OBJECTIVE: Increased attention has recently been paid to the well-being and flourishing of patients in psychotherapy. This study investigated the occurrence of positive affect (PA) and strength-based behaviours within psychotherapy sessions contrasting positive versus neutral imagery instructions.
METHODS: This is a secondary analysis of a randomized controlled trial. Seventy-eight sessions of cognitive behavioural therapy involving 26 patients (69.23% female; Mage = 40.31) treated by 13 therapists were selected. PA and strength-based behaviours of patients and therapists were coded on a minute-by-minute basis with the Resource-Oriented Microprocess Analysis. Each session started with a brief mental imagery instruction. Data were analysed using multilevel modelling.
RESULTS: Mild levels of PA were very common, whereas stronger expressions were occasional, especially at the beginning and end of sessions. Strength-based behaviours were employed in one-fifth of the videos analysed. Therapists in the positive imagery instruction showed more strength-based behaviours in the beginning phase of sessions, p < 0.05. The two imagery instructions significantly differed in the session trajectories of PA, p < 0.05. A quadratic trend with higher initial values and a sharper decline in PA were found in the positive instruction, whereas the neutral instruction showed a flatter trend.
CONCLUSIONS: Patients and therapists experience PA and discuss strengths in psychotherapy sessions despite patients\' distress. The positive imagery instructions potentially induced a positive focus at baseline for therapists but had a negligible effect on the subsequent session progression.
BACKGROUND: ClinicalTrials.gov identifier: NCT03767101 (registered December 6, 2018).

Treatment personalization has evolved into an important zeitgeist in psychotherapy research. To date, such efforts have principally embodied a unidirectional focus on personalizing interventions to the patient. For example, earlier work in this area attempted to determine whether, on average, certain patients with certain characteristics or needs would respond better to one treatment package versus others. To the extent such aggregate \"Aptitude × Treatment interactions\" emerged, they could help guide overarching treatment selection. More recently, and drawing on technological and statistical advancements (e.g., machine learning, dynamic modeling), predictive algorithms can help determine for which individual patients certain treatment packages (DeRubeis et al., 2014) or specific during-session interventions within them (Fisher & Boswell, 2016) confer the most advantage for clinical improvement. Again, such work can help guide treatment decisions, though now at multiple care points. Although the aforementioned innovations in personalized psychotherapy have been leading-edge, precision care need not remain unidirectional. Rather, it can be complemented by efforts to personalize treatment decisions to the therapist. Namely, we can harness therapist effectiveness data to help ensure that therapists treat the patients they are empirically most equipped to help and use the interventions with which they have had the most empirical success. Such threads have been the focus of our team\'s novel, evolving, and multimethod work on improving psychotherapy by leveraging therapists\' own practice-based evidence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

OBJECTIVE: Research indicates psychologists typically lack subjective understanding of voice hearing. Voice hearing simulation training has potential to improve understanding, empathy and confidence among clinicians, but psychologists have had limited input into its development. This study investigated psychologists\' and a psychotherapist\'s clinical experience of working with people who hear voices and their views and recommendations for voice hearing simulation training.
METHODS: This was a qualitative study.
METHODS: Clinical psychologists and one psychotherapist (N = 17) participated in semi-structured interviews. Thematic analysis was used to analyse transcribed data.
RESULTS: The Clinical Experience theme comprised of subthemes Barriers to engagement, Diversity of voice hearing experiences, Lack of subjective understanding, Curiosity about voice hearing, Empathy for voice hearers, Using personal experiences to relate to voices, Clinical experience increases knowledge, Importance of supervision and colleague\'s support, Benefits of experiential training, Limited training in non-psychosis settings and Clinical experience increases confidence. The Views on Voice Hearing Simulation Training theme comprised of subthemes Improves subjective understanding, Concern about distress, Discomfort as a strength of voice hearing simulations, Artificiality of simulation, Increases empathy and Over-estimation of understanding. The Recommendations theme comprised of subthemes Discuss artificiality, Co-production, Promote voice diversity, Support staff and Maximise inclusivity.
CONCLUSIONS: Findings indicate that clinical experience improves psychologists\' confidence and knowledge, yet participants reported a lack of subjective understanding of voice hearing. Co-produced simulation training between individuals who hear voices and clinicians was anticipated to improve subjective understanding, empathy and therapeutic relationships, which could support a range of staff and improve quality of care delivered.

