Compassion Focused Therapy for Groups: Transdiagnostic Treatment for Turbulent Times.

The concept of compassion has a centuries-long history as a pillar of philosophical and religious discourse as a response to human suffering. More recently, Paul Gilbert, the founder of Compassion Focused Therapy (CFT) has explained compassion evolutionarily as a willingness to enter human suffering and a commitment to alleviating it. In the face of increased (and increasing) suffering in the world, compassion shows promise as both a societal and an individual intervention. In the following article, we discuss the background and theory of CFT, the empirical evidence for CFT delivered in a group therapy format, and present a standardized protocol. We then present an illustrative clinical vignette and discuss the current clinical and research limitations. We call for continued research to expand our understanding of CFT as well as its potential reach, and conclude by recommending CFT as an evidence-based group treatment that is particularly appropriate for the current global climate.

Trajectories of change in weekly and biweekly therapy.

Higher therapy session frequency has been found to result in faster recovery, but few studies have considered that clients follow diverse trajectories of change in psychotherapy. It is unknown how session frequency may affect the sizes and shapes of change trajectories. The present study examined clients' change trajectories in weekly and biweekly therapy in a naturalistic setting, as well as predictors of these trajectories. Using a sample of 5,102 clients receiving 3-10 therapy sessions at a university counseling center, we identified 886 clients attending approximately weekly therapy and 1,753 clients attending approximately biweekly therapy. We examined the change trajectories of the weekly and biweekly samples using latent growth mixture modeling (LGMM). Three trajectories were identified in weekly therapy: slow change (78.33%), early improvement (17.61%), and worse before better (4.06%), and in biweekly therapy: slow change (80.38%), early improvement (13.52%), and worse before better (6.1%). The worse before better subgroup in weekly therapy experienced greater deterioration than those in biweekly therapy. The slow change and early improvement subgroups in weekly therapy showed treatment outcome comparable to those of their respective counterparts in biweekly therapy. Clients' intake symptoms, including eating concerns, frustration/anger, depression, and academic concerns, significantly predicted change trajectories. Compared to biweekly therapy, weekly therapy leads to higher chances of early improvement and shortens the duration of suffering but results in greater deterioration for individuals who deteriorate in therapy. The impact of session frequency on treatment outcome varies across clients, and session frequency should be adjusted individually. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"I Just Want to be Acknowledged": Suicidal Ideation Experiences among Sexual Minority Students at a Religiously Affiliated University.

Research finds that sexual minority university students experience considerable psychological and emotional distress. Furthermore, a recent study at Brigham Young University (BYU)-a university affiliated with The Church of Jesus Christ of Latter-day Saints-found that suicidality prevalence and severity were twice as high among sexual minority students compared to their heterosexual peers. To better understand this finding, we interviewed ten sexual minority students at BYU who reported clinically significant current or previous suicidality. A coding team and auditors then analyzed and categorized the transcripts of these interviews using the Consensual Qualitative Research methodology. Five domains emerged related to suicidality among sexual minority students: deterrents from suicidal ideation and intent; contributors to suicidal ideation and intent; religious and spiritual experiences; experiences with BYU; and suggested improvements. We found patterns consistent with previous literature, including relational and belonging factors contributing to suicidality; we also found that certain doctrinal interpretations were related to increased suicidality. The primary improvement requested by participants was feeling better understood and accepted (rather than ignored or marginalized). We discuss study limitations (including small sample size and low generalizability,), future directions for research, and implications for religious university campuses.

Is the Measure Good Enough? Measurement Invariance and Validity of the Clance Imposter Phenomenon Scale in a University Population.

Imposter Phenomenon (IP) was coined in 1978 by Clance and Imes and has been an important construct in explaining individuals' experiences of believing that achievements are a result of luck or misperceptions of others rather than personal competence. The Clance Imposter Phenomenon Scale (CIPS), developed in 1985, is a prominent operationalization of this construct. Although this scale has been widely used since its inception, its factor structure has been inconsistent across studies and no tests of measurement invariance are documented in the literature. Using a large university sample (n = 830), the current study was designed to: (a) examine the factor structure of the CIPS using cross validation, (b) examine measurement invariance across gender, and (c) examine differences in the CIPS factor by demographics. We found that a single factor structure for the CIPS was the best fitting model. We also found that the measure achieved invariance across gender after removing item 18 (and in the absence of items 1, 2, and 19, removed for poor fit). Finally, we found that being single, a woman, and having experienced lower socioeconomic status (SES) were all associated with higher IP. We discuss these findings in the context of a university setting and suggest avenues for future research.

