Cultural humility and racial microaggressions in cross-racial clinical supervision: A moderated mediation model.

Cultural humility is important in supervision; however, studies have primarily sampled White supervisees. Racially and ethnically minoritized trainees experience microaggressions during their training, yet cross-racial supervision is less often studied. We examined a moderated mediation model to test whether the supervisory working alliance mediated the relationship between frequency of racial microaggressions and satisfaction with supervision, and whether the impact of racial microaggressions on the supervisee and supervisor cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance. In a sample of supervisees of color (N = 102; majority cisgender women, 86.2%, and heterosexual, 59.8%; 35.3% Black/African American, 28.4% Asian/Pacific Islander, 18.6% Hispanic/Latine) receiving clinical supervision from White supervisors, we found that racial microaggression frequency was negatively associated with satisfaction with supervision, and this relationship was fully accounted for by the supervisory working alliance. Racial microaggressions in supervision were found to be detrimental to the supervisory working alliance, which was then related to lower satisfaction with supervision. Further, racial microaggression impact and cultural humility moderated the relationship between racial microaggression frequency and the supervisory working alliance; this relationship was strongest when racial microaggression impact was high and cultural humility was average or high. The social bond hypothesis suggests we are more likely to allow ourselves to be vulnerable when we assess cultural humility to be high. We posit that the observed moderation effect may be due to supervisees experiencing greater shock when experiencing racial microaggressions from supervisors whom they perceived to be culturally humble. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Practice-based evidence for spiritually integrated psychotherapies: Examining trajectories of psychological and spiritual distress.

The aims of this practice-based evidence study were to (a) examine clients' trajectories of psychological and spiritual distress over the course of spiritually integrated psychotherapies (SIPs) and (b) explore the role of varying types of spiritual interventions in these outcomes. In total, 164 practitioners of SIPs from 37 settings in a practice-research network administered the Clinically Adaptive Multidimensional Outcome Survey (Sanders et al., 2018) at each session with 1,227 clients and reported their use of theoretical orientations and spiritual interventions on an after-session summary checklist. Focusing on sessions over an initial 12-week period, latent growth curve modeling analyses revealed that clients, on average, experienced significant reduction of psychological distress during their engagement in SIPs with improvements occurring most sharply in the first month. Further, other findings revealed a salient reciprocal interplay with spiritual distress throughout treatment, such that clients who were struggling with their religious faith and/or spirituality were more psychologically distressed and displayed a more attenuated and gradual pattern of symptom reduction. In such cases, clinicians frequently utilized spiritual interventions involving basic skills (e.g., spiritual assessment), virtues (e.g., discuss self-control), and religious attachment (e.g., encourage acceptance of divine love) that were uniquely associated with clients' rate and duration of decline in psychological and spiritual distress. The present findings affirm the routine effectiveness of SIPs along with highlighting the potential value of certain spiritual interventions in supporting holistic recovery among clients who want clinicians to be culturally responsive to their spiritual and/or religious identities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Automating the assessment of multicultural orientation through machine learning and natural language processing.

Recent scholarship has highlighted the value of therapists adopting a multicultural orientation (MCO) within psychotherapy. A newly developed performance-based measure of MCO capacities exists (MCO-performance task [MCO-PT]) in which therapists respond to video-based vignettes of clients sharing culturally relevant information in therapy. The MCO-PT provides scores related to the three aspects of MCO: cultural humility (i.e., adoption of a nonsuperior and other-oriented stance toward clients), cultural opportunities (i.e., seizing or making moments in session to ask about clients' cultural identities), and cultural comfort (i.e., therapists' comfort in cultural conversations). Although a promising measure, the MCO-PT relies on labor-intensive human coding. The present study evaluated the ability to automate the scoring of the MCO-PT transcripts using modern machine learning and natural language processing methods. We included a sample of 100 participants (n = 613 MCO-PT responses). Results indicated that machine learning models were able to achieve near-human reliability on the average across all domains (Spearman's ρ = .75, p < .0001) and opportunity (ρ = .81, p < .0001). Performance was less robust for cultural humility (ρ = .46, p < .001) and was poorest for cultural comfort (ρ = .41, p < .001). This suggests that we may be on the cusp of being able to develop machine learning-based training paradigms that could allow therapists opportunities for feedback and deliberate practice of some key therapist behaviors, including aspects of MCO. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Biological Sex as a Moderator of Work Determinants of Health: Implications for Work and Stress.

