Social Work News Headlines

Updated on: Tue, 13 Nov 2018 06:00:36 GMT

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)

The alliance in adult psychotherapy: A meta-analytic synthesis.
The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance–outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy.
In the youth treatment literature, the alliance has been defined and measured as a consensual or collaborative bond. In this article, we review varied definitions of the alliance, enumerate its frequent measures, and present clinical examples. We provide a meta-analytic review on the relation between the therapeutic alliance and treatment outcome in child and adolescent psychotherapy. In particular, this review only includes prospective studies of youth therapy that used an explicit measure of alliance. The meta-analysis of 28 studies revealed a weighted random effect size of r = .19 (k = 28, N = 2419, p < .01, 95% confidence interval [.13, .25]), which is a small to medium effect (equivalent to d = 0.39) consistent with the adult alliance literature and with prior youth meta-analyses. Given that a medium-large amount of heterogeneity was observed in effect sizes (I2 = 64.19%), theory- and method-based moderators were examined. Multiple moderators of the alliance–outcome association were found, including diagnosis class, type of therapy, study design (randomized controlled trials [RCT] vs. nonrandomized trials [non-RCT]), and treatment setting (inpatient vs. outpatient). Research limitations, patient contributions, and diversity considerations follow. The article concludes with research-informed practices for building and maintaining the therapeutic alliance with youth. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Meta-analysis of the alliance–outcome relation in couple and family therapy.
This article reviews meta-analytic evidence for the alliance–outcome relation in couple and family therapy (CFT), with implications for clinical practice. We begin by describing the unique features of CFT alliances and their measurement, followed by two case descriptions. We explain that due to the systemic context of CFT, each patient’s personal alliance with the therapist affects and is affected by other family members’ levels of collaboration. Because family members often seek help when they are in conflict with one another, “split” alliances are common, as are problematic within-system alliances, defined as the degree to which family members agree on the nature of their problems and value participating in therapy together to achieve shared goals. In our meta-analysis of 48 studies with 40 independent samples, we used a three-level random effects model (Ns = 2,568 families, 1,545 couples, and 491 effect sizes) and found r = .297. In another analysis with seven independent samples and 31 effect sizes, the split alliance–outcome association was also significant, r = .316, indicating that the more split or unbalanced the alliance, the poorer the outcome. Moderator analyses showed that alliance–outcome associations did not differ for couple versus family therapy, but correlations were significantly stronger in samples with younger problem children, older adults, proportionally more male youth and adults, and when the families voluntarily sought help (as compared with involuntary or mandated families). The article concludes with research-informed strategies for building and sustaining strong systemic alliances in CFT. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome.
This article provides meta-analyses of the relation between goal consensus and collaboration and individual psychotherapy outcome using studies published in English between 1978 and June 2017. Inclusion criteria involved (a) a measure of psychotherapy outcome, (b) a measure of goal consensus and/or collaboration, (c) a group design, (d) adult patients (aged 18 years or older), and (e) a reported effect or statistic that could be converted to an effect size. For the 54 studies (N = 7,278) of goal consensus and outcome, the result was r = .24 (95% confidence interval [CI] [.19, .28]) or d = .49, representing a medium effect. For the 53 studies (N = 5,286) of patient–therapist collaboration and outcome, the result was r = .29 (95% CI [.24, .34]) or d = .61, another medium effect. In all, 21 studies (N = 2,081) of therapist collaboration and outcome yielded an omnibus effect of .26 (95% CI [.18, .35]) or d = .54. Results suggest patient–therapist goal consensus and collaboration enhance psychotherapy outcome. The article concludes with research limitations, diversity considerations, and therapeutic practices. Limitations of the studies included a dearth of diverse samples, assessment of goal consensus and/or collaboration at a single time during treatment, failure to relate measures to outcome, and analyses that do not permit causal conclusions. Research suggests that therapists seek input from patients to form and effect treatment goals and plans, provide patients with regular feedback, and seek their involvement throughout therapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Cohesion in group therapy: A meta-analysis.
Cohesion is the most popular of the relationship constructs in the group therapy literature. This article reviews common definitions of cohesion, the most frequently studied measures, and a measure that may clarify group relations using two latent factors (quality and structure) to explain common variance among frequently used group relationship instruments. We present the results of a meta-analysis examining the relation between group cohesion and treatment outcome in 55 studies. Results indicate that the weighted aggregate correlation between cohesion and treatment outcome was statistically significant, r = .26, z = 6.54 (p < .01), reflecting a moderate effect size (d = .56). Heterogeneity of effect sizes was significant (Q = 260.84, df = 54, p < .001) and high (I2 = 79.3%), supporting moderator analyses. Six moderator variables were found to significantly predict the magnitude of the cohesion–outcome association (type of outcome measure, leader interventions to increase cohesion, theoretical orientation, type of group, emphasis on group interaction, and dose or number of group sessions). Patient contributions, diversity considerations, and evidence-based therapeutic practices are highlighted. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Therapist empathy and client outcome: An updated meta-analysis.
Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .28 (p < .001; 95% confidence interval [.23, .33]; equivalent of d = .58) for 82 independent samples and 6,138 clients. In general, the empathy–outcome relation held for different theoretical orientations and client presenting problems; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Positive regard and psychotherapy outcome: A meta-analytic review.
This article meta-analytically reviews the research on the association between therapist positive regard (PR) and treatment outcome. The history of the construct of unconditional PR in client-centered theory and the efforts to clearly operationalize and measure this construct are reviewed. Several clinical examples are presented. The updated meta-analysis, which features expanded inclusion criteria and a larger number of studies (k = 64) than previous analyses, yielded a small positive association between PR and treatment outcome, g = .28. To control for the repeated use of data sets and study samples within the database, a multilevel meta-analysis was adopted that indicated a stronger relation between PR and clinical outcome (g = 0.36). These analyses support PR’s standing as a significant component of the therapy relationship that leads to improved clinical outcomes. The article concludes with limitations of the research, patient contributions, diversity considerations, and recommendations for using PR in practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Congruence/genuineness: A meta-analysis.
Congruence or genuineness is a relationship element with an extensive and important history within psychotherapy. Congruence is an aspect of the therapy relationship with two facets, one intrapersonal and one interpersonal. Mindful genuineness, personal awareness, and authenticity characterize the intrapersonal element. The capacity to respectfully and transparently give voice to ones’ experience to another person characterizes the interpersonal component. Although most fully developed in the person-centered tradition, congruence is highly valued in many theoretical orientations. In this article, we define and provide clinical examples of congruence. We also present an original meta-analysis of its relation with psychotherapy improvement. An analysis of 21 studies (k), representing 1,192 patients (N), resulted in a weighted aggregate effect size (r) of .23 (95% confidence interval = [.13, .32]) or an estimated d of .46. Moderators of the association between congruence and outcome are also investigated. In closing, we address patient contributions, limitations of the extant research, diversity considerations, and therapeutic practices that might promote congruence and improve psychotherapy outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

