SPR Program

This workshop introduces Emotional Cultivation, a culturally grounded framework that integrates Eastern relational wisdom with Western emotion-regulation science. The BEAR model operationalizes this integration through four core processes: Belief Reframing, Emotional Consequence Awareness, Action Control, and Flexible, culturally congruent emotion regulation strategies. Developed in Taiwan, Emotional Cultivation addresses youth emotional regulation difficulties that are prevalent across Asia and globally, including impulsiveness, depression, and relational distress (Wang et al., 2019). The BEAR Group is an evidence-based, school-based intervention that has accumulated large-scale empirical support from practice-oriented research, longitudinal studies, and multilevel analyses. Findings consistently show improvements in emotional cultivation, relational problem-solving, psychological needs satisfaction, and reductions in depression, including among youth with adverse childhood experiences (Kivlighan et al., 2024; Wang et al., 2016; Wang & Wei, 2018). Recent studies with teachers also demonstrate gains in emotional well-being and adaptive self-care, underscoring the model’s cross-population applicability (Wang et al., 2025). This workshop provides: (1) a conceptual overview of Emotional Cultivation and the BEAR framework, (2) practical strategies and core activities for leading BEAR Groups, and (3) structured reflection to explore opportunities for collaborative research. As one of the few empirically validated, culturally grounded interventions developed outside Western contexts, Emotional Cultivation offers a distinctive platform for joint research and international knowledge exchange. The workshop invites scholars and practitioners interested in culturally responsive mechanisms of change, cross-cultural psychotherapy research, and multi-site implementation of group interventions. Keywords: Emotional Cultivation

Aim While psychotherapy research has increasingly emphasised relational factors, training programmes often struggle to operationalise interpersonal skills in teachable and assessable ways. This paper examines the relationship between therapist interpersonal skills and outcomes for young people, and considers implications for psychotherapy education. Methods Data are drawn from a large multi-site study of youth psychotherapy using validated measures of therapist interpersonal skills alongside routine outcome monitoring. Quantitative analyses examine associations between therapist skills and client outcomes, complemented by process-informed interpretation. Results Higher levels of therapist interpersonal skills are significantly associated with improved outcomes for young people across therapeutic contexts. Findings suggest that relational competencies function as trans-theoretical mechanisms of change rather than modality-specific techniques. Discussion The paper discusses how these findings challenge technique-centred training models and support a renewed focus on relational pedagogy, reflexive practice, and culturally responsive therapist development. Implications are considered for curriculum design, supervision, and emerging uses of digital and AI-supported training tools. Ways Forward • Innovation implications - AI-assisted skills training and feedback systems. • Future research: longitudinal studies linking training interventions to interpersonal skill development.

Aim: There is lack of research on trauma focused interventions in PTSD in the Indian context. Client perception of change is an important variable considered in the change process research in order to improve the ecological validity of a therapy. Thus, the study explores clients’ perceptions of helpful and hindering therapeutic impacts during Modified CPT for PTSD, by assessing session wise experience of the participants. Methods: Twenty-four patients with PTSD completed Modified CPT in a single-arm open-label trial. Data on clients’ perceptions of helpful and hindering therapeutic impacts were collected using the Helpful Aspects of Therapy (HAT) form, which was administered at the end of each therapy session. A total of 372 HAT forms completed by patients were analyzed using the Therapeutic Impacts Content Analysis System–Revised (Elliott et al., 1985). Results: A total of 522 significant events were identified; 461 (88.31%) were helpful events and 61 (11.69%) hindering events. Personal insight was the most commonly observed helpful impact, accounting for 22.94% of the helpful impacts, followed by reassurance (19.71%.). The most frequently identified hindering impact was unwanted thoughts, accounting for 69.64% of hindering events, followed by unwanted responsibility (12.5%). Discussion: The study highlights the importance of obtaining ongoing feedback from clients to understand the therapeutic impacts of the intervention from their perspective. The helpful impacts of personal insight, problem solutions, and awareness are consistent with Elliot’s framework. The results underscore the benefits of trauma-focused interventions which outweigh any potential drawbacks.

Aim In recent years, individually tailored Cognitive Processing Therapy (CPT) protocols have gained research importance due to their potential for enhancing treatment effectiveness and addressing treatment barriers (Galovski et al., 2025; Sandanapitchai & Nixon, 2025). Such studies have primarily focused on symptom reduction and psychosocial functioning, leaving trauma-related beliefs and emotions unexplored. This study examined the impact of a modified CPT, an individually tailored two-phase intervention comprising a stabilization phase (coping skills) and a trauma-focused phase (variable-length CPT) on trauma-related beliefs and emotions in adults with PTSD. Methods Twenty-four adult survivors of heterogeneous trauma types diagnosed with PTSD completed the intervention in this single-arm, open-label trial. Trauma-related beliefs and emotions were assessed at pre-intervention, mid-intervention, post-intervention, and 3-month follow-up using the Post-Traumatic Maladaptive Beliefs Scale (PMBS) and the Post-Traumatic Emotions Questionnaire (Post-TEQ), respectively. Data from the four time points were analyzed using a one-way repeated measures ANOVA. Results Findings revealed a statistically significant reduction in all three domains of PMBS—threat of harm, self-worth & judgment, and reliability & trustworthiness of others. In addition, a significant reduction was observed in all three domains of Post-TEQ—fear, humiliation, and anger-hurt. These trauma-related beliefs and emotions showed significant reductions both across time points and between time points. Discussion Findings demonstrated that individually tailored CPT brings about positive changes in trauma-related beliefs and emotions in patients with PTSD, retaining its core therapeutic benefits. The modified protocol also provides potential advantages over standard CPT by offering flexibility to address individual patient needs.

Over 120 million people are forcibly displaced worldwide, with Muslim refugees comprising a substantial portion; with high rates of trauma exposure Muslim refugees often develop trauma-related psychopathology such as PTSD and depression. Conventional evidence-based treatments face cultural barriers and rarely incorporate faith, an important aspect of many survivors’ lives. Islamic Trauma Healing (ITH) is a lay-led, faith-based group intervention integrating empirically-supported psychotherapy and Islamic principles. This study presents secondary analysis of a randomized controlled trial of ITH conducted with adult Somali refugees (N = 101) resettled in two U.S. locations. Machine learning methods, random forest regression, was used to examine pre-intervention demographic and psychosocial predictors of improvements in PTSD and depression following ITH. Demographic predictors included gender, age, index Criterion A trauma type, years in the U.S., and years since migration; psychosocial predictors included post-traumatic cognitions, forgiveness, social-connectedness, and daily spiritual experiences. Models showed moderate prediction accuracy. Five-fold cross-validation indicated that demographic models performed slightly better than psychosocial models for predicting both PTSD (MAE = 13.26 vs. 13.68) and depression symptom change (MAE = 4.78 vs. 5.59). Feature importance analyses identified lower baseline forgiveness as the strongest predictor of larger reductions in PTSD and depression, with female gender and younger age emerging as the most influential demographic factors. Results indicate that ITH may help target forgiveness, leading to greater symptom reduction. Previous literature has found better treatment outcomes for women; younger age may act as a proxy for less concretized beliefs about the trauma, thus leading to greater symptom reduction.

The Trauma-Responsive Implementation and Practice (TRIP) initiative is a multi-year, school-based intervention launched in the 2022 academic year to strengthen trauma-informed practices in educational settings. Grounded in implementation science and psychotherapy process research, TRIP seeks to improve student well-being by enhancing the capacity, resilience, and effectiveness of school counselors, psychologists, psychotherapists, teachers, and school staff. Core components include schoolwide needs assessments, ongoing technical assistance, targeted coaching consultation, and trauma-informed training addressing trauma principles, staff resilience, classroom strategies, and historical trauma. The implementation processes are informed by the four stages of psychotherapy. Engagement involved partnering with interested schools to build buy-in, trust, and staff empowerment. Assessment focused on gathering data on school strengths and needs using structured self-assessment tools and readiness measures. The intervention included providing training, coaching, and consultation to support the application of trauma-responsive strategies and to refine emerging practices. Finally, termination/sustainability planning supported schools in reviewing progress, integrating continuous quality improvement, and preparing for long-term trauma-responsive systems. A mixed-methods developmental pilot study (2024-2026) assessed implementation quality, staff participation, readiness for trauma-responsive practice, and educator well-being using surveys (CD-RISC; ProQOL), participation data, and implementation matrices based on the Active Implementation Frameworks. Early findings demonstrate improvements in staff trauma-informed knowledge, perceived safety, and relationships for students, and positive trends in educator resilience and compassion satisfaction (increases), and also in burnout and secondary traumatic stress (reductions). Results underscore mechanisms such as provider factors (resilience, well-being), contextual moderators (school readiness, leadership support), and implementation processes that shape intervention effectiveness in real-world settings.

The therapeutic alliance consistently predicts psychotherapy outcomes, yet the specific temporal mechanisms underlying this relationship remain unclear. This study tested whether client-rated emotional bond facilitates symptom reduction by fostering psychological safety (session "softness") in subsequent sessions. Ninety-eight clients nested within 32 therapists completed session-by-session measures across up to 20 sessions (N = 1,252 complete observations). We constructed time-lagged SEMs to test whether Bond (Session s) predicted subsequent session softness (Session s+1), which in turn predicted symptom reduction (Session s+2 to s+4). Missing data (11.7% true item non-response plus 24.3% not-yet-completed sessions) were handled using Full Information Maximum Likelihood. We compared 2-Level (client clustering only) versus 3-Level models (accounting for therapist nesting). The 2-Level model yielded a significant indirect effect (β = -0.053, p = .028). However, the methodologically rigorous 3-Level model revealed this effect to be non-significant (β = 0.002, p = .780). Path analysis showed that while Path A (Bond → Softness) was significant (β = 0.28, p = .002), the crucial Path B (Softness → Symptoms) was not (β = -0.01, p = .567). Independent validation using simplified bivariate analyses confirmed Path A (β = .395) and detected consistent negative effects for Path B (β = -.16 to -.18 across lags), suggesting the relationship exists at the bivariate level but is attenuated when therapist-level variance and covariates are properly controlled. While bonds effectively foster psychological safety, this mechanism alone does not directly translate to symptom reduction when therapist effects are appropriately modeled.

Therapist flexibility is increasingly recognized as a central process variable in psychotherapy, allowing clinicians to adapt interventions, thematic focus, and interpersonal stance to clients’ evolving needs (Castonguay, 2000; Owen & Hilsenroth, 2014). Although recent entropy-based approaches have demonstrated that variability in helping skills predicts stronger alliances and improved client functioning in outpatient settings (Kivlighan & Hill, 2025), little research has examined how therapist flexibility unfolds in highly constrained environments such as jails. Clients experiencing incarceration present with elevated distress, trauma exposure, and significant structural barriers to engagement, making responsiveness both essential and difficult to enact (Kolodziejczak & Sinclair, 2018; Scanlon & Morgan, 2025). This study introduces a multidimensional entropy framework to quantify technical flexibility (variability in intervention strategies) and thematic flexibility (variability in topics addressed) within jail-based psychotherapy. Across more than 1,600 sessions conducted by 21 therapists in training treating 138 incarcerated clients, therapists reported techniques and themes each session, while clients completed the CAMOS outcome measure. Two-level multilevel models examined whether client- and therapist-level entropy predicted session-level psychological, relational, spiritual, physical, and treatment-concern distress. Consistent with emerging research on psychotherapy in jails, client distress improved over time (Argorsor et al., 2024). Client-level entropy showed limited associations with outcomes. In contrast, therapist-level thematic entropy demonstrated emerging links to lower psychological and relational distress, whereas technical entropy yielded no consistent effects. Findings highlight thematic flexibility, rather than technical versatility alone, as a potentially meaningful dimension of therapist responsiveness in correctional settings. This work advances process research by applying entropy-based methods to an underserved, structurally complex clinical context, offering implications for training, supervision, and flexible case formulation in highly-regulated clinical settings. Keywords: Jails, Entropy, Flexibility, Outcomes

Aim: Cognitive behavioral therapy (CBT) may confer longer-term benefits through acquisition and maintenance of therapeutic skills, but it remains unclear which skills show durable change. We examined 50-week changes in five CBT skill domains following smartphone-based CBT components. Methods: This exploratory secondary analysis of the RESiLIENT trial included adults with subthreshold depression randomized to nine smartphone-based CBT components or combinations, or a weekly self-check control. We assessed behavioral activation (BA), cognitive restructuring (CR), problem solving (PS), assertion training (AT), and behavioral therapy for insomnia (BI) at baseline and weeks 6, 26, and 50 using a modified CBT Skills Scale. We used mixed-effects models for repeated measures to estimate standardized mean differences (SMDs) in change scores versus the weekly self-check control at weeks 6, 26, and 50. Results: A total of 3,280 participants were included. Follow-up rates at weeks 6, 26, and 50 were 93.0%, 89.0%, and 88.2%, respectively. CR skills showed the clearest and most consistent gains across follow-up. At week 50, significant advantages versus control were observed for BA+CR arm (SMD 0.25, 95% CI 0.06–0.44), BA+AT arm (0.20, 0.07–0.34), and CR arm (0.19, 0.01–0.38). BA+CR arm showed the most durable gains across BA and CR, whereas PS, AT, and BI showed no clear evidence of durable skill gains. Discussion: Long-term CBT skill change was selective rather than uniform in this self-guided smartphone format, with BA and CR appearing more readily acquired and maintained than other CBT skill domains, particularly in the BA+CR arm. Trial registration: UMIN000043305.

Skill acquisition is often measured using speed and accuracy as proxies of skill automaticity and quality. Neither measure is relevant to psychotherapy skills. Talking at greater speed is not considered a benefit to therapeutic performance. As for measures of what 'good' looks like in specific therapeutic skills, an empirically grounded measure for specific skills is still lacking. In this series of studies, i will present potential alternatives to measuring therapist skills, using therapist speech disfluencies (as a proxy for automaticity) and leyperson feedback (as proxy for quality). The project is undergoing, with promising results for speech disfluencies as a proxy for skill automaticity, and further exploratory and confirmatory studies underway. With a clear measure for the process of skill acquisition, we can better assess which skills can be trained with behavioural rehearsal (e.g., Deliberate Practice), and how best to train them (e.g., practice skill separatly in 'blocked' learning, or mix a number of skills together in 'interleaving' learning). Results are expected to all be in and analyzed in time for the conference.

Social anxiety disorder (SAD) commonly emerges during adolescence and is associated with important functional impairments. However, help-seeking rates remain low, especially in adolescents. Digital mental health interventions (DMHIs) offer a promising avenue to deliver support. Although DMHIs demonstrate efficacy in reducing SAD symptoms, little is known about the mechanisms and timing of symptom change. The present study addresses this gap by applying Network Intervention Analysis (NIA) to examine how an 8-week CBT-based DMHI designed for adolescents influences SAD symptoms over time. 133 adolescents (90% female, M age=14.8) presenting clinical or subclinical SAD symptoms took part in a randomized controlled trial. They were assigned to the intervention (SOPHIE) or care-as-usual (CAU) groups. Participants completed measures of social anxiety (fear of social situations, avoidance, physiological arousal, fear of negative evaluation), generalized anxiety, and depressive symptoms at baseline, mid-intervention, post-intervention, and 5-month follow-up. Four networks will be estimated (one at each assessment point) using Mixed Graphical Model estimation. Each network will include 7 nodes: the 4 variables measuring SAD, general anxiety and depressive symptoms, as well as one binary treatment variable. We expect that: (i) the intervention effects on SAD symptoms will get stronger over time (from baseline to the follow-up); (ii) SOPHIE intervention will directly impact SAD symptoms; (iii) general anxiety and depression symptoms will be affected indirectly by the intervention. This study provides the first NIA-based investigation of how a DMHI drives SAD symptom change in adolescents. The results can help refine DMHI design and enhance treatment precision.

Separation anxiety disorder is one of the most common anxiety disorders in childhood and is characterized by an excessive, developmentally inappropriate fear of separation from primary caregivers. Exposures are considered an evidence-based and effective intervention in anxiety disorders. However, the mechanisms of exposure interventions in children and adolescents with anxiety disorders are not yet well understood. The present study investigated the following research questions: Which expectations do children indicate prior to exposure sessions? What influence do expectancy violations in exposure sessions have on the treatment success of children and adolescents with separation anxiety disorder? What is the influence that changes of threat expectancy exert on the treatment success? The data are from the randomized controlled multicenter trial KibA (Children beating Anxiety). Of these, 149 children and adolescents met the criteria for separation anxiety disorder. Exposure protocols were available for 130 of these children and adolescents (M = 10.3 years, SD = 1.60, range 7–15 years, 52% male). Four diagnostic instruments were used pre and post to assess treatment outcome: the Separation Anxiety and Avoidance Inventory (TAVI), the Spence Children's Anxiety Scale (SCAS), the Clinical Global Impression - Improvement Scale (CGI-I), and the severity of the structured clinical diagnostic interview Kinder-DIPS. All data has been processed, and statistical analyses are currently underway and will be presented.

Aim Adolescence is a sensitive developmental period for the onset of anxiety disorders. This study examined whether individual differences in extinction learning and avoidance behavior serve as neurobehavioral markers of anxiety severity and predictors of treatment response. Methods A total of 110 adolescents (58 clinically anxious; 52 controls), aged 12–17 years, completed a two-day laboratory threat-learning task. Day 1 assessed threat acquisition using conditioned visual cues (CS+ and CS−); Day 2 assessed extinction through unreinforced cue presentation. Neural (EEG), physiological (skin conductance responses), and subjective indices were recorded across phases. Thirty-two anxious participants subsequently completed a standardized exposure-based group treatment program. Laboratory avoidance behavior was also assessed and compared with treatment engagement. Results During extinction, higher anxiety severity was associated with elevated worry and stronger expectancy violation responses. Reduced extinction learning, indexed by persistent physiological and neural discrimination between threat and safety cues, predicted smaller reductions in anxiety symptoms following treatment. Finally, greater laboratory avoidance was related to increased behavioral avoidance of exposure exercises between therapy sessions. Discussion Findings indicate that extinction learning deficits and avoidance tendencies reflect clinically meaningful vulnerability processes in adolescent anxiety. These markers predict differential treatment response and may help identify youths less likely to benefit from exposure-based interventions. Integrating neurophysiological measures of learning processes into assessment may enhance personalized approaches to anxiety treatment and inform early identification strategies during adolescence. Key words: Threat learning, Extinction, CBT outcomes, EEG

Aim: Suicide is a leading cause of death that is often difficult to detect, predict, and treat. Psychotherapy is well positioned to support individuals experiencing suicidal thoughts; however, many patients do not spontaneously disclose suicidal ideation or planning. Suicide risk screening offers a systematic approach to improving the identification of individuals who may benefit from targeted intervention. Validated screening tools help standardize this process across psychotherapeutic contexts and ensures screening is accurate and feasible. This presentation introduces the Ask Suicide-Screening Questions (ASQ), a free suicide risk screening tool, and discusses its application in psychotherapy settings, highlighting cross-cultural considerations related to language and implementation. Methods: Using a meta-analytic approach, the diagnostic accuracy of the ASQ will be summarized. Subgroup analyses will examine sources of heterogeneity to determine if factors such as modality of administration, language, and clinical setting impact tool validity. Results: Findings will offer insight regarding the accuracy of the ASQ in clinical populations. Results will also identify key considerations for implementing suicide risk screening in psychotherapeutic contexts in ways that are culturally responsive, feasible, and accurate. Discussion: Suicide risk screening represents an important part of broader clinical pathways for identifying and managing suicide risk in psychotherapeutic settings. Tools such as the ASQ can enhance the accuracy and feasibility of screening. Moreover, when implemented in a consistent, standardized manner, validated screening tools can improve the equity of suicide prevention. Routine, culturally responsive suicide risk screening in psychotherapy has the potential to strengthen early identification, guide timely intervention, and save lives.

Aim: Suicide-related randomized clinical trials (RCTs) are frequently perceived as ethically and logistically challenging given the perceived risks to a potentially vulnerable population. These concerns span clinicians, investigators, funders, and institutional review boards. However, little evidence exists regarding how often suicide-focused trials are discontinued and why they stop. Methods: We extracted studies registered on ClinicalTrials.gov from inception through December 10, 2025, that were focused, at least in part, on interventions designed to decrease suicidal thoughts or behaviors. We identified suicide-related clinical trials that had statuses of (1) withdrawn, (2) terminated, or (3) suspended. We coded reasons for stopping using a standardized classification scheme. Results: As of December 2025, a substantial number of trials targeting suicidal thoughts and behaviors were registered on ClinicalTrials.gov, of which only a minority were terminated, withdrawn, or suspended. Reasons for stoppage included recruitment challenges, restrictions/disruptions due to COVID-19, funding issues, study staff issues (e.g., change of PI location), and technical issues (e.g., with digital interventions). No study was stopped due to direct participant safety issues. Discussion: Findings suggest that ethical or safety risks unique to suicide-focused research are not primary drivers of trial discontinuation, countering common assumptions that suicide-related clinical trials pose disproportionate risk to participants. Well-designed, rigorous research to develop and refine medical therapies and psychotherapies that target suicide risk is critical, and researchers should not be dissuaded from suicide prevention clinical trials.

Aim: Lethal means safety counseling (LMSC) is an effective clinical intervention to promote the secure storage of suicide methods, such as firearms and medications. Prior work has shown that LMSC is acceptable to patients and efficacious, including when administered in the context of psychotherapy. However, prior work has also shown that LMSC—particularly for firearms, which is the leading method of suicide in the U.S. and in other countries globally—is less efficacious for individuals with PTSD. Indeed, PTSD is characterized by a hypervigilance to threat that might interfere with LMSC interventions, including in the context of evidence-based psychotherapies for PTSD. Methods: We developed a trauma-informed LMSC that is currently being tested in a randomized controlled trial (N = 168). Participants are adults who own firearms and have a victimization trauma history (e.g., combat, physical assault, sexual assault), and a positive PTSD screen. Assessments occur at baseline, post-intervention, and 1-, 3-, and 6-months post-intervention. Results: We will present initial findings, particularly from the perspective of feasibility, as well as describe overall procedures and the intersection of PTSD symptoms and firearm ownership and storage practices. Discussion: This is the first RCT of an LMSC intervention tailored to individuals with PTSD. Findings will provide key insights regarding the rationale and procedures for adapting LMSC for patients with PTSD, with the goal of preventing suicide.

Background: During the last decades, we could observe a tremendous increase in evidence supporting the effectiveness of group treatments for a variety of psychological disorders. Accordingly, authors such as Yalom and Leszcz describe group treatments as a triple EQ treatment (effective, equivalent with individual and other active treatments, efficient). Objective: The aim of the presentation is reporting current activities in collecting evidence related to outcome, but also process of small group treatments. We will both report on activities connected with the group chapter of the coming 8th edition of the Handbook of Psychotherapy and Behavior change. We also demonstrate the current state of the website evidencebasedgrouptherapy and will discuss how results related to group research can be better disseminated, both among patients but also among clinicians. Keywords: Group psychotherapy, evidence, information, meta analyses

Globally, there is an increasing demand for mental health care for patients with common mental health disorders. Offering more group therapy is a proposed solution, with specific advantages over individual forms. Evidence-based group treatment (EBGT) protocols are available, but it is unclear whether they are recommended by various practice guidelines. The aim of this study is to provide an overview of EBBTs for common mental health disorders and compare them with recommendations in practice guidelines. We identified EBGTs on the EBGT website (APA Division 49, 2023) and conducted a systematic search to select the most common and most recent practice guidelines. Efforts have been made to investigate possible causes for any observed differences, identify gaps, and provide recommendations for future research and clinical practice.

Aims: Although research has demonstrated the effectiveness of group therapy in treating mental health conditions, there is still a gap between the available research evidence and professional practice. This work reports on the role of international networking within the SPR Special Interest Group (SIG) on group processes and outcomes. Method: The SIG was established in 2025 with the aim of improving the global impact of group treatments through international collaboration and the sharing of research. The vision of the SIG is to innovate and co-create best practice for group interventions, as well as to encourage dialogue between practitioners and researchers. Results: To date, 32 SPR members have agreed to join the SIG and are building an international network on group therapy. In 2026, two international webinars will be delivered: one on group alliance rupture and repair, and one on the effectiveness of group therapy. Furthermore, SIG members have been working on a position paper which aims to map global group practice and research, compare national contexts, and define future challenges and opportunities. Finally, an international study on group therapists' self-estimation bias is ongoing. Conclusion: The SIG on Group Processes and Outcomes is a promising tool for improving evidence-based group research and promoting group therapy as a scalable, effective mental health intervention. However, further efforts are needed to involve a larger number of international researchers in the SIG and to help researchers translate research evidence into practice within the specifics of national contexts.

Aim: This study examines the role of school‑based psychodynamic therapy in supporting adolescent mental health. Rising difficulties, intensified by societal uncertainty and overstretched public services, make schools vital sites for intervention. Psychodynamic therapy, which acknowledges the impact of internal object relationships and early separation experiences reactivated in adolescence, offers a path beyond symptom management towards long-term change. This study considers how this can be achieved despite challenges in sustaining the therapeutic frame in educational settings. Methods: The research focuses on students in further education who experience emotional difficulties. Hinshelwood’s Case Study Research Method is used to investigate psychodynamic phenomena such as countertransference. The study explores the transition from dyadic to triadic relationships, with emphasis on the creation of triangular space (Britton, 1989), where clients become able to reflect on previously unthinkable emotions. Results: Findings highlight that the therapy process involves movement from dyadic to triadic relationships, although these positions often oscillate. The creation of triangular space was observed to facilitate clients’ capacity to reflect difficult emotions and to confront aspects of reality. This process supported greater integration and contributed to the development of a firmer sense of identity. Discussion: The study underscores both the benefits and challenges of delivering psychodynamic therapy in schools. While school‑based therapy offers accessible and less stigmatised support, maintaining the therapeutic frame is more challenging than in clinical contexts. Nevertheless, findings suggest that psychodynamic therapy in schools can meaningfully support adolescent mental health and exemplify how psychotherapy can be reimagined across different contexts.

The climate crisis demands psychology’s engagement with ecological dimensions of well-being. Therapists may help reconnect humans with nature, yet public perceptions of this linkage in therapeutic spaces remain underexplored. This study examines how the general population constructs connections between sustainability and psychological well-being when imagined in therapy. Aim: Explore perceptions of therapists integrating ecological dimensions with psychological well-being, promoting critical reflexivity about this linkage. Method: A qualitative Story Completion Task presented participants with a stem depicting a therapist linking sustainability to client well-being. 69 stories were collected via web platform from general population respondents and subjected to thematic analysis. Results: Most participants constructed meaningful connections between well-being and nature, demonstrating openness to ecological dimensions in therapy. Common themes included nature reconnection as healing, sustainability as existential meaning-making, and therapist facilitation of eco-therapeutic awareness. Discussion: These findings reveal public receptivity to integrating sustainability into psychotherapy, supporting psychology’s potential role in ecological reconnection. Story completion methodology effectively captured implicit cultural constructions. Implications for eco-informed therapeutic practice and critical psychology’s environmental reflexivity are discussed.

Therapy models differ significantly in what they consider important for long-term improvement. To date, little is known on related perspectives in the general population. In 2025, a representative sample of adults were assessed in face-to-face interviews on their knowledge and attitudes toward psychotherapy. In addition, they indicated beliefs of what psychotherapists should focus on during psychotherapy in order to achieve long-term improvement. Based on Axis I of the Operationalized Psychodynamic Diagnosis (OPD) system, four areas were specified: 1. symptom reduction, 2. understanding the connections between symptoms, personality, and relationship patterns, 3. emotional support and comfort, and 4. guidance on what patients can do for themselves to change. Among the approximately 2,500 participants of the representative survey, slightly more than 40% reported a somewhat or very positive attitude toward psychotherapy. Greater knowledge about psychotherapy was associated with a more positive attitude toward psychotherapy. Given overall moderate to high agreement with all areas, focus area 1 (d = .24) and focus area 4 (d = .24) were considered more important than pure symptom reduction. Focus areas 1 and 4 did not differ significantly from each other, but both were considered more important than focus area 3 (d = .19, d = .22). A more positive attitude toward psychotherapy was significantly associated with higher agreement with these variables, and more knowledge about psychotherapy was associated with higher agreement with all factors. The results are discussed from the perspective of different psychotherapy approaches but also general models of change.

Aims: Cognitive behavioral therapy and its key cognitive strategies, which aim to correct negative thinking, have a robust evidence base. However, their use with ethnically/racially diverse clients and in situations related to a client’s ethnic/racial identity has been questioned. Validation strategies, which empathize with emotional experiences, have been posed as more helpful in these contexts. However, research on clients’ perspectives regarding the helpfulness of these strategies or a hybrid approach that incorporates both strategies is limited. Methods: We recruited 241 participants (29.05% Asian, 19.09% Black/African American, 18.26% Latino/Hispanic, 21.99% White, 11.20% multiracial) who read three hypothetical therapy vignettes varying in the degree to which features related to race/ethnicity were salient. After each vignette, participants read three therapist responses describing either cognitive, validation, or hybrid strategies. Participants rated the centrality of their ethnicity/race to their identity and each strategy’s perceived helpfulness. Results: Cognitive and hybrid strategies were perceived as significantly more helpful than validation strategies when examining findings across vignettes. Participants’ racial/ethnic centrality did not moderate the relationship between strategy and perceived helpfulness. A three-way interaction between strategy, racial/ethnic centrality, and racial/ethnic salience of the vignette emerged. Post hoc tests suggested that hybrid strategies were perceived as significantly more helpful than either strategy alone, particularly for participants with high racial/ethnic centrality and in racially salient situations. Discussion: A combination of cognitive and validation strategies may be most helpful when providing cognitive behavioral therapy to clients for whom race/ethnicity is important to their identity and in contexts that involve race/ethnicity.

Aim: School-based mental health services are in a growing need due to the rise of mental health concerns among youth around the world. Taiwan has passed and recently amended the Student Guidance and Counseling Act, which underscores interprofessional collaboration among school mental health professionals including school counselors, psychologists, and social works to best serve student clients. Although previous research in Taiwan has indicated ethical issues and challenges such as confidentiality and dual relationships faced by distinct school mental health professionals, there is a lack of study examining their perspectives and experiences of ethical practices in school settings. As a result, the purpose of this study was to investigate the differences in ethical beliefs and behaviors among school counselors, psychologists, and social works who provide mental health services in high schools in Taiwan. Methods: A study questionnaire consisting of demographic questions and 147 items in the Chinese version of the Survey about Practicing Psychologists: Ethical Conduct (SPPEC-C) was developed. The SPPEC including 18 categories was compiled by Rogers et al. (2025), and a back-translation method was used to develop the SPPEC-C. The study was approved by the university’s IRB review, and participants were solicited to participate in the study voluntarily and anonymously via the SurveyCake platform. Results & Discussion: Online survey data were collected from 295 participants who provide mental health services in high schools in Taiwan. The final sample of the study consisted of 234 participants with an online survey response rate of 79.3%. Of them, 83 (21.8%) were school counselors, 100 (42.7%) were psychologists, and 51 (21.8%) were social works respectively. Descriptive statistics and one-way ANOVAs will be used to analyze the differences in ethical beliefs and behaviors as well as ethical issues of interprofessional collaboration among school counselors, psychologists, and social work in the study. Findings of the study and implications for ethical practices and interprofessional ethics in school mental health systems will be presented and discussed.

Pasifika peoples remain statistically erased and clinically underserved when Asian American and Pacific Islander (AAPI) categories are collapsed—an “ethnic gloss” that obscures cultural specificity, needs, and strengths. This presentation, Nānā i Ke Kumu (“Look to the Source”), advances SPR 2026’s cross-cultural, cross-approach dialogue by integrating Indigenous epistemologies with rigorous psychotherapy research. We synthesize: (a) analyses from a multi-institutional student mental-health dataset (~250,000 cases; 452 NHPI) using multi-group latent growth modeling across Sessions 1–12; (b) community-engaged work in Hawai‘i, American Samoa, Aotearoa, and Fiji employing talanoa; and (c) service-use patterns showing earlier dropout among Pasifika and a preference for Polynesian therapists, signaling cultural mismatch. Convergent findings show elevated burden, underutilization, and barriers rooted in colonial histories, Western prescriptive models, and the therapist-as-expert stance. We propose a mana-enhancing, culture-centered framework that moves beyond symptom reduction toward strengthening vā (relational space), belonging, and balance (e.g., the Lokahi Wheel). Pragmatic protocols—storying (talanoa), ceremony for connection, integration of land/ancestors/spirituality, and family/church partnerships—are mapped to common process targets (alliance, engagement, dropout prevention). For SPR’s Osaka venue, we underscore Asia-Pacific resonances and bidirectional learning: how Pasifika protocols can inform intercultural practice in East Asian settings, and how innovations from Japanese psychotherapy can reciprocally refine our model. Attendees will leave with empirically grounded guidance to end AAPI lumping in research, improve engagement and retention, and embed Indigenous protocols within assessment, intervention, training, and program design.

Aim: This study has two primary objectives: ① To explore actual clinical experience of MBT clinicians during the ET building process. ② To re-evaluate the concept of ET regarding its cross-cultural applicability. Methods: Semi-structured interviews were conducted with 18 Japanese MBT clinicians, and the data were analyzed using Thematic Analysis. Results: 8 main themes and 18 subthemes were identified and categorized into two sections: processes that hinder and facilitate ET building. Discussion: ET refers to “the capacity of the individual to consider the knowledge that is conveyed by others as significant, relevant to the self, and generalizable to other contexts” (Campbell, 2021). This study is the first empirical exploration of clinicians' actual experience of ET in psychotherapeutic context. The analysis revealed various elements, some of which confirm existing theoretical frameworks for ET development, while others highlight aspects not fully addressed in current theory. Regarding cultural factors, Japanese clinicians demonstrated particular emphasis on aligning themselves with their patients, creating a sense of oneness with the patient. This finding raises important theoretical questions, as the original ET framework presupposes the existence of two distinct individual minds. Moreover, Japanese clinicians noted that "the perceived differences" to be a barrier factor for ET. In the Japanese cultural context, where divergence or difference may be perceived as threatening, establishing a sense of oneness may be essential for ET. These findings have significant implications for the application of western psychotherapies in non-western (non-individualistic) cultural contexts.

Background: In previous research young American adults scored higher on the Levels of Emotional Awareness Scale (LEAS) than young Japanese adults. We tested the hypothesis that Americans manifest greater granularity (complexity) in the use of specific emotion words whereas Japanese manifest greater granularity in words describing bodily sensations and action tendencies related to emotion. Method: We administered the LEAS to 80 young American adults and 80 young Japanese adults. The LEAS poses 20 scenarios involving two people and asks the respondent to describe how self and other would feel. Each item is assigned a level score from 0-5 based on the number and differentiation of emotion words. Higher scores are given for specific emotion words. To counteract this bias, we counted every word used at every level for every item. A fluent Bilingual rater (born and living in Japan, learned English in the U.S. in childhood) rated all protocols and established inter-rater reliability with a native Japanese speaker for the Japanese protocols and a native English speaker for the American protocols. Results: Few discrepancies were observed between the Bilingual and American rater whereas there were numerous discrepancies with the native Japanese rater: the Bilingual rater tended to assign level 3 scores to the same words to which the native Japanese rater assigned level 2 scores. Conclusion: Exposure to individualistic Western culture is associated with greater granularity of specific emotion terms whereas a collectivist Japanese background is associated with greater differentiation of bodily terms related to emotion.

Background: Mental health difficulties in caregivers are associated with an increased risk of insecure attachment and can negatively affect infants’ emotional, cognitive, and social development. These risks are reflected in subtle and rapidly changing patterns of behavior during early caregiver-infant interactions. Accurately capturing such interaction dynamics is therefore essential for developmental and clinical psychology. The Face-to-Face Still-Face (FFSF) paradigm is a well-established method for studying infants’ responses to social stress and repair, and the Infant and Caregiver Engagement Phases revised German edition (ICEP-R) provides a detailed framework for coding engagement behaviors during these interactions. However, ICEP-R annotation requires extensive expert training and manual, time-intensive coding, which limits its scalability. Methods: In this work, we present an automated approach to support the annotation of caregiver-infant interactions in the FFSF paradigm using information from both video and audio recordings. Our method builds on recent self-supervised models that extract rich visual and acoustic representations directly from raw recordings and combine them with temporal modeling to capture the dynamic nature of early interactions. We evaluated the approach on 92 FFSF sessions that were manually annotated using the ICEP-R scheme. Results: A multimodal approach combining visual and auditory information yields the highest performance for infant engagement classification. This advantage is likely due to the highly dynamic nature of infant behavior: infants frequently transition between engagement phases, making visual information alone insufficient for reliable classification. Including caregivers’ vocal behavior provides important contextual cues that help disambiguate infant engagement states. In addition, infants are often partially occluded by caregivers during interactions, further underscoring the importance of auditory signals as a complementary source of information. Together, these findings highlight the value of multimodal analysis for capturing early interaction dynamics. Conclusions: We see automated annotation not as a replacement for expert judgment, but as a complementary tool that can support developmental and clinical research by reducing annotation effort and enabling the study of larger, more diverse datasets.

Aim: Consumers are using large language models (LLMs) to provide low-cost psychotherapy. While several researchers have identified the dangers of using LLMs for this purpose by testing its safety features (e.g., Santos et al., 2025), no one knows the quality of psychotherapy process conducted by these LLMs or their capacity to improve treatment delivery across sessions. This study seeks to address this gap by assessing typical psychotherapy process conducted by three LLMs (ChatGPT, Claude, Copilot), which will implement three different treatment models (psychodynamic therapy [PDT], cognitive-behavioral therapy [CBT], supportive-expressive therapy [SET]) in 54 two-session treatments. First, we hypothesized that these LLMs will be more adherent to a CBT session prototype than the other two session prototypes (PDT, SET) because CBT relies less on interpreting affective communication and more on practicing cognitive skills. Second, we hypothesized that these LLMs will be more adherent to all three session prototypes during the second session than the first because they will learn more about the patient and improve treatment model delivery accordingly. Methods: Two actors will engage as patients with the LLMs in 45-minute sessions. The Psychotherapy Process Q-Set (Jones, 2000) is a 100-item instrument that assesses the processes of therapeutic change within a transcribed psychotherapy session. Items are sorted into nine piles in a forced-choice procedure ranging from most uncharacteristic (Pile 1) to most characteristic (Pile 9) of each session. Results: To be determined. Discussion: Results will inform the quality of typical psychotherapy process delivered by LLMs and identify areas that need improvement.

The sudden transition to telemental health (TMH) during the COVID-19 pandemic challenged psychotherapists to sustain embodied and intercorporeal connections while working within virtual settings. In in-person psychotherapy, therapists and clients co-create a sense of therapeutic presence and alliance through intercorporeality, a somatic attunement often considered diminished online. This brief paper presents an explanatory sequential mixed-methods study investigating how a five-minute body scan meditation (BSM) may enhance interoceptive awareness, therapeutic presence, and working alliance in TMH sessions. Three therapists and five clients engaged in six-session TMH series that began with a BSM. Quantitative measures; the Scale of Body Connection (SBC), Therapeutic Presence Inventory–Long Form (TPI-LF), and Working Alliance Inventory–Long Form (WAI-LF); were administered at sessions 1, 3, and 6. Nonparametric analyses (Friedman, Wilcoxon, Kendall’s W) indicated upward shifts across all domains, with Spearman’s correlations (p < .01) revealing body awareness (SBC-BA) as a central node strongly associated with presence (TPI) and alliance (WAI). Qualitative thematic analysis echoed these findings, describing greater somatic awareness, calmness, and emotional regulation among both therapists and clients. Results point toward virtual intercorporeality, a digitally mediated yet relationally embodied field supporting therapeutic resonance despite physical distance. BSM appeared to harmonize awareness between clients and therapists, underscoring interoceptive awareness as foundational to presence and alliance in TMH. This relational synchronization highlighted the value of integrating somatic mindfulness into digital psychotherapy training and future research on embodied therapeutic connection. Keywords: Telemental Health, Interoceptive Awareness, Therapeutic Presence, Somatic Psychology

Virtual Reality (VR) refers to the use of technological interfaces to simulate the behavior of three-dimensional entities that interact in real time with a user immersed through sensorimotor channels, creating a strong sense of presence in a simulated digital environment. VR systems offer a uniquely controlled approach to evaluating multiple indicators of anxiety while the participant engages in a simulated immersive experience. VR components have been successfully applied in the assessment, treatment, and research of mental health conditions such as anxiety disorders. However, traditional assessment methods addressing the four dimensions of anxiety are reportedly insufficient for an integrative understanding of the mechanisms underlying its onset. Our aim is to design an anxiety assessment method using an immersive VR system. In this presentation, we demonstrate how processes of human perception and reaction are related to anxiety elicitation, and how the digital environment is being developed to assess the resulting behaviors. Preliminary results indicate promising potential for the proposed assessment method, which may contribute to therapists’ empathetic understanding of clients’ suffering and to the development of personalized strategies for problem resolution.