The power of compassion in group psycotherapy.

Research has repeatedly demonstrated that individual and group psychotherapy are equally effective. Compassion-focused therapy (CFT) has been shown to be an effective approach to treating individuals with a wide range of presenting mental health concerns. In this study, we discuss the basic tenets of CFT and introduce a 12-module CFT group psychotherapy approach for college counseling centers. We use a clinical vignette to provide an example of how psychotherapists may implement this approach. We then discuss clinical applications, including strengths and limitations of this approach.

Treatment success or failure? Using a narrative interview to supplement ROM.

Although routine outcome monitoring (ROM) has been demonstrated to improve therapy efficiency and effectiveness, categorizations of improvement or deterioration using ROM measures (typically global symptoms) may not always be consistent with the lived experience of the client. A recent line of investigation examines these discrepancies and recommends supplementing ROM with additional measures or narrative interviews. In this case study, we use qualitative analysis of a posttreatment interview to specifically examine the client's perspective of discordant outcome when ROM indicated that the client deteriorated during treatment and the client reported retrospective improvement. We find that the interview provides a unique and helpful narrative perspective that supplements ROM. Findings suggest it may be useful to supplement ROM with approaches that extend beyond global symptom measurement and that outcomes from aggregated patient-focused research may be more complex than anticipated.

Adapting stepped care: Changes to service delivery format in the context of high demand.

Given the ongoing dilemma for college counseling centers to meet steady increases in demand for services, this study outlines the implementation of an adapted stepped care model in a university counseling center. Our adapted model focused, as do other stepped care models, on treatment planning and lower-intensity interventions, with the addition of the intensive therapy option being provided on a weekly basis. We adopted our stepped care model across a large center and hypothesized that after implementation we would be able to serve a similar number of clients as our previous model and that treatment outcomes for these clients would improve. Descriptive data and regression analyses demonstrated support for our hypotheses, including an increased likelihood of clinically significant improvement for clients postimplementation. Implications for adapting service delivery models using practice-based evidence are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychotherapy session frequency: A naturalistic examination in a university counseling center.

With increasing demand for psychotherapy services, clinicians are carrying increasingly large caseloads (Bailey et al., 2020). As the number of new intakes exceeds the number of clinical hours available each week in some settings, psychotherapy is delivered on an attenuated schedule for returning clients (rather than the traditional weekly frequency); there is, however, little support for the efficacy of this practice. The present study explored the effect of session frequency on psychotherapy outcomes using a quasi-randomized controlled design. In a working university counseling center, we assigned therapists to either a treatment-as-usual (TAU) group (attenuated session frequency) or an experimental group (weekly session frequency). Clients were randomly assigned to a therapist in either condition. Using hierarchical linear modeling and survival analyses, we examined psychotherapy outcomes (measured by session-by-session Outcome Questionnaire 45 scores) for 1,322 clients (3,919 individual sessions). We found no differences between groups when examining the full sample, but also found limited fidelity in the experimental group. When identifying individuals who were seen weekly in at least the first three sessions after intake (sensitivity analysis), we found the following: (a) weekly therapy resulted in faster trajectories of change over time, (b) weekly therapy resulted in a greater likelihood of achieving recovery, and (c) weekly therapy resulted in a greater likelihood of achieving recovery sooner. We discuss the importance of including session frequency when considering the dose of therapy, as well as the implication that prioritizing weekly therapy may increase therapy efficacy and efficiency in routine practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Busy therapists: Examining caseload as a potential factor in outcome.

