Circle of Security (COS) interventions aim to improve parent-child relationships. Preliminary evidence of the effectiveness of COS interventions has been positive, but recent studies suggest mixed results that may be due to a lack of differentiation between different versions of COS interventions. This systematic review used a theory of change/program logic approach to summarize the evidence for COS interventions and to explore the conditions under which each protocol was most effective. A comprehensive systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies administering a verified COS intervention protocol with parents/caregivers of children aged 0-8 years. Studies were coded for study design, protocol type, sample characteristics, treatment fidelity, dose, risk of bias, and type of outcome. Nineteen eligible studies were included; seven were randomized controlled trials. Studies of the higher dose protocols (i.e., COS-Intensive, COS-Intensive-Revised Hybrid, COS-Perinatal Protocol) showed promising results across primary and secondary parent outcomes, longer term relationship and child outcomes, and clinical samples. Results showed mixed evidence for the efficacy of the more scalable COS-Parenting. Reviewing studies according to the theory of change/program logic suggested three sources of variability in COS-Parenting studies compared to the higher dose COS interventions that could impact outcome: treatment dose/strategies, sample type, and treatment fidelity. Differential effectiveness of COS interventions tested in seven randomized controlled trials, two nonrandomized controlled trials, and 10 single-arm trials suggests that different COS variants may be better suited to different target populations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Abundant research across various treatments indicates that therapists can differ in their general, caseload-level effectiveness. However, relatively little is known about therapist factors that predict such "performance" variability. Moreover, most of the limited existing work on this topic has relied on demographic and professional convenience variables, which have demonstrated low predictive power. Thus, it is possible that therapist effectiveness differences would be better explained by personality characteristics that are inescapably present in a clinician's work. Addressing this question, the present preregistered study preliminarily explored whether more versus less effective therapists possess more adaptive personality traits among the "big five," defense style maturity, and psychological mindedness. Data were derived from a randomized clinical trial comparing the efficacy of 16 sessions of cognitive behavioral therapy and psychodynamic therapy for depression (Driessen et al., 2013). Effective sample participants were 142 adult outpatients treated by 32 therapists nested within the treatment condition. Therapists completed multiple personality measures, and patients' depression and global distress symptoms were assessed (via self-report or observer ratings) at baseline and posttreatment. Despite there being significant between-therapist effectiveness differences (on their average patient's posttreatment outcome), multilevel models revealed no significant associations between personality characteristics and such differences on any outcome. It may be that therapists' overall effectiveness has more to do with their transferable actions versus traits they bring into their work. Alternatively, certain traits may predict between-therapist effects but only in specific treatment, patient, and/or cultural contexts that differ from the ones herein. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Despite the evidence indicating that accommodating preferences leads to better outcomes, we currently know very little about what psychotherapists prefer to deliver and whether this matches patient preferences. This research aimed to understand the degree of mismatching between patients' preferences in psychotherapy and psychotherapists' preferred psychotherapy delivery in Chinese clinical contexts. We utilized three samples from two different Chinese clinical contexts. Study 1 consisted of two independent samples of patients ( = 301) and psychotherapists ( = 1,054). The Cooper-Norcross Inventory of Preferences patient and therapist versions were administered to assess preferences. In Study 2, a paired patient-psychotherapist sample ( = 155, = 3,060) was used to replicate Study 1 findings. Results from both studies indicated two significant areas of mismatch. First, psychotherapists had a stronger preference for their patients to take the lead in psychotherapy when compared with lay patients ( = 0.74∼0.82). Second, psychotherapists showed a stronger preference for emotional intensity than patients ( = 0.57∼0.62). These differences were relatively consistent across psychotherapists' theoretical orientations and personal psychotherapy experiences, with some variation linked to psychotherapists' clinical experience. Psychotherapists' preferred delivery styles, as compared with patients' actual preferences, are consistent with psychotherapists' own preferences (as patients) and may reflect a false consensus bias. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Prior scholarship has helped demonstrate therapists' perceptions of the value of discussing anti-Black racism with Black clients in a manner that espouses cultural comfort or the ability to be at ease when discussing lived experiences related to clients' culture during treatment. Better understanding cultural comfort, an aspect of multicultural orientation, when discussing anti-Black racism with Black clients could help clarify paths by which psychotherapy does not perpetuate harm reflected in the dehumanization of such racism. However, Black clients' perspectives are missing in the literature. As such, we collected data from 153 Black participants with recent therapy experiences. They were asked about discussing anti-Black racism during therapy, satisfaction/helpfulness of these conversations, and items related to initiation and frequency of such discussions. Participants also completed measures of cultural comfort, working alliance, and perceived outcome. Perceived therapist cultural comfort did not significantly vary if anti-Black racism was discussed, and discussing anti-Black racism did not moderate the relationship between cultural comfort and working alliance or cultural comfort and outcome. Satisfaction and helpfulness positively correlated with cultural comfort. Cultural comfort scores also varied by who initiated these conversations and their frequency. We contextualize these findings in a need for greater nuance with respect to examining discussions of racism in psychotherapy and consider our findings with respect to broaching literature. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Positive regard (PR)-rated from multiple perspectives across diverse psychotherapies-correlates positively with patient improvement. Yet, existing research has generally not parsed this total correlation into its within- and between-therapist components, which limits its interpretability. Thus, the present study explored (a) the association between positive regard and outcome at both the within- and between-therapist levels, (b) whether between-therapist differences in positive regard moderated the within-therapist positive regard-outcome association, and (c) whether treatment condition (cognitive-behavioral therapy [CBT] vs. CBT that integrated client-centered principles) moderated either level of the positive regard-outcome association. Adults with generalized anxiety disorder were randomly assigned to CBT alone ( = 49) or CBT integrated with motivational interviewing (MI-CBT; = 52) to responsively address patient resistance (Westra et al., 2016). Ten therapists treated patients in CBT only, and nine distinct therapists treated patients in MI-CBT only. Patients rated therapist-offered positive regard repeatedly across 15 sessions and their worry and general distress outcomes at baseline and posttreatment. Multilevel structural equation modeling revealed a significant association between patients' experience of higher early treatment positive regard and lower posttreatment worry and general distress at the within-therapist level. There was no between-therapist association for either outcome. Additionally, neither between-therapist positive regard nor treatment condition moderated the within-therapist effect of positive regard on either outcome. Results underscore the value of therapists working to foster their patients' felt regard irrespective of the treatment they use or the general ability they have in cultivating this relational experience. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Treating the suicidal patient is a risky, often emotionally exhausting process that strains the best therapist's capacity to maintain the primary focus of psychotherapy. When fear, desperation, and urgency to resolve the suicidal state become overwhelming, therapists and patients can get lost in protracted power struggles and crisis management (Plakun, 2001). Starting from the proposition that suicidal states are primarily driven by overwhelming affective experiences (Maltsberger, 2004), the authors expand upon an earlier clinical article (Fowler, 2013) to include new facets of interventions accompanied by clinical vignettes. Targeted research findings supporting these core interventions follow each vignette. Therapists are encouraged to flexibly shift among clinical interventions while carefully monitoring the emotional state and responsivity of the patient: (a) creating a sense of interpersonal safety in the therapy dyad; (b) coregulation of emotion utilizing mentalization-based therapy interventions (Bateman & Fonagy, 2016) and elements of therapeutic presence (Geller & Porges, 2014); (c) enhancing mentalizing by modeling curiosity about suicidal states of mind (Allen, 2011; Bateman & Fonagy, 2016); (d) identifying meaning(s) and pattern(s) that precipitate suicidal states; and (e) aiding the patient in fostering an enduring sense of trust. While informed by attachment theory, mentalization-based therapy, and polyvagal theory, these interventions are best conceptualized as common factors and can be utilized in conjunction with third-wave cognitive behavioral therapy, interpersonal, and integrative approaches. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Extensive research, including meta-analytic studies, has underscored the role of working alliance in influencing psychotherapy outcomes. However, far fewer studies and meta-analyses have delved into the predictors of working alliance quality. To synthesize the literature and highlight key predictors for alliance, the present study conducted a meta-analysis of predictors of subsequent working alliance. Drawing on 898 Pearson's r effects from 130 studies involving 12,449 clients and 2,840 therapists, a multilevel meta-analysis identified five major groups of factors that preceded alliance. Among client-related factors, client resource and readiness positively correlated with alliance, showing small and medium effect sizes, respectively ( = 0.18, 95% CI [0.12, 0.24], < .001 and = 0.34, 95% CI [0.25, 0.42], < .001), while client distress negatively predicted alliance (small effect size, = -0.14, 95% CI [-0.18, -0.11], < .001). Regarding therapist-related factors, treatment execution showed a small effect size ( = 0.15, 95% CI [0.03, 0.28], = .019), and rapport building contributed to alliance quality with a medium effect size (r = 0.39, 95% CI [0.31, 0.47], < .001). The study revealed notable between-study heterogeneity and found several moderation effects. The meta-analytic effects remained robust across various sensitivity analyses. This study illuminates the significant roles of both clients and therapists in developing working alliance