Scientific research is widely recognized as an essential component of university training. Studies have shown that early exposure to research activities fosters key competencies such as critical thinking and intellectual autonomy. However, within the Argentine context, there is limited empirical evidence addressing the relationship between research experience and attitudes toward research among psychology students. Aim This study aimed to examine the relationship between previous research experience and attitudes toward scientific research in psychology students at the University of Buenos Aires. Methods A total of 190 students were evaluated using an ad hoc scale measuring attitudes toward research, alongside questions assessing previous research involvement and type of research experience. The study was quantitative, non-experimental, cross-sectional, and descriptive-correlational. Results Of the total sample, 75.79% showed neutral attitudes and 24.21% showed positive attitudes. A statistically significant association was found between having research experience and holding positive attitudes toward research (χ²(1, N=190) = 19.62; p = 0.000009). Conversely, no significant differences were found in attitudes according to the type of research experience (χ² = 0.0000; p = 1.0000), although descriptively, students involved in research fellowships or research teams showed more positive attitudes. Discussion Findings suggest that meaningful research involvement plays a formative role in shaping positive attitudes toward scientific research in university students. These results highlight the need for higher education institutions to promote real, early, and accessible research experiences that can strengthen positive dispositions toward research while fostering critical thinking and intellectual autonomy in future psychologists. Key words: Scientific Research, Attitude, University Students.

INTRODUCTION: Treatment personalization in psychotherapy seeks to determine the most appropriate approach for each individual patient, based on specific characteristics that extend beyond diagnostic categories. AIMS & METHODS: This project aims to identify patients with depression for whom emotion regulation (ER) might particularly function as a mechanism of change, with the goal of developing individual prediction models that contribute to treatment personalization. A sample of 211 consecutively admitted patients at a psychotherapy center is planned. The study will use self-reported data collected before and during the therapeutic process. Predictors will be operationalized using two sources: (1) pre-treatment patient reported measures, including the Beck Depression Inventory-II (BDI-II), the symptom Checklist-90 (SCL-90), the inventory of Interpersonal Problems (IIP-64), and the Difficulties in Emotion Regulation Scale (DERS); and (2) the admission form completed by the clinician. Changes in DERS score will be examined as the mechanism of change, while the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM and CORE-10) will be used as outcome measures. Individual prediction models will be developed using statistical and machine-learning techniques to estimate patient-specific the likelihood of improvement based on ER patterns. EXPECTED RESULTS & DISCUSSION: Expected finding are expected to contribute empirical evidence supporting ER as a key transdiagnostic process, thereby informing the implementation of personalized psychotherapy in the Argentine context. KEY WORDS: personalization, emotion regulation, mechanism of change, depression, CORE-OM

Modern psychotherapy research has shown growing interest in applying machine learning (Shatte et al., 2019). Particularly, Natural Language Processing (NLP) models have proven to be a helpful tool for identifying emotions expressed in counselling sessions (Tanana et al., 2022) and predicting suicide risk (Cook et al., 2016; Levis et al., 2020) by analyzing transcripts from session recordings and clinician notes. Another source of client natural language that can be used to predict outcomes is in their self-reported reasons for attending counselling. The present study uses NLP-based models to explore clients’ self-reported reasons for seeking therapy with naturalistic data from a large Canadian community mental health agency. We also examine whether level of detail in referral reasons predicts treatment outcomes and adherence. Our sample includes 74,000 clients (Mage = 33, 61% female, 74% Caucasian). Clients’ referral reasons are categorized using NLP models, and treatment outcomes are predicted using self-reported distress levels prior to the first counselling session (as measured by OQ-45.2; Lambert et al., 1996). This study will present the results from topic modelling and sentiment analysis on client-reported reasons for counselling and identify correlations between NLP-derived clusters and treatment outcomes, such as levels of distress and treatment adherence. These results will highlight the potential of integrating NLP into psychotherapy research to automate the processing of linguistic data, thereby enabling a better understanding of clients’ concerns through their narratives without the constraints of diagnostic criteria.

Background: Prior research indicates that clinicians' self-compassion is associated with important aspects of therapeutic functioning, including empathy, emotional regulation, and interpersonal effectiveness. However, little work has examined whether self-compassion is linked to ruptures in the therapeutic alliance and clinicians' self-reported comfort and competency working with high-risk patients. Self-compassion may be particularly relevant in high-risk clinical work, as it can buffer emotional strain and reduce self-critical responses during challenging sessions. Understanding this gap is critical as clinicians' ability to manage alliance ruptures and feel competent with high-risk patients may directly influence treatment effectiveness. The present study aims to address this gap by examining associations between clinicians' self-compassion and their perceived comfort, competency, and therapeutic alliance when working with patients at elevated risk for suicide. We hypothesize that higher clinician self-compassion will be associated with lower rupture presence and with greater self-reported comfort and competency working with high-risk patients. Methods: This study will collect data from mental health professionals (expected N = 85). Participants will be recruited through professional forums, institutional mailing lists, and LinkedIn. They will complete validated measures of self-compassion (SCS-SF; Raes et al., 2011), alliance ruptures (3RS; Eubanks et al., 2025), and comfort and competency (SCI; Lund et al., 2017), along with demographic information. Anticipated results: We will examine the association between clinician self-compassion and the presence of an alliance rupture using a point-biserial correlation. A Pearson correlation to assess the relationship between clinician self-compassion and clinicians’ perceived comfort and competency when working with high-risk patients.

Aim Mentalization-based parenting interventions can foster transformations in caregivers’ subjective meanings regarding themselves, their relationships, and their parenting practices. While evidence supports their effectiveness, less is known about how change unfolds in these interventions. Drawing on the Generic Change Indicators (GCI) model, this study aims to examine ongoing psychotherapeutic change processes in an MBT-P Lighthouse Programme group therapy for parents with a history of trauma. Methods A 12-session online group therapy was co-facilitated by two trained clinicians. Sessions were qualitatively analyzed using the GCI framework, identifying change moments and examining their progression across stages of change, from initial consolidation of the therapeutic context to higher-order transformations of subjective meaning. Results Preliminary findings indicate a progressive organization of change processes. Early sessions showed acceptance of difficulties, emotional validation, and consolidation of the group. As therapy progressed, participants showed higher-stage indicators, including questioning habitual understandings of self and parenting, recognition of personal participation in relational difficulties, and establishment of new associations linking past attachment experiences with current parenting challenges. These shifts were consistent with enhanced mentalization, increased emotional awareness, perceived parental competence, reduced self-blame, and greater reflective engagement with children’s internal states. Peer interactions frequently facilitated change moments, highlighting the co-constructive nature of meaning-making in the group. Discussion By capturing changes as they unfold, the GCI model complements self-report outcome measures, offering a process-sensitive perspective on change in Mentalization-Based parenting interventions. Findings underscore the value of integrating process-oriented models with mentalization frameworks to advance the understanding of change mechanisms in group psychotherapy.

Objective: We conducted a randomised controlled trial (RCT) to evaluate the effectiveness of a brief behavioural treatment for insomnia (BBTI) that focuses on sleep restriction and stimulus control (SC)—both established as effective standalone interventions. This article presents the study protocol to examine whether adding BBTI to treatment as usual improves outcomes in patients with chronic insomnia. Methods and analysis: We will conduct a multicentre RCT. We will randomly assign patients with chronic insomnia to two groups (BBTI vs sleep hygiene) in a 1:1 ratio. The BBTI consists of three 15 min sessions over 4 weeks delivered by healthcare professionals following a detailed manual. The primary outcome is the Insomnia Severity Index at 8 weeks. Secondary outcomes include sleep latency, wake after sleep onset, total sleep time, sleep efficiency, Generalized Anxiety Disorder- 7, Patient Health Questionnaire- 9 and Euro Qol- 5D- 5L. We will conduct the assessment at weeks 0 (baseline), 4 (end of intervention), 8 (post- intervention, primary endpoint) and 12 (follow- up). We will assess each sleep variable from the sleep diary at weeks 0 and 8. The analysis will be performed on an intention- to- treat basis. Ethics and dissemination: This study has been approved by the Ethics Committee for Clinical and Epidemiological Research of Toyama University (approval no. R2023152). Trial registration number UMIN000052911; pre- results. This presentation has already been published BMJ Open 2025; 15: e094602. doi:10.1136/bmjopen-2024-094602

Background: The Draw-a-Person-in-the-Rain Test (DPRT) is a projective technique used for assessment in clinical settings and may also serve as a tool that facilitates individuals’ self-awareness of their current stress situations and their capacity to cope with stress. The present study aimed to develop a self-understanding workbook using the DPRT to promote awareness of one’s stress situations and psychological resources, and to examine whether its use enhances self-understanding. Methods: A self-understanding workbook based on the DPRT was developed and administered to university students (n=57). Before and after the workbook intervention, participants completed the following scales: (1) the Bidimensional Resilience Scale (Hirano, 2010), (2) the Sense of Coping Ability Scale for College Students (Kamata & Makino, 2005), and (3) the Japanese version of the Self-Reflection and Insight Scale (Nakajima et al., 2017). Results: Paired t-tests were conducted to compare scale scores before and after the intervention. After the intervention, BRS scores for Optimism (t(56)=4.28), Action (t(56)=2.68), Problem-Solving Orientation (t(56)=2.83), and Self-Understanding (t(56) = 2.88) were significantly higher. SSCA scores for Expansion of Life (t(56)=2.98) and Sense of Difficulty in Coping (t(56)=2.53) were also significantly higher. In addition, SRIS scores for Self-Reflection (t(56)=3.10) increased significantly. Discussion: These findings suggest that the workbook may promote awareness of coping strategies and psychological resources in stressful situations, thereby deepening self-understanding. In particular, the increase in the Sense of Difficulty in Coping may reflect enhanced self-understanding through recognizing one’s own limitations and difficulties rather than a negative change.

Religious patients have consistently expressed a preference for religious matching with therapists, yet little research has been done to assess the actual impact of religious matching and mismatching on therapy (Dimmik et al, 2021; Dimmick et al., 2020; Walker et al., 2011; Fluckiger et al., 2018). For Orthodox Jewish individuals, recent global events may impact these preferences, and experiences in therapy, in varied and important ways. The current study explored the relationship between religious matching and mismatching and the therapeutic alliance, ruptures and repairs in the alliance, and experiences as a Jewish person in therapy following the October 7th 2023 attack on Israel and subsequent war in Gaza in 19 female Orthodox Jewish patients who were in therapy between October 2023 and January 2024. Among the participants, 7 worked with non-Jewish therapists, 6 worked with Jewish and non-Orthodox therapists, and 6 worked with Orthodox Jewish therapists. Participants were interviewed over Zoom between December 2024 and January 2025. These interviews will be transcribed and then coded using the Generic Descriptive-Interpretive Qualitative Research method (Elliot & Timulak, 2005) to gather relevant themes related to the alliance, rupture and repair, and cultural identity by the first author. An auditor (the second author) will conduct a reliability check by independently applying the codebook to the interview transcripts. Potential clinical implications of findings will be reviewed.

A lack of established and reliable methodology to assess meaningful relational narrative change over the course of long-term psychoanalytic and psychodynamic psychotherapy presents a significant challenge to an empirical understanding of treatment efficacy. Here, we seek to address this challenge, utilizing data from the Adult Attachment Interview (AAI) captured as part of the Anna Freud Centre Young Adult Research Project. This study indicates the use of attachment instruments to measure process mechanisms in psychotherapy treatments for young people. We present AAI data administered over the course of long-term treatment, demonstrating non-linear change in attachment-related narrative coherence. These data show temporary decreases in narrative coherence over the course of treatment, followed by its re-establishment at treatment termination, supporting a burgeoning literature on non-linear processes in psychotherapy outcome research. Our findings augment the current empirical literature, further supporting the idea that long-term psychoanalytic treatment may be especially suited for young people with complex needs to support the development of more coherent attachment-related narratives. Further research utilising within-patient data is needed to understand with greater clarity how changes in attachment-related processing occur over the course of long-term treatment. The majority of outcome research in psychotherapy focuses on post-treatment change, thereby preventing investigation of change during treatment, which may not follow linear trends associated with differences between pre- and post-treatment.

Background: Attachment dimensions are generally viewed as stable personality structures; however, insecure attachment may hinder a therapist's professional growth. Quality supervision offers the potential to moderate this relationship. Aim: The research examines the intersection of attachment dimensions and supervision experiences in relation to professional development and clinical challenges. Furthermore, it provides a comparative analysis between social work students and experienced practitioners. In addition, it examines the moderating effect of supervision in the relations between attachment dimensions and the experience of both practice difficulties and professional development. Method: The sample comprised 174 participants: 95 social work students and 79 professionals. Participants completed questionnaires assessing attachment dimensions, supervision experience, professional development, and difficulties in practice. Results: For both groups, attachment anxiety correlated with diminished professional development and increased practice difficulties. Students reported higher anxiety levels than professionals, raising questions about the "state vs. trait" nature of attachment. Distinct moderation effects emerged: among highly anxious practitioners, supervision satisfaction predicted greater professional development. Conversely, highly anxious students reporting lower supervision satisfaction exhibited higher professional development. Discussion: Effective supervision is critical in mitigating challenges linked to attachment anxiety. These findings emphasize the need for adaptive supervisory models tailored to the specific developmental stage and attachment profile of the social worker.

Aim. To investigate how self-differentiation (i.e., reactivity, cutoff) and insecure attachment experiences (i.e., anxiety, avoidance) predict dyadic adjustment (i.e., satisfaction, consensus, cohesion, affectional expression). Our hypotheses were: 1) Higher self-differentiation predicts higher dyadic adjustment. 2) Higher insecure attachment predicts lower dyadic adjustment. Method. Participants were 68 heterosexual, Spanish-speaking couples from Argentina, Costa Rica, Guatemala, Mexico, and Spain. We utilized an Actor-Partner Interdependence Model (APIM), complemented by a Monte Carlo simulation-based power sensitivity analysis. Results. Male differentiation in emotional reactivity was associated with male consensus (b = 2.72, p = .034) and female affectional expression (b = -.71, p = .039). Female differentiation in emotional cutoff was connected with male consensus (b = 3.90, p = .011). Male differentiation in emotional cutoff was linked to female consensus (b = 2.61, p = .014) and female affectional expression (b = 1.41, p < .001). Meanwhile, attachment avoidance was linked to satisfaction for females (b = -2.63, p < .001) and males (b = -1.79, p = .007). For males, attachment avoidance was associated with cohesion (b = -1.10, p = .049), and attachment anxiety was connected with affectional expression (b = -.97, p = .001). Discussion. Overall, higher differentiation (i.e., lower emotional reactivity and cutoff) was associated with greater consensus and affectional expression, while higher attachment anxiety and avoidance were linked to decreased satisfaction, cohesion, and affectional expression. Our findings emphasize the complex interplay between romantic partners' differentiation of self, attachment experiences, and relationship well-being. Keywords: Dyadic Adjustment, Self-differentiation, Attachment Experiences, Couple Relationships, Actor-Partner Interdependence Model

Aim: Many scholars describe a “golden age” of couple therapy, yet clinicians often encounter this claim through competing model narratives and training markets. We map and compare the claims advanced by six widely disseminated couple therapy models. Methods: Qualitative document analysis of publicly citable materials (books/articles, official descriptions, and cited empirical sources) for Gottman Method Couple Therapy, the Developmental Model, Relational Life Therapy, Emotionally Focused Couple Therapy, Integrative Behavioral Couple Therapy, and Imago Relationship Therapy. We extract discrete claims and code them in four domains: (1) distress/functioning, (2) mechanisms/tasks of change, (3) outcomes/evidence assertions, and (4) training/competence. Claims are synthesized via domain-by-model matrices (Framework Method) with traceability to sources. Results: Analyses are underway. Preliminary coding indicates convergence on distress as entrenched interactional patterns and escalating negative affect, and on the value of a deliberate therapist stance paired with structured in-session tasks. Models diverge most in their primary causal narratives (e.g., attachment/co-regulation, differentiation/self-regulation, behavior change vs. acceptance, confrontation/authenticity) and in how strongly and specifically they articulate evidentiary, outcome, and competence claims. Discussion: A “claims landscape” clarifies where leading approaches converge, diverge, or use shared terms differently, supporting cross-approach dialogue and cumulative research. The map can support responsible model selection and training investment and generate testable questions for future process, outcome, and implementation research.

Psychotherapy is often described linearly, presuming a predictable unfolding such as establishing a therapeutic relationship, assessing client needs, setting therapy goals, conducting appropriate interventions, and termination (Hackney & Bernard, 2017). While this representational depiction has heuristic value, many therapeutic encounters are interrupted before this process is complete; clients often leave before reaching an agreed upon termination. Estimates of premature termination range from 20 percent (Jensen et al., 2014) to 53 percent (Hatchart & Parkins, 2003). Premature termination of therapy may have negative consequences for clients, therapists, and for mental health delivery systems (Roos & Werbart, 2013). While explanations for abrupt, client-initiated termination of therapy have been offered from multiple perspectives, the client’s perspective is key to understanding therapy outcomes (Elliott, 2010; Levitt et al., 2006; Levitt et al., 2016). We aimed to examine how clients experience and make sense of their decision to prematurely terminate psychotherapy. We employed a thematic analysis (Braun & Clarke, 2022) method and explored 12 clients’ experiences of dropping out of therapy with a view toward understanding their decision as well as the process of deliberation prior to making their decision. Findings are centered around ethical concerns, including perceived harm, boundary violations, role reversals, and perceived therapist indifference. Clients in our study frequently assumed responsibility for the problems they encountered and tended to delay their decision to terminate psychotherapy, leaving them with lingering feelings of guilt. The findings of this study will be presented considering therapist training and supervision, as well as avenues for future research.

Introduction: Client‑perceived helpfulness is a critical indicator of psychotherapy quality yet is seldom examined alongside clients’ reasons for ending care. Methods: We are conducting a mixed‑methods analysis of 802 former clients surveyed after 90 days post‑termination at a university counseling center. Quantitatively, participants rated helpfulness on a six‑level ordinal scale (harmful, very poor, unimportant, somewhat helpful, quite helpful, very helpful) and the importance of 14 termination reasons (e.g., improvement, dissatisfaction with therapist, session limits, therapist turnover, access barriers, life/medical constraints, referral/medication). Qualitatively, clients provided open‑ended explanations of why their stated reasons mattered. Our primary comparisons will contrast clients who rated treatment as harmful/very poor/unimportant (n=59) with those who rated it as somewhat/quite/very helpful (n=743). Analytically, we will (a) model helpfulness using ordinal methods and derive reason domains from the 14 items to reduce dimensionality, and (b) conduct a binary sensitivity analysis for negative vs. positive helpfulness. The qualitative data will undergo thematic analysis, and findings will be integrated in joint displays to align quantitative signals (e.g., dissatisfaction, continuity/access issues, planned improvement) with client narratives. Results: Data processing and analyses are in progress; results will be available by the time of the conference. Discussion: We anticipate generating actionable implications, including continuity safeguards, rupture‑repair practices, and access improvements, to advance SPR’s goal of reimagining psychotherapy through client‑centered quality and cultural responsiveness. Key words: client perceptions, termination reasons

The aim of this longitudinal study was investigating how perceptual synchrony regarding session quality develops over the course of therapy between Chinese beginning therapist trainees and their clients and whether therapists’ state mindfulness shapes this process. Participants were 525 trainees and their 2745 clients, who completed a total of 5 sessions. Before each session began, therapists provided ratings of their state mindfulness. After each session, clients rated the session’s quality from their perspective, and therapists reported both their own session quality and their estimation of how the client experienced the session. Session-by-session ratings of session quality were analyzed using a truth-and-bias framework. Results indicated that, first, therapist trainees showed a general tendency to underestimate their clients’ session quality ratings. Second, therapists’ judgments of how helpful a session was for the client were shaped by both their own session experience (i.e., bias) and clients’ actual session ratings (i.e., truth), with the former exerting a much stronger influence than the latter. Third, therapist state mindfulness shifted this balance: higher pre-session mindfulness strengthened the impact of clients’ actual ratings on therapists’ estimates (truth) while modestly reducing the influence of therapists’ own perceptions (bias). Implications for understanding the development of therapist–client perceptual synchrony and for training interventions that cultivate therapist mindfulness are discussed.

Repairing alliance ruptures can serve as a powerful mechanism of change in psychotherapy. While substantial progress has been made in understanding ruptures, a focus on ruptures arising from radical value disagreements between patients and therapists remains unexplored. This is despite the increasing polarisation of contemporary societies and the central role that radical value disagreements may play in this process. Understanding value disagreements and strategies for their resolution may contribute to efforts to actively counter societal polarisation. The healthcare setting is not exempt from value disagreements, which may arise, for example, around issues such as mandated vaccinations, gender identity, and decisions related to the termination of pregnancy. While some disagreements may be resolved by, for instance, providing additional information to clarify misunderstandings, others may persist due to underlying value differences. However, it is unclear how to identify and address such value disagreements while adequately respecting patient autonomy. The psychotherapeutic context provides an ideal setting for examining value disagreements in depth, as strong therapeutic bonds develop between therapist and patient, within which significant ruptures may occur and be examined in detail. However, to explore them, we need suitable definitions for the healthcare context. For these reasons, this scoping review aims to synthesize existing research on value disagreements in healthcare settings, including available definitions and strategies in resolving them. The findings from this review will set the basics for empirical research on value disagreements in healthcare, with a specific focus on the psychotherapy context.

Aim: Cultural responsiveness is an essential attribute for providing effective care. There is widespread recognition it ought to be taught in graduate programs, emphasized in clinical practice, and considered in research design and interpretation. However, there is a lack of standardized assessments designed to evaluate these competencies within gold-standard therapeutic modalities, such as cognitive behavioral therapy (CBT). The present study aims to develop and validate a standardized performance-based measure of cultural responsiveness in CBT. Methods: In the first phase, we developed an empirically based assessment and associated observer scoring criteria, which were refined through feedback from a panel of experts in cultural psychology and CBT to ensure content validity. Our measure assessed therapists’ responses to video vignettes of standardized clients, focusing on the skillful application of CBT techniques while demonstrating cultural responsiveness. In phase two, we pilot-tested the newly developed measure with 30 student therapists across various clinical training programs. Participants also completed self-report measures of CBT knowledge, cultural humility, cultural competence, and social desirability. Results: To establish the measure’s validity, we will evaluate interrater reliability, convergent and divergent validity and examine the associations between clinician trainees’ performances on the measures with their qualifications and clinical experiences. Data collection has recently been completed; analyses and a discussion of the study’s findings will be ready to be presented by the conference dates. Discussion: Our standardized and comprehensive assessment of cultural responsiveness in CBT will have the potential to drive research and clinical efforts to improve mental health services for diverse populations.

Aim: Building on the well-documented importance of therapist attunement to cultural identities (i.e. broaching; Day-Vines et al., 2007) and the tendency for therapists to overestimate their cultural attunement in ways that hinder minoritized clients’ treatment (Argyriadis et al., 2022), this study aims to develop a coding system for broaching strategies, examine how they relate to pillars of the Multicultural Orientation Framework (cultural comfort, cultural humility, and cultural opportunities), and assess the congruence between therapists' self-assessed and observer-rated performance when responding to clients' cultural identity disclosures using performance tests.  Method: Seventy-two counseling psychology master's students responded to seven video vignettes depicting clients disclosing culturally relevant content. Responses were coded for MCO dimensions (cultural comfort, cultural humility, cultural opportunities) and five broaching strategies (Proactive, Open, Wait-and-see, Avoidant, Insensitive). Participants also completed self-report measures of multicultural counseling skills and self-rated their performance.  Results: Observer-rated cultural opportunities correlated positively with Proactive and Wait-and-see broaching and negatively with Avoidant broaching. Cultural humility was positively associated with Proactive, Open, and Wait-and-see strategies, and negatively with Insensitive broaching. Cultural comfort related positively to Proactive and Wait-and-see approaches. Notably, 15% of the variance in broaching was attributable to therapist effects. Self-assessments showed minimal alignment with observed MCO attitudes and actual broaching performance. Discussion: Findings suggest broaching represents a behavioral manifestation of multicultural orientation, particularly cultural opportunities. The disconnect between self-assessed and observed performance highlights critical training implications for developing cultural engagement skills.

Aim: The current presentation examines the clinical and cultural implications of clients’ gift giving within the client-therapist relationship. While knowledge of local and regional ethics codes and appropriate supervision and consultation are important, there remains a need to expand psychotherapy research and dialogue by reimagining how clients’ gift giving is conceptualized within a clinically and culturally responsive framework. Methods: To address this gap and illustrate the clinical and cultural implications of clients’ gift giving, I present several de-identified case examples from my clinical work. Using a contemporary relational psychodynamic lens, the case material is examined to explore how transference and countertransference emerged and was processed with clients from diverse socioeconomic, religious, and racial backgrounds in the United States. Results: Across cases, three recurring process dimensions were identified that shaped the clinical and cultural implications of clients’ gift giving: (1) treatment focus, (2) timing, and (3) cultural context. Treatment focus referred to clients’ presenting concerns and therapy goals (e.g., processing attachment patterns and trauma history). Timing referred to the stage of therapy and client progress (e.g., emerging client-therapist relationship vs. termination). Cultural context referred to the clients’ cultural backgrounds, norms around gift giving, and interaction with therapist’s cultural positionality. Discussion: In line with the conference theme, this presentation invites dialogue across cultural contexts by reimagining gift giving as a meaningful process in psychotherapy, rather than exclusively an ethical dilemma. Clinical and cultural implications involve improving client-therapist relationship, quality of care, and treatment outcomes for clients from diverse backgrounds.

Objective: To examine how a single therapist–client dyad in a training context engaged with cultural opportunities during three simulated psychotherapy sessions. It explores how these moments emerged in the client’s narrative and how the therapist’s responses related to narrative–emotion shifts. Method: A microanalytic analysis was conducted on three role-play sessions in an undergraduate psychology training program in Brazil. The therapist’s interventions and the client’s narrative-emotion process were assessed minute by minute using the Person-Centered & Experiential Psychotherapy Scale (PCEPS-10) and the Narrative-Emotion Process Coding System 2.0 (NEPCS 2.0), respectively. Cultural opportunities in the client’s narrative were categorized into identity meaning, relational community context, symptom, and feeling. Results and Discussion: Three clinical vignettes - one from each session - illustrate how the therapist engaged with cultural opportunities within the client’s broader narrative process. The first addresses the therapist’s attempt to capture the client’s religious and spiritual meanings, the second highlights how worldview shaped clinical decisions, and the third examines a potential microaggression invalidating the client’s experience. The microanalytic approach may serve as a useful methodology for exploring links between therapist interventions and the client's change process. Findings suggest that cultural opportunities can potentially be identified before analyzing therapist responses, offering insights into therapeutic interventions.

All too often qualitative researchers receive questions about their recruitment that are based on considerations that are relevant for quantitative research but that misunderstand what makes for adequate recruitment using qualitative methods. For instance, methodologists are often asked “how many participants” should be included in a study and papers are rejected from journals because of low numbers of participants. In this presentation, I describe how the conceptualization of variation within qualitative methods is distinctive from that in quantitative methods and how participant recruitment should be approached within qualitative methods. I describe why the number of participants may matter incidentally but is not the focus in determining adequate recruitment. In contrast, I describe how the recruitment process differs if generalization is considered from the perspective of recruiting to identify variation in the phenomenon under study rather than from the perspective of recruiting to identify variability between samples. I will provide examples that describe how researchers can best made decisions about who to recruit in qualitative research, including case studies, multi-participant interview-based studies, and the analysis of transcripts or written text. Also, I will describe how qualitative researchers can respond to journal editors when they receive inappropriate reviews based on misunderstandings of the logic and mechanisms within qualitative analysis.

Qualitative interviews, together with systematic observation, constitute a central methodological approach for accessing subjective processes and lived experience in clinical psychology and psychotherapy research. Lived experience is understood here not merely as having been part of an external or internal event, but as having developed personal meaning and learning from it. From this perspective, participants respond to invitations to participate in research with their own agendas, motivations, and experiential frameworks, which are themselves expressions of lived experience. This study examines responses to the question “Why did you decide to participate?” provided by 30 participants across three qualitative investigations on suicide, mental health, and culturally competent psychotherapy with LGBT+ populations. Using thematic analysis, we identified three overarching motivational categories: (1) the desire to help others who share similar experiences; (2) the wish to contribute to the development of knowledge in an underrepresented area; and (3) the motivation to learn about or engage with the research process itself. These findings are discussed in relation to the testimonial value of qualitative research in clinical psychology and psychotherapy, highlighting how participants lived experience becomes a source of knowledge that shapes both the content and the trajectory of the research process. This perspective also relates to the concept of methodological integrity: when participants do not or cannot share the full range of their experiences, the fidelity and utility of qualitative findings may be compromised. Understanding participants’ motivations is essential to strengthening the epistemic and ethical foundations of qualitative inquiry.

In qualitative research, text-based methods play the most important role in data analysis. Interview transcripts are by far the most used data for interpretative/hermeneutic and content/thematic based research methods. However, considering the depth and scope of research questions and the limitations that text-based analysis imposes, it often makes sense to widen the spectrum of qualitative analysis beyond the written word. Especially in a psychotherapeutic setting, the analysis of nonverbal expressions opens a possibility for enhancing the knowledge on how the therapeutic relationship is constructed. Additionally, the psychotherapeutic setting encourages nonverbal expressions and uses people’s subliminal communication based on physical cues which are also embedded in a socially constructed framework outside the therapy room. To enhance knowledge in this regard, we implemented a study design in our research project on migration in the context of first interviews in psychotherapy that included analysis of physical aspects. We use the methodological framework of Constructivist Grounded Theory and include analysis of the participants’ nonverbal expressions and performative expressions of identity and habitus of both the client and the psychotherapist. With this approach we aim to increase the fidelity within the research project. We strive for a deep understanding of social implications, physical expression and subjective experience during the first encounters of psychotherapeutic relationships. Including body-based data analysis enables a more comprehensive reconstruction of the lived experience for the analyst and enhances the integrity of the process.

Background: Although machine learning (ML) methods are increasingly used in psychotherapy research, it is uncommon for studies to report sample size calculations, external validation, or comparative performance against conventional regression methods. Therefore, questions remain regarding the optimal methods and required sample size. Methods: Data from N = 1,319 patients treated with trauma-focussed CBT were split into training (N = 855) and validation (N = 464) samples. Seven different ML methods were trained to predict PTSD treatment outcomes (final session IES-R score) from pre-treatment data. Models were optimised using bootstrap internal cross-validation, evaluating prediction accuracy and error in the validation sample. A conventional linear regression model served as a benchmark. The size of the training sample was iteratively restricted to examine the influence of sample size. Results: Only marginal differences in performance were observed across ML models. Elastic net, genetic regression, and boosted generalised linear model performed well across training sample sizes and were the best performing models with training N > 80. No significant advantage of one model over another was observed once the training sample size exceeded the minimum recommended by sample size calculation (N = 337). Variable importance metrics suggested that higher PTSD and depression scores, unemployment, and younger age were predictors of higher post-treatment PTSD severity. Conclusions: ML model performance is influenced by training sample size. Where performance differences among alternative ML models are small, choice of method may be guided by other considerations such as explainability. Sample size calculations and external validation are strongly recommended.

Aim: Given the small differences in effectiveness between major psychotherapy orientations, there has been a growing shift toward transtheoretical and process-based perspectives. This study applies unsupervised learning algorithms to observer-rated psychotherapy sessions to detect clusters of psychotherapeutic interventions. The goal is to identify practice-based intervention clusters spanning a broad transtheoretical range using a data-driven approach. Exploratory analyses will examine associations between these clusters and session outcomes. Methods: The sample consisted of 105 adults with diverse diagnoses who received integrative, process-based psychotherapy in a university outpatient clinic. In total, 528 sessions are being observer-rated using a customized version of the Multitheoretical List of Psychotherapeutic Interventions (MULTI; McCarthy & Barber, 2009), with each patient contributing 4-6 sessions. The primary analytic strategy will involve applying Exploratory Graph Analysis (EGA), a network-based unsupervised learning approach for identifying data-driven communities of intervention items, combined with bootstrap-based stability diagnostics to determine robust empirical intervention clusters. Exploratory analyses will also evaluate associations between the resulting clusters and self-reported session outcomes such as symptom severity. Results: Preliminary results will include the empirical cluster structure of interventions, comparisons with the original MULTI subscales, and associations between cluster scores and session-level outcomes. Discussion: This study (1) demonstrates a data-driven approach for detecting empirical intervention clusters in an integrative treatment setting, and (2) examines how these clusters relate to session-level outcomes in a heterogeneous outpatient sample. The findings will deepen our understanding of how interventions used across different psychotherapeutic approaches relate empirically in practice and how these patterns may be linked to therapeutic change processes.

Aim: Although machine learning models are widely used to predict psychotherapy outcomes, some patients consistently yield large prediction errors. This study examines whether such errors reflect systematic, patient-level sources of unpredictability. Specifically, we investigate whether individuals who are difficult to predict in one model tend to be difficult to predict across many models, whether patients form subgroups based on their predictability profiles, and whether baseline sociodemographic or clinical variables explain these differences. Methods: Analyses use an outpatient psychotherapy dataset (N = 1,858) including sociodemographic and clinical variables. Fifteen machine learning models will be trained using nested cross-validation to predict post-treatment symptom severity. Out-of-fold residuals will serve as patient-level prediction error indices. Consistency of prediction difficulty across models will be evaluated through pairwise correlations of residuals with permutation-based significance testing. Patient subgroups will be identified through k-means clustering of standardized residual profiles, with silhouette-based selection of cluster number and ANOVA tests comparing mean absolute residuals between clusters. Differences in baseline characteristics across clusters will be examined. A sparse logistic LASSO model will then determine which baseline variables best discriminate between patients who are harder versus easier to predict. Results: Expected results include empirical identification of predictability-based patient subgroups, strength of cross-model residual consistency, and key baseline predictors of poor model fit. Discussion: This project offers a novel, patient-centered perspective on predictive error in psychotherapy research, revealing whether systematic patient characteristics underlie model failures and how these factors may inform personalized prediction strategies and model development.

Background: Although the use of artificial intelligence (AI) in psychotherapy research is increasing, most evidence comes from high-income countries. This gap is critical for evaluating whether AI models are fair and generalizable beyond privileged contexts. Individual-level heterogeneity is also relevant, as patients with fewer socioeconomic and sociocultural resources may differ in language use, symptom reporting, and emotional semantics. Addressing structural disadvantage is essential for developing predictive AI that is equitable in underserved settings. This study aims to develop predictive models of psychotherapy outcomes in Argentina and examine whether predictive performance varies across socioeconomic contexts. Methods: Naturalistic archival data from over 750 patients treated at the Aiglé Foundation, an integrative cognitive-behavioral psychotherapy center in Argentina, will be analyzed. Baseline assessments include measures of personality pathology, interpersonal problems, general psychopathology, and depressive symptoms. Treatment progress is monitored using the Clinical Outcomes in Routine Evaluation (CORE-10). Weekly probabilities of reliable change will be estimated and modeled as dynamic probabilities of improvement. A model-agnostic predictive pipeline with identical preprocessing and validation procedures will be applied across low-resource programs, standard outpatient care, and pooled samples. Predictive performance will be evaluated using discrimination and calibration metrics. Results: Predictive models are expected to identify trajectories of change as evolving probabilities of reliable improvement, with higher accuracy in homogeneous low-resource settings and lower accuracy in heterogeneous outpatient contexts. Conclusions: This study represents one of the first efforts to develop AI-based predictive models of psychotherapy outcomes in Latin America, informing context-sensitive and equitable AI-assisted clinical decision-making.

Homework is an important component of cognitive therapy (CT), and has been associated with improved treatment outcome. However, patient-level differences, such as depression symptom severity, might account for the observed relationship between compliance and outcome—rather than a direct effect of compliance on outcome, per se. Therefore, the present study aimed to evaluate the relationship between homework compliance and next-session depression symptom severity, while accounting for patient-level differences. Within the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, 113 patients received CT after failing to remit from an initial course of citalopram treatment, with 73 receiving citalopram plus CT and 40 receiving CT only. We specified a multilevel growth model to analyze the relationship between homework compliance and next-session depression severity change. We also conducted dynamic panel structural equation modeling as a sensitivity analysis. Higher homework compliance significantly predicted lower next-session Quick Inventory of Depressive Symptomatology-Self-Rated (QIDS-SR) score. Treatment group was not significant. The present study found that higher homework compliance in the preceding session was directly linked to depression severity improvement at the following session. These findings emphasize the importance for therapists to encourage their patients to complete their assigned homework.

Aim: Most people affected by depression experience significant delays to psychotherapeutic care. While depression screening may reinforce early recognition of depression, its impact on times to contact with mental health specialists (MHS) when implemented at the population level remains unclear. Methods: We developed a population-based simulation model that generates synthetic individuals (SI) at the time of the initial manifestation of depression, and follows SI in monthly cycles until their first contact to MHS (i.e., outpatient psychiatrists, or psychotherapists). Each month, SI may transition from depression to remission (or vice versa), seek help from a general practitioner (GP) or MHS, and can be recognized by GPs and subsequently referred to an MHS. Six empirically plausible screening scenarios were compared, in which depression screenings covered between 0% and 100% of all GP consultations. Results: In scenarios with screening (100%), the average time to first contact with MHS was reduced by 1.04 month (95% simulation-based CI, 0.99–1.09) compared to scenarios without screening (0%). An increasing screening rate was consistent with a further reduction in times to contact, with the marginal benefit decreasing as screening intensity increased. Exploratory analyses suggested that SI who do not reach contact spend less lifetime in depression in scenarios with screening, indicating potential indirect benefits. Discussion: Depression screening in primary care can moderately accelerate contact with MHS at the population level, with potential indirect effects to shift the burden in unreached populations. To maximize public health impact, screening may be paired with strengthened referral pathways. Keywords: health services; simulation

Though considered highly treatable, about 20-40% of patients with depressive disorders such as Persistent Depressive Disorder (PDD) and Dysthymia do not attain complete recovery. Several cognitive, affective, and interpersonal factors set these individuals apart from those who experience a briefer course. Existing modes of psychotherapy, such as CBT, IPT, MBCT, CBASP, etc., show promise, but need to be augmented by additional sessions, or have a high dropout rate due to their length. Imagery Rescripting (ImRs) as an intervention technique highlights the interplay between memory, self-representation, and emotional regulation, and has shown promising results in treating various mood and anxiety disorders, with large effect sizes and lasting effects at follow-ups. This case series aimed to explore the effect of ImRs on symptoms of chronic depression (CD). The study included a sample of 4 individuals diagnosed with PDD who underwent 12 sessions of ImRs. Depressive symptom severity was assessed at baseline, mid-treatment, post-treatment, and at 3-month follow-up using the Beck Depression Inventory–II and the Hamilton Depression Rating Scale. Secondary outcomes included changes in early maladaptive schemas (EMS) and interpersonal sensitivity. All participants demonstrated reductions in depressive symptom severity from baseline to post-treatment, with 3 showing statistically significant changes. Improvements were maintained at follow-up for the majority of cases, with participants reporting a reduction in some EMSs, but not in others. Change in Interpersonal sensitivity was not statistically significant. The results highlight the potential utility of ImRs in addressing CD symptoms arising from early experiences and their affective and cognitive impacts.

Aim: To examine the efficacy of Unified Protocol in reducing symptom severity of depression when compared to a treatment-as-usual group (TAU). Method: The study included participants between ages 18-55 with a primary diagnosis of moderate to severe depression, single episode or recurrent according to the DSM-5 criteria, with or without other comorbid Axis I diagnosis or Axis II traits as screened by DIAMOND and LPFS-SF. Five participants were assigned to the intervention group, which received 15-18 sessions of the Unified Protocol, and five participants were allocated to the TAU and monitored on pharmacotherapy. Their progress was assessed across baseline, midpoint and post-intervention. The Montgomery-Asberg Depression Rating Scale was used to assess the severity of depression, while other relevant tools were employed to evaluate the process variables of interest. Results: Findings have suggested that the participants receiving sessions of the Unified Protocol showed improvement in the depression and anxiety scores of individuals when compared to those in the control group, whose scores fluctuated across the timeline. It is also useful for improving emotion regulation, distress tolerance, experiential avoidance, and cognitive flexibility. Discussion: The results reflect that the intervention is efficacious in treating depression and its comorbidities while emphasising the need to address core emotional processes that are implicated in long-term recovery and in reducing the chances of recurrence. Unified Protocol, with its modular approach, is clinically valuable due to its emphasis on flexible experience of and response to emotions.

The present study gives voice to the offspring of Dutch Righteous Among the Nations who were children during World War II, when their parents were involved in rescuing Jews from the Nazis (Ashoulin, 2014). The focus of the study relates to the children’s personal subjective memories and experiences from the period during the war, as well as their perceptions of their parents’ and of the role of their rescue acts played in their own lives after the war. The present presentation focuses on how the offspring of the rescuers perceived the rescue activities of their parents, what role these deeds played in their own life stories, and the meaning they ascribed to them. Our findings indicate that a conflict or disequilibrium in their perceptions of their parents led to cognitive dissonance among the participants. On one hand, their parents’ actions were an outstanding example of altruism, they carried out lofty moral deeds that made them exemplary models of humanity whose righteousness received official recognition from Yad Vashem. On the other, the children had experienced their parents risking not only themselves, but their offspring as well. Contrary to the laws of nature, instead of protecting their own children, they put their children’s lives in danger by saving others. This dissonance will be discussed and the need for psychotherapy as a safe space for creating a dialogue between different voices in one's mind will be elaborated and its relevance to other experiences between pride and unresolved ambivalence will be discussed.