As demand increased for mental health services, especially in university counseling centers, providers have seen increasing numbers of clients. The effect of this increase on therapist caseloads is explored, with a recognition that past research on therapist caseloads lacks direct and fluctuating measures of caseload that reflect practice in naturalistic settings. Using a large dataset from a counseling center (N = 18,322), therapist caseload was conceptualized dynamically over rolling 30-day periods, using within-therapist counts of therapy sessions, unique clients seen, and the proportion of unique clients to sessions. Analysis of variance was used first to test for differences in caseload between months, years, then to test for differences between therapists (n = 173). Hierarchical linear models were constructed to examine the relationship between changes in therapist caseload across time and client outcome. Logistic and ordinal regression approaches were used to further examine this relationship for clinically significant change. Results included finding a small, but significant, effect of therapist caseload on outcome, with this finding discussed in the context of the effect sizes in the literature on therapist effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Therapist effects on early change in psychotherapy in a naturalistic setting.

Objective: Client trajectories of change in psychotherapy differ. Early change is a trajectory that has been shown to be associated with better outcomes over time. Little is known about the mechanisms of this type of change, however. The current study examined the therapist effect in early change, and explored differences between therapists in the likelihood that early change would occur and how early in a course of therapy the change would occur.Methods: Using 20 years of archival data from a university counseling center, we identified 16,825 clients who had been seen by 273 therapists. We examined therapist differences using chi-square analyses, multilevel logistic regression, and survival analyses.Results: We found significant variance between therapists in both their likelihood to predict early change, and how early that change was predicted to occur. Therapist effects, however, accounted for a small portion of the overall variance; despite this small effect, differences between the best performing therapists and the worst performing therapists were substantial.Conclusions: Therapists were differentially effective in helping clients achieve early change. Future research examining mechanisms associated with these effects will be important in informing psychotherapy process and therapist training.

Assessing risk of opioid misuse in the treatment of chronic pain: Building a practical actuarial approach.

OBJECTIVE: Opioid misuse risk assessment has been highlighted as an important part of clinical practice, but there is a paucity of research identifying an effective approach to assessment. Currently, practitioners use patient history, interviews, and formal questionnaires, and these data are weighed clinically to assign risk. The authors propose the use of an actuarial method-the Bayesian nomogram-as a simple, standard, evidence-based approach to opioid misuse risk assessment. INTERVENTIONS: The Bayesian nomogram relies solely on empirically established relationships between risk factors and risk and has been found in other fields to be both more efficient and more consistent than clinical judgment. The authors performed a comprehensive search of the literature to identify empirically established risk factors for opioid misuse in the treatment of noncancer chronic pain. RESULTS: As the Bayesian nomogram requires both base rates of the predicted event (opioid misuse) and odds ratios for risk factors, the authors reported the most current evidence available in the literature. The authors also included the nomogram itself for easy clinical application of base rates and risk factors in the predictive model. Finally, the authors provided examples to help illustrate practical application. CONCLUSIONS: The authors call for research comparing this methodology to "assessment as usual" to better predict risk of opioid misuse and to aid decision making for medical providers treating chronic-pain patients.

Different lens or different picture? Comparing methods of defining dramatic change in psychotherapy.

OBJECTIVES: Differing methodologies that identify dramatic change in psychotherapy have been thought to be capturing similar phenomena. We compared three methods-percentage improvement-50% (PI-50), rapid response (RR), and sudden gains (SG)-to identify similarities and differences between these approaches. METHODS: Using a large database (n = 11,764) from a western university counseling center, we examined client characteristics (including initial severity and number of sessions in a course of treatment) and treatment outcomes (including overall change and meeting clinically significant criteria) using the Outcome Questionnaire-45. RESULTS: Approximately 47% of clients (n = 5516) met criteria for one or more of the dramatic change definitions examined. Only 498 clients (3.7%) met criteria for all three methods, while 1349 (11.5%) met criteria for only one; RR identified the most clients (41.9%) and SG identified the fewest (4.9%). All definitions were associated with higher rates of clinically significant change at termination. Compared to those who recovered gradually, dramatic changers showed higher initial severity and more overall change. RR showed fewer sessions and PI-50 and SG showed more sessions than those who recovered gradually. CONCLUSIONS: Given these differences, consensus needs to be reached in the literature regarding the definition of dramatic change. We call for further theory development and research to help formulate a definition that can be simply applied and that more fully and parsimoniously captures the phenomenon of dramatic change.