The real relationship and its role in psychotherapy outcome: A meta-analysis.
Although writing about the real relationship has existed from the beginnings of the “talking cure,” it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable. In this article, a meta-analysis is presented on the association between the strength of the real relationship and the outcome of psychotherapy. Summed across 16 studies, this meta-analysis revealed a moderate association with outcome (r = .38, 95% confidence interval [.30, .44], p < .001, d = 0.80, N = 1.502). This real relationship−outcome association was independent of the type of outcome studied (treatment outcome, treatment progress, and session outcome) and of the source of the measure (whether the client or the therapist rated the real relationship and/or treatment outcome). We also present commonly used measures of the real relationship, limitations of the research, and patient contributions. The article concludes with diversity considerations and practice recommendations for developing and strengthening the real relationship. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Therapist self-disclosure and immediacy: A qualitative meta-analysis.
We review definitions and provide case examples of therapist self-disclosure (TSD) and immediacy (Im). We then present a qualitative meta-analysis of 21 studies that examined the subsequent process following TSD and Im in psychotherapy (excluding analogue and correlational studies). Across the 21 studies, the most frequent subsequent processes were enhanced therapy relationship, improved client mental health functioning, gains in insight, and overall helpfulness, suggesting that most often TSD and Im were followed by positive and beneficial therapeutic processes. In additional analyses, TSD was associated more often with improved mental health functioning, overall helpfulness, and enhanced therapy relationships, whereas Im was associated more often with clients opening up and being immediate. We also consider possible moderating variables, including client contributions and diversity issues. The article concludes with research-informed recommendations for judiciously using TSD and Im in practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Therapist and client emotional expression and psychotherapy outcomes: A meta-analysis.
Although emotion has long been considered important to psychotherapeutic process, empirical assessment of its impact has emerged only recently. The present study applied two meta-analyses to explore the association between therapist expression of emotion and psychotherapy outcome, and client expression of emotion and psychotherapy outcome. Overall, 66 studies (13 for the therapist meta-analysis and 43 for the client meta-analysis) were included. A significant medium effect size was found between the therapist’s emotional expression and outcomes (d = 0.56) and a significant medium-to-large effect size between the client’s emotional expression and outcomes (d = 0.85). Third-party rating of emotional expression emerged as a significant moderator of outcomes. Limitations of the research, diversity considerations, and therapeutic practices that conclude the article are then presented. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