AIM: To report on the newest Two-Track Bereavement Questionnaire (TTBQ-CG11) and its use in research and clinical practice. METHODS: The TTBQ-CG31 and TTBQ-CG11 were administered to 442 bereaved persons as part of a study assessing loss and trauma. RESULTS: The TTBQ-CG11 is a psychometrically derived short form of the TTBQ CG-31 with excellent agreement at the total score level and across core subscales. Its relationship to a range of demographic and outcome measures are considered. The measure demonstrates high sensitivity and specificity. DISCUSSION: The TTMB addresses bereavement along 2 axes-- Track I – Biopsychosocial Functioning and Track II – The Relationship and Continuing Bond with the Deceased. The implications of this for theory, clinical practice and research conclude the presentation. REFERENCES: Malkinson, R., Manevich, A., Rubin, S. S., & Witztum, E. (2025). Mass Trauma, Multiple Losses, and the Application of the Two-Track Model of Bereavement in the Context of War: Assessment From a Systemic-Ecological Perspective. Omega, 302228251337127. Rubin, S.S. (1999). The Two-Track Model of Bereavement: Overview, retrospect, and prospect. Death Studies, 23, 681-714. https://doi.org/10.1080/074811899200731 Rubin, S. S., & Bar-Nadav, O. (2016). The Two-Track Bereavement Questionnaire for Complicated Grief (TTBQ-CG31). In R. A. Neimeyer (Ed.), Techniques of grief therapy: Assessment and intervention (pp. 87–98). Routledge/Taylor & Francis Group. Rubin, S. S., Bar-Nadav, O., Malkinson, R., Koren, D., Goffer-Shnarch, M., & Michaeli, E. (2009). The Two-Track Model of Bereavement Questionnaire (TTBQ): development and validation of a relational measure. Death studies, 33(4), 305–333. https://doi.org/10.1080/07481180802705668 Keywords: Assessment; Bereavement; Grief; Loss; The Two-Track-Model-of-Bereavement (TTMB).

Background: Crying is uniquely human and plays a central role in affective communication. In psychotherapy, crying occurs across most treatments, and in 15%-30% of sessions. While cultural differences in everyday crying have been documented, little is known about how attitudes toward crying vary across cultures in the therapeutic context. Method: This study compared experiences surrounding patients’ most recent episode of crying in therapy across Israeli (n = 96), American (n = 95), and Italian (n = 86) samples, using the Crying in Therapy Survey (Hilsenroth, 2015). Results: Group differences were examined ANOVA tests. Israeli patients were more likely to report being surprised by their crying, that it led to new insight, that they felt more confident about therapy goals after crying, and that their therapist responded with compassion and support, understood them better after crying, and that the bond strengthened after crying, compared to the other two groups. American patients were more likely to describe crying as a moment of genuine vulnerability and a way to communicate beyond words. Italian patients reported feeling more comfortable with their tears and feeling generally better and specifically more relieved after crying. Discussion: Overall, the findings suggest that Israeli patients tend to view crying as particularly significant internally and relationally, American ones emphasize its role as a vulnerable and expressive act beyond words, whereas Italians tend to feel more at ease with crying and experience greater relief afterward. Our results highlight the significance of considering the cultural context of emotional expression in psychotherapy. Keywords: Crying; Culture; Emotion; Therapy Relationship

Aim: This study investigates the clinical impact of client-perceived hindering reactions, operationalized as proxies for the meta-categories of hindering significant events. We examine their acute and cumulative associations with symptom distress (CORE-10) and well-being (WHO-5). By evaluating the predictive utility of these proxies – including their moderation by baseline severity – we aim to identify unique drivers of clinical deterioration through competitive modeling. We specifically test if these indicators can serve as a systematic safety-monitoring component within Routine Outcome Monitoring (ROM), informing the development of a Psychotherapy Critical Incident Reporting System (CIRS). Methods: Three-level mixed-effects models (therapists, patients, sessions) analyze longitudinal data. We employ an uncentered, lagged binary indicator to isolate acute symptom shifts. Robustness is ensured via pre-registered step-down procedures (starting with zero-correlation), Holm-Bonferroni corrections for multiple testing, and Cook’s distance to detect influential observations. Missing items are handled via prorating at 80% completeness to maximize the use of available Routine Outcome Monitoring (ROM) data. Results: We anticipate identifying hindering categories with unique incremental validity in predicting deterioration. Competitive modeling will prioritize reactions that constitute critical incidents and illustrate their impact on clinical trajectories within a large-scale ROM dataset. Discussion: Findings will evaluate the utility of monitoring hindering reactions as a specific mechanism to enhance ROM’s capacity for proactive early warning. By evidencing proxy impact, this study informs an evidence-based safety infrastructure, addressing the need for systematic reporting of negative effects in psychotherapy. Keywords: hindering reactions, Routine outcome monitoring, mixed-effects modeling, negative effects in psychotherapy, Critical Incident Reporting System

Psychotherapy training may be an important context for the development of reflective functioning (RF). RF is the capacity to interpret one's own and others’ behaviour in terms of underlying mental states. RF develops through social interactions, supporting social learning, adaptation, and psychological resilience (Luyten et al., 2020). Ineffective RF – reliance on flawed interpretations of self and others – increases vulnerability to psychological distress. People with depression often view themselves, others, and their relationships negatively, which can further hinder the reflective processes necessary for adaptive social learning. Depression may undermine the development of RF in trainees during psychotherapy training, and so might concealment-based perfectionistic self-presentation (PSP). Specifically, hiding perceived imperfections or shortcomings during training may restrict feedback and social learning, thereby limiting RF. Aim: This study examines whether PSP interferes with the development or maintenance of RF during training, thereby increasing depressive symptoms. Methods: Across three years, 216 psychotherapy trainees enrolled in a school of psychotherapy in Italy (~90% female; year 1 Mage = 30, SD = 6.76) completed self-report measures of RF (Badoud et al., 2015), PSP (Hewitt et al., 2003), and depressive symptoms (Kroenke et al., 2001) annually. Analyses: Cross-lagged panel modeling showed that reduced RF predicted subsequent increases in depressive symptoms, while depressive symptoms predicted further deterioration in RF. In line with expectations, PSP prospectively predicted weaker RF. Discussion: Findings suggest that concealment-based PSP impedes RF development which then impacts wellbeing. To support RF development and wellbeing, psychotherapy training should normalize uncertainty and encourage discussion of difficulties and errors.

Enhancing counselling self-efficacy is a key training goal for psychotherapists, as higher counselling self-efficacy predicts more effective and efficient services (Larson & Daniels, 1998). Yet, little is known about how counselling self-efficacy develops or which factors shape its growth. Aim: This study examines how time-varying perfectionistic self-presentation, anxiety, and trainees’ alliance with their program influence counselling self-efficacy trajectories. Further, recognizing that identity factors influence training experiences, which could result in distinct developmental pathways within the same program, this study examines how sociocultural dimensions may moderate counselling self-efficacy trajectories. Methods: 500 trainees in a 4-year psychotherapy program in Bergamo, Italy completed self-report measures of perfectionistic self-presentation (Hewitt et al., 2003), anxiety (Grös et al., 2007), and program alliance (Hatcher & Gillaspy, 2006) annually. Identity factors included gender, age, race, sexual orientation, and immigration background. Data collection is ongoing, and we will use the available data (N = 500) in the analyses currently underway. Analyses: Latent-growth and multilevel models will test whether perfectionistic self-presentation and anxiety impede the development of counselling self-efficacy, whether program alliance buffers these effects, and whether identity characteristics shape distinct patterns. Discussion: We will discuss the personal and professional influences on the development of counselling self-efficacy. Findings will inform educational practices by clarifying how, when, and for whom counselling self-efficacy develops, ultimately guiding recruitment, training, and retention strategies to improve client mental health outcomes.

Aim. Therapeutic metacommunication (TM) is a psychotherapy intervention in which the therapist turns the focus of discussion towards the therapeutic relationship in the present moment. TM is an effective therapeutic approach that can promote positive relational outcomes for patients and help build, maintain, and strengthen the therapeutic alliance. However, TM research and training are limited, primarily because there is no evidence-based measure of TM. The present research aims to develop a new observer-rated measure of TM. Methods. To establish construct validity, we conducted a thorough literature review and a content analysis of transcripts from five interviews with psychotherapy research experts to define TM and categorize its clinical applications. Using these data and sources, we produced a preliminary Therapeutic Metacommunication Scale (TMS) and User Manual. This scale requires coders to identify, categorize, and rate instances of TM in sessions. Currently, four trained coders are conducting pilot testing of TMS on recorded psychotherapy sessions to evaluate usability and interrater reliability. Results. A review of the existing literature and an analysis of expert interviews informed a coherent definition of TM. Categories of TM included Clarifying, Reparative, Elaborative, Socializing, Corrective, and Constructive. We will report data on the interrater reliability of the TMS. Discussion. The TMS will enable researchers, clinicians, and trainees in supervision to better understand the utility and impact of TM by psychotherapists. Such research will inform evidence-based training and care to help improve patient mental health outcomes.

Aims: Online learning has become an increasingly adopted modality in post-graduate training due to its lower cost, convenience, and accessibility. It also has the potential to train large numbers of mental health workers. However, this modality may limit the interpersonal and experiential aspects that often characterize psychotherapy training. There are also doubts about its quality and ability to engage learners. Little research has explored psychotherapists’ experiences with post-graduate asynchronous online learning. Therefore, it is important to study how this modality is experienced by psychotherapists to inform its delivery, quality, and acceptability. Methods: Semi-structured interviews were conducted with psychotherapists who participated in a Psychotherapy Practice Research Network (PPRNet) online asynchronous training. Six interviews of psychotherapists have been completed to date, with an anticipated total of 15-20 interviews to achieve thematic saturation. Given the limited research on asynchronous learning and the exploratory nature of this study, an inductive thematic analysis is used to analyze interview transcripts. Results: Results will provide insights into how psychotherapists perceive their experiences with online asynchronous learning as part of their post-graduate professional development. Emerging themes may be identified that touch on positive and negative aspects of asynchronous online training from therapists. Discussion: Findings will clarify which aspects of asynchronous training psychotherapists find most helpful or challenging. Emerging themes will inform future research aimed at improving the quality, experience, and accessibility of asynchronous online training for psychotherapists. Because asynchronous training may help expand the mental-health workforce, understanding how psychotherapists experience and engage with this modality becomes essential.

Aim. This study aims to delve into the lived supervision experiences of international psychotherapists in the USA who come from culturally and linguistically diverse backgrounds. The focus is on how this group of psychotherapists navigates and negotiates power dynamics and differences shaped by their cultural, linguistic, and professional identities, as well as their transnational training and migration experiences. Methods. This study will use purposive sampling to recruit up to 25 international trainee psychotherapists and licensed therapists with international backgrounds who are currently practicing or training in the USA. Since power dynamics and negotiation processes can unfold differently across developmental stages, participants will represent a range of training phases, including beginning practicum, advanced practicum, internship, and post-graduation practice. Data will be analyzed using a reflexive thematic analysis (Braun & Clarke, 2022) with a process-oriented focus. Results. Preliminary findings will be presented through themes that reflect the shared meaning structures of participants' lived experiences with power, language, and cultural differences, along with analytic narratives and data extracts. These themes will explore how participants interpret, negotiate, and make meanings of their supervision process and professional development. Results will be contextualized with variations related to location, developmental stages, language, and nationality. Discussion. The findings are expected to provide qualitative evidence to enhance the professional development of international psychotherapists. Furthermore, the results may have practical implications for institutions, supervisors, and clinical training settings by identifying unique training needs and supportive advocacy efforts aimed at fostering more affirming and inclusive supervisory environments for international psychotherapists.

Objective: To examine the bidirectional cross-lagged associations between client ambivalence towards change and psychological distress change during psychotherapy, testing whether higher ambivalence at one time point predicts increased subsequent psychological distress and, conversely, whether higher psychological distress predicts increased subsequent ambivalence towards change. Method: A longitudinal repeated-measures design was employed in a sample of clients attending individual psychotherapy. Participants from a psychotherapy training service in Ecuador completed the Ambivalence in Psychotherapy Questionnaire every four sessions throughout therapy and the Clinical Outcomes in Routine Evaluation-10 (CORE-10) session-by-session. Data will be analyzed using a cross-lagged panel model to estimate prospective temporal associations between ambivalence and psychological distress across therapy. Expected Findings and Discussion: The presence of statistically significant positive cross-lagged effects would support the conceptualization of ambivalence as a relevant longitudinal correlate of outcomes in psychotherapy. A strong distress-to-ambivalence link would suggest that higher distress levels precede and may contribute to greater subsequent ambivalence towards change. These findings would have immediate clinical implications, advocating for the monitoring of ambivalence as a relevant component of routine outcome monitoring and potentially integrating motivational interventions and strategies early in therapy to address this conflict. The results will contribute to the understanding of the temporal dynamics of change processes and could promote data-informed decision-making in training settings.

This work-in-progress presentation offers an initial reflection on teaching a graduate course in Child and Adolescent Clinical Psychology. Using a reflexive, experience-near perspective, the authors explore how clinical, developmental, and ethical dimensions of the field shape both the learning process and my role as an instructor. Observations highlight several emerging tensions: balancing theoretical frameworks with students’ need for practical, emotionally grounded engagement; navigating the complexity of clinical material involving children, adolescents, and families; and adapting teaching practices within rapidly shifting institutional contexts. In the Latin American context, teaching this material also requires acknowledging that mental health is deeply intertwined with political, social, and national dynamics. Classroom discussions inevitably intersect with broader sociopolitical realities, making it both challenging and enriching to integrate these dimensions alongside core clinical content. These conditions shape how students approach clinical work, as well as the kinds of questions and tensions that emerge in class. Taken together, these dynamics reveal how the classroom becomes a relational space where uncertainty, curiosity, and discomfort can coexist and support professional growth. This early analysis suggests that teaching in this area involves more than transmitting knowledge: it requires creating conditions for reflective dialogue, supporting students’ evolving clinical identities, and recognizing how the material and socioeconomic conditions of students themselves form part of the environmental frame that influences learning and engagement.

Perinatal depression and anxiety affect many women in Singapore, yet the application of Internet-based Cognitive Behavioural Therapy (iCBT) programmes in Asian settings remains underexplored. This study examined the feasibility and acceptability of an iCBT programme tailored for mothers-at-risk in Singapore and its fit within existing services. Nine web-based self-help modules targeting vulnerability factors of perinatal depression and anxiety were developed. Thirty mothers, comprising patients and community controls, enrolled and received personalised module recommendations based on their individual vulnerability profile. Feasibility and acceptability were evaluated via semi-structured interviews with participating mothers and ten service providers working with the perinatal population in Singapore. Interview data was analysed using structured prompts we developed for GPT-5 to extract and organise key points into themes. Human researchers independently reviewed and adjudicated themes, resolving any discrepancies by consensus. Overall feedback indicated strong relevance and value of the iCBT programme. Mothers reported high satisfaction, with 70% indicating that it had a positive impact on their mental health and 60% noting the relevance of examples to their everyday life. Many liked the asynchronous nature of the programme as it allowed them to engage with the material at their own pace around caregiving demands. All mothers interviewed stated they would recommend the programme to others, illustrating the effectiveness of the programme. Meanwhile, service providers highlighted the need for clear data-governance policies and well-defined risk-escalation procedures. Four service providers also noted the pivotal role of case managers in onboarding and sustaining engagement. This feedback will guide future refinement and implementation.

Aim: Alliance ruptures are common in psychotherapy and predict poorer outcomes when unrepaired. Although the Rupture Resolution Rating Scale (3RS) is well validated as an observer-based measure, the self-report version (3RS-SR) has yet to be validated in the general population, let alone with a high-risk patient population. The goal of this study was to take advantage of clinicians’ interactions with a standardized virtual patient at high risk for suicide to assess the psychometric properties of the instrument. Methods: Seventy psychologists completed the 3RS-SR based on their clinical interactions with a virtual adolescent patient. Factor structure, internal consistency, interrater reliability, and convergent validity were assessed using principal component analysis, Cronbach’s Alpha and McDonald’s Omega, rwg, and Pearson’s r, respectively. Results: The measure demonstrated good fit for a three-factor solution. Overall internal consistency across all items was moderate (Cronbach’s α = .56), with good reliability for the working together (Cronbach’s α = .83) and rupture (Cronbach’s α = .73) subscales. Interrater reliability was moderate and convergent validity was good. Discussion: This study’s findings suggest that the 3RS-SR is a psychometrically valid and reliable diagnostic tool to assess the presence of alliance and rupture processes with virtual patients at high risk for suicide. Findings support the factor structure of the measure and demonstrate acceptable interrater reliability and convergent validity. Interrater reliability is consistent with the inherently subjective nature of alliance rupture processes, suggesting that the 3RS-SR captures meaningful variability in clinicians’ responses. Future studies should replicate results with actual patient samples.

Aims: The Suicide Crisis Syndrome (SCS) is an acute mental state indicating an imminent risk for suicidal behaviors, surpassing traditional risk factors in predictive validity. Preliminary findings from an ongoing study of the SCS-C, a clinician-rated dichotomous (yes/no) measure of SCS, suggested that rating SCS symptoms on a continuous scale may improve the instrument’s psychometric properties. This study leveraged virtual patient interactions to examine the psychometric performance of a Likert-scale version of the SCS-C, including factor structure, reliability, and convergent validity. Methods: Seventy clinicians interviewed a standardized virtual adolescent patient at high risk for suicidal behavior and completed the continuous SCS-C and the Columbia–Suicide Severity Rating Scale (C-SSRS) screener. CFAs were used to assess the goodness of fit of a 1- and a 5-factor model. Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega. Convergent validity was examined via correlations between SCS-C scores and C-SSRS suicidal ideation severity and recent suicidal behaviors, while divergent validity was evaluated through associations with psychiatric diagnoses. Results: CFAs suggested that the 5-factor solution fit the data well. Internal consistency was acceptable (α = .71; ω ≈ .86). Convergent validity was supported by moderate correlations between SCS domains and the C-SSRS screener, while divergent validity analyses showed small correlations with psychiatric diagnoses. Discussion: Findings support the reliability, convergent validity, and higher-order factor structure of the continuous SCS-C. The standardized virtual patient enabled controlled assessment of clinician ratings while minimizing patient variability. Future studies should replicate these findings in larger samples and real-world clinical settings.

Introduction: The Suicide Crisis Syndrome(SCS) is an acute pre-suicidal mental state diagnosed when Entrapment(A) co-occurs with four Criterion B domains: Affective Disturbance(B1), Loss of Cognitive Control(B2), Hyperarousal(B3), and Social Withdrawal(B4). Current patient- and clinician-rated measures use standardized assessment without accounting for individual variation in symptom dynamics, despite cross-cultural research demonstrating population-level variation in SCS network structure. We applied a functional analysis computational framework to develop an individualized dynamical case conceptualization for SCS. Method: Using Monte Carlo, we simulated 60-day SCS trajectories for Noah(n=1), a standardized clinical training avatar presenting with SCS-positive status(A:1/1,B1:3/4,B2:4/4,B3:3/4,B4:2/2). We translated Noah's profile into coupled differential equations where stressors drive A, A drives B domains(α parameters), and B domains influence each other(γ parameters). Parameters were individualized to Noah's assessment: elevated α for A→B2 reflecting his 4/4 activation, elevated γ for B1→B2 reflecting rumination. Intervention effects were modeled by modifying coupling and decay parameters for four treatment targets. Results: Simulation identified B2 as the dominant pathway with SCS-positive threshold crossing at day 40. Problem-solving therapy targeting A produced the largest reduction in SCS status(0.10vs0.98,90%reduction) compared to cognitive restructuring targeting B2 directly(0.92vs0.98,6%reduction). Discussion: Computational modeling offers a promising approach for individualized treatment prediction from standardized assessment. Future research should validate these predictions against empirical treatment outcomes to advance understanding of suicide as a complex dynamical system.

Background: Although the therapeutic alliance is essential to the work with high-risk patients, clinicians often experience difficulties establishing and maintaining it. Research on the alliance, ruptures and repair with suicidal patients, and on the contribution of clinicians’ personality characteristics to these processes, remains limited. This study aims to address this gap by examining how clinicians’ emotion regulation difficulties, perceived competence, and self-compassion relate to the alliance in high-risk contexts. We expect emotion regulation difficulties to be negatively associated with alliance quality, clinician competence to be positively associated with alliance strength, and self-compassion to be associated with more effective rupture repair. Method: Participants (N=175) will be licensed clinical psychologists who conduct individual therapy with patients who currently experience active suicidal ideation. Clinicians will complete measures assessing their self-reported competency level in working with this population, their emotion regulation and self-compassion skills, as well as therapeutic alliance and rupture-repair with their high-risk patients (3RS-SR). Correlational and regression analyses(α=.05) will examine how clinician characteristics predict therapeutic alliance quality and rupture-repair processes in high-risk contexts. Anticipated Results: Descriptive analyses will identify common alliance ruptures and repair strategies. Emotion regulation difficulties are expected to relate negatively, and clinician competence and comfort positively, to alliance quality. Self-compassion is anticipated to support effective rupture repair. Discussion: Findings will clarify whether clinician competence, emotion regulation, and self-compassion should be targeted in training to strengthen the therapeutic alliance with high-risk patients, informing both clinical education and future research on alliance dynamics in suicide risk contexts.

Objectives: Despite decades of research, suicide remains a major public health concern, underscoring structural problems in suicide prevention research. First, suicide prevention and psychotherapy research remain siloed. A good example is the therapeutic alliance, where findings from dyadic process research have yet to be evaluated with high-risk patients. Second, most suicide prevention research relies on quantitative methods, which do not adequately capture the complexity of patient and therapist experiences. Third, suicide survivors are rarely included as partners in the research process. Last, there is a dearth of literature on “super shrinks” and successful therapy dyads with high-risk patients. This paper aims to present an innovative study to address these structural issues and to gain actionable insights into the role of the therapeutic alliance in effective therapy for suicidal thoughts and behaviors. Methods: Population: The study includes both suicidality survivors who consider themselves recovered and the therapists they credit with their recovery. Research team: Two graduate student PIs, their research mentor with expertise in alliance and suicide prevention, and a consultant with lived experience of suicidality, were all involved in study design, data collection, analysis, and dissemination. Study design and analytic approach: Stage 1 consists of in-depth open-ended qualitative interviews with former patients and therapists, analyzed using Reflexive Thematic Analysis. In stage 2, participants collaboratively interpret findings and co-develop respectful and equitable dissemination strategies. Results: Challenges encountered during recruitment and stage 1 will be discussed, as well as initial impressions from early interviews.

Introduction: Prior research shows that personality traits are associated with mindful awareness, with higher conscientiousness and agreeableness and lower neuroticism predicting greater mindfulness. Studies also indicate that more mindful therapists display more adaptive emotional responses to high-risk patients. Accordingly, the current study examined the possible mediating role played by mindfulness in the relationship between therapists’ personality traits and their emotional responses to patients at high-risk for suicide. Method: The Therapist Response Questionnaire–Short Form (TRQ-SF), the Mindful Attention Awareness Scale (MAAS), the Big Five Inventory–Short Form (BFI-SF), and a sociodemographic questionnaire were administered to 152 mental health professionals immediately following a clinical interaction with a virtual adolescent patient at high-risk for suicide. The hypothesized mediation was examined using linear regression and the PROCESS macro in SPSS, which estimates indirect effects with bootstrapping. Results: Conscientiousness and neuroticism significantly predicted mindfulness, with higher conscientiousness (t(152) = 3.24, p = .001) and lower neuroticism (t(152) = –4.50, p < .001) associated with greater mindful awareness. Mindfulness predicted therapists’ fewer negative emotional reactions on the TRQ (t(152) = –2.20, p = .030). PROCESS analyses showed a significant indirect effect for conscientiousness (effect = –.13), supporting mindfulness as a mediating pathway. Neuroticism and other traits showed no indirect effects. Conclusion: These findings suggest that mindfulness partly explains how personality traits shape clinicians’ emotional responses to high-risk virtual patients. Conscientiousness appears particularly to benefit therapists through its link with mindful awareness. The results underscore the value of integrating mindfulness training for clinicians. Future research should examine whether enhancing mindfulness improves therapeutic processes when working with high-risk real patients.

Aim Prior research suggests that clinicians’ emotional functioning may shape how suicide risk is perceived, while mindfulness may buffer affect-driven judgment. The current study examined whether clinicians’ mindfulness moderates the association between emotion dysregulation and clinician-rated level of suicide risk during interactions with White virtual patients high-risk for suicide. Methods The Clinician Predictions Scale (CPS), the Mindful Attention Awareness Scale (MAAS), and the Difficulties in Emotion Regulation Scale (DERS; 18-item version) were administered to mental health professionals (N = 66) immediately after a clinical interaction with a virtual White adolescent patient at high-risk for suicide. The hypothesized moderation was examined using linear regression and the PROCESS macro in SPSS. Results The overall model was not significant, R² = .05, F(3, 62) = 1.29, p = .29. Emotion dysregulation did not significantly predict suicide risk ratings, b = 0.64, p = .25, nor did mindfulness, b = −0.14, p = .77. The interaction between emotion dysregulation and mindfulness was also not significant, b = 0.41, p = .25. Discussion Contrary to hypotheses, mindfulness did not moderate the association between emotion dysregulation and clinicians’ suicide risk ratings. The absence of effects may reflect differences between virtual and real clinical encounters, as virtual patient interactions may not fully elicit the emotional complexity required for clinicians to assess suicidal risk. Additionally, because the outcome reflects the result of the assessment rather than the assessment process itself, it remains unclear how clinicians’ emotion dysregulation influenced information processing during the interaction.

Objective To analyze the effect of psychosocial and family variables on suicide risk in a diverse population of university students. Methods A multicenter cross-sectional study was conducted with 2,392 university students from Colombia, Spain, Mexico, and Bolivia. Suicide risk was classified into three levels (low, medium, and high) using multinomial logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to assess the association between predictor variables and suicide risk levels. Results Family history of suicide emerged as the strongest predictor of suicide risk, increasing the likelihood of belonging to the high-risk group by more than three times (OR > 3) and to the medium-risk group by more than ten times (OR > 10), compared to the low-risk group. In contrast, family history of mental illness was not significantly associated with suicide risk. Additionally, a positive self-perception of health and better family functioning were significantly associated with a reduced probability of belonging to the medium- and high-risk groups. Discussion These findings provide robust evidence of the protective role of positive health perception and family support, while highlighting family history of suicide as a key risk marker. The results underscore the importance of preventive strategies focused on early detection and psychosocial intervention, particularly those aimed at strengthening family dynamics. Furthermore, this study offers cross-cultural empirical evidence to inform the development of public health policies and suicide prevention programs tailored to university populations in Ibero-America. Keywords: university students, psychosocial predictors, suicide risk, family history.

Artificial intelligence (AI) has become an increasingly important source of mental health–related support. Evidence from independent research, industry data, and platforms such as OpenAI for Healthcare suggests that many individuals now use AI to address psychological concerns. However, little is known about who uses these tools and why, or about the characteristics of those who choose not to use them. Individual differences such as personality traits, perceived socioeconomic status (PSES), and sociodemographic factors are known to shape help-seeking behavior, yet their role in AI-based mental health support remains poorly understood, particularly in regions with limited access to formal mental health services, such as Latin America. This study used latent class analysis (LCA) to identify profiles based on the Big Five personality traits, gender, age, PSES, and educational level in a nationally representative online sample of Ecuadorian adults (n = 1,200). AI-based mental health use was then examined as an outcome of latent class membership to determine which profiles were more likely to use AI as a mental health consultant. We also examined differences between profiles in their reported motivations for using and not using AI. Final results will be available by the end of January; preliminary findings suggest that younger women with higher levels of neuroticism are more likely to use AI for mental health purposes. This study aims to clarify the socio-psychological profiles and motivations underlying AI-based mental health use in an underrepresented region, identifying groups for whom AI may function as a substitute to traditional care.

Data suggests that the top-most use of generative AI chatbots is for therapy/companionship. Yet user-centred perspectives on the capabilities, limitations, and relational qualities of these chatbots to provide mental health support remain markedly under-explored. A qualitative study designed to explore user experiences with generative AI chatbots for mental-health support interviewed 11 users from India. Data was analysed using thematic analysis. Findings revealed that AI-mediated mental health support is experienced as a relational process characterised by low-stakes entry, interactional co-construction, and the emergence of varying degrees of emotional connection. While participants described chatbots as offering validation, cognitive clarity, and functional support, their engagement was shaped by ruptures in digital alliance due to AI’s misattunements, relational and interactional limitations. This was reflected in their ambivalent patterns of chatbots usage that ranged from its selective supplementation to moments of substitution for support. The presentation would highlight how the context of usage, development of trust on AI and perceived agency, link to digital alliance. Implications for mental health practitioners and developers of technology will be discussed. Keywords: Digital Therapeutic Alliance, User-Experience, Chatbot Support, Mental Health

Despite the efficacy of treatments such as CBT, remission rates remain low for most psychiatric disorders. This is partly due to the gap between sessions, during which clients often struggle to apply skills without support. Traditional homework is often unengaging, and emerging “AI therapist” chatbots often foster dependency by mimicking human empathy. To address these limitations, we developed an AI tool designed to facilitate active learning and reinforce specific therapeutic concepts without relying on a simulated “therapeutic relationship” with AI. Instead of the “AI-as-expert” model, the system uses a learning-by-teaching framework, where a client user is asked to explain the concepts of cognitive distortion to an “AI student” and guide the “student” to reach a balanced thought. This dynamic encourages clients to actively recall and explicate therapeutic material from sessions with their human therapists, transforming passive bonding with AI into active skill consolidation. To further understand the current landscape of inter-session AI support, we also conducted surveys and interviews with individuals with lived mental health experience, exploring how they use existing AI chatbots and how they navigate discussing these tools with their clinicians. This presentation presents initial insights into user engagement and feedback with our system. To contextualize these findings, we integrate themes from our survey and interview data to highlight how clients use AI chatbots for mental health support, and the complexities of discussing these tools with their clinicians.

Mental health disorders pose a critical global challenge, affecting millions and imposing substantial socio-economic burdens. Traditional one-size-fits-all interventions often fail to capture the complexity of individual mental health trajectories, highlighting the urgent need for more personalized approaches. Digital phenotyping, which leverages multimodal data from smartphones and other sensors, offers a promising avenue for advancing mental health care. However, existing research largely relies on single-modality approaches or “black-box” machine learning (ML) models, limiting both interpretability and clinical applicability. This brief paper introduces a conceptual framework that integrates multimodal digital markers—including text, acoustic signals, facial expressions, physiological data, and behavioral patterns—to refine mental health assessment and intervention. A key innovation of this framework is distinguishing between trait-like markers (relatively stable, individual-specific characteristics) and state-like markers (within-individual changes over time). This distinction is crucial for understanding psychopathology and therapeutic change yet remains largely unexamined in existing research. By synthesizing findings across affective, cognitive, and behavioral domains, we demonstrate how automated markers can offer novel insights into mental health mechanisms. Focusing on markers such as vocal tone, facial expressivity, or linguistic features, their trait-like components predict treatment prognosis and state-like components track real-time therapeutic progress. This approach enhances the precision and personalization of mental health interventions, bridging the gap between digital phenotyping and clinical practice. By advancing personalized, mechanistic insights into mental health, this framework lays the foundation for more effective, scalable interventions that move beyond symptom tracking to actively transforming therapeutic outcomes.

Aims: This systematic review aims to synthesise qualitative research on client experiences of systemic family therapy for mental health problems published since 2010. It addresses gaps in existing evidence by foregrounding client perspectives on therapy processes, outcomes, and power dynamics, and by examining how systemic practices support or constrain client agency. By synthesizing a broad range of qualitative studies on client experience in systemic therapy in different countries, this review aims to develop a substantive body of qualitative evidence that can inform systemic practitioners working in mental health services and researchers. Method: The review was pre-registered and follows PRISMA guidelines. Through systematic searches in relevant electronic databases (resulting in 1771 hits) and cross-referencing 24 studies were identified that report qualitative findings on client experiences of systemic psychotherapy for diagnosed mental health problems. The primary studies were critically appraised by at least two reviewers and data (findings) from them extracted. The data will be thematically analysed and synthesised by comparing and contrasting themes and subthemes across studies, allowing the identification of both commonalities and variations in clients’ experiences. Results: The procedures to analyse and synthesis the extracted data from the identified studies is currently in progress. The results from the qualitative meta-synthesis will be available in Spring 2026. Discussion: The findings will provide an understanding how clients experience systemic therapy for mental health problems, including what they find helpful, challenging, or transformative. They can help refine clinical practice, improve therapist training, and ensure that systemic interventions are both evidence-based and client-centred.

Aim: This study explores the evolving role of counseling psychologists as consultants within Taiwan’s family court and community mental health systems. Moving beyond traditional counseling rooms, it examines how psychological professionals engage in indirect interventions—consulting with parents, teachers, and social workers—to promote the well-being of children and families involved in custody disputes or psychosocial crises. Methods: Drawing from Caplan’s (1970, 1993) framework of six types of mental health consultation—particularly case-centered, consultee-centered, administrative, and community-centered models—this qualitative reflection analyzes over four years of supervisory and consultation experiences in the Taipei District Family Court. Case documentation and reflective supervision notes were reviewed using reflexive thematic analysis to identify recurring consultation patterns, professional dilemmas, and systemic opportunities for change. Results: Three dominant themes emerged: (1) Consultation as indirect advocacy—psychologists act as bridges between legal and emotional needs; (2) Systemic containment—consultative dialogues among judges, social workers, and teachers reduce inter-agency fragmentation; and (3) Reframing responsibility—shifting from individual pathology toward shared caregiving accountability. These findings align with Caplan’s tertiary prevention principle, reducing psychosocial impairment through coordinated, multi-system interventions. Discussion: Taiwan’s integration of psychological consultation into judicial and community contexts illustrates a paradigm shift from treatment to systemic prevention. Consultation becomes not merely a professional service but a civic collaboration promoting child protection and family resilience. Implications highlight the necessity of counselor training in legal literacy, cultural humility, and interprofessional negotiation. Key words: Consultation Family Court Psychology Community Mental Health Interprofessional Collaboration

Community mental health models in Latin America have expanded psychotherapeutic practice beyond individual clinical encounters by incorporating community-based and psychosocial interventions. Despite this expansion, the involvement of community-based actors in such interventions remains insufficiently systematized within psychotherapy research. This study aimed to synthesize the existing literature on community mental health interventions involving community-based actors in Latin America and to examine their implications for psychotherapeutic practice. A systematized narrative literature review was conducted using Scopus, SciELO, and Redalyc. A focused search strategy combining the exact phrase “community mental health” with actor-related terms was applied. Publications published between 2000 and 2025 were considered. Of 397 records initially identified, 12 peer-reviewed articles met the inclusion criteria. Data were analyzed using a thematic narrative synthesis. Four analytical categories were identified: (1) the operationalization of community mental health interventions, marked by a partial translation of community-oriented principles into practice; (2) the role and positioning of community mental health agents, characterized by strategic relevance alongside limited institutionalization and uneven training; (3) relational and collective outcomes, including empowerment, participation, and the strengthening of social bonds, which were prioritized over symptom-focused outcomes; and (4) structural and institutional conditions shaping implementation, such as programmatic rigidity, resource constraints, and challenges in intersectoral coordination. The findings indicate that community mental health interventions contribute to an expanded conceptualization of psychotherapeutic action that foregrounds relational, collective, and contextual processes. These results underscore the need for psychotherapy research to more systematically engage with community-based interventions and actors in order to better understand how psychotherapeutic processes operate beyond traditional clinical settings.

Aim: Reproductive experiences commonly emerge within psychotherapy settings. However, the influence of reproductive autonomy on women’s mental health and therapeutic needs has not been synthesised. Purdy (2006) defines reproductive autonomy as the freedom and ability to make reproductive decisions based on adequate information and free from coercion. This review aims to synthesise qualitative evidence on how women experience reproductive autonomy, and how these experiences relate to psychosocial wellbeing in the UK. Methods: A systematic search of PsycINFO, PubMed, Web of Science and CINAHL was conducted using predefined qualitative, reproductive-health, and mental health terms. Eligible studies were qualitative, UK-based, focused on women, and examined reproductive decision-making, agency, or coercion alongside psychological or well-being outcomes. 13 qualitative studies met the inclusion criteria and were appraised using CASP-checklist. Studies were analysed using thematic synthesis. Results: Findings indicate that reproductive autonomy is linked to emotional safety, identity, and agency. Three themes emerged: navigating decisions within systems of care and regulation, within relational and cultural contexts, and in relation to psychosocial wellbeing. Narratives describing constrained choice, limited information, or reproductive coercion are linked to distress and reduced well-being, whereas supported and voluntary decision-making is associated with greater emotional stability and trust in relationships. Discussion: This review highlights reproductive autonomy as a relational and social process with implications for mental health and wellbeing such as understanding distress, power, and empathy in psychotherapy. Findings have implications for trauma-informed, rights-based, and culturally responsive psychotherapy practice,when working with reproductive loss, decision-making, coercion, supervision. Keywords: reproductive autonomy; women’s mentalhealth; psychotherapy

Objective: Patients’ histories, the characteristics of their pathology, their interactional style, and their intentions trigger therapists’ cognitive-emotional reactions (Hayes, 2004). A recent review (Zeeck, 2025) on countertransference (CT) in the treatment of eating disorders (ED) summarizes a range of both unwanted and beneficial reactions. However, a comprehensive investigation of CT is still lacking, and the effect sizes of trigger–reaction relationships have yet to be determined. Method: German-speaking psychotherapists with experience in treating EDs were asked to describe two recently treated cases in an online survey. Regarding triggers, they rated a list of symptoms, personality traits (PID-5-BF+) / personality functioning (OPD-SQ), and possible therapeutic challenges encountered during treatment. Regarding reactions, they rated their own emotional experiences during sessions, their countertransference (TRI/CTQ), and work involvement (TWIS). Results: A total of 127 psychotherapists participated (82% female, 63% CBT). The strongest triggers were found in impaired personality functioning and specific challenges (ambivalence, cheating about weight, or binge–purge behavior). These factors strongly predicted therapists’ self-perceived helplessness and disengagement and also significantly impaired the session process (Flow). The ED symptom spectrum was only weakly related to therapist reactions. Conclusion: Ambivalence, cheating, and low levels of personality functioning are antagonistic to the goal, task, and relationship dimensions of the therapeutic alliance. Therapists appear to react most strongly when patients undermine the therapeutic relationship. Although therapists understand these behaviors as part of the illness, they cannot fully avoid feeling alienated or devalued, which increases the risk of disengagement and disaffiliation. Managing negative emotions is therefore a highly relevant task in ED treatment and should be addressed in training and supervision.

Aim: The aim of the current research was to investigate the role of reflective function (RF) and of emotion control (EC) in relation to relationship satisfaction (RS) within adult couples. We hypothesized that couples’ higher RF, and lower EC would be related to their higher RS and that couples’ higher RF would be related to their higher RS through their own lower EC. Methods: The participants in this study consisted of 27 couples involved in committed romantic relationships. Couples had to have been living together for at least one year and had to be over eighteen years of age. They were asked to complete a battery of questionnaires online, which included the Reflective Function Questionnaire (RFQ; Fonagy et al., 2016), the Courtauld Emotional Control Scale-Revised (CECS-R; Feeney, 1995; Watson & Greer, 1983) and the Dyadic Adjustment Scale (Spanier, 1976). Results: Results demonstrated that RS and RF were significantly related, but in the opposite direction than expected. Specifically, couples who were lower in RF through scoring higher on the certainty scale of the RFQ (i.e., the scale that measures hypermentalizaton), were more satisfied in their relationships than couples who were higher in RF according to that scale. We also found that lower EC was significantly related to higher levels of RS. Discussion: The finding that suggest that lower EC is significantly related to higher RS is consistent with previous research (e.g., Feeney, 1999). In addition, the findings on RF suggest that there may be some benefits related to hypermentalization in relationships.

