James O. Prochaska (1942-2023).

Memorializes James O. Prochaska (1942-2023). Prochaska was an internationally recognized clinical psychologist who revolutionized health behavior change. Prochaska is best known for codeveloping (with former student and friend Carlo C. DiClemente) the transtheoretical model (TTM). For 50 years, he served on the Psychology Department faculty at the University of Rhode Island. Prochaska, with his life partner of 56 years Janice Prochaska, established Pro-Change Behavior Solutions to disseminate and translate the science of behavior change to real-world solutions (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Psychotherapy skills and methods: Introduction to the special issue.

This article introduces the special issue of Psychotherapy on evidence-based skills and methods and concomitantly, outlines the purposes and processes of the Interorganizational Task Force that guided the work. We provide the rationale for reviewing psychotherapy skills and methods, define and contrast skills and methods with other components of psychotherapy, describe how to assess skills, methods, and outcomes (immediate in-session, intermediate, and distal), how to link skills and methods with outcomes, and how to summarize the extant research on those skills and methods. Finally, we describe how the research reviews of skills and methods lead to training implications and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Donald K. Freedheim (1932-2023).

Memorializes Donald K. Freedheim (1932-2023). Freedheim was a renowned child psychologist, respected professor, American Psychological Association (APA) leader, and gifted editor. He was widely known for his pioneering contributions to professional psychology and his gentle wisdom in personal interactions. He served as the founding director of the Schubert Center for Child Development at Case Western and on the boards of a number of youth-oriented nonprofits. His leadership in the Division of Psychotherapy (now Society for the Advancement of Psychotherapy) entailed a term as president (1988) and initiation of several pioneering projects in concert with APA. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychologists conducting psychotherapy in 2022: Contemporary practices and historical patterns of the Society for the Advancement of Psychotherapy.

This study updated and extended investigations from 1981, 1991, 2001, and 2012 on the contemporary psychotherapy practices and historical patterns of United States psychologists in the American Psychological Association Division of Psychotherapy/Society for the Advancement of Psychotherapy. In 2022, 475 psychologists (48% response) completed an online questionnaire regarding their sociodemographic characteristics, professional activities, therapy formats, employment settings, theoretical orientations, personal therapy, and career satisfactions. Results showed an increasingly female and aging membership with primary employment in independent practices and universities. Psychotherapy, research/writing, and administration were the most frequent professional activities. Individual therapy remained the most common format, and the most popular theoretical orientations remained psychodynamic/relational (29%), integrative (27%), and cognitive (19%). Eighty-two percent of psychologists have undergone personal therapy at least once. Career satisfaction, likewise, has remained consistently high across the 40 years. The limitations and implications of these 40-year patterns are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Research evidence on psychotherapist skills and methods: Foreword and afterword.

This article serves as both the foreword and the afterword to the special section of Psychotherapy Research devoted to research reviews of psychotherapist skills and methods: it introduces the interorganizational Task Force that guided the reviews and then features its conclusions. We begin by operationally defining therapist skills and methods and then contrasting them with other components of psychotherapy. Next, we consider the typical assessment of skills and methods and how they are linked with outcomes (immediate in-session, intermediate, and distal) in the research literature. We summarize the strength of the research evidence on the skills and methods reviewed in the 8 articles in this special section and in the companion special issue in Psychotherapy. We end with diversity considerations, research limitations, and the formal conclusions of the interorganizational Task Force on Psychotherapy Skills and Methods that Work.

Skills and methods that work in psychotherapy: Observations and conclusions from the special issue.

