This study explores therapists' personal outcomes of the Portland Model (PM) approach to online peer group supervision. This approach is rooted in acceptance and commitment therapy, whose main features are being self-conducted and using experiential techniques. The study compared clinicians attending six PM sessions (N = 14) with a control group (N = 14) in terms of inclusion, self-compassion, burnout, well-being and mindful awareness. Furthermore, we used sociograms to explore the relationship network formed within the group. Results show that PM group supervision improves the sense of inclusion and mitigates some aspects of burnout. However, the approach didn't foster strong in-group relations.

Objective: Countertransference research has demonstrated the importance of countertransference management for successful therapy outcomes. In this study we expand the notion of countertransference management by investigating the relationship between countertransference experienced within sessions and the elaborative activity taking place between sessions. Method: Twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of 69 counseling sessions and to complete a Post Session Therapist Questionnaire, an instrument assessing three relevant reflexivity activities in the post-session time. The 69 sessions were also recorded, transcribed, and evaluated by three external raters, who applied the Countertransference Behavior Measure. Results: Results showed significant correlations between some dimensions of countertransference experienced in the session and some dimensions of the therapists' post-session working through. Conclusion: Our results highlight the centrality of therapists' in-between session reflexivity processes in addition to awareness of countertransference within sessions, a process that has a potential impact on therapeutic outcomes.

ObjectiveCountertransference (CT) has been shown to interfere with therapy goals, and its management is crucial to desired treatment outcomes. As a first step, a clinician's awareness of their covert and overt CT reactions is critical to successfully managing CT. Research on CT awareness is scarce, however, mainly because of difficulties in empirically investigating and measuring this construct. In this study, we sought to develop and validate two instruments: one to measure CT feelings and one to measure CT behaviors.MethodWe developed the Countertransference Feelings Awareness Measure and the Countertransference Behavior Awareness Measure, both composed of 12 items comprising 3 dimensions: dominant, hostile and distant. A sample of 245 Italian and 110 American clinicians participated in the research. Confirmatory factor analysis was conducted to verify the factor structure of the measures. Reliability and invariance analyses were conducted for both measures and both samples.ResultsFactorial structure, reliability, and configural invariance across nationalities of both measures were confirmed.ConclusionThese tools should prove useful for future research, supervision, theoretical advances, and clinical application, allowing a deeper understanding of how clinicians' awareness of different elements of their CT experience impacts the outcome of therapy..

Fibromyalgia is a chronic disorder causing widespread pain, fatigue, and cognitive issues, linked to central nervous system dysfunction. This cross-sectional study compared the psychological profiles of women with fibromyalgia (N = 76) and women with non-fibromyalgic chronic pain (N = 73). Using cluster analysis, scale score comparisons using MANCOVA, and correlation difference tests, we examined whether these conditions present distinct psychological profiles in terms of touch avoidance, anxiety, depression, psychotic symptoms, self-criticism, pain acceptance, pain impact, and positive emotions. Cluster analysis successfully differentiated between FM and non-FM CP patients with 76% accuracy with and an adjusted Rand index of.26, suggesting distinct psychological profiles while acknowledging substantial overlap. FM patients reported significantly higher levels of anxiety, depression, and psychotic symptoms, along with greater self-criticism and reduced activity engagement (p < .001 for all significant comparisons expect psychotic symptoms, p = .07, and opposite sex touch avoidance, p = .014). Both groups showed elevated touch avoidance, with no significant differences between them. Correlation analysis revealed that self-criticism played a more central role in FM patients' psychological distress, showing stronger associations with depression, anxiety, and positive emotions compared to non-FM CP patients (Jennrich test for differences between the two correlation matrices: Χ2 = 436.72, p < .001). These findings suggest that while FM and non-FM CP share common psychological features, FM patients experience more severe psychological distress, with self-criticism potentially playing a crucial maintaining role. Results suggest that psychological interventions for FM patients should prioritize reducing self-criticism and enhancing self-reassurance, while healthcare providers should be mindful of the significant psychological burden these patients carry.

Measuring psychological traits with standardised questionnaires is an essential component of clinical practice and research; however, patients and participants risk fatigue from overly long and repetitive measures. When developing the short form of a questionnaire, the most widely used method for selecting an item subset uses factor analysis loadings to identify the items most closely related to the psychological construct being measured. However, this approach will tend to select highly correlated, homogeneous items and might therefore restrict the breadth of the construct examined. In this study, we will present Yarkoni's genetic algorithm for scale reduction and compare it with the classical scale reduction method. The algorithm will be applied to the shortening of three instruments for measuring self-compassion and social safeness (two unidimensional measures and a three-factor measure). We evaluated the shortened scales using correlation with long-form scores, internal reliability and the change in the correlations observed with other related constructs. Findings suggested that the classical method preserves internal reliability, but Yarkoni's genetic algorithm better maintained correlations with other constructs. An additional qualitative assessment of item content showed that the latter method led to a more heterogeneous selection of items, better preserving the full complexity of the constructs being measured.