Objective: Parental rejection significantly impacts the mental health of sexual and gender minority (SGM) young adults and damages the parent-child relationship. Attachment-Based Family Therapy for Sexual and Gender Minorities (ABFT-SGM) aims to repair these ruptures by facilitating "corrective episodes" where parents respond to their child’s pain with empathy rather than defensiveness. Theory suggests that Parental Reflective Functioning (RF) is a necessary precursor to such constructive enactments. This study examined whether parents’ RF during individual preparatory sessions predicts their observed relational behaviors during subsequent conjoint sessions. Method: Participants included 45 parents of LGBTQ+ young adults from an open clinical trial of ABFT-SGM. Parents’ RF was observationally coded from individual therapy sessions using a modification of the Reflective Functioning Scale. Parents’ behaviors during subsequent conjoint sessions were coded using the Parent-Child Interaction Coding System Results: Consistent with our pre-registered hypothesis, higher levels of parental RF in individual sessions predicted a greater frequency of constructive in-session behaviors, specifically validating the young adult’s experience and soliciting their emotional reactions. Conversely, higher RF predicted significantly lower frequencies of patronizing and judgmental behaviors. Contrary to our hypothesis, parents' defensiveness was not associated with RF levels. Notably, parental RF in the final preparatory session remained a significant predictor of behavioral outcomes even when controlling for baseline RF, suggesting that fostering mentalization prior to conjoint sessions is a crucial therapeutic mechanism. These findings link in-session mentalizing to observable relational repair behaviors, underscoring the importance of targeting parental RF during preparatory work to equip parents for corrective attachment episodes

Aim Research links employment to students' well-being, but its impact on students seeking mental health treatment remains unclear. This study explored the prevalence of paid employment and work hours among treatment-seeking college students, examining factors associated with employment, including work status, hours worked, and differences in distress (e.g., depression, anxiety) and demographics (e.g., race, SES, disability status). Method Data were collected from the Center for Collegiate Mental Health (CCMH), which collects data from over 800 U.S. college counseling centers. The sample consisted of 72,938 undergraduate and graduate students who sought treatment during the 2019-2020 academic year. Standardized assessment measures were used to gather data on presenting concerns and demographic information. Results The study found significant differences in students' demographics, presenting mental health concerns, and financial distress based on the number of hours students worked each week. Discussion Results highlight how the amount of work correlates with students' distress and demographic characteristics, revealing important patterns among treatment-seeking students. These findings have implications for campus counselors, suggesting that employment status and work hours should be considered when assessing students' mental health concerns. Understanding these factors can help improve support for students in postsecondary settings.

Objective. Group psychotherapy offers an effective and efficient treatment format for a wide range of psychological disorders, including personality disorders (PDs). Despite strong evidence for its efficacy, group therapy remains underutilized in specialized mental health care, where individual therapy continues to be the default. The allocation process, in which the decision for individual or group therapy is made, is still a ‘black box’. The present study aims to shed light on this understudied topic by examining which patient characteristics predict allocation to group or individual psychotherapy, among patients with cluster C PDs. Method. Baseline data were drawn from the psychotherapy FOR Cluster C Effect Studies (FORCE), conducted at a specialized treatment center implementing a “group unless…” policy to promote group-based treatment. Allocation to therapy format served as the dependent variable. A wide range of demographic, diagnostic, and clinical variables were included as predictors. Machine learning methods—logistic regression with LASSO regularization and Random Forest—were applied to identify both linear and nonlinear predictors of allocation, using cross-validation to minimize overfitting. Results. Analyses are ongoing, but will be ready to present in June 2026. Conclusions. This study seeks to contribute to the empirical foundation for optimizing treatment allocation in PD care. By clarifying which patients are selected for group versus individual therapy, it aims to inform clinical decision-making, direct future research and promote more efficient and equitable access to psychological treatment.

Group psychotherapy holds a “triple E-status”: effective, equivalent to individual therapy, and efficient. Yet, research on group dynamics has been relatively neglected, despite their predictive power for therapeutic outcomes. This study introduces an innovative qualitative approach that integrates observational data with visual network analysis (Pokorny, 2017) to make group processes visible and analytically testable. In an ongoing psychodynamic group for older adults (60+), two consecutive sessions were audio-recorded, transcribed, and independently coded by two researchers. The analysis proceeded inductively by identifying sequences of meaningful responses between participants, followed by a deductive phase using the MAGI framework (Borek et al., 2019) to classify interactional themes. Networks from sessions rated as more or less effective by participants were compared to explore distinctive process patterns. The primary objective is to examine the association between visual network features and perceived session effectiveness; the secondary objective is to assess the feasibility of this method as a proof-of-concept for future process research. By combining qualitative meaning analysis with computational visualization, this study reimagines psychotherapy research as a dialog between narrative and structure, bridging subjective experience and observable interaction within the therapeutic field. The outcomes of this study will be presented at SPR.

This research aimed to examine who benefits most from the BEAR group interventions—an 8-session emotional cultivation group for children and adolescents, and how the interventions can be more effective. Two studies were conducted using data from 307 student clients and 250 teachers. In Study 1, a latent profile analysis was conducted using four dual emotional regulation strategies from student clients’ perspectives and two behavioral problems from teachers’ perspectives. Three distinct emotion and behavioral problem profiles emerged: student clients with internalizing problems, student clients with hidden problems, and student clients with impulsive problems. Study 2 examined whether different types of student clients progressed differently and under what conditions the BEAR group interventions were more effective. Multilevel modeling was conducted to analyze the nested data of 53 groups. Results showed that BEAR group was more effective in (a) decreasing negative affect for student clients with impulsive and internalizing problems, (b) increasing cultivating emotion strategies for student clients with hidden problems, and (c) increasing academic efficacy for student clients with impulsive problems. Group composition also influenced outcomes; intervention was more effective in (a) decreasing negative affect from student clients’ perspectives when the group had fewer student clients with hidden or impulsive problems, and (b) increasing cultivating emotion strategies from teachers’ perspectives when the group had more student clients with impulsive problems. In conclusion, the BEAR group benefited all student clients, though different types of student clients received help in different aspects, and the impacts of their characteristics and group composition were discussed. Keywords: children and adolescence, latent profile analysis, group effectiveness, group composition, member characteristics

As Associate Director of Education tasked with embedding research informed teaching across programmes and educational phases, I will reflect on building a research culture within a practice oriented institution. I will trace the shift from isolated, piecemeal initiatives to a fully integrated framework connecting teaching, learning, and practice, and discuss the challenges encountered along the way.

In my position statement, I will share some of my experiences of setting up and acting as Academic Director for the Independent Training in Child and Adolescent Psychotherapy training in the UK. In particular, I will provide some background to how (and why) child psychotherapy training in the UK became a doctoral-level programme, and what impact this had. I will share my thoughts on why it is of value to include a research element within clinical training, and some of what we learned about what worked – and what didn’t.

Professional bodies have a crucial role to play in supporting the provision of research-informed teaching within practitioner training, but how might this best be achieved? Speaking from my experience as Head of Research with the British Association for Counselling and Psychotherapy, I will share our work to support practitioner training courses ranging from HE Level 4 to doctoral level, highlighting the tensions inherent for a professional body within a voluntary regulatory system.

Distortions in the recollection of autobiographical memories are a transdiagnostic feature of multiple mental health conditions in adults, implicated in the onset, maintenance and recovery from disorder. In adolescents, much of this research to date has focused on the role of reduced memory specificity, typically assessed using the Autobiographical Memory Test (AMT), with less research examining biases in other domains of autobiographical memory recall. In this study, we administered a novel recall paradigm, the Good Day-Bad Day Task (Hitchcock et al., 2019), to assess autobiographical memory fluency for positive and negative events, memory specificity, and the Fading Affect Bias – the extent to which the emotional intensity associated with positive memories fades less than for negative memories overtime – in adolescents at high (n=201, Mage=17.20, SD=.60, 84.6% female, 2% other) and low clinical risk (n=117, Mage=17.10, SD=.60, 77.8% female) of affective disorder. We found that superior recall for positive relative to negative events and a strong fading affect bias were associated with good mental health. Risk of affective disorder was associated with a significant reduction in these positive biases, and recall of a higher number of negative memories compared to Low Risk adolescents. Memory specificity did not differ by risk status. Findings extend research on autobiographical memory processing to two novel domains in adolescence and further elucidate how differences in autobiographical memory recall may underlie mental health, with implications for the development of memory-based interventions.

Background: Adolescence is characterised by heightened social evaluative sensitivity, emerging status regulation, and shifts in motivational priorities. How adolescents appraise socially valuable traits in others and how these priorities differ from adults or vary with mood and perceived social rank remains unclear. Methods: A novel Social Value Questionnaire (SVQ) was developed using adolescent and adult focus groups, refined via EFA (n=481) and validated using CFA (n=200). Using harmonised adolescent–adult data (N=681; ages 12–65), structural equation modelling quantified age-related trajectories and the influence of depressive symptoms and perceived social status on latent value factors. Results: A robust four-factor structure emerged: Warmth, Sociability, Competence and Unpleasantness. Age exerted dissociable effects. During adolescence, endorsement of Sociability and Competence was highest, consistent with status-relevant and identity-consolidation goals, while Warmth increased linearly across adulthood. Unpleasantness showed a monotonic decline across age. Across the full sample higher depression scores and higher perceived rank independently predicted greater tolerance of Unpleasantness. Discussion: Adolescents prioritise socially performative (Sociability) and capability-related (Competence) traits more strongly than adults, suggesting that value endorsement is tuned to developmental imperatives around peer integration and competitive status. Mood-related increases in tolerance of negative traits in others, observable already in adolescence, align with evolutionary accounts of social risk management. These findings indicate that the calibration of social value perception in early developmental windows may constitute a mechanism linking social context, status regulation, and emerging vulnerability to psychopathology.

Young people face significant barriers to accessing mental healthcare including financial, temporal, and stigma concerns. Therefore, to halt the tide of the global youth mental health crisis, innovations in preventative approaches are needed. High uncertainty in recent global health, geopolitical, and climate crises has been proposed as one important driver of the rise in youth mental health problems. Therefore, intolerance of uncertainty – a transdiagnostic risk factor – is a promising target to protect and improve young people’s mental health. This research presents an ultra-brief digital training that took a synergistic mindset approach to promote uncertainty-as-adaptive and growth mindsets, along with reducing repetitive negative thinking. The 30-minute self-guided Uncertainty-Mindset Training was compared with Psychoeducation and No-Training control groups in 259 older adolescents/emerging adults (18-to-24-year-olds). Participants were recruited internationally, with 87.6% residing in South Africa. This study found that the Uncertainty-Mindset Training significantly reduced intolerance of uncertainty (d = 0.86), anxiety symptoms (d = 0.50), and depression symptoms (d = 0.60) one month later. Importantly, the clinical gains were mediated by reductions in intolerance of uncertainty. Given that this ultra-brief training can be delivered at scale globally and at no cost to the users, it shows promise for a significant public health impact.

Feeling valued by others is essential for wellbeing. During adolescence, where friendships and social hierarchies are in flux, our responses to changes in social value may be important in shaping mental health. We developed a novel experimental task to directly manipulate adolescents’ sense of social value within a group context. In this task, participants work in teams to write short stories, and team members vote for who contributed most to the team’s success. We show that adolescents’ momentary mood and anxiety closely track changes in their social value, and that those with elevated social anxiety symptoms show heightened emotional reactivity, particularly to low social value. Finally, socially anxious adolescents showed greater self-focused attention, evident both in their self-reports and in their memory for the social interaction, where they remembered more of their own contributions, compared with others', than non-anxious adolescents. This shift of attention inwards may prevent adolescents with social anxiety from recovering from periods of low social value, a line of work we are now directly testing. Increasing our understanding of this link between social experiences and mental health may help identify new treatment targets during this critical developmental period.

Aim: Understanding mechanisms of change in the treatment of psychopathology is essential for optimizing therapeutic interventions. Beyond the effectiveness of specific methods and techniques across psychotherapeutic approaches, meta-analytic evidence highlights the relevance of common factors, such as the therapeutic alliance, consensus on treatment goals, the promotion of hope and positive expectations, and the management of alliance ruptures. Both common and specific factors have been shown to be consistently associated with symptom change across psychotherapeutic, psychiatric, and digital treatment contexts. The present study examines whether common and specific factors can be reliably assessed across different treatment settings within the multimodal German healthcare system. Methods: The Common and Specific Factors Inventory (CSFI) was developed based on meta-analytic evidence on common factors, facilitative interpersonal skills, and psychotherapeutic techniques, supplemented by expert focus groups and pilot studies. Within the PSYMPACT study - a longitudinal naturalistic investigation of changes in psychopathology in relation to treatment characteristics - data were collected from N = 2,384 participants receiving psychotherapeutic (n = 956), psychiatric (n = 421), or digital (n = 1,007) mental health treatments in Germany. Results: The CSFI demonstrated acceptable to good model fit across all three treatment settings. Measurement invariance was supported for psychotherapeutic and psychiatric settings, with partial invariance observed for digital treatments. The influence of symptom severity and treatment integrity on CSFI scores and measurement properties is also examined. Discussion: Findings indicate that common and specific factors can be assessed using the CSFI across psychotherapeutic, psychiatric, and digital treatment treatment settings. The CSFI thus offers a valid foundation for comparing change processes and advancing a more differentiated understanding of mechanisms of change across treatment modalities.

Aim The therapist-patient relationship is a key mechanism behind therapeutic change. We aimed to examine this process on the neural level. Inter-brain synchrony – coordinated activity of specific brain regions between two people – is associated with closer relationships, and with a better therapeutic alliance in single session studies. The current study examined whether it is also associated with therapeutic change. We hypothesized that over the course of multiple therapy sessions we would detect inter-brain plasticity - i.e., consistent changes in inter-brain synchrony – associated in turn with improved general interpersonal functioning outside of the clinic. Method 21 participants with major depressive disorder underwent 16 sessions of supportive-expressive therapy. Therapist-patient inter-brain synchrony was examined every other session using functional near-infrared spectroscopy (fNIRS). Interpersonal functioning was examined every 4 sessions using the index of interpersonal problem circumplex (IIP-C) questionnaire. Results Therapist overall brain activity became synchronized more with clients’ left inferior frontal gyrus (IFG) activity and less with clients’ left pre-motor region activity. These changes were correlated with improved general interpersonal functioning, more specifically with reduced submissiveness. Discussion Our results suggest that inter-brain plasticity, i.e., changes in inter-brain synchrony, may be a key mechanism for interpersonal changes over the course of therapy. The shift between synchrony in the pre-motor region to the IFG may indicate a shift between a hypervigilant relationship pattern to one based on emotional empathy, associated with the reduction in submissiveness. These results pave the way to better understanding neurological mechanisms underlying interpersonal processes in therapy.

Previous research has identified an association between nonverbal synchrony and the therapeutic alliance, although findings appear to be heterogeneous across different clinical contexts. This study adopts a single-case (N=1) design to examine the session-by-session covariation of these variables across the course of treatment. In doing so, this study seeks to address a key challenge in this area: namely, the modest levels of concordance often found between client and therapist alliance ratings. Consequently, ascertaining the extent to which synchrony reflects the therapeutic bond may rest on statistical approaches capable of isolating the shared variance within these potentially divergent perspectives. We analysed recordings from a complete 16-session therapy course using a dual-pipeline approach. Facial features were extracted using automated analysis (OpenFace 3.0) and acoustic features via OpenSMILE (GeMAPS), with synchrony quantified using Windowed Cross-Correlation (WCC). To model the therapeutic bond, Multilevel Modelling (MLM) was applied to post-session alliance ratings, facilitating the extraction of a latent ‘shared’ alliance trajectory—representing the variance common to both client and therapist ratings per session. The study thereby explores the extent to which movement and acoustic synchrony covary with this shared trajectory, alongside pre-to-post clinical change (PHQ-9; GAD-7). By utilising MLM to refine the measurement of the alliance, this study proposes a formalised protocol for evaluating nonverbal synchrony as a potential process marker. Whilst results from a single dyad are not generalisable, this approach highlights the potential for multimodal markers to capture how the therapeutic relationship unfolds over time.

Aim Relationships are central to mental health, and psychotherapy is fundamentally an interpersonal process. This presentation introduces a new four-year project funded by the Research Council of Finland, The Rhythm of Connection: Individual Traits, Relationship, and Situation Shaping Interpersonal Synchrony (IRSync, 2025–2029). Although interpersonal synchrony has been linked to social and therapeutic processes, research has lacked a structured approach clarifying how individual, relational, and situational factors associate with synchrony. The project examines moment-to-moment coordination between interacting individuals in autonomic nervous system activity, movements, and facial expressions, and variation across relationship types and interaction contexts. Methods The target sample includes 300 dyads from Central Finland representing six relationship types: romantic couples, friends, siblings, parent–adult child pairs, colleagues, and strangers. Dyads participate in a two-hour interaction with nine 8-minute themed discussion segments. Topics vary in emotional climate, cognitive alignment, perceived interpersonal connection, and cooperation. Continuous physiological data are collected using electrodermal activity and heart rate measures, alongside video recordings of facial expressions and body movements. Multimodal synchrony is analyzed using time-series and multilevel modeling. Results At the time of the conference, data collection and analyses will be underway. The presentation will include preliminary findings on interpersonal synchrony, which will be discussed in relation to our earlier findings on synchrony in couple therapy. Discussion This research advances understanding of bodily synchrony as a core interpersonal process with implications for psychotherapy. It also generates open multimodal datasets and methodological resources for research on social interaction and embodiment. Other keyword: interpersonal synchrony

An important goal in psychotherapy research is to better understand its mechanisms of change. The research project we will present in this communication aims to investigate interpersonal synchrony as a key mechanism underlying therapeutic change in depression, with a particular focus on the therapeutic alliance and alliance ruptures. Building on our prior research on alliance ruptures and interpersonal synchrony, this new funded project of our team conceptualizes alliance ruptures as critical moments of tension or disengagement that, if unresolved, are associated with poor outcomes or dropout. On the other hand successful rupture resolution is hypothesized to rely on mutual affective regulation between therapist and patient, occurring across behavioral, emotional, and physiological levels. This regulation can be captured through patterns of interpersonal synchrony in body movement, cardiac activity, and electrodermal responses. This project recruits 30 patients diagnosed with an emotional disorder, who engage in a 16-session psychotherapy protocol with follow-up assessments. Across 480 therapy sessions, multimodal physiological data (movement, heart rate, and electrodermal activity) from both therapists and patients are recorded, alongside alliance and outcome self-reports. Alliance ruptures will be identified through systematic observational coding using the 3RS System (Eubanks et al, 2022). Synchrony will be quantified using cross-correlation methods controlling for incidental synchrony. Analyses will examine both macroscopic associations between synchrony, alliance, and outcomes, as well as and microscopic synchrony dynamics of rupture emergence and resolution. Our findings will inform the development of feedback tools, supervision strategies, and an alliance-focused training program for therapists. This project represents a novel integration of interpersonal synchrony and alliance rupture research, with direct implications for advancing psychotherapy practice and training

Aim:This panel discusses the psychotherapeutic significance of psychological testing and its feedback. Methods: This paper investigates the current state of psychological assessment in Japan and the professional growth process of mental health practitioners related to assessment skills, based on literature such as research reports and practice reports. Results: While testing is conducted in various clinical settings in Japan, time constraints in medical settings often prevent sufficient time for sharing results. Similarly, in private practice, economic constraints limit the types of tests that can be offered and the time available for feedback.Although these approaches are practiced within limited structures, several methods exist that connect to psychotherapy and psychological support. Discussion:It discusses how therapeutic elements within psychological assessment can be enhanced within the existing structure of clinical settings, and the unique elements specific to Japan that can be extracted from this.

Aim:In this presentation, the view that non-attendance results from setbacks in overcoming the conflict between recognizing individuality and being “just like everyone else” is outlined. Methods:I investigated literature related to past research and conducted a review and analysis. Results:The result shows the importance of balancing the two supports to overcome the setback. Discussion:The first support is individual one that allows them to re-experience the mother-child relationship. The second support is to set up a place where they can experience being “just like everyone else” at their own pace. Furthermore, it is seemed to be necessary to support students of non-attendance to grow so that they do not repeat the same setbacks. they are considered to need to overcome the conflict between recognizing individuality and being “ just like everyone else” in order to achieve social independence in a “schooled society”.

Aim: In Japan, school refusal has reached record highs for twelve consecutive years, from 2012 to 2024. Approximately one in fifteen Japanese junior high school students is classified as refusing to attend school, and it is estimated that nearly twice that number exhibit tendencies toward school avoidance. This growing trend underscores the urgent need for effective support systems for these students. The purpose of this presentation is to introduce a case study of the Kofu City Board of Education, which successfully curbed the rate of increase in school refusal. Methods: The Board of Education convened a committee dedicated to formulating strategies for addressing school refusal, chaired by the panelist, who is a psychologist. The committee implemented three key measures: (1) introducing the ‘KIMOCHI Meter,’ a mental health monitoring application; (2) establishing an in-school educational support center; and (3) revising individualized support plan cards. A comparative analysis was conducted to assess changes before and after the implementation of these interventions. Results: As a result, (1) the number of students reporting feelings of anxiety decreased, and (2) the number of students successfully reintegrated into classrooms from the in-school educational support center increased. Discussion: This discussion explores the potential roles of psychologists within the organizational structures and cultural contexts of schools.

Aim: In Japan, two major credentials for psychological professionals—Clinical Psychologist and Certified Public Psychologist—are awarded, and universities serve as the primary institutions responsible for their training. This presentation introduces the training curricula for both qualifications and discusses current issues facing the Japanese training system. Methods: Official documents were reviewed to summarize the curriculum structures for each credential. Results: Training for Clinical Psychologists is primarily oriented toward psychotherapeutic practice, whereas the Certified Public Psychologist credential emphasizes multidisciplinary collaboration. Consequently, the two curricula share several components but also include requirements unique to each credential. Discussion: Students aiming to obtain both credentials often face highly condensed schedules, limiting students’ flexibility in academic and clinical learning. Moreover, although university-based training is a distinctive feature of the Japanese system, the coexistence of academic education and professional training within a single institutional framework continues to present structural issues.

This study explored how emotion-focused therapists deepen client experiencing. Emotion-focused therapist response modes were evaluated and their effect on shifting the client’s focus of attention from external to the internal was studied. The study investigated emotion episodes extracted from two client groups: those classified as experientially engaged clients (EE) (N= 13) as compared to experientially distant clients (ED) (N= 42). EFT therapist responses were grouped into two broad categories: holding (which includes empathic reflections, empathic affirmations, and following responses) and deepening (which includes exploratory reflections/questions, evocative reflections, empathic conjectures, and empathic refocusing). Each therapist response within each emotion episode was coded as either ‘holding’ or ‘deepening’, while each client response within each emotion episode was coded as either internally or externally focused. The study assessed which response mode is used more frequently with each client subgroup. The study then evaluated which response mode is predictive of client internal focus, and if this differs depending on client subgroup. Results showed that therapists provided significantly more deepening responses with EE clients as compared to ED clients, with significantly more holding responses having been provided to ED clients. Results also showed that deepening responses were significantly predictive of client internal focus, regardless of whether a client belonged to the EE or ED subcategory. This provides support for one of emotion-focused therapy’s (EFT) central tenets: that, although clients enter therapy with differing access to their emotional experience, all clients are more likely to respond to deepening responses with increased experiencing. This study sheds light on the effectiveness of active emotion-focused exploration in deepening client experiencing, regardless of their initial propensity toward emotional awareness. This provides further evidence for the use of EFT with both initially experientially engaged and distant clients, as opposed to exclusive application with clients who arrive to therapy with a heightened emotional awareness.

Background: Carryer and Greenberg have found that a high level of emotional arousal for about one third of the therapy session was the optimal amount of arousal as it significantly predicted outcome. Since this was done over the full extent of the therapy, it would be useful to analyze how emotional arousal is optimally mobilized within a single task. In Emotion-Focused Therapy, some tasks require a high level of emotional arousal to be productive. In empty-chair dialogues, the patients enact a past interaction, with a significant other that has hurt them, in order to generate new meaning from this experience. This study will look at the optimal amount of arousal within the empty-chair dialogue task and how it relates to outcome. Methods: Emotional arousal of N = 38 patients from private clinics, obtained from the large- scale EFT study (Kramer et al., 2024), will be measured using the Client Expressed Arousal Scale (CEAS-III-R) on the recorded therapy sessions, during the emotionally evocative therapeutic task, on a minute-by-minute basis. The main outcome will be defined by a decrease in the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM). Results: Data will be analyzed and later presented at the conference. Conclusion: Understanding how client emotional arousal is managed in experiential tasks in EFT is important to better understand where the emotional arousal is to be invested and will contribute to optimizing psychotherapy benefits.

Emotion is central to counseling, yet its articulation and interpersonal navigation within the therapeutic dyad remain challenging. Emotions serve distinct functions and thus require differentiated, context-sensitive responses that go beyond reflection of feelings. While most existing research has linked emotional expression to outcomes or catalogued therapist strategies at session level, few studies have closely examined how therapists' moment-to-moment, turn-by-turn responses to specific client emotions influence the subsequent depth and trajectory of emotional exploration within the emotion process. Aim: To address this gap, this study employs Consensual Qualitative Research to explore how therapist responses to specific client emotions influence the emotion process. Methods: All coding decisions are made through iterative team discussion until consensus is reached. Data will be drawn from 15–20 session with more clients’ emotion-word, obtained from a university-based training clinic in Hong Kong. Results: The analysis involves systematic coding and rating therapists' skills used to respond to client emotions, along with coding of clients' subsequent emotional expressions and in-session processes (i.e., client’s reaction). All sessions have been collected and the emotion word ratios calculated. Segment selection and data coding are ongoing. Discussion: By moving beyond looking at the frequency and type of techniques therapists use, this research seeks to illuminate features of therapists’ responses that facilitate or hinder in-session emotional exploration and therapeutic progress. The findings are expected to offer nuanced, evidence-informed guidance to help therapists respond more effectively to clients' varying emotional states across a session.

The primary proposed change process in Emotion-Focused Therapy models for couples involves partners accessing and revealing vulnerable emotions and responding to such disclosures with empathy and compassion. Therapists often use enactments (guiding partners to communicate with each other directly) to facilitate this process. However, many therapists report lacking confidence and clarity in how best to facilitate enactments, and it remains understudied which therapist interventions within enactment episodes contribute to vulnerability sharing and responsiveness expression. This preregistered study examined the role of three interventions used during enactments—systemic meaning-making (narrating), emotional engagement (experiencing), and interaction guiding (choreographing) in promoting these processes. One hundred forty enactment events from 21 treatment couples were coded and analyzed. Trained raters coded therapists' interventions and partners' behaviors. In contrast to our hypothesis, systemic meaning-making and interaction-guiding were not associated, and emotional engagement was only marginally associated with greater vulnerability expression. Interaction guiding was positively associated with responsiveness. However, systemic meaning-making was negatively associated with responsiveness, and emotional engagement was not associated with responsiveness. Vulnerability expression did not predict partner responsiveness. These findings highlight the importance of tailoring therapist interventions in enactments according to their distinct contributions to facilitating vulnerability and responsiveness.

Aim: Although rupture repair is a core process in psychotherapy, the specific mechanisms through which alliance ruptures are repaired remain insufficiently understood. In this theory-building case study, we used an explanatory sequential mixed-method design to reconstruct the dyadic work involved in successful versus unsuccessful withdrawal rupture repair during a psychodynamic treatment. Method: We assessed rupture and repair across N = 81 video-recorded sessions. We applied EWMA control charting to identify two treatment phases characterized by above-average success in rupture repair, and one phase with below-average repair. Sessions from these phases were analyzed using grounded theory coding informed by sensitizing concepts derived from a clinical discussion group. Results: The analyses yielded the core category of a case-specific working model for rupture repair. By this, we mean that during the first two phases, therapist and patient jointly and tacitly established and refined their own specific way of working with the patient’s typical avoidance patterns. In the third phase, however, this working model could no longer be applied effectively, potentially due to changes in the treatment context that altered the transference-countertransference dynamics. Discussion: Developing and sustaining a case-specific working model for rupture repair may be crucial for navigating impasses and maintaining therapeutic progress.

Aim: Depression is one of the mental health disorders that has attracted most attention to improve its management in primary health care settings, due to institutional barriers and lack of training for its treatment. Aim of this study was to present a model of core psychotherapeutic competencies for the management of depression in institutional and PHC settings based on the perspective of patients, therapists, and experts. Method: The study used consensual qualitative method (CQR). Results: The model proposes that one must have a background of knowledge that allows one to adapt the technique to the characteristics and needs of the consultants, be active to intervene, be flexible in terms of theoretical approach and in terms of professional performance and be engaged to the consultant. All these competencies act as bridges to build and nurture a bond that results in a corrective and therapeutic experience for the patient with depression. Discussion: The proposed competencies are in line with empirically supported models (e.g. common factors model, adaptive indication), and it is discussed how these skills were inserted as inputs for the generation of a competency training for depressive disorders in PHC settings.

Aim: Facilitative interpersonal skills (FIS) are widely used as an operationalization of therapists’ interpersonal competence. However, it is not yet clear to what extent these skills are specific outcomes of formal psychotherapy training, or instead reflect more general abilities developed across different professional pathways or outside of any formal training. Methods: To test whether psychotherapy students show a stronger stage-related increase in FIS levels than students from other fields, this study protocol outlines a cross-sectional cohort design in which FIS levels are assessed at three training stages (entry university level, end of bachelor, end of master) across four professional pathways using the FIS task as a standardized performance-based assessment. The group comparisons include (1) psychotherapy students as the reference group, (2) nursing and (3) teacher education students as comparison groups with high interpersonal demands but without specific mental health training, and (4) students from STEM fields as a baseline group with comparatively low interpersonal demands and no mental health training. Results: We will use linear mixed-effects models with professional pathway and training stage as main fixed effects. The primary test will evaluate the interaction between the two factors. Discussion: Findings will inform the conceptual understanding of psychotherapeutic competence and the extent to which FIS represent training-specific outcomes. If psychotherapy students do not show a stronger stage-related increase in FIS levels than students from other fields, the findings would raise important questions about the rationale for formal therapy training, or about the validity of the FIS framework and task as indicators of therapist competence.

Aim: Personal therapy (PT) is widely regarded as an essential component of psychotherapy training, aimed at fostering core therapist qualities such as self-compassion and reflective functioning. Alongside supervision and other elements of professional formation, PT may serve as a key factor in preventing therapist burnout and attrition, as well as enhancing therapeutic effectiveness and, consequently, patient outcomes. This study is a mixed-methods longitudinal investigation of the subjective experiences in personal therapy (PT) during psychodynamic training. In this abstract, we examined longitudinal changes over one year across different PT formats (low-frequent vs. high-frequent individual PT). Method: This study is part of a mixed-methods longitudinal project. Data was collected in summer–autumn 2023 and one year later. Candidates completed an online survey in which they reported, among other constructs, self-compassion (SCS), mindfulness (CHIME), reflective functioning (RFQ) and work involvement (TWIS). They evaluated the therapeutic relationship, reported how therapeutic or educational they perceived their PT and gave examples for the interventions experienced. Results: Participants experienced their PT as highly therapeutic, and moderately educational. Consistent with previous cross-sectional findings showing stage-related differences in therapist variables, we observed evidence of meaningful development across one year of PT in the measured constructs. Discussion: The findings underscore the role of personal therapy in supporting the ongoing development of essential therapist characteristics throughout psychodynamic training. These results highlight the importance of integrating and systematically evaluating PT within psychotherapy training curricula to promote sustainable professional growth, prevention of burnout and therapeutic competence.

Psychological interventions are typically predicated on specific theories or models regarding the causal and maintaining mechanisms of the presentations they address. However, there is a gulf between such clinically-driven formulations and the broader frameworks that much research in mental health relies on. Although atheoretical nosologies such as the DSM have provided a pragmatic means of organising relevant knowledge, they do not adequately reflect the complexity, comorbidity or fluidity of clinical presentations, or generate testable hypotheses regarding mechanisms that might underlie these dynamics. Data-driven approaches, including dimensional and network methodologies, show promise; but the complex and multilayered nature of the problem poses methodological challenges for robust inference on a purely empirical basis. There is a need for theory of a scope capable of explaining both diagnosis-specific and transdiagnostic phenomena, translating between academic and clinical conceptualisations of mental health disorders, and generating testable hypotheses regarding potential underlying mechanisms. We argue that predictive processing models are well positioned to bridge the explanatory gap between clinical models and basic science in cognitive neuroscience, and we outline a transdiagnostic predictive processing model which can predict a wide range of disorder-specific and transdiagnostic phenomena on the basis of a small number of shared and relatively simple mechanisms. We present simulations to illustrate this point at the level of observed symptom dynamics within and across diagnostic categories, and also through modelling task performance across a range of established paradigms within cognitive neuroscience. We suggest that such models can assist the design of principled, mechanism-focused, clinically-compatible future research.

This talk will follow on from Bevan’s presentation to provide an account of Post-Traumatic Stress Disorder (PTSD) within a transdiagnostic predictive processing model discussed above. We review and extend existing, predominantly narrative, predictive processing accounts of PTSD to explain how core symptom presentations (re-experiencing, avoidance, alterations in arousal and reactivity, negative alterations in cognition and mood) can arise following trauma exposure. We also consider how predictive processing accounts can explain individual differences in risk for, and trajectories of, PTSD as a result of key differences in agents’ pre-trauma environments, learning and action choices. To do this, we model the impact of a prototypical, single-event trauma on five different agents, or ‘pre-trauma personalities’, to illustrate different trajectories of PTSD, including chronic, latent and complex subtypes of the disorder, resilience, and the process of recovery from PTSD (both naturally and via therapeutic intervention). Implications for research and clinical practice will be discussed.

Expecting negative outcomes more than positive ones is a key feature of anxiety disorders, particularly in response to ambiguous information. The ambiguous-cue interpretation task measures optimistic and pessimistic responses to ambiguous stimuli, and previous work has demonstrated that individuals with higher anxiety and depression symptoms interpret ambiguous stimuli more pessimistically. Earlier analyses using drift diffusion modelling (DDM) suggested that this pessimistic bias reflects differences in how quickly people accumulate evidence, rather than an initial bias toward negative choices. However, DDM assumes trials are independent, but recent work suggests that feedback may shape how people interpret later ambiguous cues, suggesting learning processes are involved. To explore this, we combined reinforcement learning (RL) models with DDM. In an online study (N = 378; 103 with depression/anxiety), participants completed the ambiguous-cue interpretation task. We compared simple decision rules, RL models, DDM, and hybrid RL-DDM models fit using Bayesian hierarchical modelling. Anxiety (GAD-7) scores were used to test how model parameters relate to mental health. Higher anxiety was linked to fewer optimistic choices overall. Within the DDM, higher anxiety was associated with a more negative starting point suggesting participants began each decision biased toward a pessimistic interpretation. Anxiety was not related to RL learning rate or reward sensitivity. These findings suggest that anxiety influences how people approach ambiguous decisions, rather than how they learn from outcomes. Combining modelling approaches helps clarify the cognitive mechanisms behind this key clinical feature and may guide future work on neural mechanisms and treatment effects.

Real-world decision-making often requires active information search in environments where outcomes are spatially structured and can involve both gains and losses. While computational models of exploration - such as function learning - have successfully explained behaviour in reward-based settings, much less is known about how these mechanisms operate in environments dominated by losses. In this project, we examine human search behaviour in spatially correlated environments under gain and loss conditions using large-scale, preregistered online studies. Participants explore grid-based environments in which outcomes are correlated across space, allowing them to generalise from observed locations to unobserved regions. Behaviour is analysed using computational models that combine Gaussian Process function learning with uncertainty-guided decision rules, including Upper Confidence Bound (UCB)–based exploration. Across studies, we observe systematic differences in search behaviour between gain and loss environments, despite equivalent underlying value structures. These differences are evident in spatial properties of exploration, including how participants distribute search across the environment over time. Computational modelling suggests that these behavioural patterns can be captured by extending function-learning models to incorporate valence-sensitive decision processes, consistent with interactions between uncertainty-guided exploration and loss-related biases. In a preregistered follow-up study, we further investigate individual differences in search behaviour by relating model-derived parameters to transdiagnostic psychiatric symptom dimensions, with a particular focus on anxiety and uncertainty-related traits. Together, this work extends computational accounts of exploration to aversive environments and provides a framework for linking adaptive and maladaptive search strategies to underlying cognitive and clinical dimensions.

Mechanisms of change are widely assumed to be activated by the onset of treatment. This foundational premise underlies decades of psychotherapy research and guides the timing of measurement and intervention in clinical science. The present study challenges this assumption by demonstrating that one of the most well-established predictors of treatment outcome—the therapeutic alliance—not only changes before therapy begins, but that these early, pre-treatment changes predict both alliance development and symptom reduction throughout treatment. In a randomized controlled trial for depression (N=100), the therapeutic alliance was assessed twice before patients met their therapist, and weekly thereafter. The pre-treatment change in alliance significantly predicted subsequent alliance dynamics and clinical improvement, above and beyond baseline levels. The findings remained robust even after controlling for pre-treatment outcome expectations and previous treatment experience. These findings suggest that mechanisms traditionally viewed as the result of treatment targeting may, in fact, be antecedents. By revealing pre-treatment shifts in a mechanism once thought to be non-existent prior to patient–therapist contact, this work may challenge fundamental assumptions in clinical psychology and highlights the need to reconceptualize therapeutic change as a dynamic, temporally extended process that may begin before any intervention has occurred. Such a shift has implications for how we define, measure, and intervene on core mechanisms of human change.

Introduction: This study aimed to develop and introduce a novel, session-specific metric called the Dynamic Risk Index (DRI), which defines the likelihood of treatment non-response. The DRI integrates baseline information with real-time clinical data from each session, providing a continuously updated probability of non-response to treatment. Methods: We used observational data from an outpatient clinic, including 1,010 psychotherapy patients. We compared the performance of elastic net regressions and gradient boosting machines for the prediction of non-response by session 20 using patients’ initial sociodemographic, diagnostic and clinical information, combined with data from their symptoms’ clinical evolution. Finally, we used the best performing algorithms to define the DRIs. Results: Elastic net regressions without interaction effects performed the best across the first ten sessions (accuracy = .65-.70; area-under-the-curve = .70-.77). The specificity of the elastic net models improved meaningfully when applying nested threshold criteria to define mild (DRI > .49), moderate (DRI > .67), and high risk (DRI > .84) of non-response. Midpoints of DRI groups strongly correlated with proportion of patients not responding to treatment within those groups (weighted correlation= .85, 95%CI [.83-.86]). Conclusion: These findings positioned the DRI as a timely-sensitive index to determine the risk of non-response to therapy session-by-session. If implemented in clinical practice, DRIs has the potential of enhancing precision in mental health care going beyond baseline models of treatment personalization.

Theoretical background: Resource activation is a transdiagnostic, process-based intervention principle focusing on positive qualities within the therapeutic communication. Comparative efficacy studies provide evidence that strength-based methods can slightly improve the effectiveness of cognitive behavioral therapy in the treatment of anxiety and depression. However, what is lacking in the literature are meta-analytic studies that systematically summarize the predictive value of perceived resource activation and therapeutic success. Research question: To what extent does perceived resource activation during a therapy session predict therapeutic success at the end of therapy? Methods. Based on a systematic literature review, the predictive relationship between perceived resource activation in sessions and therapy success at the end of therapy is summarized meta-analytically. Meta-analytic multilevel models are applied for the nested data structure (individual predictive effect sizes nested in studies). Results: Twelve studies were identified, reporting a total of 32 predictive effect sizes. The overall effect shows a significantly moderate correlation between resource activation and therapeutic success (r = 0.14); this effect is homogeneous. Moderator analyses showed that a shorter treatment duration had a positive influence on the correlation between resource activation and therapy outcome, i.e., the shorter the therapies, the stronger the predictive effect of resource activation on therapy success. Discussion. The results point to the role of resource activation as a process-based principle. Further studies are needed to investigate the predictive power in different treatment groups and to derive differential personalization strategies and in-session timing.

Objective: The working alliance is a well-established predictor of psychotherapy outcome, and previous research has linked alliance quality to various patient characteristics, including attachment security, personality pathology, self-concept, and adverse childhood experiences. However, relatively few studies have examined the working alliance as a mediator of the effects of patient personality characteristics on treatment outcome—and among these, even fewer have applied a design that allows for a plausible temporal ordering of the mediation process. Methods: We used data from an ongoing routine outcome monitoring system in Swedish outpatient psychiatry. At intake, patients completed the Personality Inventory for DSM-5 (PID-5; personality pathology), the Structural Analysis of Social Behavior – Introject form (SASB; self-concept), the Adverse Childhood Experiences questionnaire (ACE), and the Experiences in Close Relationships scale (ECR; attachment). During therapy, patients completed the Working Alliance Inventory – 6 item version (WAI-6) and the Clinical Outcomes in Routine Evaluation – 10 (CORE-10) on a weekly basis. Using continuous time cross-lagged panel modeling, we estimated a mediation model with four time-invariant predictors (PID-5, SASB, ACE, ECR), weekly WAI-6 scores as mediator, and weekly CORE-10 scores as outcome at the within-patient level. Results: Data will be analyzed during spring 2026, and results will be presented at the conference. Discussion: The findings will inform how clinicians can work with the therapeutic alliance during treatment to mitigate the potentially negative impact of maladaptive personality traits and adverse experiences on therapy outcomes.

Facilitative Interpersonal Skills (FIS) constitute a core competency in psychotherapy, capturing therapists’ capacity to respond empathically, flexibly, and effectively to challenging interpersonal situations. Although human coding of FIS provides a valid, performance-based assessment of therapist skill, it is time-intensive, costly, and difficult to scale. Recent advances in large language models (LLMs) offer new opportunities for automating FIS scoring, yet existing approaches have largely relied on text-only responses, limiting their ability to capture the paralinguistic and non-verbal cues central to interpersonal effectiveness. In this work, we present a multi-modal LLM–based framework for automated scoring of FIS responses that integrates textual transcripts with audio and video signals. By leveraging multi-modal representations of verbal content, vocal prosody, timing, and facial expressions, the proposed system aims to more closely approximate human judgments of facilitative skill. We empirically compare text-only LLMs with multi-modal LLMs across multiple FIS dimensions, examining their agreement with expert human raters, sensitivity to nuanced interpersonal behaviors, and robustness across diverse response styles. Results indicate that incorporating audio-visual cues substantially improves alignment with human ratings, particularly for dimensions that depend on emotional attunement and relational stance. This work demonstrates the promise of multi-modal LLMs as scalable, reliable tools for assessing facilitative interpersonal skills, advancing both psychotherapy research and clinician education.

