Empathic reflections by themselves are not effective: Meta-analysis and qualitative synthesis

Objective: We present a mixed methods systematic review of the effectiveness of therapist empathic reflections, which have been adopted by a range of approaches to communicate an understanding of client communications and experiences. Methods: We begin with definitions and subtypes of empathic reflection, drawing on relevant research and theory, including conversation analysis. We distinguish between empathic reflections, reviewed here, and the relational quality of empathy (reviewed in previous meta-analyses). We look at how empathic reflections are assessed and present examples of successful and unsuccessful empathic reflections, also providing a framework of the different criteria used to assess their effectiveness (e.g., association with session or treatment outcome, or client next-turn good process). Results: In our meta-analysis of 43 samples, we found virtually no relation between presence/absence of empathic reflection and effectiveness, both overall and separately within-session, post-session and post-treatment. Although not statistically significant, we did find weak support for reflections of change talk and summary reflections. Conclusions: We argue for research looking more carefully at the quality of empathy sequences in which empathic reflections are ideally calibrated in response to empathic opportunities offered by clients and sensitively adjusted in response to client confirmation/disconfirmation. We conclude with training implications and recommended therapeutic practices

Effects of Chairwork in Individual Psychotherapy: A Meta-Analytic and Systematic Review

Purpose: The present study aims to examine (1) the unique effects of chairwork on emotional process and distal outcomes across treatments in the context of individual psychotherapy, and (2) how these effects compare to those of other treatment interventions. Method: Based on the appropriateness of the data available, non-parametric within-group meta-analyses, parametric between-group meta-analyses, and narrative syntheses were conducted. Study 1: Noticeable improvements in resolution (d = 1.20) and symptom change (d = .96) are shown to emerge after a single-session of chairwork. Symptom change becomes increasingly more pronounced in multisession treatments (d = 1.42). Meanwhile, improvements in self-compassion/esteem seem to be less clear. Study 2: Single session chairwork were found to be more effective in deepening client experiencing (g = .88) and sequential transformation, but similarly effective in facilitating emotional arousal as other interventions. Improvements in resolution and symptom change after a single session of chairwork may be comparable to other interventions (g = -.02). However, when chairwork was used over multiple sessions, it accumulates a meaningful effect (g = .39) compared to treatments that did not use chairwork, with therapeutic orientation emerging as a potential moderator. Additional Syntheses: Notwithstanding its evocative nature, clients identify many components of chairwork as helpful in creating therapeutic change. Furthermore, the use of physical chairs offers a slight advantage in therapeutic gains but is not imperative for the intervention. Meanwhile the imaginal component of chairwork was identified as a crucial role in emotional processing. Conclusion: Incorporating chairwork into single-session and multisession treatments may bolster process and distal outcomes

Research on person-centred/experiential psychotherapy and counselling : summary of the main findings

In this chapter I summarise the main findings from more than 60 years of research of Person-Centred-Experiential (PCE) psychotherapies. I begin by pointing out the pioneering contributions of Carl Rogers to this literature. The body of the chapter summarises three main areas of research: First, the highly promising evidence on the quantitative effects of PCE therapies, drawing on a large meta-analysis (Elliott et al., 2013); second, research on client in-session processes, particularly the various attempts to capture the sequence by which clients change over time in therapy and the relation of these processes to outcome; third, the contribution of therapists and therapy methods to client change, including the sometimes-controversial research on therapist process guiding (e.g., chair work). I conclude with an account of how PCE therapists can become more involved in research and describe a research pathway aimed at helping their approach find a more secure place in mental health care policy

Daring to influence personality via Zoltan Gross’ approach to psychotherapy : clients’ perspective of change processes and mechanisms