A meta-analysis of the association between patients’ early treatment outcome expectation and their posttreatment outcomes.
Patients’ outcome expectation (OE) represents their belief about the mental health consequences of participating in psychotherapy. A previous meta-analysis of 46 independent samples receiving the treatment of at least 3 sessions revealed a significant association between more optimistic baseline, or early treatment, OE and more adaptive posttreatment outcomes (weighted r = .12 or d = .24; Constantino, Glass, Arnkoff, Ametrano, & Smith, 2011). The present study represents an update to that meta-analysis. To be included, articles published through June 2017 had to (a) include a clinical sample, (b) include a therapist-delivered treatment of at least 3 sessions, (c) include a measure of patients’ own OE, (d) include at least 1 posttreatment mental health outcome not explicitly referenced as a follow-up occasion, and (e) report a statistical test of the OE−outcome association. The updated meta-analysis was conducted on 81 independent samples (extracted from 72 references) with 12,722 patients. The overall weighted effect size was r = .18, p < .001, or d = .36, with high heterogeneity (I2 = 76%) and no evidence of publication bias. Several variables (patient age, measure type, and treatment manual used) moderated the OE−outcome association. These robust, replicated meta-analytic findings are discussed in light of methodological limitations and with regard to their practice implications. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

A meta-analysis of the association between patients’ early perception of treatment credibility and their posttreatment outcomes.
Patients’ perception of treatment credibility represents their belief about a treatment’s personal logicality, suitability, and efficaciousness. Although long considered an important common factor bearing on clinical outcome, there have been no systematic reviews of the credibility–outcome association. The present study represents a meta-analysis of the association between patients’ credibility perception and their posttreatment outcomes. To be included, articles published through August, 2017 had to (a) include a clinical sample, (b) include a therapist-delivered treatment of at least 3 sessions, (c) include a measure of patients’ own early treatment credibility perception, (d) include at least 1 posttreatment mental health outcome not explicitly referenced as a follow-up occasion, and (e) report a statistical test of the credibility–outcome association. The meta-analysis was conducted on 24 independent samples (extracted from 19 references) with 1,504 patients. The overall weighted effect size was r = .12, p < .001, or d = .24, with high heterogeneity (I2 = 57%) and no evidence of publication bias. There were no significant moderating effects on the credibility–outcome association for any of the potential moderators that we evaluated. The meta-analytic findings are discussed in light of methodological limitations and with regard to their practice implications. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Countertransference management and effective psychotherapy: Meta-analytic findings.
In this article, we review the history and definition of countertransference, as well as empirical research on countertransference, its management, and the relation of both with psychotherapy outcome. Three meta-analyses are presented, as well as studies that illustrate findings from the meta-analyses. The first meta-analysis indicated that countertransference reactions are related inversely and modestly to psychotherapy outcomes (r = −.16, p = .02, 95% CI [−.30, −.03], d = −0.33, k = 14 studies, N = 973). A second meta-analysis supported the notion that countertransference management factors attenuate countertransference reactions (r = −.27, p = .001, 95% CI [−.43, −.10], d = −0.55, k = 13 studies, N = 1,065). The final meta-analysis revealed that successful countertransference management is related to better therapy outcomes (r = .39, p < .001, 95% CI [.17, .60], d = 0.84, k = 9 studies, N = 392 participants). In all meta-analyses, there was significant heterogeneity across studies. We conclude by summarizing the limitations of the research base and highlighting the therapeutic practices predicated on research. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Alliance rupture repair: A meta-analysis.
A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. We present the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, and the impact of rupture resolution training on outcome, we conducted two meta-analyses. In the first meta-analysis, we examined 11 studies (1,314 patients) that examined the relation between rupture repair episodes and patient treatment outcomes. Results yielded an effect size of r = .29, d = .62, 95% confidence interval [.10, .47], p = .003, indicating a moderate relation between rupture resolution and positive patient outcome. Our second meta-analysis examined the impact of rupture resolution training or supervision on patient outcome. We examined 6 studies (276 trainees/supervisees) that compared the outcomes of trainees who received rupture resolution training with a comparison group. Results did not find a significant relation, r = .11, d = .22, 95% confidence interval [−.09, .30], p = .28. Moderator analyses indicated that the relation between training and outcome was stronger when the sample included fewer patients with personality disorders, when the training was more closely aligned with cognitive behavioral therapy than psychodynamic therapy, and when the treatment was brief. The article concludes with limitations of the research, diversity considerations, and research-informed therapeutic practices for repairing ruptures in ways that contribute to good treatment outcome. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring.
This systematic review and meta-analysis examines the impact of measuring, monitoring, and feeding back information on client progress to clinicians while they deliver psychotherapy. It considers the effects of the 2 most frequently studied routine outcome monitoring (ROM) practices: The Partners for Change Outcome Management System and the Outcome Questionnaire System. Like other ROM practices, they typify attempts to enhance routine care by assisting psychotherapists in recognizing problematic treatment response and increasing collaboration between therapist and client to overcome poor treatment response. A total of 24 studies were identified and considered suitable for analysis. Two-thirds of the studies found that ROM-assisted psychotherapy was superior to treatment-as-usual offered by the same practitioners. Mean standardized effect sizes indicated that the effects ranged from small to moderate. Feedback practices reduced deterioration rates and nearly doubled clinically significant/reliable change rates in clients who were predicted to have a poor outcome. Clinical examples, diversity considerations, and therapeutic advances are provided. (PsycINFO Database Record (c) 2018 APA, all rights reserved)