Therapists receive limited practical training on how to respond effectively and empathically to clients presenting with clinical challenges. To address this gap, we propose developing an interactive, adaptive avatar-based training tool that enables therapists to practice responding to challenging patients in a realistic, feedback-rich environment. The project will build a multimodal synthetic patient avatar capable of text, audio, and video interaction, trained using simulated patient clips, (Facilitative Intrpersonal Skills stimulus clips) and expert clinician feedback. Using MetaHuman Creator and Unreal Engine, we will construct 32 highly realistic avatars capable of real-time facial animation and synchronized speech. Dialogue will be generated through two lightweight ChatGPT-based models: a patient-response model that produces brief, scenario-based utterances, and a supportive feedback model that provides simple reflections on trainee performance after short interaction sequences. ElevenLabs text-to-speech will be integrated to deliver natural audio output, which will drive real-time lip-sync within the MetaHuman animation system. A complete software pipeline—linking user input, AI generation, TTS output, and avatar animation—will be implemented in a modular development environment. This prototype represents an essential first step toward a comprehensive avatar-based training tool capable of supporting future clinical, research, and pedagogical applications. By establishing the technical groundwork for responsive, multimodal digital patients, the project paves the way for advanced adaptive training features that will ultimately enhance therapist skill development and clinical competence.

Human ratings of Facilitative Interpersonal Skills (FIS) are essential for competency based clinical training, yet they are resource intensive and typically yield limited explanatory detail beyond global scores. We propose an LLM-as-Judge framework that produces structured, behavior linked feedback while maintaining alignment with human numerical evaluations. Rather than only predicting an overall rating, our system generates an interpretable feedback report that explicitly ties scores to observable verbal and nonverbal behaviors (e.g., empathic reflections, collaborative stance, emotional attunement cues) and to likely downstream outcomes relevant to training (e.g., alliance building, client engagement, rupture risk). A key innovation is multi episode integration: trainees are often evaluated across multiple FIS stimulus videos that vary in client presentation and interpersonal demands. To synthesize consistent, meaningful feedback across episodes, we will integrate information from multiple videos using a multi agent pipeline in which specialized agents extract evidence for specific rubric dimensions, adjudicate disagreements, and compile a consolidated report. The output includes (a) dimension level ratings mapped to a standardized rubric, (b) evidence snippets anchored to concrete behaviors, (c) a cross-video summary of stable strengths and recurrent growth edges, and (d) targeted, actionable practice recommendations. We will evaluate (1) score agreement with human raters, (2) the explanatory quality and interpretability of feedback, and (3) usability for supervision and training. This work complements ongoing efforts in automated FIS assessment by shifting the focus from score prediction to score plus explanation, advancing scalable, feedback rich tools for psychotherapy research and clinical education.

Aim: Psychotherapy process–outcome research still struggles to explain change as it unfolds moment by moment, partly because it relies on self-report snapshots or narrow single-process coding that under-represents the dynamic intrapersonal (within-patient) and interpersonal (patient–therapist) exchanges through which change is enacted. Leveraging recent advances in AI, we tested whether temporal association rule mining can identify recurrent therapist–patient sequences that reliably precede micro-transitions from maladaptive to adaptive patient states. Method: We analyzed 928 sessions from 58 patient–therapist dyads in short-term psychotherapy for depression. Sixty sessions were manually coded by trained clinical judges using MIND, a transtheoretical scheme that represents dialogue via four experiential building blocks—Affect, Behavior, Cognition, Desire (ABCD)—and indexes state adaptivity. Large language models (LLMs) coded the remaining corpus with performance comparable to human agreement (micro-F1 = 0.64–0.89 across codes). We then applied temporal association rule mining to discover recurrent, lagged therapist intervention → patient response sequences that preceded transitions and tested whether their occurrence was associated with session outcomes. Results: Mining yielded a parsimonious set of robust, state-contingent sequences that reliably preceded maladaptive→adaptive transitions. These sequences were associated with more favorable session outcomes, beyond marginal code frequencies. Discussion: Interpretable sequence discovery offers a scalable, data-driven window into clinically meaningful pathways of change, complementing theory-driven process hypotheses. Findings support a context-sensitive view of therapeutic action—what is helpful depends on the patient’s momentary state.

Aim: Routine Outcome Monitoring (ROM) can improve treatment outcomes, yet its implementation in routine care remains limited due to additional workload. Advances in automated transcription and AI-based analyses may allow treatment progress to be measured directly from session transcripts. Recent work suggests that LLMs can capture latent psychological constructs, raising the question of whether an LLM rating-scale approach could measure outcomes, enable automated ROM, and produce trajectories resembling questionnaire-based progress. Method: We analyzed 1,630 transcripts from 358 patients treated in a university clinic. From a pool of 200 items, an LLM-based outcome scale was developed and evaluated using internal consistency, confirmatory factor analysis, and validity indices (HSCL-11, PHQ-9, OQ-30). Treatment effects and longitudinal trajectories were examined in a subsample with multiple consecutive sessions. Results: The LLM scale demonstrated high internal consistency (ω = .94) and excellent model fit (CFI = .998, TLI = .997, RMSEA = .042, SRMR = .010). It correlated meaningfully with validation measures (e.g., HSCL-11, r = .50) and showed a treatment effect comparable to questionnaire-based outcomes. Longitudinal analyses indicated that LLM-derived trajectories captured general distress over time, though sudden gains and losses were not always detected in parallel with questionnaires, and higher distress levels tended to be slightly underestimated. Discussion: The findings show that the LLM rating-scale approach can capture outcomes from psychotherapy transcripts with good psychometric quality. Comparison with questionnaire trajectories suggests suitability for automated ROM. However, the results highlight the need for improved sensitivity to abrupt changes and reduced bias at higher severity levels.

Background: Harm assessment for LLMs in mental-health contexts typically focus on preventing obvious harms like sycophantic agreement with harmful ideas. However, these approaches fail to address clinically-informed harm assessment for specific conditions like OCD, where naive harm reduction strategies (e.g., providing reassurance or encouraging "careful" performance of compulsions) can paradoxically worsen clinical outcomes. This disconnect between evidence-based practice and intuitive responses makes OCD an ideal test case for evaluating safety of LLM interventions. Without proper clinical understanding, LLMs risk causing harm by reinforcing maladaptive patterns that maintain or exacerbate OCD symptoms. We developed a framework for assessing how LLMs respond when interacting with individuals experiencing OCD. Method: We created simulated clients with OCD, designed to reflect real-world case conceptualizations. These LLM patients were developed using the Yale-Brown Obsessive Compulsive Scale (YBOCS) and clinical presentations from public patient forums. The simulated clients represent diverse manifestations of OCD. We incorporated challenging client behaviors into our simulation scenarios, including resistance, demanding interactions, and argumentative exchanges. Using human raters, we trained an ML-based evaluation framework identifying behaviors in therapist LLMs, such as reinforcing compulsions, or providing reassurance sustaining OCD symptoms. Results: Preliminary results indicate that experts found LLM-patients to be representative of real patients with OCD. There was high accuracy in detecting potentially harmful interventions, and such interventions appeared in the majority of conversations. Discussion: The use of standardized patients paired with automated ratings of proscribed interventions may be a useful tool for evaluating how LLM based agents respond in specific mental health contexts.

Aim: Understanding non-verbal behavior is a central challenge in researching the dynamics of interactions across cultures. It has been shown that non-verbal behavior differs significantly according to the cultural background of the acting person and their interlocutor. Interpreting this behavior correctly for each individual and each culture is an essential part of understanding the inner processes of the acting person and the dynamic of the conversation. Method: In our research we use a multi-modal machine learning approach to further understand non-verbal behavior and how it reflects a person's engagement, the interest in continuing the active conversation. For this we recorded the NoXi-J dataset, which, combined with its base dataset NoXi, consists of 150 dyadic free-flow conversations across 9 languages and over 25 hours of video material. All video data were annotated with engagement per frame. We utilized cultural indicators, extracted features of body and face such as Facial Action Units to analyze differences in non-verbal behavior and estimate engagement. Results: In our preliminary research, we found significant differences in non-verbal behavior across cultures, which correlated with and proved helpful in estimating annotated engagement. For example, we found that Japanese conversation partners smiled notably more than German conversation partners and that, compared to German smiles, these smiles correlated significantly stronger with engagement (Correlation of r = 0.27 for Japanese, r = 0.11 for German). Discussion: In further research, we are using these findings to model virtual 3D agents that generate culture-specific non-verbal behavior.

Aim: Caregivers of children who have experienced sexual abuse often exhibit a higher prevalence of insecure attachments and early adverse experiences in childhood, which may influence the psychological symptoms presented in children. The aim of this study was to evaluate the role of attachment pattern of non-offending caregivers in the relationship between their own experiences of emotional neglect during childhood and the clinical symptomatology in children under their care undergoing treatment for sexual abuse. Methods: This study evaluated the role of attachment in the relationship between experiences of childhood emotional neglect in 78 caregivers and clinical symptomatology in children aged 4 to 9 undergoing treatment for sexual abuse. A quantitative cross-sectional and correlational study was conducted, with moderation analysis. The relationship between emotional neglect (CTQ) and child symptomatology (SDQ) was analyzed, evaluating the moderating role of caregiver attachment avoidance and anxiety (ECR). Results: The results showed a 50% prevalence of dismissive or avoidant attachments and a 12% prevalence of caregivers with significant experiences of childhood emotional neglect. Positive associations were found between the caregiver’s emotional neglect and children’s symptoms, as well as between the caregiver’s attachment avoidance and children’s symptoms. The association between emotional neglect and children’s symptoms was observed when caregivers exhibited moderate and low levels of avoidance. Discussion: These results alert us about the importance of including caregiver variables for understanding and treating childhood sexual abuse, as well as for exploring possible mechanisms associated with intergenerational trauma.

Aim: Foster carers are the backbone of the alternative care system in Ireland with 92% of children in state care placed in foster care. While multiple stakeholders are responsible for a child’s wellbeing, foster-carers are often a child's primary care-giver on a daily basis. This study aims to investigate foster carer experiences of (and perspectives on) the mental health needs of children in care and helpful and unhelpful responses to those mental health needs. Methods: The present study is nested within a larger project that investigated foster carer experiences of a trauma informed training programme. A subset of data from transcripts of semi-structured interviews with foster-carers (n=10) pertaining to foster-carer accounts of the mental health presentations of children they cared for, was qualitatively analysed for the present study using a descriptive and interpretive framework. Results: Six domains were identified: mental health presentations; mental health needs; helpful factors in responding to mental health needs; unhelpful factors in responding to mental health needs; outcomes for children in care; and internal experiences and needs of foster carers. Discussion: Communication and cooperation between stakeholders, as well as an understanding of developmental trauma appeared to be particularly salient to perceived effective responses. The impact of creating a safe ‘home base’ was seen as transformative where children were given plenty of time, patience, care and stability. Supporting the carer-child relationship was identified as an important component of a ‘home base’, that can help children and carers navigate a complex multiple-stakeholder landscape.

Aim: Children in care often present with complex emotional, psychological, and mental health needs. It is important to identify effective ways to support these children, their families, and the foster carers who care for them. The present research study explored foster carers’ experiences of a Dyadic Developmental Psychotherapy (DDP)-informed training programme as a therapeutic approach to supporting children with attachment- and trauma-related difficulties. Method: Foster carers (n=11) who had completed the training took part in semi-structured interviews, exploring their experience of the training and its impacts on themselves and the children they cared for. Qualitative data from these interviews were analysed using a descriptive and interpretive framework. Results: Findings are reported within seven domains: (1) general experience of the training; (2) what was helpful; (3) what was unhelpful; (4) challenging but helpful; helpful but challenging; (5) changes in self (and/or as a carer); (6) relationship between own childhood experience of care and tendencies as a parent/carer; and (7) peer impact. Discussion: The findings indicated that foster-carers experienced the DDP-informed training programme as helpful in a variety of ways, including enhancing their capacity to mentalise, to understand trauma, and to respond therapeutically to the children in their care.

Aim: Relational consequences, such as the ability to trust and read others’ intentions, have been signalled as an impact of complex trauma in children and as a barrier for establishing a positive therapeutic relationship in psychotherapy. However, scarce research has addressed this topic in the field of child psychotherapy. This study aims to describe the therapeutic relationship and epistemic trust in the therapeutic process due to complex trauma from the perspectives of children, caregivers and therapists. Methods: A qualitative longitudinal study, based on the analysis of 21 semi-structured interviews with 7 therapy triads, comprising children, caregivers, and therapists, and children’s drawings of the therapeutic relationship, was conducted. Grounded theory and drawing qualitative analysis guidelines were employed. Results: Participants tend to describe positive child-therapist relationships, based on children’s positive feelings, collaboration and validation towards the therapist. However, when delving into the narratives, contents related to epistemic hypervigilance, such as anxiety in children related to the therapeutic context, difficulties in reading the therapist’s intentions and desires to go home, and credulity, such as very early love and closeness with the therapist, emerged. Discussion: A good alliance based on collaboration, where children like and validate their therapist, is not enough to sustain authentic trust in the relationship. There is a risk of relying solely on these types of relational indicators as evidence of a good therapeutic relationship; however, in the context of complex trauma, a deeper understanding is needed to offer a genuine opportunity for a healing therapeutic relationship.

Aim: Many adolescents in foster care experience significant mental health difficulties, resulting in their accessing psychotherapy to meet their unique and diverse needs. Most of the literature on how adolescents experience services draws on experiences of mental health services in general and tends to neglect those young people who are in state care. This study sought to capture the experiences of these young people while they were attending or had recently attended psychotherapy and were still in foster care. Method: Interpretative Phenomenological Analysis (IPA) was used to capture the lived experience of attending psychotherapy while in foster care, from the perspectives of those adolescents. Individual interviews were conducted with seven young people in foster care, recruited through agencies providing support to foster families. Results: Four themes were identified: being powerless; risking relationship; opening up; and finding connection. Young people revealed complex and individual experiences where they felt disempowered, drew on their courage to gradually build trust in therapists, were able to share their innermost thoughts and feelings and established deeper connections with themselves and others. Discussion: This lived experience illustrates a journey of relational connection that aligns with recognition theory in highlighting young people’s need for authentic recognition as individuals in their totality, who desired psychotherapy that offered emotional connection and opportunities for systemic relational growth. The study illuminates the inherent challenges, as well as informing practice about how to engage with young people in foster care in a meaningful and helpful way.

Culture fundamentally shapes how people perceive themselves, others, and mental illness. These interpretive frameworks, known as worldviews, influence how individuals make sense of their suffering, what they define as a disorder, and how they engage in treatment. Despite their centrality in lived experience, worldviews remain underexplored in psychotherapy research. This study examines the role of worldviews in psychotherapy for depression and their relationship to therapeutic alliance, mechanisms of change, quality of life, and depression. An ongoing mixed-methods design combines quantitative and qualitative approaches among adults who have recently received, or are currently undergoing, psychotherapy for depression. Quantitative analyses will explore associations between worldview (Worldview Test), depression (BDI-II), therapeutic alliance (WAI-SR), and quality of life (MHQoL). Qualitative interviews (Elliott’s Change Interview) will provide insight into mechanisms of change, the lived experience of psychotherapy, and the role of the client’s worldview in these processes. Participating therapists will complete the Worldview Test and WAI-SR. Different psychotherapy modalities will also be compared. The study aims to collect approximately 300 quantitative responses and 40 qualitative interviews. It is expected that mechanisms of change will be expressed in line with clients’ respective worldviews. Therapist-client worldview matching is expected to relate positively with therapeutic alliance. Integrative psychotherapies may prove to be more flexible in accommodating clients’ worldviews, allowing therapists to adapt their approach in ways that enhance therapeutic alliance, and consequently therapeutic effectiveness. In exploring how worldviews influence mechanisms of change and therapeutic alliance, this study contributes to developing more culturally responsive and personalised psychotherapeutic approaches.

Help-seeking preferences for mental health concerns vary markedly across sociocultural identities. Existing research examines preferences in terms of likelihood - which sources someone is likely to seek care from - yet little research has examined how cultural identity impacts ranking of preferences in addition to likelihood. We were particularly interested in the comparison between sense of belonging to multiple salient cultures, which we term bicultural identity, and identity with minoritized racial/ethnic, sexual, and gender identity groups and their influence on the ranking of preferred support sources. Understanding these patterns can clarify which groups are most likely to disclose distress to informal networks (romantic partners, friends, relatives) versus formal providers (mental health professionals, physicians, clergy), and who is least likely to seek help at all. We used conditional inference trees to identify identity-based splits that best predicted help-seeking rankings. Bicultural identity as the strongest predictor of help-seeking patterns. Students identifying as having a bicultural identity more consistently ranked both informal supports (romantic partners, friends, relatives) and formal providers (mental health professionals, physicians, clergy) more favorably than non-bicultural peers, and showed the lowest likelihood of endorsing “no help.” Among non-bicultural students, race/ethnicity and gender identity further differentiated patterns of willingness to seek support. The findings in this study highlight identity-linked disparities in preferred help-seeking pathways and underscore the need for culturally responsive outreach strategies.

Common Mental Health Disorders (CMD) have become one of the most common causes for disabilities worldwide. Lower- and Middle-Income countries are disproportionally affected by these disorders compared to Western countries. One in 27 individuals living with depression sought treatment in the Lower and Middle Income Countries, and access to treatment has been scarce in this part of the world. Even though when help was available, individuals did not often seek help, thus, help-seeking intention has been identified as a major barrier for treatment in this region as well. Thus, an exploration of help-seeking intentions for mental health disorder could be one of the potential ways to increase access to mental health treatment in this region. We aim to understand the relationship between Mental Health Literacy (MHL) and help seeking intentions through a cross-cultural study. Participants consisted of Australian (N =159) and Bangladeshi (N = 181) adults who completed Mental Health Literacy (MHL) vignettes, emotion regulation questionnaire, and psychopathology questionnaire. Three vignettes were presented to participants depicting depression, depression with suicidal ideation, and social anxiety. Afterwards, participants were asked to report their help-seeking intention. Preliminary analysis showed that correct identification and recognition of depression is more influential than culture only for depression but not for social anxiety. Moreover, Australians participants favoured internet-based treatment less than Bangladeshi participants. These findings may indicate the nuanced nature of help seeking intentions across culture. It also showed that treatment preferences may vary across culture.

Children experiencing mental health difficulties often face considerable barriers in accessing services. At the individual level, issues related to confidentiality, low mental health literacy, and fear of being perceived as a “failed” parent may act as barriers. Commonly reported interpersonal barriers were societal stigma, fear of negative judgment, and limited informal support networks. Common structural barriers include long waiting times, time and money constraints, and difficulties in navigating a complex system. Furthermore, these barriers often acutely impact migrant families as they often find it challenging to access culturally safe services. In the past, various researchers examined treatment-seeking barriers among some migrant groups, yet little is known about Bangladeshi migrant parents, particularly in relation to children’s externalising mental health disorders. The present study investigated whether perceived treatment-seeking barriers differed between Bangladeshi migrant parents and non-migrant Australian parents, and whether there is an association between barriers and symptom severity. It was hypothesised that Bangladeshi migrant parents would report greater barriers to treatment-seeking than non-migrant parents, and that higher child externalising symptoms would be associated with increased perceived barriers across groups. The sample comprised 295 parents, including 196 Australian and 99 Bangladeshi parents. Findings from this study aim to inform mental health professionals and policymakers about key barriers to accessing care for child externalising disorders and to guide the development of culturally responsive interventions for diverse families in Australia.

Introduction: Most studies examining psychotherapy dropout rely on longitudinal designs where dropout is defined through patient-therapist agreement. Nonetheless, to move toward precision psychotherapy, big-data strategies are needed to accurately identify risk profiles which can inform targeted interventions. This need is especially pronounced among children and adolescents, where dropout reach an alarming rate of up to 50%. Studies utilizing large electronic health records to explore dropout are rare, and those that exist utilize different methodological definitions to dropout, while focusing exclusively on adult populations. This study aims to explore the accuracy of existing definitions to dropout, while focusing on children and adolescent psychotherapy. Methods: Medical files of patients undergoing psychotherapy (N=15,544) between the years 2000-2024 aged 1-18 were extracted from the electronic health records of Clalit Health Services (CHS), the largest healthcare organization in Israel. Based on extensive literature review, four definitions of early and late dropout were operationalized: (a) intake dropout, defined as termination immediately after intake (b) early therapy dropout, defined as termination within the first three therapy sessions, (c) time-limited late dropout, defined as termination after up to 12 sessions within four months; and (d) late dropout defined as termination after the sample median number of sessions. A 10% sample (n = 250) of patients was selected and evaluated for therapist’s documented report of dropout, based on data availability considerations. Conclusions: The development and evaluation of methodological strategies for assessing psychotherapy dropout through bid-data strategies may set the stage to improve the accuracy of dropout prevalences estimates, enhance identification of children and adolescents at-risk and minimize the harmful short- and long-term effects of untreated mental illness. Keywords: Children and adolescents Psychotherapy; Dropout; Electronic health records; Big data

Introduction: Growing evidence suggests that child and adolescent psychotherapy may influence patterns of healthcare utilization beyond symptom reduction. Examining changes in mental and physical healthcare use before and after the initiation of psychotherapy may provide a broader indicator of treatment effectiveness and its implications for healthcare systems. This study aims to assess changes in medical and psychological service utilization before and after psychotherapy for children and adolescents big-data strategies. Methods: children and adolescents who received at least one outpatient psychotherapy session were identified (N = 15,455) through the Clalit Health Services (CHS) databases in Israel. Participation in psychotherapy was defined as documented attendance in at least 12 sessions across four-month period, consistent with definitions of a therapeutic intervention in the literature. Measures of healthcare utilization included primary and secondary care visits, general emergency room (ER) visits and hospital admissions, as well as psychiatric ER visits and admissions. Linear multilevel models (LMMs) were used to examine trends in healthcare utilization before and after the initiation of psychotherapy. Conclusions: Measuring psychotherapy outcome through big-data strategies is likely to enable the prediction of therapeutic success and inform future efforts to personalize treatments. Moving beyond symptom-based outcomes, the results of this study may also inform healthcare resource allocation and support policy efforts aimed at improving access to psychotherapy services for children and adolescents. Keywords: Children and adolescents Psychotherapy, Psychotherapy outcome, electronic digital records, Health Care Utilization

Aim: This study aims to describe when patient dropout occurs over the course of child and adolescent psychotherapy and to examine whether commonly assessed pre-treatment characteristics are associated with session-specific dropout risk under routine care conditions. Dropout is associated with poorer treatment outcomes and increased strain on mental health services, yet research on its predictors has yielded inconsistent findings. These inconsistencies likely reflect methodological limitations, including small or selective samples and analytic approaches that disregard the timing of termination and the coexistence of multiple, competing reasons for treatment ending (e.g., regular completion or relocation). Methods: We employ time-to-event analysis to estimate session-by-session dropout risk while explicitly accounting for regular treatment completion as a competing event. This approach allows modeling of the temporal dynamics of treatment termination while appropriately handling competing events and censored observations. Analyses are based on data from the KODAP project, a transregional research network of German university outpatient clinics (n > 5,000). We first describe how dropout risk unfolds across treatment sessions and then examine whether primary diagnosis, age, gender, and number of diagnoses are associated with dropout risk. These variables were selected as clinically salient baseline characteristics so that our analyses provide a foundation for more complex, process-oriented models in future research. Results: Analyses are currently prepared and results will be presented in the talk. Discussion: This study contributes to a more dynamic understanding of when and for whom therapy dropout occurs in child and adolescent psychotherapy and provides a methodological illustration of time-to-event analysis in psychotherapy research. Keywords: Survival analysis, dropout, competing events, time-to-event analysis, treatment outcome

School counselors occupy a critical role in supporting young people, particularly with increasing focus on children’s mental health needs in educational settings. While the importance of the role of the school counselors is understood well, counselors are often met with dynamic environments that require fine balancing of needs of young people at the intersection of education, child protection and mental health systems. Drawing from the work of two field action projects of the Tata Institute of Social Sciences, Rahbar and SIMHA, the presentation highlights reflections and learnings from working with public schools across different states in India. The presentation scopes how supervisory work in public schools can help counsellors strengthen implementation of school mental health programmes as well as help in counsellor’s professional development. The role of the supervisor is critical in helping build mental health friendly school systems as well as navigating contextual challenges and ethical dilemmas that originate in such settings. The presentation will highlight key issues, dilemmas as well as possibilities for supervision in schools.

Although there is a growing body of literature on the challenges of psychotherapy with children (e.g. the emotional demands of working with children and parents, transference countertransference dynamics, vicarious trauma, and ethical complexities), supervision of psychotherapists working with children and adolescents remains under-represented in the empirical literature. Child and adolescent psychotherapy is not a simple extension of adult work; it involves distinctive developmental, ethical, relational, and systemic complexities that shape the therapeutic process and affect therapists in particular ways. Yet, the dilemmas faced by child and adolescent therapists, their supervisors, and the supervision process itself are rarely documented. Drawing on the author’s ongoing doctoral work, this paper reviews the existing literature on the supervision of child and adolescent psychotherapy and examines key conceptual, empirical, and practice frameworks. It identifies significant gaps in the literature and argues that generic supervision guidelines inadequately address the unique needs and challenges of those who work with children and those who supervise them. The paper underscores the need for contextually grounded supervision models, developed through qualitative research that centres the voices of supervisors and supervisees working with children in low- and middle-income country (LMIC) contexts.

Counsellors in the disaster-affected communities can help in providing effective and expedient support. However, it puts them at risk of adverse mental health outcomes and role-related stress reactions. Supportive supervision is essential in mitigating this risk. The cultural and contextual-informed supervision in the context of disasters remains underexplored. This paper presents learning from supervisory experiences across three disaster contexts in India, that is, during the COVID-19 pandemic, a large-scale train accident and an entire state affected by floods. Each of these settings had distinct challenges which were shaped by cultural and contextual diversity. During the pandemic, supervisors navigated an unprecedented global disaster with no prior training to help counsellors engaged in a pan-Indian helpline while being impacted by the pandemic themselves. Post the train accident, supervisors helped counsellors facilitate rapid delivery of services and sensitivity to survivors from diverse cultural backgrounds. In the third scenario, supervisors helped counsellors provide long-term support as they were actively participating in the rebuilding processes in their communities. The paper will highlight key dilemmas, cultural nuances, and practice-based insights that emerged across these contexts, and will discuss the implications for developing context-responsive and culturally-sensitive models of supervision within disaster mental health work.

Developing a supervisory identity requires more than clinical expertise. It demands a distinct set of competencies particularly while working within organisations so as to offer contextually responsive psychotherapy supervision. Organisations are complex ecosystems that call for managing multiple stakeholders- clients, partner companies, founders and other employees and therefore supervisors often don multiple hats as managers, administrators, therapy supervisors and colleagues. The multiplicity of roles generates questions about whose interests gain dominance, what outcomes should supervision seek to work towards and balancing supervisee welfare with meeting client and organisational demands. Rahbar conceptualised and launched India’s first supervisor training programme, informed by research on therapists’ supervisory needs in the Indian context and aligned with international best-practice frameworks. Initiated in 2021 and offered annually since, the programme was intentionally designed as a live and dynamic learning space. The presentation will discuss these dilemmas of supervision in organisations by highlighting key issues as well as ways of responding to these dilemmas in supervisory conversations.

Introduction: Routine Outcome Monitoring (ROM) is supported by robust empirical evidence, yet its use in routine clinical practice remains limited. Beyond organizational and technological barriers, therapists often report difficulties in translating ROM feedback into clinical reasoning. Psychotherapy is increasingly conceptualized as a dynamic dyadic process, in which patient and therapist jointly shape the trajectories of intervention. Within this framework, convergence and discrepancy between patient and therapist evaluations of alliance and outcome may provide more clinically meaningful and practically usable information. The present study introduces the F.A.C.E. (Feedback Assisted Clinical Exchange) platform, designed to integrate dyadic ROM data and support reflection on patient–therapist agreement and disagreement. Methods: Fifteen therapists were asked to recruit patients and implement session-by-session monitoring. The 70 patients recruited completed the CORE-10 and the Working Alliance Inventory (WAI-P), while therapists completed a parallel outcome measure (T-ROM-4) and the WAI-T. Reciprocal influences were examined using cross-lagged panel models, and convergence–discrepancy effects were explored through Response Surface Analyses. Results: Cross-lagged analyses showed no reciprocal effects for psychological distress, whereas therapist-rated alliance significantly predicted patient-rated alliance at the subsequent session (β = .17, p = .003). Response Surface Analyses indicated that alliance discrepancy was clinically informative, with higher therapist-than-patient alliance ratings associated with lower subsequent distress (b = −.015, p < .001) as reported by both clinicians and patients. Conclusions: Findings support the clinical value of a dyadic ROM framework and highlight the utility of monitoring convergence and discrepancy to enhance process-informed clinical decision-making.

We investigated turn-to-turn linguistic-control exchanges (dominance/submission) between client and therapist—conceptualized as flexibility/rigidity—and examined their associations with session quality (Working Alliance-WA and Session Evaluation-SE). Data comprised 2,392 speaking turns nested within 40 sessions of a single therapist–client dyad, conducted as a systematic single-case in open-ended psychodynamic psychotherapy. We operationalized control with LIWC clout (Boyd et al., 2022) and flexibility/rigidity with the Location–Scale Model. Using DSEM (Asparouhov et al., 2018), we analyzed associations between linguistic-control, WA, and SE. Both the client, B = -0.121, S.D. = .021, 95% CI [-.163, -.081], and therapist control, B = -0.072, S.D. = .020, 95% CI [-.112, -.033], in the current speaking turn was plausibly and negatively associated with each other’s control in the previous speaking turn. Session quality moderated the effect of therapist control on subsequent client control: in low- and average-quality sessions, therapist dominance–submission predicted complementary client responding, whereas this association wasn’t credibly different from zero in high-quality sessions, B = -0.015, S.D. = .036, p = .0.345, 95% CI [-.084, .057]. Stronger WA was plausibly and positively associated with greater within-session variability in client dominance–submission across speaking turns, B = 0.735, S.D. = .185, 95% CI [.107, 1.364]. Grounded in Interpersonal Theory, results suggest control complementarity is a default “gravity”; rigid in low-quality sessions reflects maladaptive cycles, whereas attenuation in high-quality sessions indicates a more flexible field allowing the therapist and client can shift positions to meet relational needs. Strong alliances foster variability and growth in client dominance, signaling greater and adaptive agency.

Objective: Alliance ruptures—moments of strain or breakdown in the therapeutic alliance—are central to psychotherapeutic change and are commonly examined using observer-based coding systems such as the Rupture Resolution Rating System (3RS). Despite their clinical importance, rupture studies are often limited by small sample sizes due to the extensive resources required for manual coding. The present study introduces a natural language processing (NLP) framework for exploring the semantic organization of psychotherapy dialogue in relation to alliance ruptures, leveraging a large corpus of observer-coded rupture segments in Hebrew. Method: The dataset includes 700 rupture-coded segments annotated with the 3RS, representing one of the largest linguistically analyzed rupture corpora to date. Psychotherapy session recordings are transcribed using a Hebrew-optimized Whisper model and processed with neural speaker diarization to produce time-aligned transcripts. Sessions are segmented into 5-minute windows and aligned with rupture annotations. Semantic representations are extracted using AlephBERT, a Hebrew-specific transformer language model. Embeddings are used to compute semantic similarity and to construct semantic maps via dimensionality reduction, enabling exploratory analysis of rupture and non-rupture dialogue within a shared semantic space. Results: The framework enables the examination of whether rupture-labeled segments differ in their semantic organization from non-rupture segments and whether withdrawal and confrontation ruptures exhibit distinct semantic structures. Results from applying this approach will be presented at the conference. Conclusion: This study presents a scalable, semantics-focused methodology for studying alliance ruptures in psychotherapy using Hebrew NLP, complementing traditional observational and qualitative process research.

Aim: While research has established the importance of therapist emotions in psychotherapy, studies have typically examined these either within single sessions or averaged across entire treatments. This study employed a trajectory-based approach to examine longitudinal patterns of therapist emotions throughout short-term psychodynamic therapy and their associations with client outcome trajectories. Methods: Eighty-eight clients with mild to moderate depression were treated by 58 therapists over 16 weekly sessions of supportive-expressive therapy. Therapists completed the Feeling Word Checklist after each session, assessing inadequacy and parental feelings. Clients completed measures of symptom severity (OQ-45), emotion regulation difficulties (DERS-18), and therapeutic alliance (WAI). K-means longitudinal clustering identified distinct trajectories, and generalized linear mixed-effects models examined associations between therapist emotion trajectories and client outcomes. Results: Two distinct trajectories emerged for both therapist inadequacy feelings (Stable Decrease and High Fluctuating) and parental feelings (Stable Low and Gradual Increase). Client outcome trajectories similarly divided into two patterns for symptom severity, emotion regulation difficulties, and alliance. A significant interaction emerged: therapists experiencing both high fluctuating inadequacy and gradually increasing parental feelings—a "doubting caretaker pattern"—predicted substantially poorer client trajectories in symptom severity and emotion regulation difficulties, though not alliance quality. Discussion: This study demonstrates that therapists' emotional experiences follow distinct temporal patterns throughout treatment, and that specific combinations of these patterns—particularly mounting emotional investment paired with persistent self-doubt—predict poorer therapeutic outcomes. These findings highlight the importance of monitoring therapist emotion trajectories and have implications for clinical training and supervision, particularly for early-career therapists.

Aim Interpersonal expectations are assumed to play a central role in shaping interpersonal experience and behavior in dyadic interactions. Testing this hypothesis under controlled conditions remains challenging. This study examines whether participants implicitly express interpersonal expectations in spontaneous dyadic interactions with virtual characters in MovES, a novel paradigm for assessing interpersonal processes. We hypothesized that (1) character behavior aligning with participants’ expectations predicts more positive affect during interactions, and (2) participants elicit expectation-conforming behavior from a flexible, adaptive character by behaving complementarily to their interpersonal expectations. Methods Sixty-two students completed the INTREX questionnaire to assess interpersonal expectations regarding parents in childhood and the currently closest attachment figure (CAF). They performed MovES, consisting of nine dyadic encounters with virtual characters differing in interpersonal traits. In the virtual environment, interpersonal behavior was expressed nonverbally by controlling objects corresponding to transitive and intransitive SASB positions. Participants rated their affect after each encounter. Number and duration of object controls served as dependent variables in linear regression models with Bonferroni-Holm correction. Results Expecting the CAF to behave in an affection-seeking way predicted more positive affect in interactions with the affection-seeking character, F(1, 60)=9.72, p=.015, adjusted R2=.13, β=-0.37, p=.006. When encountering the flexible character, participants partially (37.5%) behaved complementarily to their interpersonal expectations of others’ behavior, Fs≤5.27, ps≤.044, adjusted R2s≤.07 (e.g., lower dominant expectations of the CAF predicted shorter control of the submissive object, β=-0.34, p=.018). Discussion Interpersonal expectations predict experience and behavior in MovES, supporting its potential to capture clinically relevant, implicit interpersonal patterns.

Aim The aim of this study was to investigate the effects of intensive short-term psychodynamic group psychotherapy on headache severity and personality dysfunction in patients treated for neurotic and personality disorders. A more detailed analysis was conducted in the subgroup of patients who developed headaches. Methods The study included 233 patients who completed a cycle of group psychotherapy for neurotic and personality disorders at the day-care unit of a University Hospital. Headache severity was assessed using the Symptom Checklist “O”, and 24 personality traits were measured with the Neurotic Personality Questionnaire (KON-2006). Results In 32% of patients (n = 74), headaches subsided or decreased. 20% (n = 51) reported worsening of headaches, including the onset of headaches during treatment (n = 37). ANOVA revealed significant differences (p < .05) in personality dysfunction between the groups. Patients who developed headaches after psychotherapy demonstrated a higher prevalence of personality dysfunctions such as a sense of lack of control, imagination and indulgence in fantasy, irrationality, and a sense of being overloaded. They also demonstrated lower levels of impulsivity and a reduced sense of dependence on others. Discussion Psychodynamic group psychotherapy may alleviate headaches in many patients; however, some individuals report symptom worsening. This phenomenon may be related to confrontation with reality and comparison with other group members, which can challenge previously protective beliefs and defense mechanisms. Lower impulsivity and reduced dependence on the environment may limit spontaneous sharing within the group and restrict engagement in the therapeutic process, thereby diminishing therapeutic effectiveness.

Aim: A participatory research approach is adopted to collaboratively conduct a systematic review on gender- and intersectionality-sensitive psychotherapy. The review is carried out together with psychotherapy-patient advisory partners. Participation, increasingly emphasized in health research and promotion, serves as a guiding principle throughout the project and facilitates the integration of lived experience into methodological and interpretive decision-making. We aim to demonstrate how this multi-perspective dialogue is implemented, highlight emerging insights for gender- and intersectionality-sensitive psychotherapy, and outline challenges arising throughout the process. Methods: The participatory process brings together academic researchers, clinicians, and psychotherapy patients with diverse gender and intersectional backgrounds. Participation includes full-group meetings and thematic working groups to collaboratively refine project content. Participants may also engage in individual tasks between sessions, such as reviewing materials. Results: The participatory approach contributes to improved methodological and conceptual outcomes, such as a refined search strategy incorporating search terms on gender-based discrimination and a continuous, context-sensitive interpretation of findings. Advisory partners draw on practical experience to contextualize and visually present results of the screening and data extraction phases, and to identify gender-related evidence gaps in psychotherapy research. Challenges include the methodological demands of conducting a systematic review, limited time resources, and differing expectations. Conclusions: Participation functions both as a valuable research tool and as a social negotiation process, with ongoing dialogue among multiple stakeholders providing opportunities to refine methods and examine underlying assumptions. Based on these insights, the contribution outlines implications and recommendations for future participatory research settings. Keywords: Participation, systematic review, gender data gap, psychotherapy

Aim: Emotion differentiation (ED), the ability to distinguish among discrete emotional states, appears to be malleable and has been linked to well-being and therapeutic change. However, little is known about how ED changes during psychotherapy and whether such changes contribute to symptom reduction. Thus, this study examines ED as a potential change mechanism in brief psychotherapy. We hypothesize that (1) Negative ED (NED) will increase during treatment; (2) greater NED increases will predict larger symptom reductions above and beyond baseline affect; (3) positive ED (PED) will show minimal change. Method: Forty-four clients with test anxiety completed a six-session imagery-based cognitive-behavioural treatment (Prinz et al., 2019). ED was assessed using experience sampling, with Profile of Mood States items rated four times daily across two-week periods before and after treatment. ED indices were computed using inverse ICC values. Symptom change was assessed with measures of test anxiety, generalized anxiety, and depressive symptoms. Multilevel models will estimate individual slopes of ED change and evaluate their predictive value after adjusting for levels and variability of negative affect. Results: Analyses are ongoing. We expect NED, but not PED, to increase across treatment and anticipate that steeper NED slopes will predict greater reductions in symptoms. Although shared variance with negative affect is expected, NED change is predicted to retain unique predictive value. Discussion: Positive findings will support the possibility that ED is a psychotherapeutic change mechanism, and would suggest that ED may be a promising, potential target for intervention and future mechanism-focused research.

Aim: Borderline personality disorder (BPD) is characterized by marked emotional reactivity and instability, and profound interpersonal difficulties. These symptoms often lead to high levels of distress, non-suicidal self-harm and hospitalizations. The cognitive and biological processes underlying these symptoms, however, are not yet clear. This study aims to explore patterns and associations among mentalizing, arousal, and interpersonal synchrony in adults with BPD during an in-depth attachment-based Interview, compared with healthy and psychiatric control groups, . Methods: A total of 153 participants took part in the study, including individuals with BPD, psychiatric controls (PC) and healthy controls (HC; n = 51 in each group). All participants completed the Brief Reflective Functioning Interview (BRFI), where they were asked to reflect on their relationship with two attachment figures. Mentalizing was rated using the Reflective Functioning Scale applied to the participants’ interview responses, and physiological biomarkers, namely skin conductance and heart rate, were measured in both participants and interviewers during the interview Results: In the current study, we expect the BPD group to exhibit lower mentalizing abilities and higher levels of arousal compared to both control groups. In addition, we will explore patterns of interpersonal physiological synchrony among individuals with BPD, examining whether synchrony patterns differ across groups. Discussion: This study’s results will deepen understanding of the cognitive and biological processes underlying emotional reactivity and instability in individuals with BPD, as manifested in an interpersonal context resembling psychotherapy. This knowledge may inform the development of effective, in-session therapist interventions for emotion processing and reflectivity.