We draw recommendations and conclusions from the articles presented in this special issue and the companion special section in Psychotherapy Research on evidence-based therapist skills and methods. For distal (end-of-treatment) outcome, 10 skills/methods were judged to be demonstrably effective (affirmation/validation, paradoxical interventions, homework, routine outcome monitoring, strength-based methods, emotional regulation, imagery rehearsal therapy and exposure relaxation and rescripting therapy for nightmares, meditation/mindfulness/acceptance, behavioral activation, cognitive restructuring) and four were probably effective (rupture repair, role induction, collaborative assessment methods, chairwork). For intermediate (postsession or midtreatment) outcome, one method was judged to be demonstrably effective (cognitive-experiential dreamwork) and two methods probably effective (paradoxical interventions, homework). For immediate (in-session) outcomes, five skills/methods were judged to be probably effective (in-dialog silences, extended silences, role induction, strength-based methods, and emotion regulation). For the rest of the immediate, intermediate, or distal outcomes for skills/methods, there was either no or insufficient research available upon which to base judgments. Possible harmful effects, diversity considerations, and research limitations are summarized. The article ends with training implications, therapeutic practices, and the formal conclusions of the interorganizational Task Force on Psychotherapy Skills and Methods that Work. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Validation of the Cooper-Norcross Inventory of Preferences (C-NIP) in Chinese lay clients and mental health professionals: Factor structure, measurement invariance, and scale differences.

The Cooper-Norcross Inventory of Preferences (C-NIP) is one of the most widely used measures of psychotherapy preferences. However, its psychometric properties have not been examined in non-Western samples. Research on disparities between the preferences of mental health professionals and their clients is also limited. We evaluated the C-NIP's psychometric properties and measurement invariance in Chinese lay clients and mental health professionals and evaluated the latent mean differences between clients' and professionals' scores on the C-NIP's four scales (preference for therapist vs. client directiveness, emotional intensity vs. emotional reserve, past vs. present orientation, and warm support vs. focused challenge). This cross-sectional investigation involved 301 lay clients and 856 mental health professionals who completed the Chinese version of the C-NIP. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to examine the factor structure of the C-NIP. ESEM provided stronger evidence than CFA for the four-factor model in both samples. The four scales had adequate internal consistency in both the lay clients (αs = .68-.89) and the mental health professionals (αs = .70-.80). Partial scalar invariance was established across these two populations. Chinese mental health professionals preferred less therapist directiveness, past orientation, and warm support-but more emotional intensity-than Chinese lay clients (ds = 0.25-0.90). Culture-specific cutoff values (norms) to identify strong therapy preferences were established. This study supports the application of the C-NIP to non-Western populations and suggests that discrepancies between the preferences of lay clients and mental health professionals are a cross-cultural phenomenon. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Predicted Future of Psychotherapy: A Decennial e-Delphi Poll.

Whither psychotherapy in the 2030s? Following a decennial tradition, the authors conducted an e-Delphi poll on the future of psychotherapy in the United States. A panel of 56 psychotherapy experts participated in two rounds of predictions and achieved consensus on most items. The experts forecast multicultural, mindfulness, and cognitive-behavior therapies to increase the most, whereas classical psychoanalysis, reality therapy, and gestalt therapy to decrease the most. Technological, relationship-building, strength-oriented, skill-building, and self-change interventions were expected to rise. Master-level clinicians of multiple professions were projected to expand while psychiatrists to decline in the proportion of psychotherapy rendered. Therapy platforms with the highest likelihood of flourishing were videoconferencing, texting, smartphone applications, and multiple or flexible platforms. Short-term therapy, crisis intervention, and very short-term therapy were predicted to increase the most. Forecast scenarios with the highest likelihood were therapy personalization, treatment of health problems, requirement of evidence-based practices for insurance reimbursement, and integration of psychotherapy into primary care. Limitations of the Delphi methodology are elucidated, and practice implications for health-service psychologists are advanced.

Psychologist Self-Care During the Pandemic: Now More Than Ever.

The COVID-19 crisis has transformed the lives and practices of psychologists and has highlighted the need for time-efficient self-care. The anxiety among psychologists (and humans) is practically universal-nearly every psychologist worldwide is experiencing some negative impact on their mental health. We offer nine research-supported, practitioner-friendly methods of self-care to manage anxiety and maintain optimal performance during these extraordinary times.

Personal Therapy and Self-Care in the Making of Psychologists.

Psychologists are skilled in assessing, researching, and treating patients' distress, but frequently experience difficulty in applying these talents to themselves. The authors offer 13 research-supported and theoretically neutral self-care strategies catered to psychologists and those in training: valuing the person of the psychologist, refocusing on the rewards, recognizing the hazards, minding the body, nurturing relationships, setting boundaries, restructuring cognitions, sustaining healthy escapes, maintaining mindfulness, creating a flourishing environment, cultivating spirituality and mission, fostering creativity and growth, and profiting from personal therapy. The latter deserves special emphasis in the making of health care psychologists. These strategies are recommended both during training and throughout the career span. Recommendations are offered for enhancing and publicizing systems of self-care throughout the profession.

