Chairwork in individual psychotherapy: Meta-analyses of intervention effects.

The present study examines (a) the unique effects of chairwork on emotional process and intervention outcomes across treatments in the context of individual psychotherapy and (b) how these effects compare to other treatment interventions. Based on the appropriateness of the data available, meta-analyses with estimated effect sizes and narrative syntheses were conducted for psychotherapy process as well as symptom outcomes. Single-session chairwork was found to be more effective in deepening client experiencing than empathic responding (d = .90), although it may have an effectiveness similar to other interventions for facilitating emotional arousal or shifting the credibility of core beliefs. A single session of chairwork also has noteworthy pre-to-post symptom change (d = 1.73), although these improvements may be comparable to other methods of intervention (d = .02). However, when chairwork was used multiple times over the course of a treatment, it accumulated a meaningful effect (d = .40) compared to treatments that did not use chairwork. Therapeutic orientation emerged as a potential moderator. Incorporating chairwork into treatments may bolster process and intervention outcomes. We conclude the article with training implications and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Depth of experiencing and therapeutic alliance: What predicts outcome for whom in emotion-focused therapy for trauma?

OBJECTIVE: The purpose of this study was to determine the extent to which therapeutic processes - working alliance and depth of experiencing - contributed to outcome. METHOD: Individual differences in these processes were examined at the early and working phases to determine their impact on symptom reduction. An archival data set of N = 42 individuals who underwent emotion-focused therapy for trauma for childhood maltreatment was used to examine the differential quality of client processes throughout treatment. RESULTS: For those who had difficulty forming an alliance early in therapy, alliance scores during the working phase were the best predictor of outcome (ß = -.42). This was complemented by a process change of improvement in alliance from the early to working phases (d = 1.0). In contrast, for those who had difficulty engaging in deepened experiencing early in therapy, depth of experiencing in the working phase was the best predictor of outcome (ß = -.36). This was complemented by an improvement in depth of experiencing from the early to working phases (d = .69). CONCLUSIONS: The findings of this study suggest that focusing on the process that clients have trouble with early in therapy contributes to the best treatment outcome. PRACTITIONER POINTS: Sometimes early treatment sessions reveal an abundance of one kind of processing but limitations to another, which poses a puzzle for treatment planning. Our findings suggest that within the first four sessions, therapists could develop tailored treatments based on the relative presence or absence of critical therapeutic changes processes. When it becomes evident that therapy is progressing with a weaker alliance between client and therapist, therapists should redouble their efforts in alliance-building. However, when therapy is developing in a fashion that lacks deep emotional experiencing on the part of the client, treatment efforts should aim to facilitate a richer exploration of moment-by-moment experience. As such, our findings suggest relying on the existing processing strengths within a dyad (e.g., emphasis on an already strong relationships, or augmenting an existing aptitude for deeper experiencing) while shortcomings exist in another kind of process is not optimal responding. Therapists should focus their work on the process that clients have trouble with early in therapy to facilitate the best treatment outcome.

Verbal fluency and digit span variables as performance validity indicators in experimentally induced malingering and real world patients with TBI.

Objective: This study was designed to examine the classification accuracy of verbal fluency (VF) measures as performance validity tests (PVT).Method: Student volunteers were assigned to the control (n = 57) or experimental malingering (n = 24) condition. An archival sample of 77 patients with TBI served as a clinical comparison.Results: Among students, FAS T-score ≤29 produced a good combination of sensitivity (.40-.42) and specificity (.89-.95). Animals T-score ≤31 had superior sensitivity (.53-.71) at .86-.93 specificity. VF tests performed similarly to commonly used PVTs embedded within Digit Span: RDS ≤7 (.54-.80 sensitivity at .93-.97 specificity) and age-corrected scaled score (ACSS) ≤6 (.54-.67 sensitivity at .94-.96 specificity). In the clinical sample, specificity was lower at liberal cutoffs [animals T-score ≤31 (.89-.91), RDS ≤7 (.86-.89) and ACSS ≤6 (.86-.96)], but comparable at conservative cutoffs [animals T-score ≤29 (.94-.96), RDS ≤6 (.95-.98) and ACSS ≤5 (.92-.96)].Conclusions: Among students, VF measures had higher signal detection performance than previously reported in clinical samples, likely due to the absence of genuine impairment. The superior classification accuracy of animal relative to letter fluency was replicated. Results suggest that existing validity cutoffs can be extended to cognitively high functioning examinees, and emphasize the importance of population-specific cutoffs.