While a significant amount of research illustrates the positive effects of therapists’ use of mindfulness, few studies have addressed whether therapists’ mindfulness actually improves psychotherapy outcomes. Additionally, no existing research has examined whether therapists’ use of a mindfulness exercise immediately before meeting with a client could also have a positive impact on the following session. The purpose of this study was to test whether engaging in a centering exercise 5-10 minutes before a session could have a positive impact on therapy, in particular on the therapists’ ability to remain present in session. Results indicated that the trainee therapists did not report changes in mindfulness after the brief mindfulness training program. Results also indicated that completing the centering exercise before a session did not appear to impact client ratings of therapeutic presence and session outcomes. The results suggest that more intensive training in mindfulness may be necessary to impact psychotherapy outcomes.

While a significant amount of research illustrates the overall positive effects of therapists' general use of mindfulness, very few studies have addressed whether therapists' use of mindfulness translates to improved psychotherapy outcomes. The present study utilized a randomized-controlled design to test whether a brief mindfulness training program and pre-session mindfulness practice could have a positive impact on therapy; in particular, we hypothesized that mindfulness training and practice would improve ratings on therapeutic presence as rated by clients and therapists and session effectiveness as rated by clients. The present study also examined whether clients' subjective ratings of therapy outcome and therapists' theoretical orientation impacted outcome measures after therapists completed mindfulness training. The 20 participating therapists were randomly assigned to either the mindfulness training (MT) group or control group according to a computer generated randomization list. Results indicated that clients did not significantly improve on outcome measures after completing the mindfulness training. Clients' subjective ratings on a psychotherapy outcome measure did predict changes in their ratings of therapeutic presence. This finding may have important implications for future research examining client characteristics that may moderate the relationship between therapeutic presence and session outcomes. Limitations of the present study and future directions are discussed.

The therapeutic alliance has consistently been associated with improved client outcomes across numerous psychotherapy outcome studies. Previous systematic reviews have, however, evaluated the univariate association of the alliance with client outcome. The present meta-analytic review examines the association of the alliance with improved client outcomes after accounting for the presence of therapist empathy, client attachment styles, and client expectations. Across 23 independent studies, the alliance, adjusted for the presence of the other variables, remained as the most robust predictor of improved outcomes r = .258 (SE = .01, p < .001), with a 95% confidence interval of r = .18 to r = .33. After accounting for therapeutic alliance, therapist empathy was a small but statistically significant predictor of improved outcomes. These findings provide the first attempt at synthesizing multivariate estimates of the contribution of the alliance with improved outcomes when in the presence of empathy, client attachment style, and client expectations. The findings presented here suggest the superordinate nature of the alliance as a variable that exists on a separate conceptual level from the other variables evaluated.

The field of mental health treatment is making efforts to better serve all psychotherapy clients, but especially the 5–10% of clients who deteriorate in treatment (Lambert & Ogles, 2004) and the 30–60% who drop out prematurely (Pekarik & Stephenson, 1988). These efforts involve collaboration between research and practice. Both research and practice have been treatment focused for much of their history, primarily examining treatment efficacy or effectiveness, and never quite settling on the generalizability or applicability of specific treatments. The patient-focused research paradigm has shifted the focus from treatment outcomes on the group level to outcomes on the individual client level. This movement involves outcome monitoring for purposes of treatment planning and quality care. Some of these monitoring systems include early warning systems that could help identify and better serve clients who are at risk for negative outcome. The present study validated previous warning system studies for youth and replicated tests for variables that were predictive of youth change trajectories using the Youth Outcome Questionnaire-30 (YOQ; Burlingame et al., 2004). This study also replicated the accuracy of a warning system for at-risk youth clients, exploring various approaches to creating the cutoffs the warning system uses for its predictions, and reporting the respective accuracy of each. This study contributes to future studies comparing outcomes between client groups whose therapists do or do not receive systematic feedback. This endeavor offers many benefits to quality improvement efforts being made by clinicians and managed care organizations.