This study examined whether biological sex moderates the relationship between experiences of workplace culture and urinary levels of catecholamines and their metabolites. We conducted a series of regression analyses (predictors: 3-methoxytyramine (3MT), 5-hydroxyindolacetic (5HIAA), and dopamine (DA); outcomes: employee engagement and workplace culture) in a sample of 218 participants. Compared to men, women rated workplace culture less positively (r = -0.210; p < 0.01) and had stronger positive associations with 3MT (r = 0.328; p < 0.001), DA (r = 0.376; p < 0.001), and 5HIAA (r = 0.168; p < 0.01). There was a significant moderation effect between 3MT and sex on employee engagement (b = -1.76 (SE = 0.84); p < 0.01), and 3MT had a positive significant association for men with engagement (p < 0.05); however, there was no significant association for women. Findings suggest that for women, less positive experiences with workplace culture could elevate 3MT, stimulating sympathetic nervous tone and potentially amplifying risks for negative health outcomes. Conversely, men who reported higher employee engagement had higher levels of 3MT, suggesting possible health risks associated with high levels of engagement, rather than lack of engagement. Overall, study findings suggested differential health risks based on biological sex, potentially impacting health risk policy development.

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.

A randomized wait-list controlled trial of Men in Mind: Enhancing mental health practitioners' self-rated clinical competencies to work with men.

Improved engagement of men in psychotherapy is an essential element in improving male health outcomes. This trial examined whether the Men in Mind intervention improved practitioners' self-rated clinical competencies to engage and respond to male clients in therapy. A parallel, single-blind, wait-list randomized controlled trial was conducted with Australian-based mental health practitioners, currently administering psychotherapy to males, fluent in English, and not currently completing their undergraduate degree. Participants were randomly assigned 1:1, through variable-sized blocks stratified by gender, to either the intervention (Men in Mind) or wait-list control. Men in Mind was offered as a self-led 6-week, five-module online program to upskill practitioners to engage and respond to male clients. The primary outcome was self-reported competency in engaging men in psychotherapy, measured by the Engaging Men in Therapy Scale (EMITS) at 6 weeks. All analyses were by intention-to-treat. Between January 16 and March 17, 2022, 587 participants were randomly assigned to the intervention (n = 300) or wait-list control (n = 287). In total, 492 (84%) participants completed the primary endpoint assessment at 6 weeks. Men in Mind demonstrated a large effect of improved EMITS scores compared to the control group (d = 2.63, 95% CI [2.39, 2.87], p < .001). Men in Mind was effective at increasing mental health practitioners' self-reported efficacy to work with men, which is potentially a key change mechanism in their ability to improve health outcomes for male clients. A limitation of the trial was the use of a bespoke, self-reported primary outcome, while a strength was the gender-responsive intervention design. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Therapist engagement in measurement-based care: The association between client outcomes and therapist viewing frequency.

Engagement in measurement-based care (MBC) has been shown to be an effective practice for optimizing psychotherapy outcomes. Best practices for MBC suggest that it is crucial for therapists to consistently review scores. However, the exact impact of this practice on MBC's effectiveness has yet to be fully elucidated. The current study examined the association between the frequency of therapists reviewing clients' depression scores and client psychotherapy outcomes. The sample consisted of 6182 clients diagnosed with depression who sought treatment from 2248 therapists through a practice research group. Patient Health Questionnaire-9 (PHQ-9) was administered prior to sessions, and therapists could access the scores via their therapist portal. The results based on multilevel modelling revealed that how often therapists view their clients' PHQ-9 results was not a significant predictor of therapy outcomes. However, therapists who, across their caseloads, viewed client PHQ-9 scores more frequently facilitated better treatment outcomes. These results suggest that therapists who routinely engage in MBC facilitate better therapy outcomes. Implications for practice and research are provided.

Supporting Clinical Competencies in Men's Mental Health Using the Men in Mind Practitioner Training Program: User Experience Study.