OBJECTIVE: This study examined therapists\' dispositional empathy profiles and how they differ based on professional and personal characteristics.
METHODS: A total of 376 clinicians was recruited for this study. Dispositional empathy was assessed with the Interpersonal Reactivity Index (IRI). Profiles were generated using latent profile analysis. Predictors of profiles were assessed with multiple self-report questionnaires measuring demographic and professional characteristics, romantic attachment styles, five-factor personality traits and vulnerable narcissism.
RESULTS: A four-profile solution was retained with the following proportions: rational empathic (20%), disengaged/detached (10%), empathic immersion (35%) and insecure/self-absorbed (35%). Overall, few relationships were found regarding demographic and professional characteristics. In contrast, significant relationships were found between profile membership and personal characteristics, including avoidant and anxious attachment, agreeableness, conscientiousness, neuroticism, intellect/imagination and vulnerable narcissism.
CONCLUSIONS: The findings show that differences in therapists\' empathic dispositions are linked to personality dimensions. Implications for psychotherapy research, practice and training are discussed.

OBJECTIVE: Telepresence may play a fundamental role in establishing authentic interactions and relationships in online psychological interventions and can be measured by the Telepresence in Videoconference Scale (TVS), which was validated only with patients to date. This post hoc study aimed to validate the Italian version of the TVS with mental health professionals.
METHODS: The Italian TVS was included in an online survey, whose primary aim was to assess the experiences of Italian psychologists and psychotherapists with online interventions during the first wave of the COVID-19 pandemic and was filled in by 296 participants (83.4% females, mean age = 42 years old).
RESULTS: Exploratory factor analysis supported the original factor structure only partially because the scale \'Absorption\' (i.e., the feeling of losing track of time), as it was formulated, did not measure telepresence. Correlations were also explored between the TVS scales and some survey items pertaining to intimacy and emotional closeness to patients, comfort and positive as well as negative experiences with online interventions.
CONCLUSIONS: The TVS may be a useful tool to measure physical and social telepresence in online interventions, both in patients and in professionals.

Attorney-client privilege was held by the Supreme Court to extend beyond death in 1996, albeit only ratifying centuries of accepted practice in the lower courts and England before them. But with the lawyer\'s client dead, the natural outcome of such a rule is that privilege--the legal enforcement of secrecy--will persist forever, for only the dead client could ever have waived and thus end it. Perpetuity is not traditionally favored by the law for good reason, and yet a long and broad line of precedent endorses its application to privilege. The recent emergence of a novel species of privilege for psychotherapy, however, affords an opportunity to take a fresh look at the long-tolerated enigma of eternity and the imprudence of thoughtlessly importing it to the newest addition to the family of privileges. Frankly, humanity has always deserved better than legalisms arrogating to the inscrutability of the infinite.

BACKGROUND: This research explores the impact of the COVID-19 pandemic on psychotherapists\' practices and their ability to maintain a framework despite a shared reality with their patients. The specific focus in this article is on the Lebanese context, which is characterized by a series of crises including economic collapse, the COVID-19 pandemic, and the Beirut blast. The objective of this study was to examine how the destabilization of the meta-frame due to crises necessitates adaptations in theoretical knowledge, practice, and setting.
METHODS: We conducted a qualitative study among a population consisting of mental health professionals, which were recruited in Lebanon through associations and societies of psychologists, psychotherapists, and psychoanalysts. Data was collected using semi-structured individual interviews. The interviews were analyzed using interpretative phenomenological analysis (IPA), which allowed for a dynamic exploration of the participants\' experiences.
RESULTS: Our study revealed four superordinate themes: (1) The strained frontiers; (2) The cumulative traumatic reality and its impact; (3) A challenged professional identity; (4) The creativity stemming from collective trauma.
CONCLUSIONS: Our results highlight the insecurity caused by external reality infiltrating the therapeutic setting. Online therapy allowed for continued work, but uncertainty about the online environment\'s impact on therapeutic relationships was observed. The study underscores the importance of adaptability, containment, and support for therapists navigating crises, particularly in the online setting.