This study is a phenomenological investigation of psychotherapists' experience receiving quantitative and evaluative feedback on job performance. Participants were licensed psychologists working at a university counseling center. They were given feedback reports that compared their clients' psychotherapy outcomes with the outcomes of their colleagues' clients. Psychotherapy outcomes were measured using the Outcome-Questionnaire 45 (OQ-45), a self-report outcome instrument designed for tracking client progress through repeated measurement. Feedback reports included data about where psychotherapists' outcomes ranked (in quartiles) in comparison to the rest of the counseling center. Interviews were conducted with participants to gain a deeper understanding of their experience receiving quantitative and evaluative feedback. Interviews were conducted, transcribed, and analyzed in accordance with the phenomenological method as explained by Wertz (2005) and the descriptive psychological phenomenological method as explained by Giorgi (2003). Content of interviews was grouped into four emergent themes: Ego Responses, Interpretation, Credibility, and Application. Responses indicated that participants felt both threatened and reassured by their feedback. Those who reported feeling reassured were more inclined to see this as a validation of their approach to psychotherapy while those who felt threatened were more inclined to see the feedback as an assessment of identity. Many indicated that they struggled to understand terminology on the feedback reports as well as the statistical methodology used to analyze the data. Those who struggled to interpret the feedback reports were more likely to distrust or dismiss the results. While very few participants were dismissive of the notion that the feedback reports were valid measures of therapist efficacy, many were ambivalent about this question. Participants did not indicate making concrete behavioral changes as a result of receiving the feedback, although a few reported that the feedback induced introspection about "what is good psychotherapy," as well as dialogues with colleagues.

Researchers have found evidence that when clinicians use an evidence-based feedback system that uses Clinical Support Tools (CST) for not-on-track clients, deterioration rates fall and success rates improve (Shimokawa et al., 2010). Despite multiple studies finding evidence in support of using the CST, there has been a discrepancy between effect sizes (i.e., d = 0.5; Simon et al., 2012). As such, further replicate of these past studies is needed to discover if small effect sizes still persist and if so, what possible variables may contribute to inconsistent findings. For the current study, it was predicted that the use of the CST would result in significantly lower OQ-45 scores at treatment termination after controlling for the intake OQ-45 score. Additionally, previous research indicated that the combined intervention of the progress feedback plus CST would significantly reduce deterioration rates with those NOT. Out of 1,122 participants, 172 were randomly assigned to one of two conditions: The CST feedback group (n = 71) and the no CST feedback group (n = 101). There was not a significant difference in the mean OQ-45 scores for the CST feedback group (M = 2.39, SD = 20.95) and the no CST feedback group (M = 4.17, SD = 19.74). The results of this study raise questions about how regularly the therapists were monitoring their clients' progress feedback and whether the CST are effective. Additionally, the author evaluates the timing of when the CST were administered to clients and when therapists reviewed the feedback.

Variables such as stigma, weak ethnic identity, and cultural mistrust have been linked to the underutilization of therapy amongst ethnic minority populations. As such, ethnic minority populations may reach a higher threshold of distress-including areas such as anxiety and depression-before seeking professional help. While there is substantial research documenting ethnic differences among various ethnic minority populations (e.g., African Americans, Asian Americans, Hispanics) very little research has been conducted exploring differences among individuals from Native Hawaiian and Pacific Islander (NHPI) backgrounds. For the current study, we explored differences in distress upon intake as well as the change in anxiety and depression scores over the course of 12 therapy sessions for NHPI college students compared to college students from other ethnic groups. We also explored the effect that spirituality and religiosity had on depression and anxiety among NHPI college students. We collected data from the Center for Collegiate Mental Health (CCMH), a practice research network that has aggregated data from hundreds of university counseling centers across the United States, from the years 2012-2015. Our total sample was N = 256,242; of that sample, n = 452 identified as NHPI. We selected independent variables from the Standardized Data Set (i.e., ethnicity, age, gender, estimated socioeconomic status, importance of spirituality and religiosity) and dependent variables from the Counseling Center Assessment of Psychological Symptoms-62 and -34 (i.e., depression, social anxiety, generalized anxiety). We analyzed data using latent growth modeling and computed a conceptual effect size by comparing the change in standard deviation between treatment effects. Results yielded significant differences (p < .05) between both intercept and slope estimates for NHPIs compared to African Americans, Hispanics, Asian Americans, and Whites. Notably, NHPI depression scores improved at the highest rate over time compared to other ethnic groups, while anxiety scores among NHPIs improved at the lowest rate. The effect of spirituality and religiosity on anxiety and depression was statistically insignificant. The results of this study indicated that NHPI college students experience psychotherapy outcomes differently than other ethnic groups, including Asian Americans, with moderate-to-large magnitudes of effect. Considering substantial meta-analytical research supporting the benefits of culturally adapted treatment, results of this study suggest the need to disaggregate the combined demographic Asian Americans and Pacific Islanders (AAPI), as research conducted on this broader group provides questionable validity when applied to clinical settings for NHPIs.