Introduction: Borderline personality disorder (BPD) is characterized by emotional instability and difficulties in interpersonal relationships, posing unique challenges the formation of the therapeutic alliance. While nonverbal synchrony, particularly vocal pitch, has been proposed as a potential indicator of emotional arousal and interaction quality, little empirical research has examined its role in clinical settings with BPD patients. Method: This study investigated the relationship between vocal synchrony, assessed as the correlation of fundamental frequency (f0) between interviewers and participants at lagged talk-turns, and interviewers’ emotional response (Countertransference Questionnaire; CTQ), during diagnostic interviews of individuals with BPD (N = 46) and healthy controls (HC; N = 46). Results: Interviewers reported higher levels of overinvolvement when interviewing BPD participants, compared to HC (Cohen’s d = .95, p < .001); a significant association of participant-interviewer pitch was observed in the BPD group (p = .03), but not HC; while overinvolvement marginally predicted interviewers’ pitch in the BPD group (p = .06), positive reaction significantly predicted it in the HC group (p < .001). Neither positive reaction nor overinvolvement moderated the association between interviewer and interviewee pitch. Discussion: The findings highlight complexity of vocal measures as dynamic, context-dependent phenomenon, suggesting its potential as an indicator of emotional dynamics within clinical interactions. The distinction between overinvolvement and positive reaction in relation to pitch and pitch synchrony underscores the importance of exploring further the emotional and cognitive components of countertransference, and the mechanisms through which they shape therapeutic interactions in BPD populations.

In recent years, psychotherapy research has sought to deepen the understanding of processes and mechanisms of change in therapy; our goal is to bring schema therapy terms, and in particular, a mode-oriented approach, into psychotherapy research. Specifically, though schema modes have been increasingly examined, their role as a mechanism of change in therapy has received limited attention. The present study investigates changes in schema modes over the course of a structured short-term therapy and explores whether these changes are associated with therapy outcomes. It utilizes data from an open trial in which 60 university students with clinically significant test anxiety levels (Test Anxiety Inventory [TAI] score ≥ 55) were treated. Participants completed three 2-week bursts of momentary assessments of schema modes using the Momentary Schema Modes Questionnaire (MSMQ, Lazarus et al. 2020) administered four times daily. In the present work, we focused on observed change in four key modes: Healthy Adult, Vulnerable Child, Critical Voice, and coping modes. We hypothesized that greater reduction in test anxiety would be associated with an increase in the activation of the Healthy Adult mode and with decreases in the activation of the Critical Voice and Maladaptive Coping modes. No specific directional hypothesis was made regarding the Vulnerable Child mode. Due to anticipated multicollinearity among modes, we will categorize them into clusters. These clusters will be utilized in regression models to identify unique predictors of clinical improvement. These findings may shed light on the role of schema modes as mechanisms of change in psychotherapy.

Aim. This study introduces a computational method to detect and quantify Experiential Depressive Language (LDE) in psychotherapy dialogue and to contrast it with Descriptive Depressive Language (LDD), a more diagnostic, externally derived register. We aim to build paired linguistic libraries (LDE vs. LDD) and derive an interpretable Experiential Anchoring Index indicating whether a therapy dialogue is closer to experiential meaning-making or to generic descriptive formulations. Methods. An initial development corpus of psychotherapy transcripts is used to derive an LDE library from client utterances. In contrast, an LDD library is built from diagnostic/psychoeducational sources and controlled LLM-generated text. Both libraries are embedded in a shared vector space and represented through prototype centroids. Crucially, the proposed proximity index is computed on new, previously unseen therapy transcripts provided subsequently as test inputs, producing (a) a global LDE–LDD proximity score and (b) a ranked map of segments most strongly associated with each pole. Results. The planned evaluation will compare model classifications with expert human coding of LDE vs. LDD at the segment level, estimating inter-rater reliability and model–human agreement. We will also explore whether higher LDE proximity is associated with process-relevant markers such as emotional depth and subjective meaning-making. Discussion. By operationalizing a clinically meaningful distinction between experiential and descriptive depressive discourse, this approach offers a scalable and interpretable tool for psychotherapy process research and qualitative review. Future work will expand the development corpus (e.g., 500+ transcripts) to strengthen the LDE library and improve generalizability.

Aim: This study investigates linguistic features of self-criticism (“inner critic” speech) and their associations with self-reported self-criticism, self-compassion, and depressive symptoms to compare patterns between a clinical and non-clinical sample. Methods: Participants were 184 university students (84.2% female) and 45 inpatients treated for a depressive disorder (62.2% female). Following a standardized negative emotion induction, participants verbalized self-critical thoughts by speaking aloud as their “inner critic.” Verbalizations were analyzed with the Linguistic Inquiry and Word Count tool (LIWC). Self-criticism was additionally assessed via an established self-report measure, alongside self-compassion and depressive symptom measures for validation. Non-parametric Spearman rank correlations examined associations between LIWC categories and questionnaire measures within subsamples. Group differences between students and patients were tested. Results: Across both subsamples, small but significant associations emerged between LIWC categories and self-reported self-criticism, self-compassion, and depressive symptoms (|ρ|=.13–.39). Correlational patterns differed slightly between both groups, suggesting qualitative differences in clinically relevant self-criticism versus non-pathogenic self-reflection. Compared with depressed inpatients, students used fewer pronouns (t=−5.14, p<.001) and fewer negative emotion words (t = −4.19, p < .001), particularly sadness-related words (t=−3.18, p=.003), when speaking as their “inner critic.” Discussion: Combining linguistic analysis with self-report assessment and contrasting clinical and non-clinical groups adds nuance to how self-criticism is expressed and related to affective symptoms. The observed group differences point to potentially distinct self-critical processes in depression versus normative self-evaluation. These findings may inform psychotherapy research on mechanisms and change processes as well as support clinical and public mental health strategies targeting maladaptive self-criticism.

Background: NEET (Not in Education, Employment, or Training) youth and hikikomori-type social withdrawal are often attributed to “vulnerability,” poor stress tolerance, or lack of motivation—labels that can oversimplify the underlying psychological process. This integrative review reframes withdrawal as a protective outcome of a coherent pathway: over-sensitivity → over-interpretation of others’ criticism → low self-esteem → social withdrawal. Core proposition: Some youth are highly sensitive to interpersonal cues and evaluation. In low psychological-safety contexts characterized by frequent comparison, criticism, or performance pressure (e.g., family, school, workplace), they may interpret subtle social signals (silence, tone of voice, facial expressions) as the strongest possible criticism. Such threat amplification fosters shame, anxiety, and self-invalidation, gradually consolidating into low self-esteem and expectations of future rejection. Mechanisms: The review synthesizes plausible processes including (1) heightened interpersonal sensitivity and evaluative anxiety that rapidly labels ambiguity as threat; (2) cognitive distortions such as mind-reading, magnification, and catastrophizing that inflate perceived criticism; (3) shame-driven self-devaluation that undermines self-efficacy and action readiness; (4) repeated negative social experiences that strengthen “I am not worthy/I cannot do it” beliefs; and (5) avoidance and reduced social exposure maintained by negative reinforcement, as withdrawal provides immediate anxiety relief and becomes a stable lifestyle pattern. Operationalization: Outcomes can be indexed through NEET status, withdrawal duration, range of daily activity, sleep–wake regularity, perceived stress, self-esteem, self-efficacy, rumination, shame, and functional participation in education, work, and community life. Testable hypotheses: The model predicts stronger associations between interpersonal sensitivity, criticism over-interpretation, low self-esteem, and withdrawal; amplification of these links in high-criticism/high-comparison environments; and greater improvement when interventions simultaneously reduce threat amplification (e.g., cognitive restructuring, graded exposure, ambiguity tolerance) and rebuild self-esteem through psychologically safe relationships and family communication adjustment. Conclusion: Rather than treating withdrawal as mere fragility or poor resilience, this review conceptualizes hikikomori/NEET-related withdrawal as a protective response shaped by over-sensitivity and criticism over-interpretation that erodes self-esteem—offering a more empathic, testable, and intervention-relevant framework.

Aim: Biological sex, gender and intersecting identities shape mental health risks, coping, and psychotherapy outcomes, yet gender- and intersectionally diverse populations remain underrepresented in randomized controlled trials (RCTs). Moreover, existing reviews rarely include gender-sensitive analyses or focus on a narrow set of psychological disorders. This study investigates (1) the extent to which psychotherapy RCTs incorporate gender- or intersectionality-sensitive analyses and (2) the evidence for gender-specific psychotherapeutic approaches. Methods: We conduct a systematic review (PROSPERO: CRD420251112590; Funding: Federal Ministry of Research, Technology and Space, 01GN2525) using a participatory research approach. We systematically searched PubMed, PsycInfo and CENTRAL for RCTs of cognitive behavioral or psychodynamic psychotherapy reporting gender-sensitive analyses on therapy efficacy or evaluating gender-specific interventions. The primary outcome is psychosomatic symptom severity, complemented by standardized mental health measures. A meta-analysis will be conducted if feasible. Results: The search strategy yielded N=8,855 records. Preliminary findings from screening show that gender- and intersectionality-sensitive analyses are rarely reported and that definitions of gender-sensitivity vary widely. Early patterns indicate underrepresentation of non-binary gender groups and a focus of existing gender-targeted interventions on women’s reproductive or relational concerns, with few male-specific programs, often limited to forensic settings. Discussion: This review is expected to highlight a substantial gender data gap in psychotherapy research and the scarcity of gender- and intersectionality-sensitive approaches. Findings will inform future study designs, contribute to developing more equitable and inclusive psychotherapeutic interventions, and support evidence-based guidance for clinical practice and mental-health policy. Keywords: gender data gap, gender-sensitive psychotherapy, intersectionality, systematic review

Aim. Sex and gender are related to prevalence, etiology as well as treatment efficacy of various mental disorders. Still, knowledge about the extent of these sex/gender differences as well as the distinct mechanisms that contribute to these differences is limited. This presentation outlines how Findable, Accessible, Interoperable, and Re-usable (FAIR) research data can further leverage our insights into sex and gender aspects in psychotherapy research. Method. The potential of FAIR data principles for sex- and gender-sensitive psychotherapy research as well as methodological and ethical challenges were analyzed. Results. Four manners in which FAIR data can facilitate sex/gender-sensitive psychotherapy research are discussed. 1) FAIR data may overcome the current lack of sex/gender-sensitive reporting in our field by enabling secondary sex-stratified analyses; 2) FAIR data may facilitate data pooling across studies and thereby increase statistical power of sex/gender-related analyses into psychotherapy outcomes and its underlying mechanisms; 3) FAIR data may promote the reliability and robustness of sex/gender-related psychotherapy research; 4) FAIR data may aid in creating an evidence-base for currently understudied sex and/or gender minorities by means of data pooling across studies. Remaining challenges and further considerations are presented. Practical tools and resources for implementing FAIR data are outlined. Discussion. FAIR data provides an important and feasible avenue to address pressing and timely questions on sex/gender-related aspects in psychotherapy research. By applying the FAIR data principles, researchers can contribute to improving equality, innovation and FAIRness in psychotherapy research. Keywords: sex, gender, FAIR data, methods

Background The neuropsychobehavioural model of persistent somatic symptoms (PSS) proposes that prior experiences shape expectations (“priors”) about bodily sensations and influence how new sensory information is interpreted. Insufficient updating of priors may contribute to symptom persistence. Understanding how individuals with PSS narrate and integrate bodily experiences is therefore highly relevant for psychotherapy research. Objective This qualitative study examined how individuals with PSS describe symptom-related experiences, and whether these narratives reflect processes assumed in the neuropsychobehavioural model, particularly the formation and updating of priors. Method Semi-structured interviews were conducted with adults reporting PSS for at least six months. Participants were recruited across healthcare and community settings and compensated for participation. Interviews were transcribed verbatim and analysed using iterative qualitative content analysis (Kuckartz et al., 2022) to identify themes relevant to symptom interpretation and experiential learning. Results Twenty-one interviews (February–June 2025) yielded 275 meaning units. Participants described symptom-triggering, amplifying, and attenuating experiences. Narratives were frequently fragmented, with limited integration into a coherent understanding of their condition. Early experiences strongly shaped the interpretation of later bodily sensations. This experiential narrowing appeared to reinforce maladaptive priors, constraining opportunities for corrective learning. Conclusion Initial findings support core assumptions of the neuropsychobehavioural model: fragmented symptom experiences may hinder the adaptive updating of priors, contributing to persistent symptom interpretation patterns. For psychotherapy, these insights highlight the potential relevance of interventions that foster coherent illness narratives, enhance precision of sensory information, and promote experiential re-learning. Future experimental work should test whether facilitating integration of symptom experiences functions as an active psychotherapeutic mechanism in PSS treatment. Keywords: Persistent somatic symptoms, somatic symptom disorder, patient experiences, qualitative research

Aims: Knowledge deficits, anticipated or experienced stigma, emotional ambivalence, and limited local services often prevent parents, caregivers and guardians (PCG) from affirmatively supporting trans and non-binary children. Building on this, the study investigates how PCG use online forums to manage emotional challenges and uncertainties about their children’s gender identity; which discursive features promote or hinder affirmative responses; and which interactional processes are associated with changes in PCG understanding and caregiving behavior. Methods: We apply a netnographic approach grounded in the LiLEDDA framework (literature review, localization, ethics, data collection, analysis, abstraction) and combine it with reflexive thematic analysis. Data are drawn from online forums used by PCG of trans children and adolescents. Threads will be sampled to capture diversity in theme and interaction. Coding focuses on emotional expressions (including ambivalent experiences of loss), concerns about safety and stigma, interactional dynamics, cognitive reframing, and caregiving behaviors. Results: The dataset will comprise several hundred threads between January and June 2025. Expected findings include tensions in the parental role between gatekeeping and advocacy, negotiation of normative expectations versus commitment to children’s self-determination, and peer-mediated cognitive reappraisal and emotional-regulation processes that support affirmative stances. Conclusions: By mapping specific support needs and interactional levers like peer testimony, targeted resources, and emotional-support strategies, the study aims to inform interventions and educational offerings to strengthen affirmative care for trans and non-binary youth.

Background: Many individuals experience enduring psychological distress following the loss, disruption, or invalidation of a central identity component (e.g., a core goal, role, value, relationship, or ideal) that is tightly linked to their self-concept. Existing psychiatric constructs and diagnoses (e.g., depression, trauma, demoralization, moral injury) capture aspects of this experience but do not directly assess identity-level rupture. We introduce Identity Wound as a distinct construct referring to difficulties integrating the loss of a central identity component into an evolving sense of self, and present the development and validation of the Identity Wound Questionnaire (IWQ). Methods: An initial item pool of 47 items and 5 qualitative prompts was developed to assess two theorized domains: (1) internalized dreams, goals, and identity-defining expectations, and (2) emotional and cognitive consequences of their loss or non-realization. The questionnaire was administered to an adult sample (N = 350), alongside established measures of depression, anxiety, trauma-related, and obsessive-compulsive symptoms, shame, well-being, and identity goals. Psychometric evaluation included exploratory and confirmatory factor analyses, internal consistency, test–retest reliability, and convergent and divergent validity. Results: Factor analyses supported a stable multidimensional structure comprising three interpretable factors reflecting identity-related goals, experienced loss, and identity-related growth or reorganization. The IWQ demonstrated excellent internal consistency (Cronbach’s α = .95). Convergent validity was observed with measures of depression, demoralization, and shame, while divergent validity was supported by weaker associations with anxiety, posttraumatic, and obsessive–compulsive symptoms. The factor structure and psychometric properties were robust across analyses. Conclusions: The Identity Wound Questionnaire is a reliable and valid measure of identity-level disruption following the loss or invalidation of core ideals. The IWQ offers a novel tool for studying existential and identity-based distress and may have clinical utility for identifying identity-focused mechanisms of suffering and recovery commonly observed in clinical practice.

Anatolia’s ancient tattoo tradition—historically known as DEQ or dövme—represents one of the oldest symbolic systems linking body, culture, and emotional life. These motifs have long served as markers of belonging, identity continuity, protection, grief, transition to adulthood, and intergenerational memory. Despite their psychological richness, such embodied cultural symbols remain largely unexplored within contemporary psychotherapy research. Understanding these motifs may offer new insights into how individuals organize identity and regulate emotion within culturally embedded frameworks. This presentation aims to illuminate how Anatolian tattoo motifs operate as emotional and identity-based symbol systems, and how these systems can inform culturally sensitive psychotherapeutic work with adolescents and adults. A conceptual–clinical approach is employed, integrating perspectives from Emotion-Focused Therapy, Eriksonian identity development, self-psychology, and anthropological research on body marking. Clinical vignettes drawn from therapeutic encounters illustrate how clients’ symbolic worlds—including cultural traces such as tattoo motifs—shape affect processing, meaning-making, and self-organization. Findings indicate that Anatolian tattoo motifs function as externalized emotional schemas, containers for affective experience, and anchors for self-continuity. They support emotion regulation by providing symbolic grounding, narrative integration, and embodied expression of primary emotions. In therapy, attending to such culturally embedded symbols deepens the therapeutic alliance, enhances access to core emotional experiences, and strengthens the client’s sense of identity and belonging. Exploring embodied cultural symbols within psychotherapy can enrich our understanding of emotion and identity across cultural contexts. Anatolia’s tattoo tradition offers a unique lens for reimagining psychotherapy’s dialogue with culture, aligning with SPR 2026’s theme of innovation through cross-cultural exchange.

Disabled people encounter greater mental health challenges than non-disabled people. Despite this, little is known about disabled people's perceptions and experiences of counselling and psychotherapy, and the barriers and facilitators to access therapy. Hence, this scoping review aims to identify and synthesise existing evidence to inform practice, research and policy to allow for more inclusive psychological therapy and reduce barriers for disabled clients seeking therapy. This scoping review follows the methods outlined in the Joanna Briggs Institute (JBI) manual scoping review framework (Peters et al., 2020) and the PRISMA-ScR guidelines (Tricco et al., 2018). The databases searched include PsychINFO, CINAHL, Medline and EBSCO. Eligible studies were limited to those published from 2015 to 2026. Titles and abstracts have been screened according to inclusion/exclusion criteria, and full texts will be sought for relevant articles. Data will be extracted from included papers, and a narrative synthesis will address the research questions. This review is being co-produced with a Lived Experience Advisory Panel, the research team consists of disabled and non-disabled researchers, and disability organisations will be consulted when developing recommendations for practice. Results will provide insight into how disabled people perceive and experience receiving counselling and psychotherapy, and highlight the barriers, challenges and accessibility issues for this population. Recommendations will focus on how practitioners can adapt their practice to better meet the needs of disabled people and future directions for research.

Aim: Researchers and practitioners have emphasized the need to reimagine therapeutic processes through culturally grounded, globally relevant understandings of client well-being. This study examined how three dimensions of perceived social support (family, friends, and significant others) predict life satisfaction among racially/ethnically minoritized (REM) college students with disabilities, a population navigating intersecting stigmas that shape mental health and help-seeking. Findings offer insight into how culturally embedded support systems inform well-being and can strengthen psychotherapy approaches. Methods: Cross-sectional data were analyzed from REM college students with disabilities (Mage = 22.7). Participants completed the Multidimensional Scale of Perceived Social Support and the Satisfaction with Life Scale. Hierarchical linear regression, guided by Cohen & Wills’ stress-buffering model, was used to examine incremental effects of significant other, friend, and family support. Results: Social support predicted 47% of the variance in life satisfaction. Although friend and significant other support showed positive associations in earlier steps of the model, only family support remained a significant predictor in the final model, contributing the largest increase in explained variance. Discussion: Findings highlight the centrality of culturally embedded family networks in shaping well-being for REM students with disabilities. For psychotherapy practice, these results underscore the importance of moving beyond individually focused models toward relationally and culturally attuned approaches. Integrating family-informed assessment, culturally responsive engagement practices, and context-specific support structures may enhance therapeutic relevance globally, particularly in collectivistic contexts or among marginalized communities whose wellness is deeply relational. This study contributes to ongoing dialogue on reimagining psychotherapy through culturally grounded, equity-oriented innovation.

A case study is presented examining the adaptation of Emotion-Focused Therapy (EFT) for a patient with Prolonged Grief Disorder (PG-13-R score: 32). The patient is a twenty years old girl who looked for psychological help with the lost of his grandmother, her main attachment figure, five years ago. She completed 20 EFT-based therapy sessions, which included tasks such as Empty-Chair for Grief or Compassionate Self-soothing task. All sessions were qualitatively analyzed through video observation and rubric-based scoring; while symptom change was assessed by several questionnaires: PG-13-R (Prolonged Grief Disorder), CORE-10 (Psychological Distress), PHQ-9 (Depressive Symptomps) and GAD-7 (Generalized Anxiety Symptoms); finally, has been discussed the relation between symptom evolution and the content of each session. Qualitative analysis revealed the connection between grief complications and core emotional pain stemming from unmet needs across the individual's life. Furthermore, the EFT therapeutic process is described: the transformation of core emotional pain through adaptive emotions via EFT tasks (such as empty chair dialogue), contextualized within an empathic, person-centered, Rogerian therapeutic relationship. The treatment yielded positive results, showing significative improvements not only in grief processing but also in reducing anxiety and depressive symptoms and psychological distress, objectively measured from session to session using the previously mentioned questionnaires. This clinically significative symptom reduction and therapy analysis support the effectiveness of EFT in alleviating the complications associated with Prolonged Grief Disorder, in addition to provide a detailed demonstration of the development of EFT treatment for Prolonged Grief Disorder.

Objective Alexithymia entails difficulty identifying and describing emotion, associated with trauma, adversity, insecure attachment, and immature defenses, functioning as a personality trait that disrupts treatment adherence and progress. Psychic retreat involves withdrawal to protect against anxiety and pain. Individuals with both tendencies avoid therapeutic engagement and emotional contact. This study exploring the experiential transformation of two college students in interpersonal group psychotherapy. Method Group included 8 college students (6 completed). Four with alexithymic traits (TAS-20 > 61), and two of them with both alexithymia and psychic retreat, were selected for analysis. The intervention comprised 10 sessions; pre/post interviews and group sessions were transcribed. Analysis was conducted through narrative inquiry from within-case to cross-case with triangulation. Result Elisa expressed loneliness and a wish for relationships but felt burden and reject contact. Hearing others discuss parents, she spoke about difficulty receiving love and inferiority toward her outstanding sister, later showing engagement and altruistic behavior. Amy declined invitations to speak, afraid of attention, her mind blank. Listening, she recognized similarities, slowly shared, spoke about shame and worthlessness, developed trust, and her persecutory fears lessened. Conclusion Alexithymia and psychic retreat are notorious for contributing to difficulties in therapeutic work. Limitations in identifying and describing feelings lead to externally oriented thinking, while psychic retreat deepens withdrawal, reducing the capacity for contact. Compared to individual therapy, clients can choose when to move forward and when to withdraw for safety. Group provides a protective function and relief what Bion described as attacks on linking. Keywords: alexithymia, psychic retreats, interpersonal group psychotherapy, narrative inquiry

Aim Cohesion is a central curative factor in group psychotherapy, yet research typically examines it as a static and average outcome, overlooking within-group variability and the conditions that shape its development. This study advances a dynamic model of cohesion in youth group psychotherapy by investigating whether perceptions of leader responsiveness at early intervention predict (a) average level of cohesion and (b) the trajectory of within-group variability across treatment. Methods Participants were 181 Taiwanese elementary and junior high school students nested in 31 emotional cultivation groups (8 sessions each). Cohesion was conceptualized as the degree of shared engagement within each session and assessed using the Engagement subscale of the Group Climate Questionnaire. Leader responsiveness was measured at early treatment as a group-level, standardized index derived from the Perceived Responsiveness Scale. A three-level location–scale model simultaneously estimated change in mean engagement (location) and within-group variance (scale) over time, with sessions nested within members and members nested within groups. Results Engagement increased significantly across sessions. Groups with higher early leader responsiveness demonstrated consistently higher mean engagement, while responsiveness did not moderate engagement growth rates. Within-group variance decreased over time for all groups, indicating increasing cohesion. Importantly, early leader responsiveness significantly moderated the decline in within-group variability, suggesting faster convergence in members’ experiences among groups with perceived more responsive leader. Discussion Perceived leader responsiveness operates as an early relational condition that shapes cohesion development. Rather than altering engagement trajectories, responsiveness functions as a stabilizing interpersonal force that facilitates cohesiveness in members’ experiences.

Background: Since the early 2000’s shared decision-making (SDM) has been pivotal in healthcare to enhance patient involvement in treatment decision-making. In mental health, SDM is increasingly also recognised as a key approach for tailoring psychotherapy to patients’ individual needs. In SDM, therapists contribute clinical expertise and knowledge of treatment options, while patients bring insights into their circumstances, experiences, and treatment preferences. Although research on SDM in mental health care has documented impact of SDM on patient involvement and patient activation, little is known about the implications of SDM in psychotherapy. Methods: To investigate how SDM is enacted in the therapeutic encounter, this study draws on audio-recordings of ten SDM dialogues in psychotherapy. Patients participated in a group-based Cognitive Behavioral Therapy (CBT) program for depression, and took part in individual decision-making sessions, during which the therapist and the patient collaboratively decided on the content of 3–5 individualized add-on sessions. Results: We identified three forms of negotiation that shape SDM in the therapeutic encounter: (1) negotiating frames: how SDM is situated within psychotherapy; (2) negotiating preferences: the balance between patient autonomy and therapist authority; and (3) negotiating meaning: whether SDM functions as a symbolic gesture or as a catalyst for change. Discussion: The findings show that SDM is not straightforwardly enacted in the therapeutic dialogue, but is a rather complex endeavour due to the ongoing interactional process of psychotherapy, that implicate a continuous negotiation of frame, preferences and meaning.

Background: Fear of criticism, social failure, and negative self-evaluation characterise social anxiety disorder (SAD). Patients closely monitor others for signs of disapproval, which reinforces this rigid framework and makes it difficult to perceive moments of progress. The Innovative Moments (IM) model conceptualises therapeutic change as the emergence of exceptions or deviations from a maladaptive framework of meaning, occurring in clients’ discourse. Research has shown that IMs are associated with therapeutic outcomes. We developed an IM-based add-on for group CBT for SAD, designed to promote the recognition of such exceptions—first by observing changes in others, and later by fostering their emergence and integration within the self. Method: A 15-session CBGT protocol for SAD was developed (combining components from Heimberg &amp; Becker, 2002; and Wells &amp; Clark, 1995) and implemented with one pilot group (5 participants, two therapists). The IM add-on began in Session 6 and continued until Session 14, with tasks at the end of sessions focusing on IMs in others. Two additional sessions (9 and 14) focused on reflecting on changes in the self and comparing changes identified by others with those identified by the participants themselves. The written materials produced during these reflections, as well as an adaptation of the Change Interview (Elliott, 1999) to group therapy, conducted at the end of treatment, were analyzed using consensual qualitative research. Results: Data analysis is ongoing.

Background: Despite decades of extensive research, the effectiveness of suicide risk assessments and interventions continue to be limited due patient factors (patients’ lack of trust, reduced engagement, and non-disclosure), clinician factors (negative countertransference, lack of self-confidence, and limited skills), and systemic factors (assessments that rely heavily on self-report and rigid risk stratification). This paper presents two studies that investigate the promise of virtual patient interactions for addressing these barriers by transforming the content and process of suicide risk assessment in a general population psychiatric outpatient department (study 1) and an active-duty military psychiatric outpatient unit. Methods: Study 1: 156 outpatient clinicians were randomly assigned to the training vs. control vs. extraneous control conditions. The impact of the training on clinicians’ alliance with their actual patients and those patients’ suicidal outcomes was assessed with repeated measures ANOVAs. Study 2: 20 clinicians a military hospital were randomly assigned to the training vs. TAU. The impact of the training on clinicians’ outcomes with virtual and actual patients and on patients’ outcomes (self-reported alliance and suicidal outcomes) will be assessed with repeated measures ANOVAs. Results: Study 1: The training led to greater improvement in patients’ and clinicians’ ratings of the alliance as well as greater reduction in suicidal outcomes compared to controls. Study 2: The data collection is ongoing. Discussion: The findings will be discussed with special focus on the contribution of virtual patient interactions to clinical training in suicide risk assessments and interventions in general and with vulnerable groups in particular.

Background. AI-based mental health interventions aim to provide scalable approaches to address conventional obstacles in mental healthcare delivery. However, clinical and ethical concerns exist regarding their use, and psychological factors influencing patient acceptance remain unclear. This study examined whether psychological characteristics, including mental health symptoms, epistemic trust, and attachment security, predict acceptance of AI-based interventions (avatars, chatbots) compared to human-delivered teletherapy. Method. We collected self-report data from 1,612 participants (potential patients and clinicians) and conducted cluster analysis to determine whether psychological profiles are associated with AI intervention acceptance. Results. Three distinct clusters emerged: (C1) Avoidant-not trusting, (C2) Secure-trusting-healthy, and (C3) Young-anxious-ambivalent-symptomatic. Paradoxically, participants in the two most vulnerable clusters (C1 and C3) showed highest acceptance of AI-based interventions, whereas the psychologically healthier cluster (C2) reported lowest AI acceptance and strongest preference for teletherapy. Additionally, prior therapy experience as either patient or provider was associated with reduced AI acceptance. Conclusion. These findings suggest that AI-based interventions may be particularly appealing to and engage individuals experiencing interpersonal difficulties, potentially offering a critical treatment entry point for those most in need. However, patients most inclined toward AI interventions are also most vulnerable to its potential risks, especially regarding attachment to non-human therapists and missing out on the relational learning opportunities they would need and that could occur through a genuine human connection.

The study asses NLP-based diagnosis of depression by comparing its results with those of human raters using the gold-standard Hamilton Rating Scale for Depression (HRSD) and explores differences in depression severity both within individuals and between individuals throughout therapy. The data for this study is drawn from two large, rigorous randomized controlled trials conducted at the University of Haifa (2018, 2021). The setting provides an opportunity to assess the accuracy of NLP methods in diagnosing with real patients over the course of therapy. Two hundred and forty-two patients between the ages of 18-60 participate in the study. At intake, patients reported problems related to MDD, including depressed mood, feelings of worthlessness or excessive guilt, anxiety, relationship problems, meaning in life, grief or loss, career concerns, etc. Those who met the criteria received 16 50-min psychodynamic time-limited psychotherapy sessions using comprehensive treatment protocols. Depression severity was assessed by HRSD twice pre-treatment and 16 times weekly, during treatment. Each interview was administered and scored by human raters, reaching an inter-judge reliability of 0.98. Automatically transcribed interviews were analyzed using a pre-trained large language model in a prompt-based framework. Model outputs were compared with human ratings to assess correspondence in identifying between-individual and within-individual differences in depression severity. The study comprises 3800 responses from n=242 participants, with ongoing analysis of automated transcripts using NLP. We compare two NLP approaches: one based on sentence-by-sentence evaluation, and the other based on linguistic changes between sessions for scoring. Our preliminary results show that these methods produce highly correlated results despite the differences in the approaches and they correlate with the human judgments. Moreover, the results are accompanied with explanations in the form of citations from the texts and depression symptoms expressed in them.

Objective: There is increasing support for the positive association between cultural humility and alliance quality, yet racial/ethnic disparities in psychotherapy outcomes persist. Culturally salient ruptures may contribute to these inequities. The present study aims to examine therapists’ perceptions of cultural moments across diverse training levels and cultural contexts through the use of video vignettes. Method: Participants were asked to watch short video vignettes that simulated ruptures related to the working alliance in therapy and answer questions designed to capture their perceptions of ruptures, repairs, and the working alliance. Measures included the Rupture Resolution Rating System – Self Report (3RS-SR) and free-response questions that captured (a) perception of ruptures and resolutions, (b) perception of working alliance, and (c) reflective inquiry of how the participant would respond in the situation of the vignette. Results: This is a mixed-methods study. Quantitative analyses will identify patterns in participants’ ratings of rupture detection, impact, and working alliance, while qualitative analyses will provide context and depth to participants’ subjective interpretations and reasoning. Through this combined approach, we hope to better understand the nuances in perception of cultural ruptures, influenced by therapist cultural background, training, or prior clinical experience. Discussion: Findings from this study aim to inform diversity training and cultural humility practices in psychotherapy, with a broader goal of reducing racial and cultural disparities in treatment outcomes.

Cultural humility (CH) has been associated with many positive aspects of therapy processes and outcomes (e.g., higher alliance ratings, better outcomes). However, less is known about what interventions are associated with CH. Understanding when and how culture becomes salient in psychotherapy requires analytic systems capable of detecting these fluid expressions. Adherence ratings typically rely on human coders, a costly and time-intensive approach that limits scalability and replication. Advances in natural language processing (NLP) offer scalable alternatives. Using the Lyssn AI platform, which has demonstrated performance comparable to human coders, we examined the dynamics of CH in a graduate training clinic with a sample of 62 therapists, 39 clients, and 575 total sessions. Two-level hierarchical linear models were used to analyze client reports of CH with NLP-derived session variables. Therapist affirmation accounted for the largest proportion of variance in CH (ΔR² = .104, b = .02, p < .001), while sessions with angry emotional content demonstrated a moderate contribution (ΔR² = .041, b = –0.07, p = .006). Motivational Interviewing (MI) adherence (ΔR² = .103, b = –.011, p = .005) accounted for a large proportion of variance and was negatively associated with CH, whereas MI nonadherence (ΔR² = .034, b = .027, p < .05) accounted for a smaller proportion of variance and was positively associated with higher CH. These findings highlight the complex, diverse, processes through which CH manifests in session and demonstrate how NLP-based tools can illuminate clinically meaningful session information. Implications for practice will be provided.

Aim Therapist self-disclosure (TSD) has been predominantly studied in Western contexts, with limited understanding of how clients from diverse cultural backgrounds perceive its helpfulness and respond to various types of disclosures. This study examines Chinese and Western clients’ perceived helpfulness of four types of TSD: factual, feeling, insight, and strategy, and their reactions to these disclosures. It also explores how individual cultural values may be associated with these perceptions. Methods Participants are being asked to rate the helpfulness of each TSD type and select reasons for why that disclosure is helpful or unhelpful. They also complete measures of individual cultural values, including the Individualism-Collectivism Scale (ICS) and the Social Dominance Orientation Scale (SDO). Planned analyses include mixed-design ANOVAs to compare helpfulness ratings across cultures and TSD types, and regression models to examine whether ICS and SDO scores account for cultural differences in helpfulness and reaction ratings. Data collection is ongoing. Results We hypothesize cultural differences in helpfulness ratings: Western clients are expected to rate feeling-SD and insight-SD as more helpful than Chinese clients, whereas Chinese clients will rate strategy-SD as more helpful. Minimal cultural differences are expected for factual-SD. Furthermore, individual differences in cultural values, particularly individualism vs. collectivism and egalitarianism vs. hierarchy, are expected to partially explain these cross-cultural patterns. Discussion This presentation will highlight how culture and cultural values are associated with clients’ evaluations of TSD. Findings will inform culturally responsive therapeutic practices and guide clinician training to better align self-disclosure strategies with clients’ cultural orientations.

Somatic symptoms are a common phenomenon in psychotherapeutic practice and are often conceptualized as problems to be reduced or eliminated. This paper presents a process-oriented conceptual model in which somatic symptoms are understood as guides within the therapeutic process, pointing toward unmet needs, disruptions of self-support, and broader field dynamics. Grounded in Gestalt therapy and a dialogical foundation, the model describes two equally central modes of working with somatic symptoms: phenomenological inquiry and experimentation, particularly body-oriented experimentation. Phenomenological inquiry involves sustained, non-interpretive attention to immediate bodily experience, supporting awareness of sensations, emotions, and the quality of contact. Body-oriented experimentation offers a direct way of engaging with somatic experience and allows exploration of how needs, boundaries, and patterns of self-regulation are organized. An additional key feature of this approach is focused clinical observation aimed at distinguishing what belongs to the client’s own lived experience and what reflects transgenerational or field-based influences. Through this differentiation, somatic symptoms emerge as meaningful organizers of experience, revealing both personal and inherited patterns relevant to the therapeutic process. Within this model, symptom reduction is not a primary goal but may occur as a secondary effect of restored self-support and an increased capacity to satisfy one’s own needs. The proposed model contributes to qualitative and process-oriented psychotherapy research and offers a conceptual framework for studying embodied processes of change in clinical practice.

This study aimed to explore novice group counselors’ learning experiences regarding practice difficulties encountered while leading unstructured counseling groups across different stages of group development. Participants were 27 master’s-level counseling students who each served in a three-person team consisting of a group leader, a co-leader, and an observer while conducting a 10-week unstructured counseling group. Based on the four-stage model of group process—initial, transition, working, and termination stages—participants’ experiences of practice difficulties were collected and analyzed. Data were obtained through open-ended questionnaires and analyzed using qualitative content analysis. The results categorized novice group counselors’ practice difficulties into six major domains: (a) overall group leadership and management, (b) facilitation of interpersonal interactions, (c) member-level intervention and processing, (d) co-leadership collaboration and practice, (e) technical performance and skill application, and (f) awareness and management of the leader’s personal state. Practical implications were discussed in relation to these six domains, and recommendations were proposed for the design of group counseling training curricula and the development of systematic supervision and intervention strategies to support novice group counselors.

The professional development of counselors-in-training (CITs) is a central concern in counselor education, particularly in relation to group counseling competence. This study investigated the effects of an applied, systematic group counselor training model consisting of 54 hours preparation training course and 18 hours intensive training followed by live-supervised practice, and examined changes in group leadership competencies as well as CITs’ reflections on practice-related difficulties. The training groups were conducted in an intensive three-day format, comprising eight semi-structured sessions of 75 minutes each, with interpersonal problem solving as the primary therapeutic focus. A total of 37 CITs participated as group leaders after providing informed consent, and valid pre–post data from 28 participants were included in the analyses. Group leadership competencies were assessed using the “Group Leadership Competencies Scale”, which 49 items measures eight core competencies relevant to unstructured counseling groups. Practice difficulties were assessed using the “Practice Difficulties Reflection Questionnaire for Trainee Group Counselor” (PDRQ-TGC), a 27-item instrument covering six dimensions of process-related challenges. Paired-sample Wilcoxon signed-rank tests indicated that post-training scores were higher across all competency dimensions, with a statistically significant improvement observed only in “Cohesion Facilitating”, suggesting a selective but robust training effect. Pearson correlation analyses revealed moderate to strong associations between key competencies—particularly “Cohesion Facilitating”, “Individual Depth Enhancing”, “Change and Action Facilitating”, and “Terminating and Change Intensifying”—and practice difficulty dimensions related to “individual member processing”, “co-leadership collaboration”, and “counselors’ personal adjustment”. Multiple regression analyses further indicated differential predictive patterns, including opposing effects of certain competencies on “intervention skill application”. Overall, the findings highlight the central role of cohesion-related competence and underscore the importance of jointly examining leadership competencies and process-related difficulties in group counselor training.

Objective: Patients with an eating disorder (ED) are considered difficult to treat. We aimed to identify the characteristics of patients with an ED, which are considered especially challenging to treat from the therapist perspective. Method: Psychotherapists with experience in ED treatment were asked to describe a “normal” as well as a “difficult” case they treated lately, using an online-survey. They described their patients by filling in a list of symptoms and their severity, on personality traits and functioning as well as a list of possible therapeutic challenges experienced over the course of treatment. Results: 127 psychotherapists were recruited. “Difficult” cases were characterized by variables which could be related to three areas: patients´ motivation (higher level of ambivalence), interactional behavior / personality traits (more antagonism) and somatic complications, such as electrolyte imbalance. Ambivalence was the strongest predictor of case difficulty, followed by patient` personality. Therapist characteristics or work place characteristics were not associated with experiencing treatments as “normal” or “difficult”. Conclusion: In particular aspects related to the therapeutic process and relationship characterize the group of “difficult” cases from a therapist view.

Theoretical Background. Understanding which composition of therapeutic interventions leads to which outcomes for which patients is a longstanding priority in psychotherapy research and practice. Systematic analysis of psychotherapy session transcripts enables us to describe in detail the interventions therapists carry out, which may in turn be associated with outcomes for patients or may be fed back to therapists as a record of their actions, stimulating a reflection of their practice. Recent developments in natural language processing may aid in automating such analyses, which may then be carried out at scale to uncover hidden intervention-outcome associations for specific groups of patients, or may be fed back in processed or raw form to therapists in training. The aim of this particular study was to automate the identification of verbal therapist microskills. Methods. A large language model was fine-tuned on a corpus of diarised, unitised and anonymised psychotherapy transcripts from the Osnabrück psychotherapy outpatient clinic. Transcript chunks were labelled according to the majority vote of two trained human coders using the Helping Skills System (Hill) to categorise therapist utterances contained in chunks. Automated identification performance was evaluated through cross-validation, comparing several metrics, and waging against human interrater agreement. Model behaviour was explored through LLM classification explanations as well as through correct and incorrect classification examples. Results. Quantitative metrics and qualitative model behaviour exploration indicated adequate, human-comparable LLM performance for circumscribed and frequent codes. Discussion. Automated identification of therapist microskills is feasible, and shows potential for integration into feedback systems in outpatient psychotherapy.