Tese de mestrado, Psicologia (Secção de Psicologia Clínica e da Saúde, Núcleo de Psicologia Clínica Cognitivo-Comportamental e Integrativa), Universidade de Lisboa, Faculdade de Psicologia, 2018Once Psychotherapy’s efficacy is widely demonstrated, Psychotherapy research has shifted its focus to better understand how therapy brings about change in clients, focusing on the study of active ingredients of therapies. Lately, such studies have taken a qualitative approach, from clients’ perspective, in their own voice. The goal of the present dissertation is first to qualitatively verify the effectiveness of Zoltan Gross’ personality oriented integrative therapeutic approach. Then one aims at identifying actual in-session change processes performed by clients and therapists, as well as out-session changes that might reflect potential change mechanisms underlying this approach. A sample of 13 clients, 12 of which currently in process, responded to the Change Processes and Mechanisms Interview. Grounded theory analysis of data resulted in 7 categories of in-session change processes (Awareness and Challenge of Patterns and Traits; Meaning Making, Links; Shift, Interruption, Baseline Communication; Fluent in Feelings: Awareness, Experiencing and Communication of Feelings; Safe Attachment; No Directions, No Advice; and A Dash of Humor) and in 6 categories of out-session changes (Pattern Awareness and Change; Improved Interactions; Awareness, Experiencing and Regulation of Feelings; Self-acceptance, Confidence and Presence; Empowerment and Resourcefulness in Daily Life and Work; and Better at work). Zoltan Gross’ approach to psychotherapy is reported by their clients to be an effective model of therapy. Some of its in-session processes are common to other approaches, yet some may be distinctive. The same happens regarding the achievements that clients report. Some of these achievements can hint at potential changes mechanisms, even when grasped via qualitative means. Results are discussed in terms of their relative position to recent qualitative meta-analysis using client’s perspective, and distinctive aspects are highlighted that can shed light on clinical practice aiming at structural personality change.Uma vez largamente demonstrada a eficácia da Psicoterapia, a Investigação em Psicoterapia, redirecionou a sua atenção no sentido de compreender como ocorre a mudança nos pacientes, focando-se no estudo dos ingredientes activos das terapias. Recentemente, estes estudos têm adoptado uma abordagem qualitativa, segundo a perspectiva do cliente, pela sua própria voz. O objectivo da presente dissertação é, em primeiro lugar, verificar a eficácia da abordagem terapêutica integrativa, orientada para a personalidade, de Zoltan Gross. Em seguida, procura-se identificar processos de mudança presentes em sessão desempenhados pelos clientes e terapeutas, assim como mudanças fora das sessões que possam reflectir potenciais mecanismos presentes nesta abordagem. Uma amostra de 13 participantes, 12 dos quais em processo terapêutico, respondeu ao questionário Processos e Mecanismos de Mudança. A análise dos dados, realizada através da metodologia grounded theory, deu origem a 7 categorias de processos de mudança em sessão (Promoção da Consciência e Desafio de Padrões e de Traços; Criação de Significado; Links; Shift, Interrupção; Comunicação ao nível da Baseline; Fluente em Sentimentos: Consciência, Experiência e Comunicação de Sentimentos; Vinculação Segura; Sem indicações, Sem conselhos; e Uma pitada de Humor) e a 6 categorias de mecanismos de mudança, fora das sessões, (Consciencialização e Mudança de Padrões; Melhores Relações; Consciência, Experiência e Regulação de Sentimentos; Auto-aceitação, Confiança e Presença; Capacitação e Desenvoltura na vida diária e no trabalho e Melhor no trabalho). A abordagem de Zoltan Gross à psicoterapia é reportada pelos seus pacientes como um modelo de terapia eficaz. Alguns processos em sessão são comuns a outras abordagens, enquanto outros podem ser distintivos. Verifica-se a mesma situação em relação às conquistas que os pacientes relatam. Algumas destas conquistas podem sugerir potenciais mecanismos de mudança, mesmo quando são captadas através de métodos qualitativos. Os resultados são discutidos em termos da sua posição relativa face a meta-análises segundo a perspectiva dos pacientes, e são destacados aspectos distintivos que podem clarificar elucidar a prática clínica visando a mudança estrutural da personalidade

Ruptures and repairs of group therapy alliance. an untold story in psychotherapy research

Although previous studies investigated the characteristics of therapeutic alliance in group treatments, there is still a dearth of research on group alliance ruptures and repairs. The model by Safran and Muran was originally developed to address therapeutic alliance in individual therapies, and the usefulness of this approach to group intervention needs to be demonstrated. Alliance ruptures are possible at member to therapist, member to member, member to group levels. Moreover, repairs of ruptures in group are quite complex, i.e., because other group members have to process the rupture even if not directly involved. The aim of the current study is to review the empirical research on group alliance, and to examine whether the rupture repair model can be a suitable framework for clinical understanding and research of the complexity of therapeutic alliance in group treatments. We provide clinical vignettes and commentary to illustrate theoretical and research aspects of therapeutic alliance rupture and repair in groups. Our colleague Jeremy Safran made a substantial contribution to research on therapeutic alliance, and the current paper illustrates the enduring legacy of this work and its potential application to the group therapy context