Objective: Countertransference (CT) research has demonstrated the importance of CT management for successful therapy outcomes. Over time, CT research began to take this aspect more and more seriously and expanded the concept of CT management to include aspects, such as stable characteristics of the therapist and his or her theoretical model, that do not necessarily pertain the single session (e.g., therapist’s self-integration, theoretical framework). In this study we further expand the boundaries of CT management by investigating the relationship between CT experienced within sessions and the elaborative activity taking place between sessions. Method : Twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of 69 counselling sessions and to fill the Post Session Therapist Questionnaire, an instrument assessing three relevant reflexivity activities in the post-session time. The 69 sessions were also recorded, transcribed and evaluated by three external raters, who applied the Countertransference Behavior Measure. Results: Results showed significant correlations between some dimensions of CT experienced in the session and some dimensions of the therapist’ post-session working through. Conclusion: Results highlighted the centrality of the reflexivity processes that therapists put in place between sessions and not only within the session to increase awareness of their countertransference, a prerequisite for its handling during the session for therapeutic purposes.

Patients with health pathologies may exhibit psychological features in addition to medical symptomatology. A sample of 76 Italian women with an age range between 23 and 78 years old (mean = 50.22 ± 10.47 years) diagnosed with fibromyalgia (a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, cognitive and mood issues) was examined to identify typical characteristics of their psychological profile. All patients were administered a series of questionnaires, to assess avoidance of physical touch by others; anxiety; depression; risk of developing psychotic disorders; self-criticism and perfectionism; acceptance of chronic pain; general impact of the pathology on their lives, and the predisposition to experience positive emotional states. The scores resulting from this assessment were evaluated against the normative data. Patients with fibromyalgia showed psychological dysfunction in most of the scales administered, with a significantly higher disposition to experience compassion towards others (t = 5.94, df = 75, p < 0.001). A higher risk of psychosis was related with higher levels of depression (B = 0.49, t = 0.20, p = 0.015), poor involvement in daily activities (B = 0.41, t = 0.13, p = 0.002), touch avoidance (especially towards strangers, B = −0.20, t = 0.14, p = 0.01), and overall poor quality of life (B = 0.40, t = 0.16, p = 0.01). This study may broaden the possibility to evaluate psychological features in this clinical population; it may contribute to tailoring psychological care and related treatments in the context of health services.

In recent years, especially in the era of the COVID-19 pandemic, we have witnessed a partial transition in the field of psychotherapy from in-person settings to remote ones (i.e., online therapy). This trend has raised the question of whether the two settings are interchangeable. With the research described here, the authors explore, within a transactional analysis theoretical framework, whether the therapeutic impact of in-person sessions, assessed by both patients and therapists, is different from that perceived with a remote setting. Using the Session Evaluation Questionnaire (SEQ), 20 transactional analysis psychotherapists and their patients evaluated the impact of two pairs of sessions—one in person and one online—for a total of 160 SEQs. The data were then analyzed through t-tests to verify the research hypotheses. For therapists only, the impact of remote sessions was perceived to be lower than that of in-person sessions. The implications are discussed from a clinical point of view.

The role of interpretation as a core intervention promoting good outcomes in psychotherapy is well acknowledged and established. Nevertheless, evidence of the role of interpretative interventions in promoting patients’ change dynamic is still lacking. The present work, a good outcome psychotherapy single case study, focuses on how different interpretative modalities support different patients’ intrapsychic dynamics implied in changing affective experience interpretation and clinical success. The grid of the models of interpretation (GMI) and the Discourse Attributes Analysis Program (DAAP) were applied to all therapy transcripts (N = 76 sessions) in order to detect, respectively, the interpretative models enacted by the therapist and patients’ intrapsychic processes subtending affects elaboration. Two different regression models tested the role of interpretative interventions in promoting specific processes supporting patients’ affective elaboration. A further regression model then highlighted a specific configuration in the clinical course in processes promoting affect elaboration. Results are discussed, offering cues for a clearer understanding of the role of the therapist’s interpretative interventions in promoting the clinical dynamics, thereby paving the way for the change process.