Generating psychotherapy breakthroughs: Transtheoretical strategies from population health psychology.

Over the past 40 years, few breakthroughs have dramatically increased the impacts of psychotherapy. There have been new and exciting therapies, but the research does not convincingly demonstrate that any recent or more established therapies produce greater impacts than 40 years ago. Seven strategies from the transtheoretical model that have produced breakthroughs in health psychology/population health are analyzed to illustrate how they can similarly generate breakthroughs in mental health outcomes. The first three strategies can enhance impacts by increasing the percentage of troubled populations entering and completing best-practice treatments: reach, recruit, and retain. The fourth strategy accords higher value to synergy than to specificity by generating more benefits from whole-health therapies that briefly treat the small number of behaviors that account for a large percentage of chronic disabilities and premature deaths. The fifth breakthrough strategy creates multiple synergistic changes within individuals; changing one problem behavior promotes the probabilities that individuals will change a second problem (coaction). The sixth strategy increases impacts by complementing psychologists with tailored technology that extends their influence into homes, schools, workplaces, and communities. The seventh strategy calls on researchers to test their innovations against best practices and to benchmark outcomes, like those found with depression. We conclude by advancing a framework that can generate more inclusive and effective psychotherapies by integrating individual health care with population health practices. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychotherapy preferences of laypersons and mental health professionals: Whose therapy is it?

What do patients prefer in their psychotherapy? Do laypersons and mental health professionals (as patients) want the same, or different, things? The authors systematically examined patients' psychotherapy preferences and quantitatively compared two samples of laypersons (N = 228, 1,305) with one sample of mental health professionals (N = 615) on the four dimensions of the Cooper-Norcross Inventory of Preferences: Therapist Directiveness Versus Client Directiveness, Emotional Intensity Versus Emotional Reserve, Past Orientation Versus Present Orientation, and Warm Support Versus Focused Challenge. On average, laypersons wanted therapist directiveness and emotional intensity. Robust differences were found between laypersons' and professionals' preferences on these two dimensions: Mental health professionals wanted less therapist directiveness than did laypersons (gs = 0.92 and 1.43 between groups) and more emotional intensity (gs = 0.49 and 1.33). Women also wanted more warm support than men (gs = 0.40 and 0.57). These findings suggest that psychotherapists should be mindful of their own treatment preferences and ensure that these are not inappropriately generalized to patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline.

The therapeutic relationship and responsiveness/treatment adaptations rightfully occupy a prominent, evidence-based place in any guidelines for the psychological treatment of trauma. In this light, we critique the misguided efforts of the American Psychological Association's (APA, 2017) Clinical Practice Guideline on Posttraumatic Stress Disorder in Adults to advance a biomedical model for psychotherapy and thus focus almost exclusively on treatment methods for particular disorders. Instead, the research evidence, clinical expertise, and patient preferences and culture (the necessary triumvirate of evidence-based practice) should converge on distinctive psychological guidelines that emphasize the therapy relationship, treatment adaptations, and individual therapist effects, all of which independently account for patient improvement more than the particular treatment method. Meta-analytic findings and several trauma-specific studies illustrate the thesis. Efforts to promulgate guidelines without including the relationship and responsiveness are seriously incomplete and potentially misleading. The net result is an APA Guideline that proves empirically dubious, clinically suspect, and marginally useful; moreover, it squanders a vital opportunity to identify what actually heals the scourge of trauma. We conclude with recommendations for moving forward with future APA practice guidelines. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Stages of change and psychotherapy outcomes: A review and meta-analysis.

