor structure of the GCS in the European context. The scale showed that the Czech version of the GCS is a valid and reliable brief tool for measuring both aspects of group cohesiveness.

Therapeutic change mechanisms in adults with medically unexplained physical symptoms: A systematic review.

OBJECTIVE: Although psychological treatments for patients suffering from medically unexplained physical symptoms (MUPS) show promising results, evidence for their effectiveness is still limited. The aim of this study was to review the existing empirical support for change mechanisms that explain treatment effect in terms of symptom intensity and symptom interference in the daily lives of patients. METHODS: A systematic database search was conducted. Sixty-seven eligible studies were found, and change mechanism effects were extracted from them. The data were subjected to a systematic review. RESULTS: Fifteen change mechanisms were identified. Those receiving the most consistent support included Increasing symptom acceptance, Development of coping strategies, and Positive treatment expectations, although the last mechanism was investigated in only two studies. Almost all mechanisms received support for at least one type of outcome, either at post-treatment or at follow-up. CONCLUSIONS: Although some empirical support exists for many mechanisms, some of them have received only marginal attention in empirical studies. These limitations prevented us from deriving more definite conclusions.

Validation of the Czech Version of the Relational Needs Satisfaction Scale.

AIM: If we want to understand people's satisfaction in their relationships, it is essential to have a valid and reliable measure of relational needs satisfaction. The aim of this study was to test the factor structure of the Czech version of the Relational Needs Satisfaction Scale (RNSS) as well as the scale's measurement invariance and convergent validity. METHOD: In total, 419 adults answered a battery of measures, including the RNSS, in an online survey. Confirmatory factor analysis was conducted to test the factor structure and the measurement invariance of the RNSS across gender and age. A correlational analysis was conducted to assess the convergent validity. RESULTS: The five-factor structure of the RNSS was confirmed. Furthermore, support for a second-order global relationship satisfaction factor was found. The hierarchical model was strictly invariant with respect to gender and age. Furthermore, the RNSS demonstrated an expected pattern of correlations with the reference instruments. CONCLUSION: The Czech version of the RNSS can be considered a valid and reliable method.

Facets of the psychotherapy relationship: a metaphorical approach.

Although many separate aspects of the psychotherapy relationship have been studied, including empathy, working alliance, and self-disclosure, a metaphorical approach has the potential to generate a more holistic perspective of this phenomenon. Hence, the goal of this study was to explore the nature of the psychotherapy relationship from the psychotherapists' perspective using a metaphorical approach. In an online survey, a sample of N=373 Czech psychotherapists and counselors rated a set of relational metaphors in terms of how accurately they depicted their roles in their relationships with their clients. The single most endorsed metaphor for the practitioner's role was a guide. Furthermore, the principal component analysis identified three relational components, namely, Mentor, Resource Supplier, and Remedy Distributor. The associations among these components and multiple practitioners' variables, including demographic and practice-related variables and theoretical orientation, were explored. These three components represent general dimensions of the psychotherapy relationship that cut across various theoretical orientations and, thus, define psychotherapy relationships in a general sense.

Common therapeutic strategies in psychological treatments for medically unexplained somatic symptoms.

Objective: Medically unexplained somatic symptoms (MUSS) represent a frequent complaint in health care services. While psychological treatments have demonstrated some effect in patients with MUSS, further progress may be achieved by a synthesis of clinical strategies used in diverse treatment models. The aim of this study was to identify clinical strategies shared across multiple psychological treatments intended for the treatment of adult patients with MUSS. Method: Descriptions of psychological treatments for patients with MUSS were searched in the PsycINFO, PsycARTICLES, and Medline databases and manually. N = 135 resources met inclusion criteria and were subjected to qualitative analysis. Results: Similarities across treatments were captured in 8 broad categories and 18 subcategories that covered aspects of the therapeutic relationship, specific skills (bodily, emotional, and relational) for patients to develop, search for the meaning of symptoms, and the orientation on life beyond symptoms. Conclusions: Despite the differences in technique, it was possible to identify common therapeutic strategies in psychological treatments for patients with MUSS. These overarching treatment strategies, many of which have already obtained empirical support, may inspire further research and the development of comprehensive treatments with enhanced efficacy. Limitations of the present study include the lack of focus on specific syndromes.

Adaptation of the negative effects questionnaire into the Czech context.

Objective: The aim of this study was to adapt the Negative Effects Questionnaire (NEQ) into the Czech context and to assess its psychometric properties as well as the extent to which it covers important areas of the negative aspects of psychotherapy. Method: A total of 226 respondents answered an online survey. Confirmatory and exploratory factor analyses were conducted to assess the NEQ factor structure. Thematic analysis was used to analyze the open-ended NEQ item. Results: In terms of confirmatory factor analysis, the six-factor model proposed by the authors of the NEQ did not demonstrate an adequate fit. In a subsequent exploratory factor analysis, a more parsimonious, five-factor solution was proposed instead. Furthermore, a thematic analysis revealed some areas underrepresented in the NEQ, particularly clients' relationships with their relatives. Conclusions: The NEQ is a reliable instrument with a high added value for research and practice. Several directions for future development are suggested.