and discusses its implications, limitations, and future research directions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Employment status, an essential socioeconomic factor, may be an important driver of disparities in mental health and access to treatment. However, prior research has been inconclusive and utilized broad employment categories. The present study investigated the associations between various types of employment status and baseline symptomology, psychotherapy engagement, and psychotherapy outcomes. We examined 27,258 patients (age = 32.54; 62.9% female; 75.8% White) who attended 115,936 psychotherapy sessions at a Canadian mental health agency between January 2014 and July 2022. Employment status was categorized into nine distinct groups (e.g., full-time, part-time, unemployed and looking for work, unemployed not looking for work, and retirement). Multilevel models examined the association between employment status and baseline symptoms, psychotherapy engagement (e.g., total sessions, early termination), and outcomes (e.g., symptom change). Patients who were unemployed (both looking for and not looking for work) reported higher baseline symptoms and increased odds of suicide concern compared to patients with full-time employment. Contrary to our preregistered hypotheses, patients who were unemployed attended more sessions and showed no significant differences in symptom change or trajectory of change compared to those employed full-time. Retirement was linked to lower baseline symptomology, and both retirement and full-time student status were associated with slower trajectories of change relative to full-time employment. Findings suggest that unemployment is associated with worse baseline mental health but does not hinder psychotherapy engagement and effectiveness. Ensuring accessibility of psychotherapy for unemployed individuals is crucial, given their heightened risk of psychological distress. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study examined changes in emotion regulation difficulties during short-term dynamic psychotherapy and their temporal relationship with symptom change, considering attachment styles as potential moderators. Sixty-three patients with mild to moderate depression and/or anxiety underwent 16 weeks of supportive-expressive therapy. Emotion regulation difficulties, symptoms, and attachment styles were assessed using self-report measures. Contrary to hypotheses, no overall improvement in emotion regulation difficulties was observed. However, patients with high attachment avoidance showed increased emotional clarity, while those with anxious attachment demonstrated greater acceptance of negative emotions over time. A deterioration in emotion regulation strategies was observed across all patients, particularly among those with avoidant attachment. Cross-lagged panel analysis revealed complex temporal dynamics: bidirectional relationships between emotion regulation and symptoms during early sessions, decoupling in intermediate sessions, and unidirectional effects (regulation predicting symptoms) in late sessions. These findings highlight the complex phase-dependent dynamics of emotion regulation change in short-term psychodynamic psychotherapy. The results emphasize the importance of considering both treatment phase and attachment styles when addressing emotion regulation difficulties in therapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Despite evidence from randomized controlled trials of long-term psychodynamic psychotherapy's (LTPP's) efficacy in treating depression, qualitative research on patient perspectives remains limited. This study aims to provide a deeper understanding of patient experiences, including perceived therapeutic mechanisms, challenges, and benefits, in LTPP. A qualitative study using naturalistic, semistructured interviews was conducted with 12 adult patients (six male, six female) from Australia and New Zealand/Aotearoa. Participants had received an average of 7.8 years of LTPP. Interviews were analyzed using reflexive thematic analysis to identify core themes related to treatment access, engagement, therapeutic change, and outcomes. Six themes were developed (a) experiences with prior treatments, (b) initial challenges in engaging with LTPP, (c) the centrality of the therapeutic relationship, (d) gaining self-insight, (e) experiences of internal change, and (f) the emotional and financial costs of long-term therapy. Participants described LTPP as a challenging yet transformative treatment, facilitating affect regulation, self-compassion, and improved interpersonal functioning. Participants attributed benefits to their LTPP treatments and emphasized the importance of a stable therapeutic relationship and insight in subjective improvement. However, they also described the process as emotionally painful and resource intensive. These findings indicate that patient experiences of LTPP are broadly consistent with psychodynamic theories of change and underscore the importance of integrating patient perspectives into psychotherapy research and policy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The longstanding tension between psychology and religion/spirituality poses significant challenges for therapists who are themselves religious or spiritual, especially when integrating these dimensions into their professional practice. This study explored how trainees from diverse religious, spiritual, and cultural backgrounds navigate the intersection of their professional and religious identities within a culturally sensitive clinical psychology training program in Israel. Using qualitative thematic analysis of semistructured interviews with 30 of the program graduates-including Ultra-Orthodox Jews, Arab Muslims, Ethiopian Jews, immigrants from the former Soviet Union, and secular Jews-we identified four central tensions: the historical and contemporary attitudes of psychology toward religiosity and spirituality; religious