Theoretical background. Despite advances in psychotherapeutic treatments, enhancing effectiveness remains a core task of clinical psychology. Routine outcome monitoring (ROM) with session-based feedback is a promising transdiagnostic intervention for detecting unfavorable treatment courses, adaptively adjusting therapy, reducing dropout, strengthening active factors (e.g., the therapeutic alliance), and enhancing outcomes. However, ROM has focused mainly on symptom trajectories assessed by self-report questionnaires and has largely ignored transdiagnostic mechanisms of change. In practice, repeated assessments also place considerable burden on patients and therapists. AI-supported procedures may enable continuous, automated, and thus less burdensome assessment that is easier to implement. Research question. The current research examines how transdiagnostic mechanisms of change – exemplified by resource-oriented microprocess analysis (ROMA) – can be rendered usable for the application of generative AI in the therapeutic process through transcript-based coding. Method. Based on a factor-analytic strategy, we first developed a one-factor model for eight therapeutic constructs or mechanisms of change – including “positive reinforcement”, “resource activation”, “goal orientation”, and “reframing” – each with the subfacets “responsiveness”, “specificity”, and “ipsativity”. Results. Preliminary reliability analyses indicate adequate to excellent reliability (α, ωₜ = .75–.89) and moderate to high factor loadings, providing initial evidence for coherent operationalization and measurement of the therapeutic constructs. Conclusion. The results on assessing mechanisms of change with the standardized item structure support the feasibility of transcript-based evaluation of therapeutic microprocesses. Prospects of combining this approach with audio feature-based symptom assessment and digital phenotyping of behavioral markers in a comprehensive automated feedback system will be discussed.

Theoretical background: Routine Outcome Monitoring (ROM) is a transdiagnostic intervention that enables stable incremental therapy effects. In practice, however, problems often arise during implementation: Session-based questionnaires are considered too time-consuming, and patients perceive the focus on symptom assessment as pathologizing, with the result that feedback is not always used. According to current research, a key prerequisite for successful implementation is the involvement of patient representatives and therapists. Research question: How can AI-generated session feedback be recorded, processed, and presented in a way that benefits both therapists and patients? Methods: A co-design process was carried out with two patient representative boards and one therapist board. In addition, initially generated AI feedback on relevant processes (e.g., resources, behavioral activation, intervention styles) was prepared and used by 10 therapist-patient dyads over 3-5 sessions each. The use was evaluated on the basis of usability questionnaires and qualitative interviews conducted during each session. Results: Preliminary results highlight the complexity of implementation. Patients cite the need for comprehensibility, equal access to data, and complementary recording of strengths and resources. In addition, mechanisms should be implemented to reject unhelpful feedback. Therapists also attach great importance to comprehensibility and would like to see mechanisms in place to prevent their work from being monitored by superiors. Conclusions: While generative AI has great potential to improve feedback applications in psychotherapy, successful and effective implementation in practice requires the involvement of stakeholders. Preliminary results show in particular the importance of comprehensibility, transparency, and rejection of unhelpful feedback.

Mood disorders such as perinatal depression are highly heterogeneous in nature, underscoring the need for interventions tailored to individual vulnerability factors. This study examined a framework using Patient-Reported Outcome Measures (PROMs) and Computerised Adaptive Testing (CAT) to efficiently profile individual vulnerabilities and recommend Internet-based Cognitive Behavioural Therapy (iCBT) modules. Screening questions and CATs were developed to identify key vulnerability factors relevant to psychotherapy and mental health in a population of 916 participants. The tools were then validated psychometrically with 78 participants, and used to personalise module recommendations based on the identified vulnerability factors for 30 participants enrolled in a nine-module iCBT programme tailored for the perinatal population. Semi-structured interviews were conducted to obtain their feedback on this approach. CAT theta estimates were strongly aligned with full-length scores (r = .98), demonstrating its ability to reduce respondent burden without compromising accuracy. Both the CAT (PHQ-9: R2 = 0.75, RMSE = 2.34; GAD-7: R2 = 0.684, RMSE = 2.81) and screening questions (PHQ-9: R2 = 0.80, RMSE = 2.14; GAD-7: R2 = 0.76, RMSE = 2.46) were able to predict outcome measures such as depressive and anxiety symptoms. They also predicted therapeutic suitability, engagement, and constructs targeted at iCBT module content. 80% of interviewed participants reported that the identified vulnerability factors accurately reflected how they felt and the personalised module recommendations motivated them to continue with the programme. These findings highlight the utility of the screening questions and CAT as efficient assessment tools and clinically meaningful guides for personalising mental health interventions.

Aim: Mentalizing, defined as the capacity to understand one’s own and others’ mental states, is increasingly conceptualized as a ‘process’ rather than a fixed outcome. This process involves how individuals interpret available information to arrive at mental state attributions, particularly in relationally and emotionally salient situations. The present study aimed to pilot a qualitative, process-focused inquiry embedded within a performance-based, multiple-choice measure—the Mentalizing Vignettes Task–24 (MVT-24)—to examine mentalizing processes. Method: Participants included seven individuals with Borderline Personality Disorder (BPD) and six community controls. Following the multiple-choice phase of the MVT-24, participants were asked seven open-ended questions probing their understanding of others’ mental states and intentions, the reasoning underlying these attributions, certainty, consideration of alternative explanations, and anticipated relational impact for six vignettes selected a priori. Preliminary analyses focused on identifying salient qualitative trends differentiating groups. Results: Three recurring patterns characterized the BPD group: (i) high personalization, marked by spontaneous anchoring of interpretations in autobiographical relational experiences; (ii) predominantly negatively valenced attributions toward others’ intentions, even in positive-valence contexts; and (iii) elevated certainty coupled with difficulty generating plausible alternative explanations. Discussion: Embedding a brief qualitative inquiry within a structured task appears feasible and promises to yield clinically relevant information about interpretive patterns that resonate with psychotherapy process research. Future studies with larger, transdiagnostic samples are needed to further examine the clinical and treatment-related implications of such process-level indicators.

Feedback informed treatment (FIT) has been shown to be an efficacious way to improve therapy outcomes. The use of advanced statistical approaches may assist in optimizing the feedback therapists receive. That is, algorithms developed within FIT programs enhance their performance in predicting therapy outcomes. In this proof-of-concept article, we analyzed data from 9,591 clients who were treated at university counseling centers and completed the Behavioral Health Measure (BHM) on a reoccurring basis. The sample was 63.7% female, 26.3% were male, and 10% did not report their sex. Regarding ethnicity, 33.2% identified as White, 6.2% as Asian/Pacific Islander, 4.4% as Latinx or Hispanic, 3.7% as African American, 0.3% as Native American/American Indian, 1.5% as multiracial, 24.5% as other, and 26.2% did not report their ethnicity. We utilized AI-derived methods known as Ant Colony Optimization algorithm and Logistic Lasso Regression to analyze the data. Early in treatment (i.e., the first three to five sessions) BHM items were tested to determine which were the best predictors of therapy outcomes. The results demonstrated that five items, which included symptom-based items and life functioning, were strong predictors of outcomes over the course of early treatment. These findings suggest that FIT platforms or programs might benefit from more nuanced examination of the signals that assist therapists and clients monitoring treatment progress.

Objective: Mentalizing is the ability to understand and interpret one’s own and others’ behavior based on underlying mental states. A number of studies have shown that various psychopathologies are associated with a deficit in mentalizing. However, research findings are inconclusive as to whether mentalization improves in the course of psychotherapy. The patient's mentalizing can be assessed from several perspectives: through self-report measures, clinician-report measures, or using an observer-based measure. The first aim is to examine the convergent validity of three measures that cover these perspectives. The second aim is to investigate whether mentalizing changes and what obstacles the measures could pose in this context. Method: The ongoing data collection is taking place at an outpatient clinic offering mainly psychodynamically oriented psychotherapy to a mixed sample with predominantly depressive and anxiety disorders. At the beginning of therapy, after 16 sessions and at the end of therapy, the Brief Reflective Functioning Interview (BRFI; Andreas et al., 2021) is conducted and evaluated using the Reflective Functioning scale (RFS; Fonagy et al., 1998). Also, the clinician-report Modes of Mentalization Scale (MMS; Gagliardini & Colli, 2019) is used. The patients complete the Mentalization Questionnaire (MZQ; Hausberg et al., 2012) before each session. Results and Discussion: The correlations between MMS, MZQ and BRFI are presented as well as the change of mentalization in our sample. The strengths and weaknesses of the three measures are discussed.

Background: The ongoing war in Ukraine has divided the lives millions of Ukrainians into “before” and “after.” Mass forced migration and the challenges of acculturation in new host countries take place against an ongoing military conflict, leading to change their views on life, their role in the surrounding world, and their sense of self — to transform basic beliefs. One of potential positive outcome of the transformation of basic beliefs is Posttraumatic growth (PTG). However, PTG does not always develop spontaneously. Most traumatized people require psychological support. At our Institute, a specialized psychological support service has been organized, and a quantitative study has been conducted. Part of its results is presented at the conference. Aim: To develop methods for monitoring the transformation of basic beliefs (stages of revision, accommodation, assimilation) as a predictor of PTG and as an indicator of an adaptive therapeutic process, as well as to determine the role of mentalization and emotion-regulation strategies in this process. Methods: An online study using self-report questionnaires. 280 Ukrainian participants. Validation of translated questionnaires and a new original instrument (DTA) is in the process. Results: Preliminary findings show that mentalization is positively associated with adaptive transformation of basic beliefs and with the use of effective emotion-regulation strategies. Statistical analysis is ongoing; extended results will be presented on the conference. Conclusions: Psychological interventions that promote mentalization can promote Posttraumatic growth and reduce the risk of PTSD. The developed tools for monitoring transformations of basic beliefs are promising for assessing therapeutic progress.

Aim Artificial intelligence (AI) is increasingly used in mental health contexts, offering possibilities for risk detection, diagnostic support, and chatbot-based therapy. Yet its integration often overlooks tensions between algorithmic logic and the philosophical foundations of counselling psychology. This poster examines these tensions and explores how AI might be re-aligned with humanistic, relational, pluralistic, interdisciplinary, and social-justice-based values. Methods A conceptual and critical inquiry analysed how current uses AI in mental health intersect with counselling psychology values. Scholarly sources from counselling psychology, AI ethics, and sociotechnical systems research were examined to identify value tensions, mechanisms through which inequalities may be reinforced, and opportunities for more ethically aligned integration. Results The analysis identified multiple risks in existing AI deployments. These relate to the potential reinforcement of structural inequalities, the exclusion of clients whose data-sharing preferences or philosophical and cultural understandings of distress differ from prevailing system assumptions, and shifts in authority where relational and contextual complexity is reduced to predictive modelling, potentially contributing to mismatches between client needs and available forms of support. Discussion AI’s current trajectory may inadvertently reproduce structural inequalities and undermine counselling psychology values. Rather than rejecting AI, this work argues for its reorientation through collaborative, ethically informed, and intersectional approaches that bridge technical design with psychological philosophy. This involves sustained critical attention to underlying design assumptions, sensitivity to contextual and cultural complexity, and recognition of the limits of computational representations in therapeutic work.

Aim Mental-health difficulties often unfold as recurrent within-person dynamics. Although consented social-media timelines provide a low-burden window into longitudinal change, prior work rarely extracts interpretable temporal patterns. We aim to surface early, clinically meaningful signals of change by identifying recurring within-person self-state dynamics - patterns of interaction and co-occurrence among Affect, Behavior, Cognition, and Desire (ABCD) - that precede and accompany reliable shifts in well-being. Methods Clinicians annotated 437 Reddit posts using a pan-theoretical self-state framework, marking adaptive/maladaptive evidence across Affect, Behavior, Cognition and Desire (ABCD), assigning GAF-anchored well-being ratings, and writing self-state summaries. An LLM trained on these annotations was then applied to 239 mental-health Reddit timelines (5,488 posts) to generate the same annotation outputs at a larger scale. We extracted posts surrounding meaningful within-person changes in well-being (change and immediately pre-change) and applied Key Point Analysis (KPA) to their self-state summaries to identify recurring patterns, contrasting them with matched within-timeline control posts. We also computed adaptive–maladaptive balance indices and compared change and pre-change windows against controls. Results KPA yielded recurring key points capturing interactions between ABCD elements, differentiating change posts from pre-change posts, and both from within-timeline control posts. Adaptive–maladaptive balance indices also shifted around change points. Discussion Reliable changes in well-being are preceded and accompanied by interpretable within-person self-state dynamics, including systematic shifts in adaptive–maladaptive balance, demonstrating how early signals of mental health change can be identified in naturalistic longitudinal data using LLM-assisted annotation and KPA.

Aim This poster explores the emerging role of psychotherapy in addressing problematic use of Artificial Intelligence (AI) systems. The aim is to highlight potential new areas for clinical intervention, preventive strategies, and therapeutic approaches to mitigate AI addiction and promote digital psychological well-being. Methods A literature review was conducted on the psychological implications of excessive AI use, with particular focus on cognitive offloading, digital emotional regulation, and interference with key areas of daily functioning. Studies describing patterns of problematic use, impacts on daily life, and potential psychotherapeutic interventions were analyzed. Results Three main aspects of problematic AI use emerged from the analysis:  Cognitive offloading: excessive reliance on AI for decision-making, resulting in reduced autonomy.  Digital emotional regulation: using AI to manage stress, anxiety, or mood fluctuations.  Impact on vital areas: interference with work, academic performance, and social relationships. These factors suggest that problematic AI use may have clinically relevant effects, analogous to other behavioral addictions. Discussion AI addiction may represent a new domain for psychotherapeutic intervention. Psychotherapy can aim to reduce compulsive behavior, enhance cognitive autonomy, and develop adaptive coping strategies. Future research should establish specific clinical protocols, preventive guidelines, and ethical recommendations to support healthy and mindful AI use.

Aim To develop an anonymisation pipeline for client text records from university psychotherapy settings that reliably masks personally identifiable information (PII) while preserving all clinically relevant information for subsequent research analyses. Methods We analysed retrospective data routinely collected by two UK university-based psychotherapy services, focusing on clients’ textual self-referrals describing their reasons for seeking psychological support (N = 27,325). We implemented a two-level anonymisation pipeline combining (1) spaCy’s transformer-based en_core_web_trf model for named-entity recognition (NER) with (2) an expanded rule-based layer tailored to the dataset. The second layer included custom EntityRuler patterns for institutional references, and contact details, as well as domain-specific libraries of mental health terms and organisations that were explicitly protected from masking. Evaluation was conducted on manually annotated subsamples of records (N=350: 200 fine-tuning, 150 validation). The study received ethical approval from the University of Sheffield Department of Psychology Research Ethics Committee (Ref.066737). Results The combined NER + rules approach achieved over 90% accuracy for PII categories, outperforming the standalone off-the-shelf NER model. The pipeline successfully retained all relevant clinical information for downstream analyses by reducing false positives involving mental health terms and organisations. Discussion This two-level, domain-adapted anonymisation strategy offers a practical, scalable solution for safeguarding sensitive clinical data. The workflow is transparent, easily adjustable, and can be replicated or generalised to similar datasets requiring high-fidelity de-identification without loss of analytical value. Keywords: Natural language processing, mental health, text data, unstructured data

Academic burnout, characterized by emotional exhaustion, cynicism, and reduced efficacy, results from sustained academic stressors. Literature identifies low self-efficacy as a key protective factor, while inadequate social support, study-work conflict, and emotional dysregulation heighten risk. Variables such as mindfulness and sense of life are also vital resources. This research aimed to collect extensive qualitativedata across the Multiversity student population investigate the impact of psychological support on these dynamics. Data collection involved semi-structured interviews to a sample of 15 students, analyzed via NVivo to identify recurrent themes. The investigation tracked experiences across three phases: Pre-Counseling, Counseling, and Post-Counseling. Sentiment analysis revealed a profound transformation: the dominant negative sentiment (127 references) pre-counseling was replaced by a significant rise in positive sentiment (87 post-counseling references), confirming distress mitigation. The Pre-Counseling phase was defined by academic isolation, acute psychological distress, and a debilitating fear of failure, all amplified by a lack of support. The Post-Counseling phase demonstrated internal growth and a key transition "from solitude to community," reflecting two major shifts: peer connection within the group sessions fostered an "emotional community" and a culture of mutual validation, transforming individual struggle into communal strength; students perceived institutional connection through the service as the "human face of the university," fostering an institutional culture of care. These findings reinforce the relational link between students and the university, confirming the intervention's efficacy for mental health. Keywords: Online Academic burnout, Strategic brief counseling, Emotional Community

Background Cyberbullying has become a significant mental health concern among adolescents, particularly due to the widespread use of social media and online communication platforms. Existing cyberbullying measures are largely developed in Western contexts and may not adequately capture culturally specific patterns of cyberbullying experiences in Chinese societies. Macau, as a unique Chinese cultural context influenced by both Eastern and Western values, lacks a validated, culturally appropriate assessment tool for identifying adolescent cyberbullying victimization Discussion The Cyberbullying Victimization Scale demonstrates strong psychometric properties and reflects culturally relevant cyberbullying experiences among adolescents in Macau. The four-factor structure aligns with international research while capturing local behavioral expressions of cyberbullying, supporting the importance of culturally grounded assessment tools. Implications for Psychotherapy and Counseling Enables early identification of cyberbullying victims in school and community settings Supports culturally sensitive assessment in psychotherapy and preventive interventions Provides a foundation for cross-cultural and Asian-region cyberbullying research Conclusion This study offers a validated, culturally appropriate instrument for assessing adolescent cyberbullying victimization in Macau and contributes to the broader field of psychotherapy research by addressing measurement gaps in non-Western contexts.

Aim: Although long recognised as critical to therapeutic efficacy, the therapeutic relationship remains poorly understood. This study moved beyond global definitions by exploring how its core components, real relationship, therapeutic alliance, and attachment to therapist, interrelate. Specifically, a mediation model was examined in which the real relationship mediated the effect of client attachment to therapist on the therapeutic alliance Methods: A cross-sectional design was employed with 241 adult clients currently in psychotherapy, who completed self-report measures of the real relationship, therapeutic alliance, and attachment to therapist. A path analysis was conducted to test the proposed mediation model. Results: Significant indirect effects of all three attachment styles on the therapeutic alliance through the real relationship. Specifically, the real relationship functioned as a partial mediator for secure attachment and a complete mediator for avoidant and preoccupied attachment. Discussion: These findings emphasise the pivotal role of the real relationship in shaping how attachment styles influence the quality of the alliance. They further highlight the need for nuanced models and clinical practices that capture the dynamic nature of therapeutic engagement.

Introduction: In routine clinical practice, approximately 10–15% of patients do not benefit from psychotherapy. Among non-responders, a high prevalence of borderline personality functioning is frequently observed. Borderline traits may introduce significant challenges during treatment, even in patients who do not meet full diagnostic criteria for borderline personality disorder. The present study aims to explore clinicians’ experiences with difficult and/or unsuccessful treatments and their perspectives on how borderline personality traits may influence the therapeutic process. Methods:Fifteen psychotherapists with different theoretical backgrounds were interviewed about a particularly challenging treatment that resulted in non-response and/or drop-out. Clinicians were also asked to report the presence of traits associated with borderline personality disorder. Interviews were audio-recorded, transcribed verbatim, and analyzed using Thematic Analysis. Results: All clinicians identified traits consistent with borderline personality functioning in the patients described, regardless of the presence of a formal diagnosis. Difficulties primarily emerged in the therapeutic relationship and setting, including heightened therapist vigilance, perceived judgment by the patient, and oscillations between dependency and avoidance. A recurrent theme concerned the discrepancy between the initial symptomatic presentation and the later emergence of more structural personality-related difficulties, often requiring a redefinition of therapeutic goals. Despite explicit patient agreement, clinicians reported implicit resistance and frequent drop-out following symptomatic improvement or during emotionally intense phases of therapy. Conclusions: Borderline personality traits, even when subthreshold, may substantially interfere with therapeutic processes and outcomes. Early identification and systematic assessment of these characteristics may help clinicians anticipate difficulties and reduce non-response and drop-out.

This exploratory study investigates the effectiveness of a career education program designed to enhance university students’ career decision-making self-efficacy. The program integrates both individual and group-based activities over a three-week period, aiming to foster students’ confidence in making future career choices. To assess the psychological and neurophysiological impact of the intervention, functional near-infrared spectroscopy (fNIRS) was employed to measure changes in prefrontal cortex activity. Participants included students experiencing career-related stress, and their brain activity was monitored before and after the program. In addition to neuroimaging, qualitative analysis of students’ verbal expressions during career interviews was conducted to evaluate shifts in future-oriented thinking. Results indicated a significant increase in self-efficacy scores post-intervention, accompanied by observable changes in prefrontal blood flow patterns. Furthermore, students demonstrated a greater tendency to articulate future goals and career aspirations, suggesting a cognitive and emotional shift toward proactive career planning. These findings highlight the potential of combining neuroscience tools with educational interventions to gain deeper insights into students’ psychological development. The study contributes to the growing field of neuroeducation and offers a novel approach to evaluating the impact of career education programs. Keywords：career decision-making, self-efficacy, fNIRS, brain activity

Aim Emotion-Focused Therapy (EFT) requires therapists to sustain empathic attunement, deepen emotional processing, and trust emergent therapeutic processes, capacities closely linked to therapists’ relationship with their own inner experiencing. This study explores how Focusing training may contribute to innovative and integrative approaches to EFT training by supporting therapists’ personal and professional development. Methods This qualitative study involved 12 EFT trainee therapists at the Swiss Institute for Emotion-Focused Therapy who completed parallel training in Inner Relationship Focusing. Data were collected through semi-structured interviews examining participants’ experiences of the Focusing training and its perceived impact on their personal growth, EFT training, and early clinical practice. Data were analyzed using a descriptive–interpretive qualitative framework (Elliott & Timulak, 2021). Results Participants reported significant personal and professional changes, including a strengthened relationship with their inner experiencing, increased self-compassion, greater confidence in the therapist role, and enhanced trust in the therapeutic process. Clinically, trainees described improved therapeutic presence, deeper empathic attunement, and an increased ability to support clients’ emotional processes, often shifting from a cognitive to a more experiential mode of engagement. Discussion Findings suggest that integrating Focusing into EFT training may enhance therapist capacities central to effective psychotherapy, supporting innovation in psychotherapy training. Given Focusing’s strong reception and adaptation in Japan, these results invite dialogue on its cultural resonance and potential relevance for psychotherapy training across East Asian contexts.

Empathy is a core therapeutic process across modalities, yet little is known about the moments when therapists struggle to remain fully empathic. These “empathy blocks” are often subtle but significant disruptions that can influence therapeutic presence, emotional attunement, and the overall therapeutic relationship. Recognising that therapists enter sessions as human beings with their own emotional vulnerabilities, this study aims to explore therapists’ lived experiences of such blocks, specifically what they identify as an empathy block, how these moments are experienced internally, the ways they attempt to work through them, and how they understand the block’s impact on the therapeutic process. Using a two-phase discovery-oriented qualitative design drawing from empirical phenomenology, Phase 1 will involve an open-ended written reflection in which trained EFT and PCT therapists describe a specific instance of an empathy block. A purposive sample of participants will then be invited to Phase 2, where semi-structured interviews will explore the identified event in detail. Data will be analysed using descriptive-interpretive methods to capture the essence and variability of therapists’ experiences. This presentation will outline the study rationale, design and emerging insights from early data collection. The study aims to contribute conceptually and practically to psychotherapy training and supervision by illuminating the often overlooked experiences of therapists. Findings will support a more person-centered and relationally grounded understanding of therapist challenges, with potential implications for training, supervision, and personal development for therapists.

Aim: 
Becoming a therapist is commonly understood as extending beyond the acquisition of theoretical knowledge, involving processes of professional identity development through practice. This study explores how early practical experiences in psychotherapy training contribute to trainees’ developing sense of professional confidence and ways of working. Methods
: Using a qualitative design, the study examines early practical experiences through in-depth narrative interviews with psychotherapy trainees, complemented by semi-narrative interviews with supervisors and internship coordinators. This design enables a triangulation of perspectives on the transition from theoretical training into clinical practice. Data are analyzed using reflexive thematic analysis (Braun & Clarke, 2021), emphasizing the researcher’s interpretative engagement and the co-construction of meaning. Results: 
Preliminary analyses indicate a perceived gap between theory and practice that formal training does not fully bridge. Early clinical encounters are frequently described as both formative and destabilizing, often accompanied by insecurity and self-doubt. Supervisors and coordinators respond to these challenges in diverse ways, ranging from empathic reassurance to more directive guidance, thereby co-shaping trainees’ developing professional confidence and ways of working. Discussion
: The findings raise questions about what forms of knowledge meaningfully prepare trainees for clinical work, how experiential knowledge is acquired in practice, and which relational and institutional conditions support the development of therapeutic competence. The in-depth exploration of experiences of students and teachers invites dialogue on how theoretical and practical components of psychotherapy training might be more closely integrated to support aspiring therapists across therapeutic modalities and training contexts.

As psychotherapy and counseling education worldwide continue to evolve, the COVID-19 pandemic accelerated an urgent need to reimagine traditional training models and engage in deeper dialogue across pedagogical approaches and cultural contexts. Historically, counseling psychology training in Taiwan, like many global settings, has relied heavily on face-to-face modalities to cultivate skills, professional identity, and ethical practice. The rapid shift to distance education raised pressing questions about how training quality, relational depth, and assessment of competencies could be preserved or transformed in online environments. This qualitative study explores how Taiwanese counseling psychology faculty navigated this transition and how their experiences contribute to broader conversations about innovation in psychotherapy training. Following research ethics approval, we conducted semi-structured interviews with 15 faculty members (5–25 years of teaching experience) from counseling psychology programs across Taiwan. Using Grounded Theory methods and thematic analysis, four interrelated themes emerged: (1) Re-envisioning transitions to online teaching and hybrid modalities, (2) Cultural and contextual conditions shaping pedagogical beliefs, (3) Reconceptualizing engagement, ethics, and assessment in digital learning, and (4) Evolving perspectives on emerging technologies and future directions for training. Together, these themes illuminate how faculty actively negotiated tensions between tradition and innovation, and how cultural values influenced decisions about online relational work, skill practice, and supervision. The findings offer a culturally grounded contribution to global dialogues on reimagining psychotherapy education, highlighting implications for competency development, ethical standards, and cross-cultural collaboration in technology-enhanced training. Keywords: Distance counselor education, Counseling pedagogy

Aim. Emotion regulation (ER) can be defined as individuals’ influence of intensity, duration, and expression of emotions. ER is considered a transdiagnostic process, and certain emotion regulation strategies have been linked to a general psychopathology factor. Several studies have shown that the use of adaptive ER strategies can impact subsequent negative affect, and others find a reciprocal effect between ER strategies and negative affect. Rumination, a maladaptive ER strategy, has also been shown to be both an antecedent and a result of negative emotion. In these studies, less attention has been given to adaptive ER and positive emotions’ roles. By unravelling what precedes what, we can understand dynamics that both explain mental health processes and can have clinical implications. Method. Based on daily dairy data over 90 days from 49 youth participating in a mental health intervention, we use dynamic structural equation modelling (DSEM) to consider how positive and negative emotions and adaptive and maladaptive ER strategies on one day are related to these constructs the day after. Results. All constructs show an autocorrelation from one day to the next. Maladaptive ER strategies were correlated with negative emotions the next day. Discussion. All constructs show a level of stability, ER strategies one day predict similar ER strategies the next, emotions on one day predicts similar emotions the subsequent day. The only significant lagged effect in the current study was maladaptive ER strategies leading to more negative emotions the next day.

Family structure transitions (e.g., parental separation/divorce, remarriage, recurrent cohabitation, and repartnering) are now common across the life course, and accumulating transitions can heighten risk through family instability. Yet contemporary evidence suggests that adverse outcomes are less about any single transition and more about the relational conditions surrounding transitions, especially chronic interparental conflict, compromised parenting quality, and prolonged instability. This presentation synthesizes research on resilience in the context of multiple family structure transitions and argues for a shift from “family form” to family processes as the central explanatory lens. Drawing on an integrative review, this presentation highlights emotion regulation (ER) as a core mechanism that supports adaptation for both children and adults by shaping appraisals, coping behaviors, and relational functioning under stress. For children, resilience is strengthened through caregiver co-regulation, emotion coaching, predictable routines, and cooperative coparenting across households; for adolescents, ER intersects with autonomy development and risk for maladaptive coping when family support is low. For adults, ER influences post-transition adjustment and the capacity to sustain civil, child-focused coparenting, thereby buffering children from ongoing conflict. Consistent with a multisystem view of resilience, we also examine complementary protective factors, cognitive flexibility, identity development/meaning-making, and social/community support, and how these resources operate differently across cultural contexts, socioeconomic conditions, and diverse family forms (including LGBTQ+ parent families). The presentation concludes with clinical, prevention, and policy implications, emphasizing scalable, culturally attuned interventions that strengthen emotion regulation and relational processes to promote resilient trajectories following family transitions. Keywords: Family Structure Transitions; Resilience; Emotion Regulation; Cognitive Flexibility; Identity and Meaning; Social Support

Acceptance-based psychotherapies propose that accepting reality as it is leads to cognitive change and improved emotional well-being. However, these treatments are comprehensive and include multiple components and techniques, which makes it difficult to isolate the effects of acceptance as a standalone mechanism of change. In this talk, I will present a series of studies that examined whether training individuals to use acceptance as a standalone coping method in daily life can enhance the use of cognitive-change-based emotion regulation strategies and improve overall emotional well-being. In Study 1, healthy individuals (N = 120) participated in a two-week training in an acceptance-based strategy from Dialectical Behavior Therapy called radical acceptance. Pre- and post-training assessments showed that participants in the radical acceptance group demonstrated greater improvement in cognitive reappraisal, which is a cognitive-change-based strategy, compared to two active control groups. Study 2 (N = 120) and Study 3 (N = 100) examined radical acceptance training among war-affected individuals, specifically women with high levels of war-related distress in Study 2 and displaced adolescents in Study 3. Both studies showed significant improvements in emotional well-being among participants who practiced acceptance in daily life relative to active control groups on a variety of measures, including levels of stress and depression. These studies demonstrate that acceptance can serve as a standalone emotion regulation strategy that fosters cognitive change and enhances emotional well-being across diverse populations and contexts. Keywords: Dialectical Behavior Therapy, acceptance, emotion regulation, cognitive change

Background: Dysfunctional beliefs such as “I am helpless against my fear” are considered to maintain panic disorders (PD). Consequently, targeting such beliefs is central to effective treatment and could be achieved through smartphone-based Approach-Avoidance Modification Trainings (AAMTs) in which individuals use swipe movements on a smartphone to push away dysfunctional stimuli (e.g., in the form of sentences) and to pull functional stimuli towards themselves. The inclusion of emotional reactions appears to enhance the efficacy of such AAMTs. The aim of this study was to determine whether an innovative, smartphone-delivered, emotion-based AAMT intervention (eAAMT-PD) leads to greater reductions in panic symptoms relative to control conditions. Methods: A clinical sample of N = 30 individuals with PD was randomized to the eAAMT-PD, a non-active control, or a swipe control condition. The eAAMT-PD included four 30-minutes training sessions combining swipe movements (day 1), high-valence words (day 2), and full body emotional expressions (day 3-4) as approach/avoidance responses towards (dys)functional panic-related beliefs. Panic symptoms were assessed at baseline (T1), two weeks (T2) and six weeks (T3) after baseline. Results: Compared to the non-active control group, the eAAMT-PD showed a significantly stronger reduction in panic symptoms from T1 to T2 (g = 0.92) and from T1 to T3 (g = 1.61). Although the eAAMT-PD was not significantly superior to the swipe control intervention, descriptive data indicated a small effect favoring the eAAMT-PD at T3 (g = 0.23). Conclusion: The eAAMT-PD appears to reduce panic symptoms and maintain these improvements. Findings will inform a larger RCT.

Aim: Borderline Personality Disorder (BPD) is a prevalent, debilitating condition associated with significant psychosocial impairment. While the standard Dialectical Behaviour Therapy (DBT) is a specialised therapy for BPD, its multicomponent and resource-intensive nature poses implementation difficulties in middle-income countries like India. Brief version of DBT skills training (DBT-ST) with culturally informed modifications, delivered in group format, has emerged in Asian literature as an efficacious and feasible treatment option. This has scarcely been researched in the Indian context, given the challenges associated with group work and the risk posed by relying solely on group sessions. Thus, the present study aims to assess the feasibility, acceptability, and utility of 12-15 weeks of modified standard DBT for patients with BPD in an Indian tertiary outpatient care. Methods: A single-arm open trial of brief DBT-ST based on Soler’s (2009) schedule, along with 3 individual therapy sessions and weekly telephone coaching, is provided in a hybrid (online/offline) group format to 19 participants diagnosed with BPD without suicidal intent. Feasibility is assessed through attendance rates, dropout rates, and the frequency of additional individual sessions or crisis calls. Acceptability is assessed through participants’ feedback at the end of the intervention. Utility of the intervention is assessed by comparing participants’ baseline scores on borderline symptoms and emotion dysregulation with post-intervention assessment scores. Results and Discussion: Sample consists of 19 participants (4 male, 15 females) aged 20-36 years (M = 26.2). This is an ongoing study; results will be discussed once the study is completed. Keywords: Borderline Personality Disorder, Dialectical Behaviour Therapy, Skills Training.

Aim Suicidal thoughts and behaviours (STBs) occur across psychiatric diagnoses, highlighting the need for suicide-specific, transdiagnostic interventions. This study examined changes in suicidality and related process variables following Cognitive Therapy for Suicide Prevention (CT-SP) delivered within a tertiary mental health setting in India. Methods A single-arm, open trial was conducted with 29 adults reporting recent, clinically significant suicidal ideation or behaviors. CT-SP was delivered over ten sessions as a structured intervention guided by individual case conceptualizations. Assessments were completed at baseline and post-intervention, with follow-ups up to 6 months. The primary outcome was suicidality assessed using the Columbia–Suicide Severity Rating Scale (C-SSRS). Process-focused outcomes included negative automatic thoughts, hopelessness, emotion regulation, problem-solving orientation, and cognitive control and flexibility. Depressive and anxiety symptoms were additionally assessed. Results Statistical analyses indicated significant reductions in the severity and intensity of STBs on the C-SSRS. Analyses of process-focused outcomes indicated significant improvements in cognitive and emotional domains, particularly negative automatic thoughts, state hopelessness, and overall emotion regulation. Further analyses examined behavioural and executive processes and affective symptoms, with reductions in depressive and anxiety symptoms. Participant feedback indicated that the intervention was perceived as acceptable and relevant. Discussion The findings support CT-SP as a brief, suicide-focused intervention, feasible in the Indian context. It suggests that changes in cognitive, emotional, and behavioral processes potentially accompany reductions in suicide risk. Despite the small sample, the study underscores the need for structured, brief interventions to address suicidality in conservative contexts like India. Keywords Cognitive behavior therapy, Suicide prevention

Background: Group Dialectical behavior therapy (DBT) is frequently offered as a transdiagnostic intervention due to its demonstrated effectiveness, but Mentalization-based therapy (MBT) may represent a promising alternative. Objectives: To compare the effectiveness of a DBT and MBT intervention, both delivered in an online group format (8–10 participants) over 16-weeks, in reducing depression, anxiety and emotion dysregulation. Methodology: 48 patients using specialized public mental health services (25 DBT; 23 MBT; non-randomized) completed questionnaires at baseline, the end of intervention, and 3-month follow-up. Measures included the Patient Health Questionnaire–9 (PHQ-9), Generalized Anxiety Disorder–7 (GAD-7), and Difficulties in Emotion Regulation Scale (DERS). Results: Mixed-effects model analyses indicated that MBT and DBT led to comparable reductions in depressive and anxiety symptoms from pretest to post-test, with improvements maintained 3 months later. Only MBT group exhibited marked improvement in emotion regulation, from baseline to the 3-month follow-up. Discussion: MBT and DBT demonstrated comparable effectiveness in reducing depression and anxiety, and MBT showed greater effect in improving emotion regulation. MBT Group appears to offer a promising alternative to DBT Group interventions.

Non-suicidal self-injury (NSSI) poses a persistent challenge across psychotherapeutic approaches, particularly in adolescent and emerging adult populations. While multiple theoretical models have sought to explain self-injury, advances in psychotherapy outcomes remain modest, suggesting limitations in how the phenomenon has been conceptually framed. This brief paper critically examines how different psychotherapy traditions explain NSSI, highlighting both their specific contributions and their shared blind spots. The presentation contrasts five broad explanatory perspectives commonly informing psychotherapeutic work with NSSI: functional and behavioral models emphasizing reinforcement processes; emotion regulation models focusing on affect modulation; interpersonal and attachment-based models highlighting relational signaling and co-regulation; psychodynamic and trauma-informed approaches emphasizing meaning, dissociation, and internal conflict; and embodied perspectives addressing pain processing, interoception, and bodily regulation. While each framework accounts for distinct aspects of self-injurious behavior, none fully captures the dynamic interplay between bodily experience, relational context, and developmental processes. Building on this comparative analysis, the paper argues that NSSI exposes the limits of siloed theoretical explanations and calls for a more integrative conceptualization within psychotherapy research. Rather than proposing a new technique or unified theory, the presentation advances integration as a clinical and epistemological stance—one that acknowledges the partial truths of existing models while situating NSSI within relational developmental systems. Implications for psychotherapy research include refining process-level constructs, improving conceptual coherence across approaches, and supporting more responsive and developmentally informed clinical formulations. Keyword: Emotion regulation

CMT offers an integrated account of how psychopathology develops and how psychotherapy enables change. Early adverse or traumatic experiences disrupt a child’s sense of safety and give rise to pathogenic beliefs—maladaptive cognitive-affective-relational templates that once preserved security but later constrain adaptive goals such as autonomy, competence, and intimacy. As these beliefs harden, they obstruct healthy aims and maintain psychological suffering. At the same time, CMT assumes that people are intrinsically motivated by control and mastery: they strive to regulate functioning according to a safety principle and to overcome trauma-based fears in the service of growth. Individuals come to therapy with an adaptive, largely unconscious plan that organises goals, pathogenic beliefs, relevant traumas, tests, and the experiences needed to disconfirm these beliefs. The plan formulation method makes this plan explicit and guides therapeutic work. Within this framework, change is driven by interlocking mechanisms. Patient agency provides the motivational engine: patients actively organise the therapeutic relationship through testing (enacting or challenging pathogenic expectations to assess safety) and coaching (communicating what they need and how they wish the therapist to work). Therapist responsiveness—defined by plan compatibility and attuned flexibility—allows these processes to be met in ways that support, rather than reinforce, the patient’s plan. When agency, testing, coaching, and responsiveness align, patients experience corrective emotional and relational experiences through which pathogenic beliefs are disconfirmed, adaptive goals restored, and mastery expands. This presentation outlines this two-part architecture—how adversity leads to psychopathology and how patient-driven mechanisms within a responsive therapeutic relationship bring about change.

Control-Mastery Theory (CMT) postulates that patients come to psychotherapy to achieve their goals and to disconfirm restrictive beliefs. Patient coaching is a patient’s attempt to make their therapist understand what they need from them to feel safer in the moment, whether it be a change in attitude, intervention, or direction. Prior studies have shown that Coaching can be reliably identified from in-session communication or behavior. Information Coaching refers to communicating the necessary content that the patient believes the therapist needs to best support them. In contrast, Direction Coaching refers to communicating how the patient wants the therapist to behave in session. All coaching can be indirect or direct, verbal or nonverbal, and is highly specific to the individual patient. As such, therapists unfamiliar with identifying this mechanism may overlook important feedback that could improve their treatment efficacy.

In the CMT framework, an important change process is the patient’s testing of maladaptive, or pathogenic, cognitive schema. In testing, patients elicit information or experiences from their therapist that help them achieve new learning or enable them to relinquish the restrictive, maladaptive beliefs that prevent them from achieving their goals. Psychotherapy research and theory have focused largely on what the therapist contributes to their relationship with the patient. However, patients actively engage in their own treatments, testing their therapists to determine whether it is safe to change. 

 In this presentation we will explore the concept of testing, its role in CMT, similar constructs in other theories, and the empirical evidence supporting testing as an important process in psychotherapy.