BACKGROUND: Engaging men in psychotherapy is essential in male suicide prevention efforts, yet to date, efforts to upskill mental health practitioners in delivering gender-sensitized therapy for men have been lacking. To address this, we developed Men in Mind, an e-learning training program designed to upskill mental health practitioners in engaging men in therapy. OBJECTIVE: This study involves an in-depth analysis of the user experience of the Men in Mind intervention, assessed as part of a randomized controlled trial of the efficacy of the intervention. METHODS: Following completion of the intervention, participants provided qualitative (n=392) and quantitative (n=395) user experience feedback, focused on successes and suggested improvements to the intervention and improvements to their confidence in delivering therapy with specific subpopulations of male clients. We also assessed practitioner learning goals (n=242) and explored the extent to which participants had achieved these goals at follow-up. RESULTS: Participants valued the inclusion of video demonstrations of skills in action alongside the range of evidence-based content dedicated to improving their insight into the engagement of men in therapy. Suggested improvements most commonly reflected the desire for more or more diverse content, alongside the necessary adaptations to improve the learning and user experience. Participants also commonly reported improved confidence in assisting men with difficulty articulating their emotions in therapy and suicidal men. CONCLUSIONS: The evidence obtained from this study aids in plans to scale Men in Mind and informs the future development of practitioner training interventions in men's mental health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s40359-022-00875-9.

Sudden gains and deteriorations: Modeling the impact across outcomes with university counseling center clients.

OBJECTIVE: This study examines the longitudinal impact of sudden gains/deteriorations across the outcomes associated with the phase model. METHOD: In a sample of 16,657 clients who completed the Behavioral Health Measure-20, we identified sudden gains/deteriorations and employed multilevel piecewise analyses to assess their impact on subsequent treatment phases. RESULTS: We found that: (1) Following a sudden gain in the well-being outcome, the mean-level for the symptom outcome increased (meaning symptoms improved), and the rate of change decreased, (2) Following a sudden gain in the symptom outcome, the mean-level for the life functioning outcome increased, (3) Following a sudden deterioration in the well-being outcome, the mean-level and rate of change for the symptom outcome decreased, and (4) Following a sudden deterioration in the symptom outcome, the mean-level for the life functioning outcome decreased. CONCLUSIONS: These findings reveal that sudden gains/deteriorations function and occur at different rates across phases of change in psychotherapy.

Meta-analysis of couple therapy in non-randomized clinical trial studies: Individual and couple level outcomes.

Couple therapy has outperformed control conditions in randomized clinical trials (RCTs). However, there have been some questions whether couple treatment in naturalistic settings is as effective as those with more rigorous controls. The current meta-analysis examined 48 studies of couple therapy in non-randomized clinical trials. The pre-post effect size was Hedge's g = 0.522 for relational outcomes and Hedge's g = 0.587 for individual outcomes. However, there was significant heterogeneity in the results. Several moderators explained some of the variance in these estimates. For relationship outcomes, studies who had older couples and longer length of relationship had better outcomes. Studies with a higher percentage of racial/ethnic minority (REM) couples and studies in Veteran Affairs Medical Centers (VAMC) had lower relational outcomes. For individual outcomes, studies that had more sessions, older couples, and VAMC had better outcomes. Studies with a higher percentage of REM couples also had worse individual outcomes. Trainee status was not consistently related to relational or individual outcomes. Implications for research and practice are provided.

Measurement-based care professional practice guideline: Don't forget the therapists!

Boswell et al. (2022) professional practice guideline builds an excellent, evidence-driven argument in favor of the routine implementation of measurement-based care (MBC). Nonetheless, as learned from the attempted implementation of evidence-based psychotherapies, presenting empirical evidence does not affect therapist behavior. As such, we argue for an actionable and practical professional practice guideline. We review some of the most hindering barriers to the implementation of MBC, and we offer guidance introducing some of the efforts needed to overcome them. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Latent Class Analysis of Predictors for Engaging in Sex: A Study with Ethnically Diverse High School Students.

Sexual activity occurs among a large portion of young adults and adolescents, including high school students. While about 40% of high school students nationwide have engaged in sexual intercourse, more information is needed about how individual characteristics may relate to larger patterns of adolescent sexual behavior. This exploratory study utilized a latent class analysis (LCA) to identify clusters of high school students (N = 801) based on demographic characteristics, sexual refusal skills, healthy relationship skills, sociosexuality, internalizing symptoms, alcohol use, various forms of social support (i.e., parents, friends, teachers), and sexual activity at baseline to predict their sexual behavior at a 6-month follow-up. Four unique latent classes were identified based on these baseline predictors. Distinctions in the profiles of high schoolers varied significantly by internalizing symptoms, race/ethnicity, sexually conservative attitudes, and social support in the prediction of adolescent sexual activity at 6-months. This study contributes to the investigation of demographic, social, psychological, attitudinal, and behavioral factors that may distinguish high school students from one another in terms of their longitudinal rates of sexual activity.