The transtheoretical model and the stages of change are often used to adapt treatment to the individual client. The aims of this study were to review the stages of change and popular measures of change readiness in psychotherapy and to conduct a meta-analysis of the relation between readiness measures and psychotherapy outcomes. We report data from 76 studies, encompassing 25,917 patients. Moderate-sized effects (d = 0.41) were found for the association among multiple disorders, including substance and alcohol use, eating disorders, and mood disorders. Outcomes were a function of the pretreatment stage of change; that is, the farther a patient along the stages, the better the treatment outcomes. This review added 37 studies to the data reported in 2010, further strengthening the link between readiness and therapy outcomes. The article concludes with limitations of the research, diversity considerations, and therapeutic practices for stage matching in psychotherapy specifically and behavioral health more generally.

Psychotherapy relationships that work III.

This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome. The expert consensus deemed 9 of the relationship elements as demonstrably effective, 7 as probably effective, and 1 as promising but with insufficient research to judge. What works-and what does not-in the therapy relationship is emphasized throughout. The limitations of the task force work are also addressed. The article closes with the Task Force's formal conclusions and 28 recommendations. The authors conclude that decades of research evidence and clinical experience converge: The psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A new therapy for each patient: Evidence-based relationships and responsiveness.

In this study, we introduce the journal issue devoted to evidence-based responsiveness and frame it within the work of the third interdivisional APA Task Force on Evidence-Based Relationships and Responsiveness. We summarize the meta-analytic results and clinical practices on the adaptations of psychotherapy to multiple transdiagnostic characteristics of the patient, including attachment style, culture (race/ethnicity), gender identity, coping style, therapy preferences, reactance level, religion and spirituality, sexual orientation, and stages of change. We then discuss the clinical and research process of determining what works, and what does not work, for whom. The limitations of the Task Force's work are outlined and frequently asked questions are addressed. The article closes with the Task Force's formal conclusions and 28 recommendations and with some reflections on fitting psychotherapy to the individual client.

Addiction training and multiple treatments for all clinical psychologists: Reply to Freimuth (2018).

The authors agree with Freimuth (2018) that addiction training among clinical psychologists would be enhanced by offering addiction-related training to all clinical students, including those who do not aim to specialize in substance abuse. It is argued that Freimuth's points in fact support Dimoff, Sayette, and Norcross's (2017) recommendation that clinical programs bolster their addiction training but, contrary to Freimuth, in all evidence-based (abstinence and nonabstinence) treatments predicated on patient needs, not on practitioner preferences. (PsycINFO Database Record

Doctoral training in clinical psychology across 23 years: Continuity and change.

OBJECTIVE: Doctoral training in clinical psychology has undergone substantial changes in recent decades, especially with the increasing heterogeneity of training models and graduate students. To document these changes, we analyzed program, student, and faculty characteristics of American Psychological Association (APA)-accredited clinical psychology programs over a 23-year span. METHOD: We surveyed directors of clinical training about their doctoral programs every 2 years from 1991 to 2013, securing 90%-98% response rates. With minimal exceptions, the survey questions remained constant. RESULTS: Percentages of female and racial/ethnic minority students continued to grow, such that women now comprise about three quarters of trainees and ethnic minorities about one quarter. There has been a decisive shift in faculty theoretical orientation toward cognitive/cognitive-behavioral and away from psychodynamic/psychoanalytic. Internship match rates were relatively high and stable until the early 2010s but have recently rebounded. CONCLUSION: We discuss the limitations of these survey results and their implications for the future of doctoral training in clinical psychology.

Addiction training in clinical psychology: Are we keeping up with the rising epidemic?

Addiction has emerged as a serious public health crisis. Clinical psychology as a hub science has a long-standing interest in addiction and is particularly well suited to offer multifaceted treatment to those struggling with substance use disorders. To examine how well clinical psychology training is addressing this proliferation of addiction-related problems, we surveyed the directors of clinical training at all APA-accredited U.S. clinical psychology doctoral programs on 7 occasions between 1999 and 2013. The number of clinical programs rose from 181 to 237 programs across the years, with at least 95% response at each wave of data collection. Results indicated that less than 40% of programs had even 1 faculty member studying addiction, and less than 1 third offered any specialty clinical training in addiction. Results also revealed that both the percentage of programs reporting any faculty studying addiction and the percentage of programs offering specialty clinics in addiction have not increased over the 14-year period. We argue that clinical psychology training must bolster its focus on addiction research and practice. (PsycINFO Database Record