Background: The negative effects of the unmanaged countertransference on session outcome are well documented, but little is known about the impact of countertransference reactions on the in-session elaboration processes. This study investigated the impact of countertransference reactions on the quality of client and counsellor's in-session work as revealed by their linguistic style, assuming that linguistic style shows the quality of speakers' referential process, i.e., their ability to translate into words and reorganize the client's emotional experiences. Methods: To test this hypothesis twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of the first three counselling sessions with one of their clients, for a total of 69 sessions. These sessions were recorded, transcribed, and evaluated by three external observers who applied the Countertransference Behavior Measure. Finally, the transcripts were analyzed by applying the computerized linguistic measures of the referential process. Results: We found that countertransference reactions were associated to clients' specific speech styles characterized by a lower referential process especially in the case of dominant, helpless, overwhelmed, and parental countertransference reactions. For the counsellors, we observed a linguistic style marked by emotional distancing. Conclusions: This study confirms that linguistic indicators can capture the impact of countertransference reactions, which shows to hinder the emotional elaboration in the counselling sessions.

Objective: The present work aims to conduct the first naturalistic empirical investigation of the process and outcome assessment of functional psychotherapy (FP) treatment. The FP model of psychotherapy is rooted in psychoanalysis and integrates the verbal communication approach founded on transference and countertransference dynamics with the analysis of bodily processes. Method: The study sample included ten patients recruited on a voluntary basis and treated by clinicians in their private practices. Each patient received FP with an average duration of 40 h (min 35 and max 42). Therapies had weekly sessions, were audio-recorded with the patient's written consent, and lasted for an average of 10 months (min 9 and max 12). Outcome and process tools included the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Luborsky's the Core Conflictual Relationship Theme (CCRT), used to assess therapeutic benefit, and the Metacognition Assessment Scale (MAS) and the Italian Discourse Attributes Analysis Program (IDAAP) system, used to evaluate therapeutic benefit and process. The MMPI-2 was used also in the follow-up assessment. Results: Results show that FP had a positive therapeutic outcome on the patients assessed in this study, and that the therapeutic benefits were maintained over time. Some specific features of the FP approach were found to contribute more than others to the observed therapeutic benefits. Conclusion: The current investigation constitutes a first step toward assessment of the therapeutic effectiveness of FP. Future developments should apply the methodology to a larger sample, possibly introducing different methodologies to enable detection of specific bodily oriented processes and techniques.

For the psychodynamic approach, being aware of and managing countertransference is a core therapeutic competency. Research has demonstrated the negative effect of unmanaged countertransference on the outcomes of all kinds of psychotherapy. In this study, we focused on the relationship between countertransference when measured by therapists and external observers and its impact on session quality. We analyzed 69 counseling sessions, held by 23 in-training psychotherapists with 23 patients. We used the Therapist Response Questionnaire and three external observers (who used the Countertransference Behavior Measure) to measure psychotherapists' countertransference. We rated the session impact perceived by patients and psychotherapists using the Session Evaluation Questionnaire and by patients through the Session Impact Scale. Psychotherapists' and observers' ratings of countertransference correlated though on different dimensions. These results indicate that comparing external and internal evaluations can help to understand various aspects of countertransference since they have different associations with the session outcome. From a methodological point of view, it is necessary to adopt various perspectives to investigate countertransference. Future research should confirm these results on a sample of experienced psychotherapists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: The present work aims to conduct a first naturalistic empirical analysis on the outcome assessment of the functional psychotherapy (FP) intervention treatment, a model of psychotherapy that has its roots in psychoanalysis and integrates the verbal communication approach founded on transference and countertransference dynamics with the analysis of bodily processes. Method: The research’s sample included ten patients, who joined the study on a voluntary basis and were met by clinicians in their private practices. Each patient received a FP with an average duration of 40h (min 35, max 42). Therapies had weekly sessions, were audio-recorded with the patients’ written consent, and lasted for an average of 10months (from 9 to 12). Different outcome and process tools were applied: The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Luborsky’s the Core Conflictual Relationship Theme were applied to verify the therapies’ outcomes; the Metacognition Assessment Scale and the Italian Discourse Attributes Analysis Program system were applied to evaluate both the therapies’ outcome and process. MMPI-2 was used also in the follow-up. Results: Results highlight that FP has a positive outcome on the patients considered in this study and that the results were maintained over time. Some specific features of the FP approach emerged through the analysis of the therapeutic processes; these features have been related to the positive outcome obtained. Conclusion: The work constitutes a first step toward an analysis of the therapeutic effectiveness of FP. Future developments shall apply the methodology to a larger sample, possibly introducing different methodologies which allow to detect the specific bodily oriented processes and techniques.

This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality diagnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.

The role of interpretation as a core intervention promoting good outcomes in psychotherapy is well acknowledged and established. Nevertheless, evidence of the role of interpretative interventions in promoting patients’ change dynamic is still lacking. The present work, a good outcome psychotherapy single case study, focuses on how different interpretative modalities support different patients’ intrapsychic dynamics implied in changing affective experience interpretation and clinical success. The grid of the models of interpretation (GMI) and the Discourse Attributes Analysis Program (DAAP) were applied to all therapy transcripts (N = 76 sessions) in order to detect, respectively, the interpretative models enacted by the therapist and patients’ intrapsychic processes subtending affects elaboration. Two different regression models tested the role of interpretative interventions in promoting specific processes supporting patients’ affective elaboration. A further regression model then highlighted a specific configuration in the clinical course in processes promoting affect elaboration. Results are discussed, offering cues for a clearer understanding of the role of the therapist’s interpretative interventions in promoting the clinical dynamics, thereby paving the way for the change process.