Longitudinal Associations Among Adolescents' Sexual Attitudes, Beliefs, and Behaviors.

Youth sex and relationship education programs aim to improve adolescent well-being by changing their knowledge, beliefs, and attitudes regarding sex and their health. However, there is a gap in existing research linking these cognitive targets to relevant behaviors, and a particular dearth of data on links with sexual behaviors. The current study tested longitudinal links between cognitive factors related to sex (attitudes about sex, normative beliefs, risk-avoidant intentions, and confidence in refusal skills) and outcomes of sexual behaviors (recent sexual encounters, number of sexual partners, and frequency of condom use). Data were drawn from three waves of data from a panel study of US high-school students and were analyzed using cross-lagged structural equation modeling. We hypothesized direct, reciprocal links between intentions and behaviors, but this hypothesis was not supported. Instead, more conservative attitudes about sex emerged as the most consistent prospective predictor of fewer sexual encounters and sexual partners, though with small effect sizes (ßs = - .08 to - .131, ps < .05). Further, bidirectional interrelationships were observed among several of the cognitive and behavioral variables over time. These results highlight attitudes about sex as a potentially useful intervention target, but also suggest that sex and relationship education curricula and evaluations should consider multiple pathways of links between cognition and behavior. Continued research is needed on causal links between adolescents' sexual attitudes, knowledge, intentions, and behavior.

Patient personality characteristics and therapeutic integration: treating borderline personality and emotionally dysregulated-dysphoric personality features.

This study examines the relationship between patient personality characteristics and therapeutic integration. Within a sample of patients (N=93) receiving outpatient psychodynamically- oriented psychotherapy, we assessed patient Borderline and Emotionally Dysregulated personality features through the Shedler-Westen Assessment Procedure (SWAP-200), and therapeutic technique using the Comparative Psychotherapy Process Scale (CPPS) during an early treatment session. We examined personality dimensionally, psychotherapy interventions across different theoretical orientations, as well as psychotherapy integration. These analyses revealed an overlap between the Borderline Clinical Prototype and the Emotionally Dysregulated-Dysphoric Q-factor, with the former associated with higher use of integration and the latter associated with higher use of either psychodynamicinterpersonal or cognitive-behavioural interventions. Secondary analyses also indicated the greater presence of interventions oriented towards emotional exploration and to the didactic instruction of effective symptom coping techniques across both of these personality subtypes early in treatment. The key differences between these personality types, as well as the theoretical, empirical, and clinical implications of these findings are discussed.

Protocol for a randomized controlled trial of the Men in Mind training for mental health practitioners to enhance their clinical competencies for working with male clients.

BACKGROUND: Although the proportion of men seeking professional mental health care has risen over the past two decades, on average, men continue to attend fewer sessions of psychotherapy and are more likely to drop out of treatment prematurely compared to women. Men account for three-quarters of suicide deaths; furthermore, over half of the males who die by suicide have engaged with mental health care in the 12 months prior to their death. These findings highlight a need to equip mental health practitioners with skills to improve male clients' engagement and mental health outcomes. This article reports the protocol for a randomized controlled trial of Men in Mind, a self-paced online training program purpose-built to advance the clinical competencies of practitioners who provide psychotherapy to male clients. METHODS: A randomized controlled trial with two parallel groups will be conducted. Participating practitioners will be randomly allocated, on a 1:1 basis, to the intervention group (Men in Mind training) or a waitlist control group. The primary outcome, efficacy of the training, will be evaluated by pre- to post-training (T1 to T2) changes in scores on the Engaging Men in Therapy Scale (EMITS) in the intervention group, relative to the control group. DISCUSSION: This trial will provide evidence of the efficacy of Men in Mind training, as an interim step towards adjusting content and delivery of the intervention to maximize the potential for sustaining and scaling. TRIAL REGISTRATION: The trial was registered prospectively with the Australian New Zealand Clinical Trials Registry on 3rd December 2021 (ACTRN12621001669886).

Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial.

