When therapists\' proposals are too demanding exceeding clients\' readiness to move into change, clients may resist advancing. We aimed to understand how a therapist behaved immediately after the client resisted advancing into change within Cognitive-Behavioral Therapy.
We analyzed a recovered and an unrecovered case, both with Major Depression, and followed by the same therapist. Through the Therapeutic Collaboration Coding System, we analyzed 407 exchanges of interest.
In both cases, clients resisted more in advancing at intermediate sessions, mainly by the therapist\'s challenges to raise insight and debate cognitive beliefs in the recovered case, and to seek experiential meanings in the unrecovered case. Immediately after clients resisted advancing, the therapist tended to insist on challenging them in the same direction. In the recovered case, the therapist did so continually throughout the therapy, sometimes balancing between insisting or stepping back. In the unrecovered case, the therapist insisted on challenging, but mostly at the final session. Occasionally, the therapist insisted on challenging, and clients resisted over consecutive exchanges.
Our results reinforce that to enact progress and change clients need to be pushed into change, however it requires therapists\' skillful assessment of clients\' tolerance to move in time.

Due to the coronavirus pandemic and crisis, psychotherapists around the world were forced to switch to video- or tele-based treatments overnight. To date, only a few studies on the effectiveness of video-based psychodynamic psychotherapy via the Internet exist. Therefore, the goal of the present study was to examine symptom improvement, therapeutic relationship, nonverbal synchrony processes, and intersession processes within a systematic single case design and compare face-to-face to video-based approaches in long-term psychodynamic-oriented psychotherapy.
We examined 85 sessions of a client with major depression whose psychodynamic psychotherapy changed from a face-to-face setting to a video-based setting. Video recordings were analyzed using motion energy analysis, and nonverbal synchrony was computed using a surrogate synchrony approach. Time series analyses were performed to analyze changes in symptom severity, therapeutic relationship, and intersession processes.
The results showed that symptom severity improved descriptively, but not significantly, across the entire course of psychotherapy. There were significant differences, however, in the therapeutic relationship, intersession experiences, and synchronous behavior between the face-to-face and video-based settings.
The results indicate that the presented methodology is well situated to investigate the question whether psychodynamic psychotherapy in video-based setting works in the sameway as in a face-to-face setting.

The COVID-19 outbreak has raised questions about how vulnerable groups experience the pandemic. Research that focuses on the view of individuals with pre-existing mental health conditions is still limited, and so are cross-country comparative surveys. We gathered our sample of qualitative data during the first lockdown after governmental measures against the spread of the SARS-CoV-2 virus came into force in Austria, Czechia, Germany, and Slovakia. A total of n = 1690 psychotherapists from four middle European countries answered the question of how the COVID-19 pandemic was addressed in sessions by their patients during the early stage of unprecedented public health conditions. We employed a descriptive qualitative methodology to determine themes following levels of the social-ecological model (SEM) regarding how the COVID-19 pandemic affected patients. At the public policy level, stressful environmental conditions concerned the governmental mitigation efforts. At the level of community/society, reported key themes were employment, restricted access to educational and health facilities, socioeconomic consequences, and the pandemic itself. Key themes at the interpersonal level regarded forced proximity, the possibility of infection of loved ones, childcare, and homeschooling. Key themes at the individual level were the possibility of contracting COVID-19, having to stay at home/isolation, and a changing environment. Within the SEM framework, adaptive and maladaptive responses to these stressors were reported, with more similarities than differences between the countries. A quantification of word stems showed that the maladaptive reactions predominated.