society's view of the profession of psychology; questions related to spiritual and religious identity; and challenges with professional identity formation. The training program addresses these tensions by fostering "familiarity" through inclusion of spirituality and religion in the curriculum and a diverse faculty/student body. On this secure basis, the program encourages "productive discomfort" by having students sit with the tensions between their religious/spiritual identities and psychological perspectives. The findings offer valuable insights into how culturally sensitive training programs can support therapists in navigating these complexities, thereby enhancing spiritual and religious competence in psychotherapy. This study contributed to understanding the specific needs of therapists undergoing such training and underscores the importance of embracing spiritual and religious dimensions within mental health services and training. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The field of psychotherapy research has come a long way since its inception. In addition to foundational data on psychotherapy's general efficacy and effectiveness, there has been steadily mounting evidence to answer questions, such as how, for which patients, when delivered by which therapists, and under what conditions does psychosocial treatment work? Moreover, there have been key methodological and data analytic developments over time, which have supported or catalyzed, respectively, more nuanced or new psychotherapy knowledge. Nonetheless, given the field's relatively young age, as well as the need for greater replication of results, better science-practice integration, and higher consensus on psychotherapy's core and consensual scientific principles, the field arguably remains somewhat immature and in need of more empirical advancements to meet the ever-rising need for effective mental health care. Such progressions will often come in incremental steps; however, "big needle movements" are also needed to embody or set the stage for more revolutionary changes in how we study, understand, and practice psychotherapy. To this end, the articles in the present special section exemplify such innovations through their big-impact results and/or promising proof-of-concept methods. In this introduction to the section, we summarize the sizeable potential of the nine included articles to influence and inspire the field of psychotherapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Spiritual and religious competence in psychotherapy is increasingly recognized as essential for supporting patients facing religious and spiritual struggles, though there is a lack of reliable objective measures to evaluate clinician competence in this area. This study aimed to develop and provide preliminary validation for the Brief Spirituality/Religiosity Functional Competency Scale, an observational tool designed to assess functional spiritual/religious competencies, and to examine the relationship between these competencies and therapeutic alliance. Participants were 105 doctoral trainees enrolled in clinical or counseling psychology programs across the United States. Using data from objective-structured clinical examinations, we assessed the scale's internal consistency, interrater reliability, convergent and discriminant validity. The observational design evaluated participants' functional competencies during brief simulated clinical encounters. The scale demonstrated acceptable reliability and validity. While the overall competency score did not significantly predict therapeutic alliance or cultural humility, individual item analysis revealed that the "Help Explore Strengths" spiritual/religious competency and general advocacy skills significantly predicted stronger therapeutic alliance (² = .10). Only advocacy skills significantly predicted cultural humility (² = .10). Religious commitment was modestly correlated with both self- and expert-rated spiritual/religious competence but was not associated with simulated patient-rated therapeutic alliance or cultural humility. These results underscore the importance of assessing discrete demonstrated spiritual/religious competencies-rather than relying on global ratings or self-perceived religious commitment-to understand their unique contributions to therapeutic alliance. The scale shows promise for use in formative and summative assessments of clinician competence in spiritual and religious domains. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Research shows how therapists struggle to stay present with their clients' existential concerns. Our goal was to explore what hinders and enables therapists to stay present and engaged when existential concerns surface in the session. We invited 22 therapists (12 novice and 10 experienced) to engage in a role-play with a client expressing her existential concerns using a standardized script. Subsequently, the therapists were interviewed using a videotape-assisted recall procedure. Data were analyzed according to the descriptive-interpretive qualitative research approach. When confronted with existential themes in the session, novice therapists experienced overwhelming feelings of powerlessness and uncertainty, blocking their ability to remain open to the client's existential experiences. Lack of knowledge and encountering their own existential vulnerability were mentioned as triggers. For experienced therapists, the main challenge was to stay present while feeling impacted by the existential topic, which they managed by grounding and reanchoring themselves. Our findings support the idea that embracing one's own existential issues and being at ease with existential themes may be essential conditions for staying present and fostering an authentic therapeutic encounter. Furthermore, our findings suggest that gaining knowledge about the existential process and learning to ground and reanchor oneself are essential for therapists. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In this study, we sought to develop and test a trainee-driven educational intervention to increase competency in working with religion and spirituality (R/S) in psychotherapy. Trainees currently in mental health graduate training programs ( = 363) were randomly assigned to one of three conditions: (a) peer group plus self-study (PG), (b) immediate self-study (ISS), and (c) delayed self-study (DSS). All participants completed six weekly online training modules that included both didactic materials and deliberate practice. Using complete case analysis, we determined that compared to those in DSS, participants in PG reported a significantly greater increase from pre- to postintervention in religious/spiritual (R/S) cultural humility, R/S skills, comfort with R/S, positive R/S attitudes, and R/S self-efficacy. Compared to those in ISS, participants in PG reported significantly greater change in R/S self-efficacy in psychotherapy. We also compared these results with results using imputed data and only the comparison between DSS and PG remained significant for R/S skills and R/S self-efficacy. In addition, although participants in the peer-group plus self-study condition were less likely to complete both pre- and postintervention questionnaires, they completed almost twice as many training modules. The findings of this study support the possible benefit of trainee-driven educational interventions to help mental health graduate students increase their cultural humility, skills, comfort, positive attitudes, and self-efficacy for working with R/S in psychotherapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This article applies the multicultural orientation framework (D. E. Davis et al., 2018) to enhance religious/spiritual competencies. The skills gap in multicultural training is especially pronounced in the area of spiritual, existential, religious, and theological competencies; many clinicians report minimal and insufficient training (Vieten & Lukoff, 2022). We frame orienting to clients' values and visions as a cultural opportunity. To integrate multicultural orientation skills into routine clinical training throughout the career, we propose three approaches: (a) course curriculum, (b) peer consultation, and (c) continuing education. First, we provide instruction on incorporating video case studies into any course to engage students in discussions that promote perspective-taking, dialectical thinking, and wisdom. Second, we outline an eight-step model of peer consultation that focuses on cultural humility to promote trust and cultural comfort and increase sensitivity in clinical judgment. Third, given the American Psychological Association's forthcoming revisions to their ethics code emphasizing social justice (Campbell et al., 2024), we propose integrating the previous two approaches with routine ethics training for continuing education. With an eye toward future innovations in training, we also discuss how these structures align with projects that employ artificial intelligence to identify markers in therapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

One of the critical gaps in promoting religious and spiritual (R/S) competencies among clinicians in training revolves around student clinician hesitancy to engage in R/S conversations in session. This reluctance, in part, may be due to attitudinal biases based on one's own R/S experiences, which do not readily improve with knowledge and skills training. There is a need to understand how clinicians in training experience the actual process of addressing R/S content in clinical practice and academic training environments. This study describes findings based on the administration of a training tool-the Religious, Spiritual, and Secular Life Story Interview (adapted version of the Life Story Interview; McAdams, 2007)-designed to help trainees explore the nature and dynamics of clinician resistance to engage with R/S in psychotherapy. Participants included a religiously and spiritually diverse sample of 23 student clinicians from master's and doctoral-level programs across counseling, psychology, and social work disciplines, all of whom reported moderate to high levels of hesitancy about broaching R/S in the training process (i.e., in the classroom and/or psychotherapy sessions). Three themes emerged from the evaluative findings- and -that offer clues about factors supporting the process of opening and engaging with religiousness, spirituality, and secularity. The discussion will address the potential of the as a training tool to facilitate the acquisition of attitude-based R/S competencies that may lay the foundation for cultivating skills-based competencies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Psychedelic-assisted therapies (PAT) can provoke personally meaningful spiritual or existential experiences in patients; these experiences have been associated with improved outcomes across several treatment targets and populations. The need for spiritual and religious competence, though present across the spectrum of psychotherapeutic practice, is especially strong in psychedelic-assisted psychotherapies. The relational spirituality model (RSM), a systematically developed and empirically tested framework for spiritual and religious competency in psychotherapy, offers a theoretical and practical framework for spiritual competency training in psychedelic therapies (Sandage et al., 2020). The model's inclusive spiritual, existential, religious, and theological (SERT) framework provides a broad and pluralistic approach that can meaningfully engage a wide range of SERT experiences and traditions in psychedelic-assisted psychotherapy. Further, the RSM can readily be integrated with other models of clinical care (e.g., palliative care), with a range of psychotherapeutic modalities, and within existing psychedelic training frameworks. To illustrate the application of the RSM to the development