Importance: Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. Objectives: To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. Design, Setting, and Participants: This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire-9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion. Enrollment occurred from June 24, 2016, to May 13, 2019. The last follow-up assessment was conducted on January 30, 2020. Interventions: CCBT included use of the 9-lesson computer program Good Days Ahead, along with as many as 12 weekly telephonic support sessions of approximately 20 minutes with a master's level therapist, in addition to TAU, which consisted of the standard clinical management procedures at the primary care sites. TAU was uncontrolled, but use of antidepressants and psychotherapy other than CCBT was recorded. Main Outcomes and Measures: The primary outcome measure (PHQ-9) and secondary outcome measures (Automatic Thoughts Questionnaire for negative cognitions, Generalized Anxiety Disorder-7, and the Satisfaction with Life Scale for quality of life) were administered at baseline, 12 weeks, and 3 and 6 months after treatment completion. Satisfaction with treatment was assessed with the Client Satisfaction Questionnaire-8. Results: The sample of 175 patients was predominately female (147 of 174 [84.5%]) and had a high proportion of individuals who identified as racial and ethnic minority groups (African American, 44 of 162 patients who reported [27.2%]; American Indian or Alaska Native, 2 [1.2%]; Hispanic, 4 [2.5%]; multiracial, 14 [8.6%]). An annual income of less than $30 000 was reported by 88 of 143 patients (61.5%). Overall, 95 patients (54.3%) were randomly assigned to CCBT and 80 (45.7%) to TAU. Dropout rates were 22.1% for CCBT (21 patients) and 30.0% for TAU (24 patients). An intent-to-treat analysis found that CCBT led to significantly greater improvement in PHQ-9 scores than TAU at posttreatment (mean difference, -2.5; 95% CI, -4.5 to -0.8; P = .005) and 3 month (mean difference, -2.3; 95% CI, -4.5 to -0.8; P = .006) and 6 month (mean difference, -3.2; 95% CI, -4.5 to -0.8; P = .007) follow-up points. Posttreatment response and remission rates were also significantly higher for CCBT (response, 58.4% [95% CI, 46.4-70.4%]; remission, 27.3% [95% CI, 16.4%-38.2%]) than TAU (response, 33.1% [95% CI, 20.7%-45.5%]; remission, 12.0% [95% CI, 3.3%- 20.7%]). Conclusions and Relevance: In this randomized clinical trial, CCBT was found to have significantly greater effects on depressive symptoms than TAU in primary care patients with depression. Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings. Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02700009.

Longitudinal measurement invariance of the Behavioral Health Measure in a clinical sample.

The practice of routine outcome monitoring (ROM) has grown in popularity and become a fixture in feedback-supported clinical practice and research. However, if the interpretation of an ROM measure changes over time, treatment outcome scores may be inaccurate and produce erroneous or misguided interpretations of client progress and therapist efficacy. The current study examined whether factorial invariance held when using the Behavioral Health Measure (BHM-20) longitudinally in a clinical sample (n = 12,467). Using multidimensional item response theory-based models for the investigation of the BHM-20 factor structure, at a single time point and then longitudinally. Based on the original factor structure of the BHM-20 a unidimensional model, a three-factor orthogonal model, and a three-factor correlated model were fit to the data, indicating poor model fit with the proposed three-factor or unidimensional models. Next, using exploratory factor analysis and subsequent multidimensional item response theory procedures, a new 4-factor (General Distress, Life Functioning, Anxiety, and Alcohol/Drug Use) model was proposed with improved model-fit statistics. Finally, when testing the longitudinal invariance of the BHM-17 over 10 sessions of treatment, it was found to be fully consistent. The current study proposes the use of a 17-item, 4-factor model for a new understanding of the BHM-17. Implications for use in ROM and limitations are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact and implementation findings from a cluster randomized trial of a youth relationship education curriculum.

The current study presents implementation and impact data from a cluster randomized trial of a youth relationship education curriculum. High school students (n = 1,135) were randomized at the school level to receive curricula-as-usual or a healthy relationships program delivered by facilitators who were not employed by the high schools. Program evaluators reported high engagement and students indicated high satisfaction with the program, but multilevel models showed no statistically significant impacts on healthy relationship skills, attitudes, and behaviors at three and nine months post-intervention. Strengths and limitations of the research design and program implementation, as well as implications for evaluating youth relationship education more broadly, are discussed.