In this paper, we present the development of a new self-report questionnaire to assess a specific characteristic of clinical work: the mental (affective and rational) work that therapists do between clinical sessions. The resulting instrument is the Post Session Therapist Questionnaire. In the pre-research phase, we generated 40 items. We had 16 experts carefully examine the questionnaire's content validity at various stages and thus obtained 38 pertinent, clear, and unambiguous items. We then carried out a pilot study with 29 clinicians, who filled out the questionnaire twice, referring to 100 patients in each case. To assess the structural validity of the new instrument, we conducted an Exploratory Factor Analysis using the session (N = 200) as the unit of analysis. Three factors supported the theoretical dimensions conceptualized in the pre-research: we called the factors Positive Regard, Comprehension, and Diagnostic Effort. These dimensions have good internal consistency. The study's results suggest that these clinical dimensions are meaningful in the development of clinical processes, thereby encouraging further study of the psychometric properties of the questionnaire, with larger samples, so as to consider these results in relationship to the outcomes of the following sessions.

Objective: Bucci's multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases. Method: We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale - Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts. Results: In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the fourfactor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts. Conclusions: The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervision.

This study aimed to investigate the mediational role of dispositional mindfulness, psychological inflexibility, and resilience in the link between attachment orientations and psychological well-being. Ninety-six adult participants in this cross-sectional study completed self-report measures of adult attachment (ECR-R), dispositional mindfulness (FFMQ), psychological inflexibility (AAQ-II), resilience (RSA), and psychological well-being (PWB). Correlation analyses showed that higher levels of attachment anxiety and attachment avoidance were associated with lower levels of psychological well-being. Multiple mediation analyses, simultaneously taking the parallel action of the mediators into account, indicated that the link between attachment orientations and well-being is fully mediated by dispositional mindfulness, psychological inflexibility, and resilience. Both attachment anxiety and attachment avoidance may significantly reduce individuals' well-being by increasing their psychological inflexibility and decreasing their resilience and mindfulness. It might be useful to develop interventions designed to improve the psychological well-being of insecurely attached individuals by promoting their self-awareness, mindfulness, and resilience, as well as reducing their psychological inflexibility.

The idea to conceive a Special Section about psychotherapy training stemmed from the reflections, definitions of critical points, and suggestions that each of us, in different situations (i.e., didactic, internship, supervision), institutions (both university and private specialization schools), and roles (trainers in the present, trainees in the past, and current psychotherapists and researchers in psychotherapy), have developed concerning the training in psychotherapy. The main question arose as follows: Which trainee factors play an important role in the therapeutic process, making it effective? Consequently, what should a psychotherapy training school address most? Moreover, in the last decades, both clinical and developmental research (e.g., Beebe & Lachmann, 2002; Siegel, 2012) has taught us to review our view of development, psychopathology, and, consequently, the concept of the mind itself. This change has had a radical impact also in psychotherapy research. The gradual integration of this new knowledge (from the observation of motherchild micro-interactions to the attachment theory; from the studies on trauma to neuroscience) in its theoretical (and empirical) fabric has radically changed the way of conceiving the mechanisms of change and the process of psychotherapy. However, in the midst of these theoretical radical transformations, the way psychotherapists are trained has remained mostly unchanged and unstudied. In this complex scenario, a spontaneous and critical question arises: What should or should not be involved in providing comprehensive and effective training for psychotherapists? Miller, Hubble, and Duncan (2008), reflecting on trainees’ and therapists’ effectiveness, stated: «it is critical that we find answers to these questions. If being the best is a matter of birth, personal disposition, or chance, the phenomenon would hardly be worth further study. But should (therapists’ and trainees’) talents prove transferable, the implications for training, certification, and service delivery are nothing short of staggering» (p. 16). They also stressed the importance of empirically monitoring the therapists’ development in relation to training programs and personal factors and experiences. Addressing this issue is very difficult, especially considering that nowadays, the study of psychotherapy process research still presents huge challenges, and it is not yet possible to develop a unified theory of all the components that play a role in it. The “starting from the model” approach to training has received many criticisms, such as that expressed by Beutler (1995), according to whom: «academic training programs continue to follow procedures that suggest a belief in the “germ theory of education”. That is, they operate Introduction to the Special Section on “The Role of Psychotherapy Research in Psychotherapy Training: Mutual Influences and Relations”