of religious and spiritual competence in PAT training, this article first describes the RSM. It then introduces methods for pragmatic training based on the RSM, which can be integrated with standard licensure-focused mental health training programs that might someday include applications for psychedelics or with specialized psychedelic-assisted therapy facilitation training programs. These include deliberate practice and experiential training components, "SERT groups," content and clinical theory, and training in assessment and case conceptualization. Finally, we discuss how the RSM can inform future directions in PAT training and support interdisciplinary approaches to PAT including collaborations across disciplines and healing communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Family Competency addressing religion and spirituality in relationships is based on principles of systems theory applied to diversity training in religion and spirituality. Relational spirituality and family systems theory are the theoretical bases for training clinicians to address religion and spirituality (R/S) competently. Relational issues of R/S include religious differences and conflicts in close relationships, spiritual impairment due to relationship distress, and the use of spiritual resources for coping in a family or community. Principles of cultural humility and comfort, clinical assessment of R/S, nonanxious presence, multidirected partiality, and differentiation were used to train clinicians. Participants ( = 174) were graduate students and professionals in mental health care who engaged in a 5-hr online training with switching replication measurement at three points before and after the training at 2-week intervals. Measurement included a newly validated six-item global measure of couple and family spiritual and religious competency (J. S. Ripley et al., 2024) and the Religious/Spiritually Integrated Practice Assessment Scale (Oxhandler, 2019). Mixed-effects models with two-way cross-level interactions of Treatment Condition (Immediate Treatment, Delayed Treatment) × Time (T1, T2, T3) supported change based on the intervention, especially for measures of self-efficacy, attitude, increased frequency of R/S integrated practice, and global relational R/S competency. Qualitative analysis of interviews with some participants ( = 10) identified several experiential themes. The models showed significant change after the training and maintenance of gains for the immediate treatment group. In conclusion, this demonstrated the efficacy of the relationally based training model in improving R/S competency in training graduate students and professionals. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Given that spiritual and religious (S/R) topics can elicit discomfort and countertransference among psychotherapists, training frameworks that promote introspection and opportunities for repeated practice, or exposure, may be ideal starting points to develop S/R competencies. The current deliberate practice informed training program targeted cultural comfort and associated multicultural orientation constructs, aligning with prescribed attitude/awareness and broaching S/R competencies. This quasi-experimental, mixed method investigation analyzed whether a new S/R training program informed by deliberate practice principles was associated with changes in participants' (graduate students in graduate clinical/counseling psychology programs in the United States; = 126) cultural comfort, self-perceived clinical performance, and self-perceived difficulty when engaging S/R video vignettes using specification curve analyses and a content analysis of follow-up interviews. Analyses indicated that all specifications had positive effects for the treatment (training condition, = 65) for comfort ( = .46, range: .36-.58; 24 of 36 specifications were significant) and self-perceived performance ( = .48, range: .45-.55; all specifications significant). Analyses indicated that all specifications for treatment had an inverse association with self-rated difficulty, but all specifications were nonsignificant, suggesting no difference between training and control ( = 61) participants. Training condition participants indicated in a survey that the training was high quality, useful, and had no technology issues; the follow-up interviews with a smaller number of training condition participants provided insights into the training's strengths and weaknesses. The data in full create a roadmap for further study and training program modifications. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This article is a practical contribution to the literature focused on developing competencies in addressing religion and spirituality in clinical practice, particularly with students in education and training programs. Details of a course in an American Psychological Association accredited doctoral program in clinical psychology are provided, illustrating the ways and means through which students are engaged in exploring, identifying, and articulating a conceptual and theoretical framework as well as developing methods and competencies that will be ethical and efficacious in the conduct of their clinical work. The course described is the third in a four-course required sequence that is focused on acquiring knowledge, skills, and attitudes that are consistent with competencies identified in the American Psychological Association Accreditation Standards as well as in the program's defined areas of special emphasis, one of which is addressing religion and spirituality in clinical practice. Key aspects of pedagogy related to readings, assignments, and classroom engagement are presented. Methods used to assess competencies are included as well as quantitative and qualitative data from student ratings of course effectiveness. Suggestions for future teaching, training, and research are offered. (PsycInfo Database Record (c) 2025 APA, all rights reserved).