A meta-analysis of client-therapist perspectives on the therapeutic alliance: Examining the moderating role of type of measurement and diagnosis.

BACKGROUND: Clients and therapists often have different perspectives on their therapeutic alliance (TA), affecting the process and outcome of therapy. The aim of the present meta-analysis was to assess the mean differences between clients' and therapists' estimations of TA among clients with severe disturbances, while focusing on two potential moderators: client diagnosis and alliance instrument. METHOD: We conducted a systematic literature search of studies examining both client perspective and therapist perspective on TA in psychotherapy among people with schizophrenia spectrum disorders, personality disorders, and substance misuse disorders. We then analyzed the data using a random-effects meta-analytic model with Cohen's d standardized mean effect size. RESULTS: Heterogeneity analyses (k = 22, Cohen's d = -.46, 95% confidence interval = .31-1.1) produced a significant Q-statistic (Q = 94.96) and indicated high heterogeneity, suggesting that moderator analyses were appropriate. CONCLUSIONS: Our findings show that the type of TA instrument moderates the agreement on TA between client and therapist, but there was no indication of the client's diagnosis moderating the effect. The agreement between client and therapist estimations seems to be dependent on the instrument that is used to assess TA. Specific setting-related instruments seem to result in higher agreement between clients' and therapists' estimations than do more general instruments that are applied to assess TA.

The use of the social skills performance assessment (SSPA) among persons with serious mental illness: psychometric assessment and network analysis.

Background: Challenges in social functioning are a major obstacle in the recovery process of persons with serious mental illness. Majority of social functioning measures use self-report assessments.Aims: To validate the use of a performance based measure and examine a network analysis that explores the centrality of items. In addition, to explore the distinctiveness between the social skills performance assessment (SSPA), and a self-report measure of social quality of life (SQoL).Method: One hundred fifty eight participants were administrated with the SSPA and SQoL scale. Intra-class correlation, Pearson correlation and Network analysis were performed.Results: A differentiation between the SQoL items and the SSPA items appeared. The strongest nodes in the network were social appropriateness (7.413), focus (7.763) and clarity (7.438) from the SSPA measure. The nodes rated highest on the betweenness measure were affect from the SSPA and satisfaction with getting along with other people from the SQoL scale.Conclusions: Interventions should target the skills of focus, clarity and social appropriateness as they present the central items in the network.

Tracing Metacognition in Psychotherapy: Associations With Symptoms of General Distress and Depression.

Deficits in metacognition have often been identified as a central feature in various forms of psychopathology. The current study explores changes in metacognition and symptoms during the process of psychodynamic-oriented psychotherapy conducted in a community setting among people with diverse psychological challenges. We examined the associations between metacognition and symptoms at both the within-client and the between-clients level. Nine good-outcome and nine poor-outcome cases of psychodynamic treatment were analyzed. In terms of metacognitive abilities, results showed that clients who were part of the good-outcome group had higher levels of decentration than did clients who were part of the poor-outcome group. In addition, clients' ability to understand the other's mind improved significantly only for clients in the good-outcome group. Furthermore, sessions in which clients' self-reflectivity was higher were followed by increased symptom levels (in the next session) beyond group (poor or good outcome group). Clinical implications regarding the improvement of metacognitive abilities and their associations with outcome measures are discussed.

Metacognitive Reflection and Insight Therapy (MERIT) Among People With Schizophrenia: Lessons From Two Case Studies.

People with schizophrenia spectrum disorder face a major challenge in the ability to reflect on their own and others' mental activities and about specific psychological problems in their lives. These deficits are associated with increased symptoms and lower functioning. Specific interventions have been designed to enhance these abilities, one of which is metacognitive reflection and insight therapy (MERIT). Several case studies and a recent pilot study have shown increased metacognitive abilities and a decrease in symptoms among clients after MERIT. This article presents two case studies of clients diagnosed with schizoaffective disorder whose psychotherapy, conducted in Israel, incorporated the MERIT protocol. Outcome measures were taken before and after treatment, and metacognitive abilities were assessed at five time points throughout treatment. Clinical implications and limitations are discussed.

Neuro-cognition and social cognition elements of social functioning and social quality of life.

Previous studies have shown that deficits in social cognition mediate the association between neuro-cognition and functional outcome. Based on these findings, the current study presents an examination of the mediating role of social cognition and includes two different outcomes: social functioning assessed by objective observer and social quality of life assessed by subjective self-report. Instruments measuring different aspects of social cognition, cognitive ability, social functioning and social quality of life were administered to 131 participants who had a diagnosis of a serious mental illness. Results showed that emotion recognition and attributional bias were significant mediators such that cognitive assessment was positively related to both, which in turn, were negatively related to SQoL. While one interpretation of the data suggests that deficits in emotion recognition may serve as a possible defense mechanism, future studies should re-assess this idea.

Agency before action: The application of behavioral activation in psychotherapy with persons with psychosis.

Incorporating behavioral activation into psychotherapy with persons with psychosis requires adaptation in its conceptualization and application owing to special deficits in the self-experience. Persons with psychosis often experience a diminished or disorganized sense of self, and have deficits in coherently narrating the experience of the self and in the ability to make sense of how to take action and direct their own lives. Based on a metacognitive model of disability in psychosis, the current paper presents a therapy process of a woman coping with schizophrenia using Metacognitive Reflection and Insight Therapy (Lysaker and Dimaggio, 2014) in the framework of an intersubjective model for psychotherapy with persons with psychosis presented by Hasson-Ohayon, Kravetz, and Lysaker (2016a). The case in point and its following discussion highlight the important significance of metacognitive encouragement as a first step of behavioral activation. (PsycINFO Database Record