The beginning of the end: A comparison of treatment completers and early dropouts in trainee-provided time-limited Cognitive Behavioral Therapy.

About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.

Identifying Ruptures and Repairs in Alliance-Focused Training Group Supervision.

Group supervision presents unique opportunities for psychotherapy trainees to deepen their understanding of alliance ruptures and repair strategies. Trainees can explore challenging clinical moments and benefit from diverse perspectives and support. Group supervision also provides trainees with multiple opportunities to experience ruptures and repairs firsthand in their interactions with the supervisor and other group members. More research, particularly research using observer-based methods, would enhance our knowledge of rupture and repair processes in group supervision. In this study, seven sessions of Alliance-Focused Training, a group supervision that specifically aims to improve trainees' abilities to recognize and negotiate ruptures, were coded for alliance rupture markers and repair strategies using a modified version of the Rupture Resolution Rating System (3RS). Excerpts of the coded sessions were used to illustrate AFT process in the absence of ruptures, and in the context of ruptures between the supervisor and trainees, between trainees, and between a trainee and the group. There were no clear examples of ruptures between trainees. The ruptures between the supervisor and the trainees were deemed to have only a minor impact on the alliance, and these minor ruptures were at least partly addressed. Based on the coding, themes related to supervisor authority, complex and subtle ruptures, and the use of metacommunication within the AFT group were discussed. The findings of this exploratory study suggest that the 3RS can be useful for measuring process in group supervision, and that greater attention to group process and ruptures within the group holds promise for enhancing the effectiveness of AFT.

What's in a Name? Evaluating the Public Stigma of Gambling Disorder.

Public stigma of gambling disorder has negative effects on the mental health and functioning of affected individuals and impedes treatment-seeking. One factor thought to be implicated in stigma is the label used to describe the condition. The aims of this research were to: (1) evaluate whether different labels for problematic gambling behavior influence public stigma; and (2) compare public stigma of gambling disorder to other health conditions. Separate samples of university student (Study 1) and general population (Study 2) participants were randomly assigned to label conditions and completed questionnaires assessing stigma and attitudes towards the assigned label. In Study 1, the eight conditions included four gambling labels (problem gambling, pathological gambling, gambling disorder, and gambling addiction) and four psychiatric or health comparison labels (depression, obsessive-compulsive disorder, alcohol use disorder, and asthma). In Study 2, compulsive buying disorder was added as a fifth psychiatric comparison for a total of nine conditions. The results indicated that the four gambling label conditions elicited similar attitudes and stigma. Those conditions were also more stigmatized than the depression, obsessive-compulsive disorder, and asthma conditions. The gambling conditions elicited similar stigmatizing attitudes as alcohol use disorder but were slightly more stigmatized than compulsive buying disorder, with these conditions showing both similarities and differences across the stigma-related outcomes. The results were largely consistent across both samples and contribute to knowledge of the nature and origins of gambling-related stigma.