A longitudinal investigation of the impact of psychotherapist training: Does training improve client outcomes?

This study is a longitudinal examination of the impact of therapist stage of training on client outcomes in psychotherapy. The study included 22 PhD-level psychologists who work in a university counseling center (8 female, 14 male) who had completed at least 2 training periods in the center where data were gathered. Therapists worked with 4,047 clients, and 40,271 sessions were included in our analyses. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis, tracking treatment response. The effect of stage of training on both the magnitude and speed of OQ-45 change was examined through hierarchical linear modeling. Therapists were found to achieve the same amount of change or less change on average in their later stages of training. Therapists were also found, on average, to achieve the same rate of change or a slower rate of change in later stages of training. Findings suggest that as therapists progress through formal stages of training, they do not improve in their ability to effect change in their clients. Given these findings, a better understanding of expertise in psychotherapy practice and how to develop it may be an important area for future theory development, research, and training program development. We call for further work examining if and how an individual therapist can become more effective with time. (PsycINFO Database Record

Sticking with it: Psychotherapy outcomes for adults with autism spectrum disorder in a university counseling center setting.

Young adults with autism spectrum disorders (ASD) experience high rates of comorbid mental health concerns in addition to distress arising from the core symptoms of autism. Many adults with ASD seek psychological treatment in outpatient facilities in their communities that are not specifically geared toward individuals with ASD. However, few studies have looked at the effectiveness of standard psychotherapeutic care in adults with ASD. This study aimed to discover how individuals with ASD fare in psychotherapy within a college counseling setting, compared to their neurotypical peers. Clients with ASD (n = 76) or possible ASD (n = 91) were retrospectively identified from counseling center case notes. Data from the Outcome Questionnaire-45 (OQ) were retrieved for each therapy session as a measure of client distress. Clients with ASD showed no difference in level of distress at intake compared to their neurotypical peers (n = 21,546), and improved about the same amount from pre- to post-treatment. However, students with ASD stayed in treatment for significantly more sessions than neurotypical clients, and took significantly longer to achieve maximum improvement on OQ reports. Results are discussed with implications for university and other community based treatment settings. Autism Res 2017, 10: 2048-2055. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study aimed to discover how individuals with autism spectrum disorders (ASD) fare in psychotherapy within a university counseling setting, compared to their neurotypical peers. Clients with ASD showed no difference in level of distress at intake compared to their neurotypical peers, and improved about the same amount from pre- to post-treatment. However, students with ASD stayed in treatment for significantly more sessions than neurotypical clients, and took significantly longer to achieve maximum improvement on Outcome Questionnaire-45 reports.

The relationship between session frequency and psychotherapy outcome in a naturalistic setting.

OBJECTIVE: The dose-response relationship in psychotherapy has been examined extensively, but few studies have included session frequency as a component of psychotherapy "dose." Studies that have examined session frequency have indicated that it may affect both the speed and the amount of recovery. No studies were found examining the clinical significance of this construct in a naturalistic setting, which is the aim of the current study. METHOD: Using an archival database of session-by-session Outcome Questionnaire 45 (OQ-45) measures over 17 years, change trajectories of 21,488 university counseling center clients (54.9% female, 85.0% White, mean age = 22.5) were examined using multilevel modeling, including session frequency at the occasion level. Of these clients, subgroups that attended therapy approximately weekly or fortnightly were compared to each other for differences in speed of recovery (using multilevel Cox regression) and clinically significant change (using multilevel logistic regression). RESULTS: Results indicated that more frequent therapy was associated with steeper recovery curves (Cohen's f2 = 0.07; an effect size between small and medium). When comparing weekly and fortnightly groups, clinically significant gains were achieved faster for those attending weekly sessions; however, few significant differences were found between groups in total amount of change in therapy. CONCLUSIONS: Findings replicated previous session frequency literature and supported a clinically significant effect, where higher session frequency resulted in faster recovery. Session frequency appears to be an impactful component in delivering more efficient psychotherapy, and it is important to consider in individual treatment planning, institutional policy, and future research.