The aim of this longitudinal study was investigating how specific dimensions of client expectations about counseling relate to the initial level and subsequent trajectory of the working alliance and symptom change in psychotherapy conducted by Chinese beginning therapist trainees. Participants included 173 Chinese therapist trainees and their 1,916 clients. At intake, clients completed a measure (Anderson, T., Patterson, C. L., McClintock, A. S., & Song, X. [2013]. Factorial and predictive validity of the Expectations About Counseling-Brief (EAC-B) with clients seeking counseling. , (4), 496-507. https://doi.org/10.1037/a0034222) assessing their expectations about counseling along three dimensions: Client Involvement, Counselor Expertise, and Facilitative Conditions. Before every session, clients reported their symptom severity level; after every session, both therapists and clients reported their perceived strength of the working alliance. Multilevel modeling results showed that (1) clients with higher initial symptom levels showed lower expectations on Client Involvement ( = -.586,  = .292,  = .045) but higher expectations on Counselor Expertise ( = .992,  = .231,  < .001); (2) clients with higher initial working alliance ratings showed higher expectations on Client Involvement ( = .162,  = .039,  < .001) and Facilitative Conditions ( = .152,  = .033,  < .001); and (3) clients with higher expectations on Counselor Expertise appeared to show a greater average decrease in symptom level (i.e., greater improvement in therapy) over the course of therapy ( = -.060,  = .024,  = .011). The findings confirms that client expectations, particularly for counselor expertise, are both a product of initial clinical factors and a predictor of therapeutic success. Conceptual and clinical implications, especially with regard to the Chinese cultural context, are discussed.

Potential negative effects of psychological treatments are recognized in research, yet the attitudes toward their disclosure during the informed consent procedure remain unexplored. This study examined individuals' perception of receiving such information, investigating the awareness regarding deterioration, non-response, and new symptoms, and how this knowledge affects willingness to initiate treatment. A mixed-method approach was used in relation to an online survey of adults in Sweden ( = 500, 75.6% women, age = 38.2), including both individuals with (76.6%) and without prior experience of psychological treatments. Descriptive statistics, -tests, one-way ANOVA, and Pearson's correlation tests were conducted to explore factors that might affect the willingness to initiate treatment, while thematic analysis was employed for open-ended responses. The majority (72%) of respondents favored being informed, emphasizing the importance of transparency, realistic expectations, and preparedness. Common concerns included increased anxiety and hesitation toward treatment. No variable was related to the willingness to initiate treatment. Most respondents preferred disclosure of potential negative effects. Clinicians should incorporate information about potential negative effects into the informed consent procedure, balancing risks and benefits and explain the nocebo effect, thereby enhancing patient engagement, trust, and willingness to engage in treatment.

The purpose of the present study was to develop a brief version of the Cultural Humility Scale (CHS; Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. , (3), 353-366. https://doi.org/10.1037/a0032595) to reduce participant burden in clinical settings. In Study 1 ( = 247), we used confirmatory factor analyses (CFA) and two-factor item response theory (IRT) models to create the Cultural Humility Scale-Short Form (CHS-SF). In Study 2 ( = 272), we performed cross-validation of the CHS-SF. We also examined construct validity using the Cross-Cultural Counseling Inventory-Revised (CCCI-R; LaFromboise, T. D., Coleman, H. L. K., & Hernandez, A. (1991). Development and factor structure of the Cross-cultural Counseling Inventory-Revised. , (5), 380-388. https://doi.org/10.1037/0735-7028.22.5.380) and the Working Alliance Inventory (WAI; Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. , (3), 207-210. https://doi.org/10.1037/1040-3590.1.3.207). The CHS-SF has two 3-item subscales (positive/negative cultural humility). The CFA for the CHS-SF showed excellent model fit, and all coefficients demonstrated good-to-excellent reliability for the whole scale. The factor structure was replicated with a unique sample, and we also found evidence of measurement invariance by gender and race/ethnicity. The CHS-SF again showed adequate estimates of reliability. The CHS-SF was positively correlated with both the CCCI-R and WAI. The CHS-SF offers an efficient tool for measuring therapists' cultural humility based on client perceptions during treatment. Like the original CHS, it is well-suited for routine care and training environments. Implications for practice and research, limitations, and directions for future inquiry are discussed.

The aim of this study was to identify therapist characteristics associated with effective rupture resolution processes. We examined the association between therapists' experience of professional self-doubt (PSD) and the resolution of alliance ruptures.

This study aimed to translate the Rupture Resolution Rating System (3RS) and the Working Alliance Inventory -Observer Short Form (WAI-O-S) into Italian. As a preliminary step toward validation, inter-rater reliability and convergent validity of the translated measures were also examined.