Case formulation is a central tool for psychotherapists, which helps them tailor psychotherapy to the individual patient, particularly for treatments for complex and multilayered clinical problems, such as personality disorders (Kramer, 2019). Case formulation methodologies are still underutilized in psychotherapy research in the prediction of therapy processes. The present study included N = 60 patients with borderline personality disorder undergoing a brief treatment using an individualized treatment component (n = 31), as compared with a standard brief treatment (n = 29; Kramer et al., 2014). For each patient (in both groups as post hoc analysis based on videos), we performed a Plan analysis case formulation (Caspar, 2019): the idiographic information from the formulation was translated into quantitative scores (on a Likert-type scale) assessing patient\'s interactional agreeableness (vs. antagonism; Zufferey et al., 2019). We modeled the session-by-session predictions of the progression of the therapeutic alliance-rated by the patient and the therapist-over the course of treatment, as a function of interactional agreeableness, the individualization of treatment, as well as their interaction with the session number. Patients with high levels of agreeableness have a significant increase in their alliance assessment over time. Treatment based on the case formulation predicted session-by-session increase of the therapeutic alliance as rated by the therapists. This study was the first to explore intra- and interindividual dynamics of the therapeutic alliance in relationship with idiographic information extracted from case formulations. The results may help understand relationship struggles at the beginning of therapy for complex clinical problems, such as borderline personality disorder. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Previous research indicates that not all children, adolescents and adults suffering from PTSD receive psychotherapy and if they do, trauma is not always considered during therapy. One reason for this undertreatment might be a limited readiness of licenced psychotherapists (LPTs) to treat patients who have experienced a trauma and thus suffer from PTSD symptoms.
The aim of this study is to explore the association between the readiness of LPTs to treat patients with PTSD symptoms and different patients\' and therapists\' characteristics.
We used case vignettes to assess the readiness of LPTs in Germany in a nationwide online survey (N = 768). The vignettes described patients with PTSD and were adapted to the age group mainly treated by the therapists (children/adolescents vs. adults). The patients\' characteristics in the otherwise identical vignettes were randomized for patient gender (female vs. male) and symptom cluster (internalizing vs. externalizing). Rating scales were used to assess readiness. Additionally, therapists\' characteristics (age, trauma-specific training, perceived fears/doubts, and objective barriers to treating the vignette patient) were assessed.
The patients\' characteristics did not influence the treatment readiness of the LPTs. Regarding therapists\' characteristics, LPTs working mainly with children and adolescents, and those who had completed trauma-specific training reported a higher readiness to treat the vignette patient.
Regarding the treatment of patients suffering from PTSD symptoms of different ages, our study indicated that the assessed therapists\' characteristics were more relevant for the treatment readiness of LPTs than the patients\' characteristics of age or symptom type.
Antecedentes: Las investigaciones previas indican que no todos los niños, adolescentes y adultos que sufren de TEPT reciben psicoterapia, y si la reciben, el trauma no siempre es considerado durante la terapia. Una razón para este tratamiento insuficiente puede ser una limitada disposición de los psicoterapeutas licenciados (LPT por su sigla en inglés) para tratar pacientes que han experimentado un trauma y que por tanto sufren de síntomas de TEPT.Objetivo: El objetivo de este estudio es explorar la asociación entre la disposición de los LPT para tratar pacientes con síntomas de TEPT y diferentes características de los pacientes y los terapeutas.Método: Utilizamos viñetas de casos para evaluar la disposición de los LPT en Alemania en un estudio en línea a nivel nacional (N = 768). Las viñetas describían pacientes con TEPT y fueron adaptadas al grupo etario tratado principalmente por los terapeutas (niños/adolescentes vs adultos). Las características de los pacientes en las viñetas por lo demás idénticas fueron aleatorizadas por género de los pacientes (femenino vs masculino), y grupos sintomáticos (internalizantes vs externalizantes). Se utilizaron escalas para evaluar la disposición. Adicionalmente, fueron evaluadas las características de los terapeutas (edad, entrenamiento específico en trauma, miedos/dudas percibidos) y barreras objetivas para tratar al paciente de la viñeta).Resultados: Las características de los pacientes no influyeron sobre la disposición a tratamiento de los LPT. En relación a las características de los terapeutas, los LPT que trabajaban principalmente con niños y adolescentes, y quienes habían completado un entrenamiento específico en trauma reportaron una mayor disposición para tratar al paciente de la viñeta.Conclusiones: En relación al tratamiento de pacientes de diferentes edades que sufren de síntomas de TEPT, nuestro estudio indicó que las características evaluadas de los terapeutas fueron más relevantes para la disposición a tratamiento de los LPT que las características de los pacientes respecto a edad y tipo de síntomas.
背景: 先前研究表明, 并非所有患有 PTSD 的儿童、青少年和成人都接受心理治疗, 并且如果他们接受治疗, 创伤在治疗过程中并不总被考虑在内。这种治疗不足的一个原因可能是执业心理治疗师 (LPT) 对治疗经历创伤并因此患有 PTSD 症状的患者的准备有限。目的: 本研究旨在探讨 LPT 治疗患有 PTSD 症状的患者的准备情况与不同患者和治疗师特征之间的关联。方法: 我们在一项全国性在线调查中使用案例记录来评估德国 LPT 的准备情况(N = 768)。这些记录描述了 PTSD 患者, 并匹配了主要由治疗师治疗的年龄组 (儿童/青少年与成人)。其他相同记录中的患者特征随机化为患者性别 (女性与男性) 和症状簇(内化与外化)。使用评分量表评估准备情况。此外, 还评估了治疗师的特征(年龄、特定创伤培训、感知恐惧/怀疑以及治疗案例患者的客观障碍)。结果: 患者特征不影响 LPT 的治疗准备情况。关于治疗师特征, 主要治疗儿童和青少年的 LPT 以及那些完成了创伤特定培训的治疗师报告说, 他们对于治疗案例患者准备更足。结论: 我们的研究表明, 对于不同年龄的 PTSD 症状患者的治疗, 被评估的治疗师特征与 LPT 的治疗准备情况比患者年龄或症状类型特征更相关。.