This study compares U.S. university counseling center therapy outcomes of Sexual Minority (SM) students who attend religiously-affiliated compared to SM peers who attend non religiously-affiliated institutions. Using archival data from the Center for Collegiate Mental Health (CCMH), we examined psychotherapy outcomes of 4257 SM student clients.We analyzed pre-treatment symptoms and post-treatment outcomes based on differences in Distress Index (DI) scores. We used the reliable change index (RCI) to separate outcomes into four groups based on the change in distress index level: no change, deteriorating, reliably improved, recovered from pre-treatment to post-treatment. Our participants (n = 4257) attended 34 religiously and non-religiously affiliated institutions (matched by geographical location, size, and percentage of the student body that were SM and sought therapy at the college counseling center). We found that SM students at religiously affiliated institutions had lower pretreatment and posttreatment distress scores than their peers at non-religiously affiliated institutions. Furthermore, gay students across universities consistently presented with lower distress than lesbian, bisexual, questioning, or self-identifying students. However, a larger proportion of SM students at non-religiously affiliated institutions achieved a reliable change status of recovered from their presenting distress levels, while a larger proportion of SM students at religiously affiliated institutions remained in the no change category. We found a significant effect of religious affiliation and Sexual Orientation (SO) on pretreatment distress scores, F(2, 4255) = 18.395, p < .001, and posttreatment distress scores, F(1, 4255)=15.199, p = .035), with moderate effect sizes (d=.137, and .061, respectively). Our findings emphasize the importance of culturally competent and affirming practices, ensuring that interventions resonate with the varied religious and cultural experiences of SM individuals. This is not just a research endeavor; it is a collective responsibility to foster campuses that prioritize the mental health and well-being of every student.

Alcohol abuse is a ubiquitous issue for college students across the United States (U.S.) including Native Hawaiians and Pacific Islanders (NHPI). As compared to their counterparts, NHPI students tend to underutilize university counseling services and have significantly lower retention rates than their White counterparts. Considering that NHPI may be reluctant to go to counseling, their levels of distress and alcohol abuse may have to reach a higher threshold before they seek treatment. This study examined NHPI college students' presenting levels of alcohol abuse both at intake and over time and compared these students to students from other ethnic/racial groups. Data were gathered from the Center for Collegiate Mental Health (CCMH), a practice-research network used by hundreds of college counseling centers across the U.S. Aggregated data from the years 2012-2015 included variables measured by the Standardized Data Set (SDS) and the Counseling Center Assessment of Psychological Symptoms (CCAPS). The data were analyzed using Latent Growth Modeling (LGM) to assess the differences at intake and over time in alcohol abuse and distress across ethnic groups. Results of this study indicated that NHPI college students at college counseling centers had higher levels of alcohol abuse and presenting distress at intake than students from other ethnic/racial groups. However, NHPI did not have significantly different changes in levels of alcohol abuse from session one to session 12 as compared to other students. Implications and directions for further research are also discussed.

The current study sought to examine client outcome data for clients seen for outpatient psychotherapy services by graduate-level student therapists in doctoral psychology training clinics in order to better understand the change process occurring in such settings and to examine whether services being offered are meaningful for clients. One hundred ninety-nine clients seen by graduate-level therapists at a training clinic setting were assessed on a session-by-session basis using the Outcome Questionnaire-45 in order to identify the percentage of clients who met criteria for clinically significant change, reliable improvement, no change, or deterioration in outcomes across the course of treatment. Approximately 28% of clients seen for treatment met criteria for clinically significant change at the termination of treatment and 23% reliably improved. Survival analysis indicated that the median time required to attain clinically significant change was six sessions. Current findings are compared to earlier investigations in both training and nontraining settings. The implications of these findings for education and training, client care and clinical services, and policy are discussed.