BACKGROUND: Treatment of (chronic) mental disorders must focus on both reducing symptoms and improving social and work participation by social medicine treatments and counselling. The objective of this study was to compare psychotherapy patients who are fit or unfit for work to describe similarities and differences regarding patient status and interventions.
METHODS: Interviews were performed with 73 cognitive behavior therapists and 58 psychodynamic psychotherapists about 188 and 134 recent cases they had seen, respectively. The case reports referred to patients who were on average 42 years old (65% females).
RESULTS: There were no differences between patients with no or short-term sick leave (up to 6 weeks, n = 156) and patients with longer sick leave (7 weeks or more, n = 140) with respect to basic characteristics of treatment (side effects, therapeutic alliance). Patients with a longer sick leave duration had more severe capacity and participation impairments and received more specific work participation-oriented treatments, whereas general saluto-therapeutic activities (sports-club, counselling, family-support) were similarly undertaken in patients with shorter or longer sick leave.
CONCLUSIONS: Therapists chose intervention options according to indication: in patients with work participation problems, more work-related treatments are undertaken, whereas interventions for general mental health improvement are distributed independent of specific work participation problems.
UNASSIGNED: HINTERGRUND: Die Behandlung (chronischer) psychischer Erkrankungen zielt sowohl auf die Symptomreduktion als auch auf die Verbesserung der sozialen und beruflichen Teilhabe durch sozialmedizinische Behandlungen und Beratungen ab. Ziel der vorliegenden Studie war es, arbeitsfähige und arbeitsunfähige Psychotherapiepatienten im Hinblick auf Gemeinsamkeiten und Unterschiede des Patientenstatus und der Behandlungssituation zu vergleichen.
METHODS: 73 kognitive Verhaltenstherapeuten und 58 psychodynamische Psychotherapeuten wurden zu 188 bzw. 134 aktuellen Patientenbehandlungen befragt. Die Fallberichte bezogen sich auf Patienten, die im Durchschnitt 42 Jahre alt waren (65 % Frauen).
UNASSIGNED: Es gab keine Unterschiede zwischen Patienten ohne oder mit kurzer Krankschreibung (bis zu 6 Wochen, n = 156) und Patienten mit längerer Krankschreibung (7 Wochen oder mehr, n = 140) in Bezug auf grundlegende Merkmale der Behandlung (Nebenwirkungen, therapeutische Allianz). Patienten mit längerer Krankheitsdauer hatten schwerere Beeinträchtigungen der Leistungsfähigkeit und Teilhabe. Sie erhielten spezifischere, auf die Teilhabe am Arbeitsleben ausgerichtete Behandlungen, während allgemeine salutotherapeutische Aktivitäten (Sportverein, Beratung, Familienunterstützung) bei Patienten mit kürzerer oder längerer Krankheitsdauer in gleicher Weise durchgeführt wurden.
CONCLUSIONS: Die Therapeuten wählten die Behandlungsoptionen indikationsbezogen aus: Bei Patienten mit Problemen der Teilhabe am Arbeitsleben wurden mehr arbeitsbezogene Behandlungen durchgeführt, während Behandlungen zur Verbesserung der allgemeinen psychischen Gesundheit unabhängig von spezifischen Problemen der Teilhabe am Arbeitsleben eingesetzt wurden.

The current demographic change means that young psychotherapists and older patients will increasingly come into contact. Unique for this constellation is the intergenerational therapeutic relationship, which forms the basis of psychotherapy, but has not yet been the focus of empirical research. This qualitative study provides preliminary insights into how older patients (aged over 65) experience and perceive the therapeutic relationship with young psychotherapists (aged in their mid-20s to mid-30s). We conducted semi-structured interviews with twelve older patients (8 women, 4 men) and analysed their data using the grounded theory approach. We found a connection between the type of transference a participant demonstrated and their biographical as well as social experiences, desires, and fantasies. Overall, a tendency to seek harmony was observed among the participants, which was reflected in their behaviour towards young psychotherapists: (a) conflict avoidance, (b) (fantasised) therapy discontinuation, (c) adaption/subordination, and (d) solidarity, support, and protection. Our findings demonstrated that various intergenerational transference phenomena, including the roles in which young therapists are perceived, are associated with certain particularities and challenges, such as the topic of sexuality. It can be valuable for young psychotherapists to become aware of a potential role reversal that may result in older patients trying to support them.

Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots.