When life gets in the way: Systematic review of life events, socioeconomic deprivation, and their impact on counselling and psychotherapy with children and adolescents

Background Life events are recognised to link low socio‐economic status (SES) with impaired mental health. Despite attention to patients’ historical environmental circumstances in psychotherapeutic practice, events that occur over the course of counselling and psychotherapy (‘intercurrent’ events) seem to have received little attention in research. Method Life events were defined to include those that are chronic and severe, as well as minor, everyday occurrences. Outcomes were restricted to internalising problems related to depression and anxiety in child, or adolescent participants. Bibliographic databases and citations and review reference lists were searched, and relevant scholars were contacted. The conceptual and methodological nature of the literature is reported. Results This review included 42 studies. Intercurrent events varied in severity and duration. Events were most frequently measured using questionnaires. The same questionnaire was rarely used in more than one study, and questionnaires were often adapted for use for the study's purpose/population. Events included in analyses tended to be analysed as a mediator of change in psychiatric symptomatology, or an outcome of therapy. Conclusions Attention to intercurrent life events appears rare in psychotherapy research. This contributes to a systematic neglect of socio‐economic issues in psychotherapy research and arguably psychotherapy more generally. This neglect is exacerbated by a lack of agreed measures of life events, both intensive and routine in nature. Recommendations are made to improve attention to such events

Depression and mentalizing: a psychodynamic therapy process study

The present study aimed to explore the relationship between changes in depressive symptoms and the capacity to mentalize over the course of a 3-month inpatient psychodynamic therapy in a sample of 56 patients with depression. Depressive symptoms and mentalizing were assessed weekly during treatment and at 1-year follow-up with the Beck Depression Inventory and the Reflective Functioning Questionnaire. Data were analyzed using latent growth curve modeling with structured residuals. In the total sample, depressive symptoms improved on average from baseline to the end of treatment, while mentalizing skills did not. However, individual variations were observed in mentalizing skills, with some patients improving while others did not. Within-patient residual changes in mentalizing skills did not predict residual changes in depressive symptoms. Accordingly, the results did not support mentalizing as a mechanism of change at this level. Nonetheless, between-patient effects were found, showing that patients with higher levels of mentalizing at baseline and patients whose mentalizing skills improved over the course of therapy also had greater reductions in depressive symptoms. We suggest that the presence of relatively higher mentalizing skills might be a factor contributing to moderately depressed individuals’ ability to benefit from treatment, while relatively poor or absent mentalizing capacity might be part of the dynamics underlying treatment resistance in individuals with severe depression

Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting

Objective Treatments for eating disorders are moderately effective, with cognitive behavior therapy (CBT) providing the strongest evidence. However, it remains important to investigate other interventions, particularly for eating disorders with greater complexity (e.g., substantial comorbidity; trauma history) or for patients who have not responded adequately to previous treatments. Method This randomized controlled trial compared CBT against compassion-focused therapy for eating disorders (CFT-E), where half of the sample had a childhood trauma history. The study was pre-registered and adequately powered. A total of 130 patients were randomly assigned to CBT or CFT-E and were assessed at pre-treatment, post-treatment and one-year follow-up. The primary outcome measure was the total score on the Eating Disorder Examination-Interview (EDE), and secondary outcome measures were the Symptom Checklist-90, Inventory of Interpersonal Problems–64 and Post-Traumatic Symptom Scale. Attrition during treatment was low (13%), suggesting good acceptability. Results Eating pathology (EDE scores) reduced substantially overall, with large effect sizes, and there were no differences between therapies. However, at follow-up, for patients with a childhood trauma history, CFT-E maintained benefits better than CBT. Conclusion: While both CBT and CFT-E resulted in significant reductions in eating pathology, CFT-E showed superior maintenance of benefits for patients with a history of childhood trauma at one-year follow-up, underlining the necessity of tailored interventions for specific patient subgroups

Do patients prefer optimistic or cautious psychiatrists? An experimental study with new and long-term patients

Abstract Background Patients seeking treatment may be assumed to prefer a psychiatrist who suggests a new treatment with confidence and optimism. Yet, this might not apply uniformly to all patients. In this study, we tested the hypothesis that new patients prefer psychiatrists who present treatments optimistically, whilst patients with longer-term experience of mental health care may rather prefer more cautious psychiatrists. Methods In an experimental study, we produced video-clips of four psychiatrists, each suggesting a pharmacological and a psychological treatment once with optimism and once with caution. 100 \u2018new\u2019 patients with less than 3\ua0months experience of mental health care and 100 \u2018long-term\u2019 patients with more than one year of experience were shown a random selection of one video-clip from each psychiatrist, always including an optimistic and a cautious suggestion of each treatment. Patients rated their preferences for psychiatrists on Likert type scales. Differences in subgroups with different age (18\u201340 vs. 41\u201365 years), gender, school leaving age (\u226416 vs. >16\ua0years), and diagnosis (ICD 10\ua0F2 vs. others) were explored. Results New patients preferred more optimistic treatment suggestions, whilst there was no preference among long-term patients. The interaction effect between preference for treatment presentations and experience of patients was significant (interaction p -value\u2009=\u20090.003). Findings in subgroups were similar. Conclusion In line with the hypothesis, psychiatrists should suggest treatments with optimism to patients with little experience of mental health care. However, this rule does not apply to longer-term patients, who may have experienced treatment failures in the past

Psychologists’ Authenticity: Implications for Work in Professional and Therapeutic Settings

Derek J. Burks, PhD, is a licensed psychologist and postdoctoral psychology fellow at the Pacific Northwest Mental Illness Research, Education, and Clinical Center (MIRECC), located within the Veterans Affairs Medical Center in Portland, Oregon. He obtained his PhD in counseling psychology from the University of Oklahoma. His current research focuses on health disparities, posttraumatic stress disorder among sexual-minority U.S. military veterans, and culturally appropriate mental health treatment for American Indians.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Looking both ways

On the occasion of the 25th anniversary of the journal, Psychotherapy Research, three former editors first look back at: (i) the controversial persistence of the Dodo verdict (i.e., the observation that all bona fide therapies seem equally effective); (ii) the connection between process and outcome; (iii) the move toward methodological pluralism; and (iv) the politicization of the field around evidence-based practice and treatment guidelines. We then look forward to the next 25 years, suggesting that it would be promising to focus on three areas: (i) systematic theory-building research; (ii) renewed attention to fine-grained study of therapist techniques; and (iii) politically expedient research on the outcomes of marginalized or emerging therapies