Psychological pain is a central risk factor for suicidal behaviour. Nonverbal synchrony between patients and therapists has been shown to facilitate the development of therapeutic alliance, which in turn is linked to symptom reduction. Building on these associations, the present study investigated whether movement synchrony in suicide-specific therapy exceeds random synchrony and whether it is associated with patients' psychological pain. A sample of 95 video recordings from therapy sessions of the Attempted Suicide Short Intervention Program (ASSIP) were analysed using Motion Energy Analysis to assess synchrony in head and upper body movements. Psychological pain was assessed using the Suicide Status Form II (SSF-II). Genuine synchrony was significantly greater than pseudosynchrony t(110.16) = 4.314,  < .001, d = 0.49, 95% CI [0.005, 0.014], confirming the validity of the synchrony measurement. Additionally, movement synchrony was negatively correlated with psychological pain (r(84) = -.319,  = .003). This relationship remained significant after controlling for potential mediating factors (r(84) = -.302,  = .008). This study highlights the role of nonverbal synchrony in suicide-specific therapy, demonstrating that it exceeds random synchrony and is associated with lower levels of psychological pain.

Recently, several studies have examined the role of spiritual and religious (R/S) issues in psychotherapy. However, to our knowledge, no studies have systematically synthesised clients' qualitative perspectives on how these themes are addressed during sessions. The present study is a meta-synthesis of qualitative studies focusing on clients' experiences and perceptions of their R/S issues in individual or group secular psychotherapy contexts.

To test the psychometric properties of the five-item patient-rated Session Evaluation Scale (SES-P) (Study 1) and to create a three-item version (Study 2), and to test the psychometric properties of the five-item (Study 3) and three-item (Study 4) therapist-rated version (SES-T).

Postpartum depression (PPD) is common but undertreated, stressing the need for scalable psychotherapies. The reward system is a promising mechanism as PPD disrupts reward-supported behaviors: reduced motivation to engage in rewarding experiences (behavioral activation) and blunted pleasure during social interactions (social reward responsivity). Engage & Connect (E&C) is a simple and scalable psychotherapy, based on neuroscience literature. It aims to increase engagement in rewarding social experiences to restore reward-supported behaviors and reduce PPD.

To assess the frequency of alliance ruptures and repairs and their impact on treatment outcome in psychotherapy among patients with substance use disorder. The moderating effects of treatment orientation, attachment style and type of substance use were analyzed.

This pilot randomized controlled trial (RCT) aimed to preliminarily assess the efficacy and acceptability of Cognitive behavioral therapy (CBT) and Emotion-focused therapy (EFT) in short-term treatment of depression within a Norwegian mental health program. The study also addresses procedural elements relevant for future research development.

Clinical supervision is considered an important aspect of therapist training. However, little is known about which elements of supervision impact on therapist skills. The current study used a qualitative approach to identify patterns of (in)effective supervision sessions for novice CBT supervisees.

Uncertainty is an unavoidable aspect of healthcare service provision, particularly for psychologists who often navigate complex ambiguous clinical scenarios, which can evoke negative responses and increase risk of adverse outcomes. This study explores the willingness of Australian psychologists to communicate uncertainty to clients, identifying facilitators and barriers to this process.

Client non-attendance and drop-out are common challenges in psychotherapy, often framed as issues of client engagement. Less attention has been paid to how therapists respond to these events, particularly within cognitive behavioural therapy (CBT). This study explores CBT therapists' cognitive, emotional, and behavioural responses to client non-attendance and drop-out using qualitative methods.

This systematic review (PROSPERO CRD42023399665) synthesized evidence from process-based microanalytic studies investigating therapist-client verbal exchanges in psychotherapy, focusing on sequential and time-series patterns.

Reflective practice is vital to high-quality therapeutic work, enabling clinicians to critically examine their professional practices. Increasing opportunities to engage in reflective processes stands to increase clinician wellbeing and thereby improve quality of care. Generative Artificial Intelligence (GAI), specifically large language models, provide new ways for clinicians to gain insight into their work. This study explores a unique unintended consequence of GAI clinical notetaking platforms, the support of reflective practice among mental health clinicians. Semi structured interviews were conducted with clinicians ( = 17) to learn about their experience using GAI clinical note-taking platforms. Interviews were recorded and analyzed using a grounded theory approach to identify themes. Respondents described how AI platforms functioned as a reflective partner by offering alternative clinical interpretations, lending clarity to their existing practice approach, and creating space to be more present during sessions. AI note-taking platforms are a feasible and scalable way to support reflective practice. Implications for clinical training and ongoing professional development are discussed, and opportunities for future research on the use of AI tools to enhance reflective practice are identified.

Emotion regulation (ER) is increasingly recognized as a key mechanism in couple therapy. However, little is known about how ER changes across treatment or how early adverse events and current attachment experiences shape this process. Using a sample of 308 married individuals in couple therapy, this study examined changes in ER difficulties across a total of 24 sessions. We also tested whether adverse childhood experiences (ACEs) and current attachment insecurity (anxiety, avoidance) predicted baseline levels and changes in ER. Multilevel modelling showed a small but significant decline in ER difficulties across sessions. Both ACEs and insecure attachment were associated with higher baseline ER difficulties. However, only avoidant attachment predicted greater improvement over time. ACEs and attachment anxiety were unrelated to change. Variance analysis revealed that most variation in ER occurred between individuals (70%) and within individuals over time (23%), with minimal variance at the couple (5%) and therapist (2%) levels. Findings support ER as a dynamic treatment target and underscore the importance of assessing developmental history and current attachment insecurity to guide intervention.