El estudio actual presenta datos de implementación e impacto de una prueba controlada aleatoriade una intervención de educación sobre relaciones para juveniles. Los estudiantes de secundaria (n= 1,135) fueron asignados al azar a nivel escolar para recibir un plan de estudios como decostumbre o un programa de relaciones saludables entregado por facilitadores que no eranempleados de las escuelas secundarias. Evaluadores de programas informaron un alto compromisoy los estudiantes indicaron una alta satisfacción con el programa, pero los modelos multinivel nomostraron impactos estadísticamente significativos en las habilidades de relación saludable,actitudes, y comportamientos a los tres y seis meses después de la intervención. Se discutefortalezas y limitaciones del diseño de la investigación y la implementación del programa, asícomo las implicaciones para la evaluación de los jóvenes.

The Alliance-Outcome Association in Couple Therapy: A Common Fate Model.

The working alliance has been shown to be a robust predictor of couple therapy outcomes. However, there are still questions regarding the best way to conceptualize and analyze the association between the alliance and outcomes in the couple therapy context. This study presents results from a relatively novel analytic approach for evaluating the alliance and therapy outcomes via the shared influence model (i.e., common fate statistical methodology) with 93 couples who had at least three sessions. Examining the alliance in couple therapy this way allows for nuance in conceptualizing the process of the alliance among partners and the therapist in couple therapy. Empirically, the question that remains is whether the shared experience of the alliance between partners is a stronger predictor of therapy outcome as compared to the unique individual experiences of the alliance. This approach has not yet been utilized to model the couple alliance-outcome association. Results revealed that the shared influence model demonstrated a significant association between the alliance and therapy outcome. Specifically, the couple-level alliance construct was adequately represented from the partners' alliance ratings with the therapist, and couples that report higher shared alliance experiences were also likely to have better therapy outcomes. These findings suggest that conceptualizing and analyzing the alliance at the couple level may be strongly advantageous. Implications for research and practice are provided.

Se ha demostrado que la alianza terapéutica es un predictor fiable de los resultados de la terapia de pareja. Sin embargo, aún quedan preguntas con respecto a la mejor manera de conceptualizar y analizar la asociación entre la alianza y los resultados en el contexto de la terapia de pareja. Este estudio presenta resultados de un enfoque analítico relativamente innovador para evaluar la alianza y los resultados de la terapia mediante el modelo de influencia compartida (p. ej.: metodología estadística del destino común) con 93 parejas que tuvieron al menos tres sesiones. Analizar la alianza en la terapia de pareja de esta manera permite matices a la hora de conceptualizar el proceso de la alianza entre los integrantes de la pareja y el terapeuta en la terapia de pareja. Empíricamente, la pregunta que queda pendiente es si la experiencia compartida de la alianza entre los integrantes de la pareja es un predictor más fiable de los resultados de la terapia en comparación con las experiencias individuales únicas de la alianza. Este enfoque aún no se ha utilizado para interpretar la asociación entre la alianza de la pareja y los resultados. Los resultados revelaron que el modelo de influencia compartida demostró una asociación significativa entre la alianza y los resultados de la terapia. Específicamente, el constructo de la alianza a nivel de la pareja se representó adecuadamente a partir de las valoraciones de la alianza de los integrantes de la pareja con el terapeuta, y las parejas que informan más experiencias de alianza compartida también fueron propensas a tener mejores resultados en la terapia. Estos datos sugieren que puede ser enormemente ventajoso conceptualizar y analizar la alianza a nivel de la pareja. Se explican las consecuencias para la investigación y la práctica.

The association of sleep duration and feeling rested with health in U.S. Hispanic women.

This study aims to understand the health correlates of sleep deficiencies in non-elderly U.S. Hispanic1 women. Data from a sample of U.S. Hispanic women (n = 1531; ages 18-65 [M = 39.98; SD = 12.85]) who completed the 2017 National Health Interview Survey were analyzed to understand (1) sleep duration and quality; (2) the association of sleep patterns with key health indicators; and (3) whether these relationships are mediated by health behaviors (ie, healthy eating and physical activity). Shorter sleep duration was associated with a higher likelihood of often feeling anxious and having hypertension. Worse sleep quality was associated with a higher likelihood of being overweight, having fair or poor health status, often feeling depressed, often feeling anxious, having high cholesterol, and having asthma. Doctor's recommendation to engage in physical activity and to decrease calorie intake served as mediators in some of these relationships. Results indicate that among Hispanic women: (1) sleep is an important determinant of a variety of health outcomes and (2) the association of sleep and many health outcomes are mediated by healthy eating and physical activity. Further research on the association of sleep and risk of chronic disease among Hispanic women is needed.