Bill to Restrict Indoor Tanning for Minors in The State of Maine

Background: Melanoma is the deadliest and the most common type of cancer in individuals age 15 to 29. Evidence has shown that ultraviolet radiation overexposure at younger ages significantly increases the risk of developing non-melanoma and melanoma skin cancer in later years. Despite these concerns, approximately 1.6 million minors under the age of 18 participate in the use of indoor tanning devices annually. The high prevalence of skin cancer in the United States continues to be a public health issue that warrants continued preventative and regulatory action. In spite of the health risks associated with indoor tanning, the state of Maine does not restrict the use of tanning devices for minors, as 18 states now do. Therefore, the aim of this DNP project was to implement a health policy change initiative with the goal of restricting access to commercial indoor tanning devices for minors. Methods:The policy process framework and population health framework were used as models for implementing the health policy initiative. The population health framework was used to develop an argument for the public health implications of excessive ultraviolet (UV) radiation and provides rationale for restricting UV exposure among minors. The policy process framework was used to guide and evaluate the legislative work of this project. The legislative work was accomplished in collaboration with Maine Representative Anne Perry and other stakeholders. Purpose/Implementation Plan: The purpose of this DNP project was to implement a substantive health policy change, that being the restriction of minors under the age of 18 from the use of commercial indoor tanning devices. The health policy change process included the following steps: 1. Create awareness of long-term health risks of indoor tanning devices among key legislators, constituents, and interest groups, 2. Work with legislators to bring a bill forward to restrict access to indoor tanning devices, 3. Evaluate the process and develop a proposal for sustainable action, if the legislation fails. The overall objective of this initiative was to decrease the risk of skin cancer among Maine’s youth. Results:A proposal for the policy change was presented to stakeholders and was developed in support of the initiative. LD #1297, An Act to Reduce Youth Cancer Risk was introduced through the efforts of the coalition. The first public hearing for LD #1297 was held on April 3, 2019 with the Health and Human Services Committee (HHS) in Augusta, Maine with support from the stakeholders. A work session was held on April 16, 2019 where the bill was voted “ought to pass” 7 to 3 by members of the HHS committee. Conclusion:The population health framework and application of the policy process framework to guide legislative efforts, resulted in greater support for LD #1297 by the HHS committee. Policy engagement to address the upstream causes of disease such as skin cancer is a professional responsibility of doctorally prepared nurse practitioners. This can be achieved by engaging in coalition building and enacting legislative initiatives for public health challenges such as the serious public health threat of indoor tanning by minors. Key Words: skin neoplasms, skin cancer, ultraviolet radiation, indoor tanning, artificial tanning, basal cell carcinoma, squamous cell carcinoma, melanom

Research on humanistic-experiential psychotherapies

In this chapter we focus on research published since our previous reviews (Greenberg, Elliott & Lietaer, 1994; Elliott, Greenberg & Lietaer, 2004), which covered research published between 1978 and 2001, plus additional earlier research on humanistic-experiential psychotherapy (HEP) outcome that we have been able to track down. A key element of the chapter is a meta-analysis of nearly 200 HEP outcome studies (through 2008) and a survey of the use of the approach with different client groups. In addition, we offer a meta-synthesis of qualitative research on these therapies (cf. Timulak, 2007), and provide a narrative review of recent quantitative research on change processes in HEPs. We conclude by reviewing and integrating the literature reviewed and discuss policy implications

Enhancing Social Connectedness in Anxiety and Depression Through Amplification of Positivity: Preliminary Treatment Outcomes and Process of Change.

BackgroundAnxiety and depressive disorders are often characterized by perceived social disconnection, yet evidence-based treatments produce only modest improvements in this domain. The well-established link between positive affect (PA) and social connectedness suggests that directly targeting PA in treatment may be valuable.MethodA secondary analysis of a waitlist-controlled trial (N=29) was conducted to evaluate treatment response and process of change in social connectedness within a 10-session positive activity intervention protocol-Amplification of Positivity (AMP)-designed to increase PA in individuals seeking treatment for anxiety or depression (ClinicalTrials.gov Identifier: NCT02330627). Perceived social connectedness and PA/negative affect (NA) were assessed throughout treatment. Time-lagged multilevel mediation models examined the process of change in affect and connectedness throughout treatment.ResultsThe AMP group displayed significantly larger improvements in social connectedness from pre- to post-treatment compared to waitlist; improvements were maintained through 6-month follow-up. Within the AMP group, increases in PA and decreases in NA both uniquely predicted subsequent increases in connectedness throughout treatment. However, experiencing heightened NA throughout treatment attenuated the effect of changes in PA on connectedness. Improvements in connectedness predicted subsequent increases in PA, but not changes in NA.ConclusionsThese preliminary findings suggest that positive activity interventions may be valuable for enhancing social connectedness in individuals with clinically impairing anxiety or depression, possibly through both increasing positive emotions and decreasing negative emotions