The focus on therapist variables and characteristics has significantly increased in psychotherapy research in recent years. While ethical considerations for patient-participants are well-established, the unique ethical dimensions of therapist-subjects remain underexplored. This theoretical paper examines three critical ethical aspects specific to therapist-participants: power dynamics in hierarchical relationships, personal-professional boundary issues, and confidentiality challenges. We analyze how these considerations manifest particularly in training contexts where researchers often hold supervisory roles over therapist-subjects (e.g., faculty supervising student-therapists). The paper explores the complex interplay between informed consent and institutional hierarchies, especially when participation may be perceived as professionally expected rather than voluntary. We examine the implications of recording and analyzing therapy sessions that expose therapists' personal characteristics and professional competencies, particularly when coded by colleagues within small professional communities. While existing ethical frameworks address research participants generally, they lack specific guidance for the unique vulnerabilities of therapists who are simultaneously research subjects and professional practitioners. We propose targeted considerations for ethical research design, including enhanced informed consent procedures, structural safeguards for managing power differentials, and privacy protections tailored to professional contexts. This theoretical exploration aims to highlight overlooked ethical complexities and guide future research practices when therapists serve as subjects in psychotherapy research.

Chairwork describes a set of experiential techniques where different parts of the self or representations of others are placed into chairs and given a voice. Using chairwork, individuals can practice self-reflexivity, address internal conflicts, and develop greater acceptance of their self-parts. There is a dearth of research regarding chairwork with young people and little is known about how therapists perceive and implement chairwork with this population. This study aims to explore therapists' experiences of chairwork with children and adolescents.

There is limited research examining factors associated with Dialectical Behavior Therapy (DBT) treatment retention among veterans, who are of critical interest given higher rates of suicide and borderline personality disorder (BPD). This study examined factors related to DBT treatment retention and BPD symptom trajectories among veterans.

Given their professional developmental stage, couple and family therapy (CFT) students are likely to have clinical concerns or fears about potential negative experiences that could occur in their clinical work as they progress through their training. A recently developed self-report measure was used to increase awareness of these clinical concerns and ultimately decrease the potential of their negative impact during clinical care. 71 CFT students (mostly female, 87.3%, and White, 70.4%) completed this measure and other potentially relevant measures (e.g., clinical self-efficacy, attachment security) at bi-monthly intervals throughout their clinical training. Results suggest that clinical concerns decreased over the course of their training and that increases in clinical self-efficacy led to a greater decrease in clinical concerns over time. This study has important practical implications for clinical training programs, particularly for ways through which supervisors can support clinicians in growing awareness of potential clinical concerns, and their impact on care delivery.

Systemic therapy (ST) is a well-established treatment approach to reduce symptoms, yet its effects across outcome domains, informants, and assessment methods remain underexplored.

The therapeutic alliance is a complex, relational construct that cannot be fully understood from a single perspective. Few studies have explored alliance dynamics from both therapist and client viewpoints in youth therapy. This case study investigates discrepancies in alliance ratings-alongside rupture and repair processes-in cognitive behavioral therapy for adolescent depression, where the adolescent consistently reported a stronger alliance than the therapist.

A substantial number of therapists in the eating disorder (ED) field have experienced an ED themselves, yet research on professionals using their personal ED experience as a therapeutic tool is scarce. This study explores the perspectives of recovered ED professionals (REDPs) who intentionally employ their experiential knowledge in ED treatment, examining its use, advantages, and challenges.

This qualitative study investigated the complex phenomenon of premature termination from psychotherapy, exploring the reasons for patients' decisions to end therapy, their methods of communicating this decision, and the subsequent long-term impact on their willingness to engage in future mental health treatment.

Patient- and therapist-reported (i.e., dyadic) working alliance evaluations have been identified as robust predictors of psychotherapy outcome. However, it remains unclear how their congruence relates to outcome and how treatment duration, a variable factor in naturalistic psychotherapy, influences this relationship. This study examined the effects of dyadic alliance judgments and their congruence on multidimensional outcomes, further assessing the role of treatment duration.

Intimate partner violence perpetrator (IPV) treatment interventions are traditionally associated with large dropout and low treatment adherence. Perceived working alliance is a proven predictor of treatment adherence and completion.

To explore parents' experiences of Family-Based Treatment (FBT) for Anorexia Nervosa (AN).

Although honesty is valued highly within psychotherapeutic work, therapists, like individuals in any interpersonal situation, are occasionally dishonest. The primary objective of this study was to explore clients' perceptions of therapist dishonesty, including their views on whether and under what circumstances therapist dishonesty is acceptable.