Aim: Deliberate Practice (DP) is a structured method for developing expertise but is limited by the need and scarcity of expert feedback. Large language models (LLMs) such as ChatGPT may offer scalable, immediate feedback, yet it remains unclear whether they can match human feedback in psychotherapeutic skill development. User acceptance may further influence implementation. Methods: Twenty psychotherapy students were randomly assigned to a human-feedback group or an AI-feedback group (ChatGPT-4o, audio). All completed one structured DP session on three skills. Across four rounds per skill, participants heard a fictional client statement, responded as the therapist, rated difficulty, and received criteria-based feedback. Outcomes were observer-rated facilitative interpersonal skills (FIS) (pre–post), self-rated FIS, subjective training evaluations, and general AI acceptance. Results: Mixed-ANOVA showed large significant within-subject improvement for observer-rated FIS (F(1,18) = 44.64, p < .01, η² = .16). Self-rated FIS also significantly improved (F(1,18) = 5.66, p = .03, η² = .09). No group × time interactions emerged for observer-rated (F(1,18) = 0.04, p = .84) or self-rated FIS (F(1,18) = 3.14, p = .09), indicating similar development across AI and human feedback. No between-group effects were found. AI acceptance did not correlate with training effects in the AI group (r = .52, p = .12). Both groups rated effectiveness, satisfaction, and stress similarly. Discussion: This proof-of-concept study suggests that ChatGPT-4o can provide similarly effective feedback compared to human experts. Although exploratory, the findings highlight the scalability of LLM-assisted training and the importance of managing expectations while further refining AI-supported DP. Keywords: deliberate practice, psychotherapy training, artificial intelligence, feedback, facilitative interpersonal skills

Aim: Understanding how psychotherapy produces change remains one of the central unanswered questions in clinical psychology. The ALF project addresses this question by building the first large-scale, secure, Danish corpus of evidence-based psychotherapy and developing an LLM-pipeline capable of transcribing, anonymizing, and automatically annotating sessions to support mechanism-focused psychotherapy research. Methods: ALF consists of three components. First, an automatic speech recognition module is used to transcribe psychotherapy audio with <10% word error rate, using targeted fine-tuning where necessary. Second, an anonymization module employs removes personally identifiable information while preserving semantic utility, following GDPR criteria. Third, an annotation module based on fine-tuned embedding models classify therapist and patient utterances according to the manualized psychotherapy coding scheme Facilitative Interpersonal Skills, aiming for F1 >0.7 and Krippendorff’s alpha >0.7. Results and Discussion: Once validated, ALF will annotate 1000+ hours of psychotherapy for schizophrenia spectrum disorders linked to extensive pre-treatment, post-treatment, and long-term follow-up measures collected in highly controlled clinical trials. This uniquely rich pairing of naturalistic psychotherapy process data with rigorous outcome assessments enables statistical analyses that relate specific therapeutic utterances to clinically significant change, offering an unprecedented opportunity to investigate mechanisms of change in psychotherapy for psychosis. Validation of transcription/anonymization quality is expected complete by June 2026. Beyond its scientific aims, ALF establishes a legal and ethical precedent for developing LLM-based mental-health tools within clinical infrastructures. The project thus forms a foundation for future AI-augmented psychotherapy research, scalable clinician tools, and data-driven intervention development. Keywords: Large language models, psychotherapy, coding, labeling, annotating, psychosis, schizophrenia

Aims: The aim of the current study is 1) to identify and document the range of LLM-based mental health solutions currently available in the commercial market, specifying their purposes, target populations, areas of application, and technical specifications (e.g., training data), and 2) to assess the quality of these solutions, i.e., their compliance with evidence-based practices for psychotherapy, data privacy protocols, and ethical standards. Method: For the systematic scoping review, we utilize the TECH framework, which emphasizes four key elements in reviews of mobile mental health applications: target user, evaluation focus, connectedness, and health domain. Moreover, we base our data extraction procedure on the READI framework, which focuses on safety, privacy, equity, effectiveness, engagement, and implementation readiness in the evaluation of AI-driven mental health technologies. Aligned with these frameworks, information is extracted based on, e.g., the technical features, therapeutic content, functionalities, and user metrics of the solutions. Next, a systematic quality assessment is conducted. Specifically, each solution included in the review is presented with a series of standardized textual prompts that simulate clinical or adversarial situations. The solution responses will be evaluated on two primary dimensions: 1) safety, i.e., the model avoiding responses that could cause harm or violate ethical principles, and 2) competence, i.e., the model demonstrating responses consistent with evidence-based standards of effective therapeutic communication. Results and Discussion: The systematic review and quality assessment analyses are ongoing and will be finalized before the conference. The study results and their clinical implications will be presented and discussed at the conference. Key words: artificial intelligence, chatbots, clients

Perinatal parental mental health is of particular importance for family functioning and infant’s short- and long-term developmental outcomes. Although maternal perinatal depression and anxiety symptoms have long been a focus of researchers attention, less is known about fathers’ mental health in this period, and about the associations between affective symptoms and parenting stress in both mothers and fathers. Among the factors that may play an important role for parental well-being in the postnatal period is how parents perceive their infant’s temperament. The aim of the study was to analyze the relationship between self- perceived levels of depressive, anxiety and parenting stress symptoms, and perceived profiles of infant temperament separately for mothers and fathers in the first year of their child’s life. Independent groups of 224 mothers and 114 fathers of babies from 3 to 12 months of age were invited to complete an internet survey, including the Edinburgh Postnatal Depression Scale, Paternal / Maternal Affectivity Assessment (Baldoni et al., 2019), Generalized Anxiety Disorder 7- item scale, Parental Stress Scale (Berry&Jones,1995), and Infant Behavior Questionnaire Revised- very short form. Moderate to high correlations were found between symptoms of depression, anxiety and parenting stress in both mothers and fathers. Dimensions of infant’s temperament were related to parenting stress in both parents but to depression and anxiety only in mothers. Regression analysis confirmed a distinct role of infant’s negative emotionality and orientation/ regulation capacities as predictors of maternal and paternal parenting stress. Implications for prevention, early intervention, and psychotherapy will be discussed.

Parent-infant psychotherapy (PIP) is a dyadic or triadic psychodynamic, attachment-promoting approach that aims to help at-risk dyads referred for reasons such as parental mental-health and bonding difficulties. PIP outcome studies from naturalistic settings are scarce. The present study examines outcome change patterns in 138 PIP-therapies initiated within infants’ first year. Assessment was conducted at multiple time-points, and outcomes include maternal mental-health, stress, bonding, representational risk, and quality of observed mother-infant interactions. Moderators, such as infant’s age at therapy onset, are also examined. Method: Assessment was conducted at PIP onset, 3 and 6 months into PIP, PIP end, and 3 months post-PIP (partial data available; M = 2.6 assessments per case). Each assessment included maternal self-reports of mental-health, bonding, and stress; a 5-minute mother-infant interaction; and a brief maternal interview addressing the mother-infant relationship, maternal expectations, and actual experiences following childbirth. Mother-infant interactions at the beginning and end points were coded with the Emotional Availability Scale (Biringen, 2008; Biringen et al., 1998). Interviews were coded with the Assessment of Representational Risk (ARR; Sleed et al., 2017), adapted for the brief interview. Results: Maternal mental-health, bonding, stress, and mother-infant interactions improved significantly from PIP onset to end. Notably, infants’ age at therapy onset interacted with treatment outcomes, such that infants who began PIP younger showed greater improvement in observed responsiveness and initiating maternal involvement. Analysis of maternal ARR and outcomes change patterns is currently underway and will also be reported.

This study uses the term “ibasho” to describe a third place that enables children to stay without pressure and feel a sense of safety. It explores why children’s ibasho should be managed by clinical psychologists. The ibasho examined here was established by a local municipality and is operated by clinical psychologists. It is a low-threshold, drop-in space requiring no referral, appointment, or permission, and not imposing structured programs on children. Although widely publicised through municipal channels, the space is accessed voluntarily by children and caregivers, without active outreach or recruitment. Clinical psychologists are present in the space but refrain from intervening unless explicitly requested. The study analysed the program records for five years of operation (2020–2024). The analysis focused on the open ibasho space utilisation and individual consultations conducted alongside it. Across the five-year period, 110 children used the ibasho (1,455 total visits). Additionally, 81 children or caregivers received individual consultations across 846 sessions. The number of unique users increased from 26 to 105, and total visits grew from 146 to 942 between 2021 and 2024, indicating a rapid and sustained rise in utilisation over time. This paradoxical professional stance may support children’s sense of safety and accessibility, highlighting ibasho as a pre-clinical psychosocial resource, with important implications for psychological practice.

Aim. This study examined a) what goals adolescents set for themselves and b) how changes in idiographic goals setting measures correspond to changes in symptoms? Methods. Consultations in this study were from a transdiagnostic intervention, comprising different elements focused on supporting emotion regulation (psychoeducation, positive activities, exposure to emotions, cognitive restructuring, mindfulness). We audio-recorded consultations (n= 237) between adolescents (N=49, mean age 14.2 range 12-16) and school nurses (N=24). Adolescents and health nurses used an idiographic measure, «Assert.”, which is based on the question “What matters to you” to identify personally meaningful goals. At each session, adolescents rated progress toward their goal on a 1-10 scale. Adolescents' goals were transcribed verbatim and categorized according to the theme of the goal using thematic analysis. We compared changes in Assert scores from first to last session to changes in symptoms using Behavior and Feelings Survey measured at pre and post intervention. Results. Across 47 adolescents, 72 goals were formulated. We identified five themes; demands and expectations, Thought and emotion, Being myself, Relationship and Lifestyle. There was a large and significant change towards goal attainment on Assert (p=0.001). There was no significant change on BFS from pre-post intervention. Discussion. The significant change in adolescents’ self-selected goals indicates that adolescents experience benefit from consultations, even when symptom measures did not change. The goals covered a broad range of concerns related to life functioning. These findings indicate that adolescents may experience improvements in functioning, at the same time as symptoms remain at the same level.

Social anxiety often manifests in everyday interactions through behaviors such as reduced gaze and lower speech volume. While these markers have been examined in face-to-face settings, large-scale assessments in real-time interactions remains challenging. Social Virtual Reality (social VR) offers an innovative approach by enabling naturalistic interactions in which behavior can be captured at scale. Study 1 (N = 128) examined associations between social anxiety, general psychopathology, verticality (a trait reflecting dominance), and interaction behavior during dyadic social VR conversations. We assessed gaze towards the partner’s eyes, speaking and smiling behavior. Social anxiety was linked to less gaze toward the partner’s eyes while speaking (β = -0.20, 95% CI [-0.35, -0.04], t(126) = -2.51, p = .013 and quieter speech (β = -0.18, 95% CI [-0.35, -0.01], t(126) = -2.12, p = .036). These patterns were not unique to social anxiety but also reflected broader psychological characteristics, including higher general psychopathology and lower verticality, suggesting that interaction markers may reflect general psychological vulnerability rather than disorder-specific effects. Study 2 extends this approach to a clinical sample matched with healthy participants. Data collection is currently ongoing. Together, these studies aim to provide a comprehensive account of behavioral modulations associated with social anxiety in avatar-based dyadic interactions. Since social VR setups allow researchers to assess a rich set of behavioral data such as eye gaze, facial expressions and speaking behavior, the technique opens novel possibilities to detect social stress, track therapeutic progress, or tailor interventions to individual behavior in VR. Keywords; Social Anxiety, Dyadic Interaction Behavior, Social Virtual Reality

Aim: Most mental health difficulties emerge during adolescence, yet many young people disengage from therapy early. The therapeutic alliance is one of the strongest predictors of engagement and positive outcomes, but clinicians often report limited training and confidence in fostering the alliance and managing moments of tension (i.e., ruptures) with this age group. These subtle relational strains, if unaddressed, can undermine collaboration and contribute to dropout. Despite the importance of these skills, no alliance-focused training currently exists specifically for youth therapists. Relate-Youth (Relate-Y) was developed to address this gap by integrating principles from Alliance-Focused Training with developmental and mentalization-based approaches. This study aims to implement Relate-Y and examine its feasibility, acceptability, and preliminary impact on therapists’ knowledge, confidence, and clinical practice. Methods: Sixty youth therapists from diverse professional backgrounds completed Relate-Y. The training was delivered online in small groups (8–12 participants) across four sessions. It combined theoretical input (youth-specific alliance processes, rupture–repair) with experiential learning (group discussions, video-based reflection, and role-plays). Participants completed questionnaires at baseline, post-training, and three-month follow-up assessing knowledge, confidence, skills, and training experience. They also participated in focus groups at each timepoint. Results: Data analysis is underway. Quantitative and qualitative findings on feasibility, acceptability, and preliminary outcomes will be presented. Discussion: This feasibility study will provide initial evidence on the acceptability and usefulness of Relate-Y as a training model for youth therapists. Findings will inform program refinement and guide future research and clinical practice aimed at strengthening alliance processes with young clients.

Recently we suggested that patient levels of perfectionism can adversely affect clinical processes and, ultimately, reduce the effectiveness of treatment through the effects on the relationship between patient and clinician (Hewitt et al., 2018). Extant research suggests that, indeed, pretreatment perfectionism is associated with lower levels of treatment outcome (Hewitt et al., 2020; Shahar et al., 2004) perhaps through its effect on the therapeutic relationship (Hewitt et al., 2018). The current research extends this work by assessing the relationship between levels of various components of perfectionism and experiences in therapy and experiences with therapists in a sample of 163 patients currently undergoing psychotherapy. These patients completed various measures of perfectionism and measures of therapeutic alliance, impact messages of the therapists, affective reactions, as well as a variety of ratings of the nature and quality of connections with therapists. Overall we found that, as expected, perfectionism components were associated with lower levels of working alliance, real relationship, and levels of connection with therapists and with greater difficulties in establishing a positive alliance with therapists, higher levels of experienced hostility, distress, and lower levels of experiences of being mentalized in the treatment. The results will be discussed in terms of the deleterious effects of patient perfectionism and pernicious personality more broadly on the therapeutic alliance and treatment outcome.

Background: Nonverbal synchrony refers to the temporal coordination of nonverbal behaviors between interaction partners, such as movements. In psychotherapy, it has been associated with positive treatment outcomes. Existing manuals are often context-specific and rely on subjective rating processes, which limit the objectivity and comparability of research findings. Research Question: How can a maximally objective and context-independent manual for coding nonverbal behavior be developed and validated to assess nonverbal synchrony across different contexts, including psychotherapy? Method: Based on Mayring’s qualitative content analysis, an initial manual was developed. Through iterative rounds of coding and revision, a final version was established. The manual comprises 24 categories across seven higher-order domains (head, eyes, eyebrows, mouth, hands, upper, and lower body). For validation, video data from diverse samples were used (student interactions, emotion induction with a psychotherapist, and real psychotherapy sessions). Interrater reliability was calculated using a total of 50 minutes of video material randomly selected from all samples, with double coding. This analysis employed Cohen’s kappa, prevalence-adjusted and bias-adjusted kappa, observed agreement, and prevalence and bias indices. Results: Preliminary reliability analyses indicate high agreement (κ = .82; PABAK = .93). Multiple revision steps led to successive improvements in the interrater reliability of individual categories. Conclusion: The strength of the manual lies in its high objectivity and cross-context applicability for quantifying nonverbal synchrony. It thereby contributes to a deeper understanding of dyadic interaction processes and provides a foundation for future automated analysis approaches that may further enhance efficiency and precision in research and practice.

In this ongoing study, ROM data from two outpatient clinics in Austria are used to investigate moderators for process and outcome of humanistic (psychodrama) outpatient group psychotherapy. The psychodrama group therapy approach is not structured and adapts to the needs of the patients while emphasizing role-playing and enactment to explore emotions, conflicts, and interpersonal dynamics. 35 patients participated in the study; recruitment is still ongoing. Primary outcome was measured using Outcome Questionnaire (OQ 45.2) and Group Questionnaire (GQ). Transdiagnostic variables were assessed using standardised questionnaires for personality (BFI-10, PID5BF), symptoms (HSCL), structural integration (OPD-SQ) and traumatic life events (LEC-5, CTQ) at baseline. Patients in-session group experiences of the therapeutic relationship and symptom levels are assessed monthly. To investigate the moderators, separate hierarchical linear models for the subscales of the respective questionnaires were calculated. All significant variables were then added in one overall model. Preliminary results for the outcome model showed a significant positive influence of the amount of therapy sessions and a significant negative influence of anankastic personality, structural integration problems regarding contact ability and depression on symptom reduction. On a session-to-session level, less perceived negative relation with the group therapist significantly predicted a decrease self-reported therapy outcome for the following session. Overall, the findings suggest that relationship factors are important predictors of process and outcome in psychodrama group therapy. The contact ability of the person itself and the working relationship and therapeutic alliance that occur over the duration of the therapy seem crucial for outcome improvement.

Introduction. Given the importance of alliance ruptures and their repair in individual therapy, exploring them in group therapy is essential. However, assessing these processes in groups is complicated by the multilevel, interactional structure of the group context, which includes relationships among members and therapists, among members, and between members and the group itself. In this presentation, we discuss the development of the Group-Rupture and Repair Rating System (G-3RS), an adaptation of the 3RS to the group therapy context, and present initial findings on the reliability and validity of the G-3RS. Method. We modified the 3RS for the group therapy context by incorporating different levels of group interactions and developed a detailed manual with clinical examples to guide raters and clinicians. Raters were trained to use the G-3RS to assess rupture and repairs on 21 therapy groups across three sessions of group psychodynamic-interpersonal psychotherapy (62 sessions in total). Results. The G-3RS demonstrated good interrater reliability at most levels of the group. Preliminary data provided evidence of convergent and predictive validity. Discussion. This study provides preliminary evidence for the reliability and validity of the G-3RS for assessing alliance ruptures and repairs across the multiple levels of group therapy. The 3RS and the development of the G-3RS represent significant steps in conceptualizing alliance ruptures and repairs, as well as in studying these concepts within the group therapy context.

This qualitative study examines long-term psychodrama group therapy through the in-depth life stories and therapeutic experiences of eleven participants. Using narrative analysis and cross-case typification, it explores how biographical patterns, ruptures, and relational dynamics manifest and transform within the group setting. Preliminary findings reveal significant biographical ruptures and recurring life-patterns that are vividly re-enacted in group interactions. These repetitions offer diagnostic insight into participants’ regulatory capacities, proximity–distance dynamics, and histories of developmental or complex trauma. Across cases, four distinct change trajectories emerged, structured along two central dimensions: group and relationship experiences (trust, safety, belonging) and biographical patterns (from developmental trauma with limited emotional availability to complex trauma involving abuse or violence). These types reflect differing capacities to regulate affect, tolerate closeness, and engage with traumatic memories. When participants were able to interrupt or modify entrenched patterns, the group process initially evoked a “regulating closeness,” providing sufficient containment to approach difficult material. Over time, this could develop into “integrated closeness,” characterised by greater relational flexibility and coherence. Conversely, when patterns were re-enacted without substantial transformation, early therapy phases were marked by closeness experienced as “unbearable and threatening.” Yet even in such cases, gradual shifts were possible: relational proximity could become “tolerable,” accompanied by an emerging sense of safety within the group. Overall, the findings underscore psychodrama group therapy as a relational arena in which deeply rooted biographical patterns are enacted, witnessed, and—under conducive conditions—reconfigured. The resulting typology offers a nuanced framework for understanding therapeutic change in the context of developmental and complex trauma.

Aims: Online guided self-help (GSH) interventions involving both professionals and peer mentors have been found to promote recovery. This study aims to test the feasibility of an eight-week online GSH delivered via a smartphone app and focused on interpersonal maintenance factors for outpatients with an eating disorder (ED). Method: A randomized controlled trial was conducted to examine the efficacy of the INTERconNEcT-EDs program via a mobile app in improving psychological outcomes such as psychological distress (CORE-OM), eating psychopathology (EDE-Q), and interpersonal problems (IIP-32). Ninety outpatients with an ED (mean age = 26 ys) were randomized to receive either TAU (n = 42) or TAU plus the GSH (n = 48). Patients received psychoeducational materials, such as workbooks and videos, and attended online weekly interpersonal group sessions. Outcomes were reported at pre- and post-intervention, and 3-month follow-up. Linear mixed-effects models applying an intent-to-treat approach were used to analyze outcomes. Results: The effect of time on psychological distress after eight weeks showed a trend towards significance (η² = 0.04; p = .060). A significant effect of time was found for the 'Eating Concern' and 'Weight Concern' EDE-Q subscale scores (η² = 0.06, p = .018 and η² = 0.05, p = .036, respectively), while the TIME × GROUP interaction was not significant. Conclusion: These results suggest that a novel online guided self-help could be feasible for individuals with ED at various stages of treatment. The role of online interpersonal groups should be validated further as the ongoing study progresses.

Fibromyalgia is associated with significant emotional disturbances and a high comorbidity with depressive disorders. Although the effects of different therapies on emotional symptoms have been widely studied, the role of cognitive change, particularly in factors such as self-construction, implicative dilemmas, and cognitive rigidity, remains largely unexplored. Cognitive change refers to modifications in how individuals organize and interpret their experience, including their sense of self and relationship with illness and pain. This study had two objectives: (1) to examine whether the therapeutic approach of Personal Construct Therapy or Cognitive-Behavioral Therapy was associated with changes in cognitive factors, and (2) to assess whether changes in these cognitive factors following treatment were related to improvements in physical and emotional symptoms. The sample comprised 68 women (21–69 years old) diagnosed with fibromyalgia, assessed before and after a psychotherapeutic intervention. Cognitive factors were measured using the Repertory Grid Technique, physical pain with the Visual Analogue Scale, functional impact with the Fibromyalgia Impact Questionnaire, and emotional symptoms with the Hospital Anxiety and Depression Scale. Results showed no significant association between the therapeutic approach and changes in cognitive factors. However, changes in self-construction conceptualized as an indicator of cognitive change, were significantly associated with improvements in fibromyalgia impact, anxiety, and depressive symptoms, but not with physical pain. These findings suggest that improvement in fibromyalgia is more closely linked to change in self-related meaning structures than to the specific treatment modality, highlighting self-construction as a key mechanism underlying emotional improvement in women with fibromyalgia.

The phase of life known as ‘emerging adulthood’ is characterized by key developmental tasks such as autonomy and identity formation, which are also described in psychodynamic theories as essential aspects of personality development. At the same time, this phase is associated with increased vulnerability to psychological stress and the development of mental disorders. Although cultural contexts have a significant influence on these developmental processes, there is a lack of cross-national studies examining psychodynamic constructs and their influence on mental health in this age group. In this project, motivational conflicts and personality functioning according to the Operationalized Psychodynamic Diagnostics (OPD) were examined from a cross-cultural perspective, as well as their association with psychological distress in emerging adults in Germany and Turkey. Students aged between 18 and 29 in Germany (N = 549) and Turkey (N = 204) took part in the online survey. Participants completed standardized questionnaires on OPD conflicts, personality functioning and psychological distress (e.g. anxiety and depression symptoms; PHQ-4). Multiple regression analyses were conducted with conflicts and personality functioning as independent variables and psychological distress as the dependent variable. Additionally, model comparisons were carried out between countries to examine cross-country differences in these associations. The results are discussed in terms of the extent to which psychodynamic concepts such as conflict and personality functioning are valid across cultures, and their role in shaping mental health among emerging adults in different cultural contexts.

Aims We aimed to co-design, develop, and validate a measure of therapy style preferences for young people (YP) aged 11–18 that can be used internationally to support collaborative decision-making and preference-sensitive therapy. Methods Seven iterative stages were undertaken: (1) collaborative design with a Young People’s Advisory Group (YPAG) (2) item generation through literature review and 22 interviews with child and adolescent therapists; (3) item pool refinement; (4) expert and youth item rating by 21 raters; (5) interviews using the Three-Step Test with seven YP; (6a) exploratory factor analysis of 45 items with a representative UK sample of 430 YP; (6b) confirmatory factor analysis and validity testing; and (7) qualitative interviews on lived experiences of therapy preference and fit. Ethical approval was granted by the University of Roehampton Ethics Committee. The study integrated EDI principles through YPAG involvement (diverse by gender, ethnicity, and background), inclusive recruitment, and sensitivity to accessibility and cultural variation in language and examples. Results Through these seven stages, we produced a measure that satisfied standard psychometric criteria (internal reliability, test-retest reliability, cross-demographic stability, convergent validity, divergent validity), as well as face validity and user satisfaction. Discussion The ‘U-PIC’ provides a novel, co-produced tool for assessing therapy preferences in YP. It has the potential to enhance shared decision-making, improve engagement, and inform more personalised, preference-responsive counselling and psychotherapy practice. Results should be interpreted in light of the sample which was UK-based; while cross-cultural validation is planned, some item content may reflect Western assumptions about therapy practices.

Introduction: Attachment style and working alliance are two fundamental variables in psychotherapy. This systematic review aims to provide data on the relationship between therapist attachment and alliance in psychotherapy, updating a previous review and providing a quantitative synthesis (meta-analysis). Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement recommendations were followed. The databases PsycINFO, PubMed and Web of Science were searched from June 1, 2016, to May 30, 2024, supplemented by a manual search. A regulated study selection process was performed, followed by data extraction and risk of bias assessment. A qualitative and quantitative analysis of the included studies was performed. Results: Nine studies were selected for the systematic review that included 354 patients and 741 mental health professionals. In five studies, different types of attachment (secure, anxious and avoidant) were related to the alliance. In addition, this relationship was partially mediated by therapeutic optimism, role security, therapeutic commitment or emotional regulation strategy. Of the 23 articles selected from both systematic reviews, 12 studies were included in the meta-analysis. A systematic correlation between anxious attachment style and the alliance was found only when the assessment of the alliance was performed by therapists (r = -0.31). Conclusions: There is evidence that therapist attachment may influence the formation and maintenance of a higher-quality working alliance. However, further studies with more precise measures of both constructs are needed to better understand this relationship and its clinical implications.

Aim. Affective maturity (AM) is broadly understood as the capacity to integrate emotional regulation, values, relational functioning, and responsibility into coherent and flexible psychological functioning. Although the term is used in clinical and educational contexts, AM lacks a clear scientific definition and empirical grounding. This study examined how Spanish psychotherapists perceive and operationalise AM, and how these perceptions relate to theoretical orientation and worldview. Methods. A cross-sectional online survey was administered to 400 psychotherapists from diverse theoretical orientations. An ad hoc questionnaire assessed training related to AM, conceptual definitions, perceived clinical symptoms and links with wellbeing and psychopathology. The instrument combined Likert-type items and open-ended questions. Analyses included descriptive statistics, correlational tests, and reflexive thematic analysis. Results. Preliminary analyses indicate substantial variability in how AM is defined and operationalised across orientations. Participants highlighted emotional regulation, relational capacity, virtues, and value–action coherence as core features. Training related to AM was perceived as limited, despite clinicians rating AM as clinically relevant for case formulation and therapeutic goals. Emerging qualitative themes revealed tensions between normative and descriptive views of AM, and divergent assumptions about its developmental and interpersonal foundations. Quantitative patterns suggested links between theoretical orientation, worldview, and the perceived clinical applicability of AM. Discussion. Findings provide the first overview of how AM is conceptualised in Spanish psychotherapy practice. The results identify key conceptual gaps, clarify areas of convergence and divergence, and offer a foundation for developing an empirically grounded and clinically useful model of affective maturity. Key words: virtues, flourishing

Within the theoretical framework of Self Psychology, the development of a healthy self is entirely dependent on the empathic responses and support from the "selfobject environment." The selfobject functions provided by this environment—including mirroring, idealization, and twinship—are crucial for fostering a sense of cohesion in the core self, establishing self-esteem, and balancing idealistic expectations. Transgender individuals, whose gender identity conflicts with their assigned sex at birth, frequently encounter systemic lack of understanding, marginalization, discrimination, and bullying in mainstream sociocultural contexts. This results in a "non-empathic deficit" in their selfobject environment across micro-interpersonal to macro-social levels, ultimately leading to unique and complex psychological distress. This paper explores the specificities of transgender individuals' self-development against the backdrop of gender identity conflict, analyzes the impact of the non-empathic environment on self-fragmentation, examines the formation and developmental stages of self-compensatory structures centered on twinship experiences, and proposes a multi-level empathic support system to promote self-integration and rebirth.

Aim: In this single-case study we investigate how alternating therapeutic settings influence the activation of attachment patterns of a complex-traumatised patient. Over several sessions we analyse how equine assisted therapy sessions affect the activation of relational patterns, how it is a helpful tool regarding the triangulational process and facilitates relational work on a deeper sensory-motor level and where EAT might reach its limitations. Methods: At the beginning a structured diagnostic process regarding symptoms and relational patterns was conducted. The treatment was a structured integrative approach, combining sessions at our clinic and EAT sessions. Clinical observations focused on attachment, affect regulation, sensory–motor phenomena, and manifestations of relational dynamics. Particular attention was given to shifts in the patient’s relational behaviors across settings. Results: Comparing setting differences, EAT sessions amplified attachment-related patterns that appeared more muted in the office setting. In the beginning the patient tried to establish a relation through pysical closeness with the horse, while simultaneously diminished attention to the animal’s signals, and heightened vulnerability to confusion and possessiveness. In further session, feelings of jealousy rose when others engaged with “her” horse. On a sensory–motor level, shifts between tension and relaxation became more evident, and the patient—typically highly verbal—became calmer and less cognitively defended. Recurrent remarks about her husband during EAT sessions introduced spontaneous triangulation processes not present in the clinical office. Discussion: Findings suggest that EAT provides a more embodied context that activates attachment dynamics. The horse as a third object appears to deepen emotional and relational processes in therapy.

Introduction: Generative artificial intelligence (GenAI) has become increasingly popular among the general public as a new avenue for emotional and mental support (EMS). GenAI tools such as ChatGPT have evolved beyond a mere tool to an “other” or an object to self, towards which users develop imaginations that may reflect interpersonal needs and desires, bringing potential ethical risks related to overdependency and trust of AI chatbots. The objective of this study is to explore, organize, and interpret the imaginations of therapeutic users of ChatGPT. Methods: This study recruited 270 adults from 29 countries who utilized ChatGPT repeatedly for EMS in April 2024. Participants provided qualitative data regarding their imagination of AI. Two trained coders utilized thematic analysis to categorize responses. Results: Findings reveal a diverse array of imaginations categorized along two axes: Abstract-Concrete being (Formless energy vs. Animal robot) and Human-Nonhuman being (Anthropomorphic Personalization, Iconic Characters, Illusionary Beings, and Robots). Within the Abstract-Concrete continuum, four themes of imagination emerged around Looking (Physical markers and Situational Contexts), Knowing (Cognitive Abilities, Supernatural Capabilities), Doing (Functional Efficiency and Innovation), and Feeling & Relating (Social and Relational Qualities). Discussion: The result reflects a societal shift wherein users not only treat GenAI as a tool for factual information but at times also as an all-knowing, powerful being that is highly interpersonal and relatable. The results highlighted the importance of examining imaginations as a mechanism to understand future human-AI relationships and the need to assess potential risks associated with such imaginations across populations. Keywords: Human-AI relationships, Emotional & Mental Health Support, Fantasy

Aim: This study sought to conduct an initial psychometric evaluation of a novel measure of client activity preferences in psychotherapy, while assisting in scale refinement. Methods: Participants were 167 depressed adult patients at a Department of Veterans Affairs (VA) hospital in the northeastern United States. Participants completed twenty items from a test version of the Therapy Preferences Scale (TPS), a novel Likert-type measure of client activity preferences. An exploratory factor analysis was conducted on all twenty items in RStudio using principal axis factoring with direct oblimin rotation. Items were iteratively removed based on a combination of theory and quantitative indicators until a convergent, well-fitting factor solution was reached. Results: An 11-item, 3-factor structure yielded the strongest theoretical coherence and model fit (RMSR = .046; Total Variance Explained = 60.6%). Two of the identified factors were consistent with the initially hypothesized factor structure and corresponded with established preference domains of therapist supportiveness and therapist directiveness. An additional factor was also identified that appeared distinct from previously-studied preference domains--appearing to emphasize both emotional and cognitive engagement as well as an active therapist role that was distinct from simple directiveness. Discussion: This study provides preliminary evidence for the structural validity of a novel measure of psychotherapy preferences, expanding on the limited literature in this area. Model fit for the reduced 11-item scale compared favorably with existing measures, and the study also identified a potential novel preference domain that merits further investigation and validation. Keyword: Preferences

Objective: University students frequently experience insomnia due to physiological arousal induced by late-night exercise. This study evaluated a 3-week LINE BOT-delivered sleep hygiene and relaxation intervention aimed at mitigating post-exercise hyperarousal and reducing insomnia severity. Methods: Four male university students with regular late-night exercise habits and insomnia symptoms (Insomnia Severity Index, ISI > 8) were recruited. Participants completed a 3-week LINE BOT intervention focusing on relaxation techniques. Assessments included the ISI, subjective sleep diaries, and objective actigraphy. Non-parametric analyses (Wilcoxon Signed-Rank & Friedman Tests) were utilized to assess efficacy trends and sleep cognitive dissonance. Results: Retention was 100%. The results revealed a nuanced profile of improvement characterized by large effect sizes despite statistical trends. Regarding subjective measures, daily parameters remained stable. However, the ISI showed a notable downward trend (Z = -1.633, p = .102), with a large effect size (r = 0.58). This suggests global symptom relief despite day-to-day fluctuations. Objectively, actigraphy data revealed an improvement in Wake After Sleep Onset (WASO) during the intervention week compared to baseline (Z = -1.604, p = .109), achieving a large effect size (r = 0.57). Conclusions: Despite statistical limitations, the large effect sizes (r > .57) in subjective ISI and objective WASO provide a promising signal of efficacy. The contrast between stable daily diaries and improved global ISI, alongside significant sleep state misperception, highlights that digital interventions must address sleep cognitive distortion as much as physiological arousal.

Aim: To explore the experiences of depression in Tohoku area in Japan. Methods: Semi-structured interviews were conducted with 10 adults in Tohoku Areas (2 male and 8 females: Average age = 38.2, SD =11.81) depressed in the past, currently recovered. Interviews were audio-recorded and transcribed. The data was analyzed using Grounded Theory Approach (Glaser & Straus, 1967). Results: The preliminary results have been consistent with the previous study (Goto& Iwakabe, 2023). New categories such as “encountering unexpected events” (e.g. the COVID-19 and natural disasters) and “being concerned about how to be seen by others” were generated. In addition, “normalizing depression” and “being supported by the local community” may also be unique in this study. Discussion: In the Tohoku region, people with depression described interpersonal wounds, distress, and self-restraint, which were similar to previous studies. New narratives (e.g. 2011 Tsunami disrupted communities and changing relationships depending on the scale of damage) also emerged. Local community bonds showed a dual role—intensifying pain through social pressure while also offering support for recovery. In the present study, narratives reflecting cultural values that regard valuing harmony, prioritizing others over oneself, and endurance as virtues were also identified. Keywords: depression, culture, experience, qualitative analysis, local community

Aim This study aimed to explore the subjective experiential processes involved in clients’ expression of dissatisfaction in psychotherapy, as well as therapists’ attitudes and involvement that become important in this process. Methods Interviews were conducted with nine participants who had experienced both the expression and non-expression of dissatisfaction in psychotherapy sessions. The verbatim data were analyzed using the Modified Grounded Theory Approach (M-GTA). Results The M-GTA analysis showed that experiencing [the development of trust and a sense of safety] based on [hopes for psychotherapy and expectations of the therapist] made clients more likely to express dissatisfaction that later arose from experiences of [feeling betrayed by the therapist]. When hesitation about expressing dissatisfaction emerged, the therapist’s "sincerity and containing presence" and efforts to "create opportunities for dialogue" facilitated such expression. When dissatisfaction was accepted and discussed, [the therapeutic relationship deepened and the sessions progressed]; when it was rejected, outcomes included [dropout] or [continued therapy accompanied by lingering discomfort]. In addition, when therapy continued without expressing dissatisfaction, an outcome described as [a calm termination accompanied by a sense of being left with unresolved feelings] was identified. Discussion The findings suggest that within a therapeutic relationship characterized by safety, trust, and mutuality, therapists’ attitudes and involvement in supporting clients to overcome hesitation and express dissatisfaction are important for enhancing the quality of psychotherapy. The findings of this study are considered to correspond to a phase preceding the process of repairing alliance ruptures proposed by Safran and Muran (2000). Keywords: working alliance; client dissatisfaction; qualitative research; M-GTA

Keywords: Couple therapy Contextual Couple Therapy (CCT) is a two-session short-term therapy developed for Japanese couples experiencing relationship difficulties. The effectiveness of CCT has been demonstrated (Mitamura et al., 2024). However, the practice procedures and changing principles of CCT have yet to be fully elaborated. This study aimed to elaborate the practice procedures of CCT by identifying common themes in therapeutic procedures and to discuss the principles underlying these procedures in light of the literature. Thirty-four recorded sessions with 17 couples, along with their transcripts, were analyzed using a thematic analysis approach. The results showed that six themes and sixteen subthemes were generated. The findings indicated that the therapist first provided orientation and ground rules, confirmed how the couple and therapist would address one another, confirmed relationship histories and expectations, and framed the meaning of the visit. Through these procedures, the therapist prepared the ground for intervention and provided feedback on relationship satisfaction. The therapist also conducted a relationship history interview by inviting the couple to reflect on their relationship history, decisive factors for marriage, and each partner’s strengths, thereby helping the couple share both strengths and concerns. Interventions included analyzing patterns of interaction and exploring their underlying meanings, providing psychoeducation about relationships, facilitating emotional exploration, reviewing recent developments, creating opportunities for dialogue between the partners, and proposing steps toward problem improvement. At the end of each session, the therapist invited feedback from the couple. The principles underlying these procedures were discussed in light of the literature.

The therapeutic relationship is a robust predictor of treatment outcomes and a core construct within the common factors’ paradigm. However, its conceptualization and clinical operationalization vary significantly across theoretical orientations, ranging from a primary intervention tool to a necessary condition for task compliance. This heterogeneity poses challenges for cross-theoretical research, clinical training, and supervision. To address this gap, this paper proposes the Seven-Axis Relationship Framework（SARF）, which deconstructs therapeutic relational phenomena into seven interconnected analytical axes: (1) Working Alliance, (2) Real Relationship, (3) Transference/ Countertransference, (4) Client’s Recent Interpersonal Patterns, (5) Client’s Early Interpersonal Experiences, (6) Therapist’s Recent Interpersonal Patterns, and (7) Therapist’s Early Interpersonal Experiences. Using a conceptual integration approach, this study constructs a "7-Axis × Major Orientations" matrix covering eight schools: Psychoanalytic/Psychodynamic, Behaviorism, Humanism, Cognitive Therapy, Reality Therapy, Adlerian, Family Therapy, and Gestalt. The findings indicate that orientation differences primarily manifest in: (a) the hierarchy of intervention priority among axes, (b) cross-axial linkage paths (e.g., linking transference to early history vs. functional analysis to recent patterns), and (c) the professional utilization of the therapist’s self. This framework offers a comprehensive mapping of the therapeutic encounter, bridging supervisory oversight with clinical action. It further bridges the gap between theory and research by providing a roadmap for session-based process research and the creation of validated assessment scales.

Most treatment manuals recommend full cognitive-behavioral therapy (CBT) for the treatment of depression, despite studies indicating the efficacy of other CBT-related techniques (e.g., cognitive interventions alone, behavioral interventions alone, and third-wave CBT interventions). There is a lack of systematic reviews comparing these CBT interventions while simultaneously considering their method of delivery (individual vs. group) in the analysis. The present review fills this gap by investigating: (1) cognitive interventions vs. CBT comparators administered in an individual setting (2) behavioural interventions vs. CBT comparators administered in an individual setting, and (3) cognitive, behavioral, and cognitive-behavioral interventions administered in a group setting. Comparative analyses between the interventions and clinical significance of the interventions were assessed. Results have shown no significant differences in patient outcome when comparing the efficacy of cognitive-behavioral interventions (full CBT), cognitive interventions alone, behavioural interventions alone, and third-wave mindfulness interventions. Clinical and research implications are discussed.

Aim: Obsessive-compulsive disorder (OCD) is a chronic condition characterized by obsessive thoughts that are soothed by compulsive actions. This systematic review sought to comprehensively understand the effect romantic relationships can have on a presenting partner's OCD and how the OCD can, in turn, affect the relationship. Methods: Search criteria included being published in English, publication between 2000 and 2025, partners in the romantic relationship being over age 18, and OCD being an independent or dependent variable in the study. Results: We are currently conducting the review. Results will be presented and discussed as part of this paper. Discussion: OCD is debilitating illness that deserves further understanding, particularly from a systemic lens. Recommendations for clinicians and limitations of the current study are included. Keyword: obsessive-compulsive disorder, romantic relationships

Hispanic immigrants in the United States face elevated risk for posttraumatic stress disorder (PTSD) due to trauma occurring before, during, and after migration, including exposure to violence, dangerous travel conditions, family separation, detention, and acculturation stress (Alvis et al., 2025; Cleary et al., 2018; Falconier et al., 2016). Although Hispanics represent 19.5% of the U.S. population, they comprise only 7.6% of participants in clinical research, highlighting major gaps in PTSD scholarship (Hildebrand et al., 2018; U.S. Census Bureau, 2024). Recent increases in policy enforcement and immigration restrictions have further intensified trauma exposure, especially among undocumented and mixed-status families (Lemon et al., 2023; Pinedo & Escobar, 2024). This systematic review identified 101 peer-reviewed articles published between 2015 and 2024 that examined PTSD among Hispanic immigrants. Articles were coded for trauma types, subpopulations, assessment tools, cultural factors, policy contexts, and clinical recommendations. Early findings reveal heavy reliance on self-report measures, and limited attention to the timing of trauma. Overall, these gaps highlight the need for cultural trauma-informed research to better address the mental health needs of Hispanic immigrants. Keywords: Hispanic immigrants; PTSD; Migration-related trauma; Acculturation stress

Key Words: ethical trust; human–technology interaction Introduction: As generative artificial intelligence (GenAI) systems like ChatGPT are increasingly used for emotional and mental health support (EMS), users may develop attachment-like relationships with these chatbots. This study developed a measure to assess human attachment to ChatGPT and examined how this attachment predicts ethical trust, usage intentions, and actual behaviors regarding GenAI for EMS. Methods: Adults ($N=269$) who repeatedly used GenAI for EMS completed an online survey. We assessed experiences with ChatGPT using a newly developed 14-item ChatGPT attachment scale, the Adult Attachment Questionnaire (AAQ), and outcome variables related to GenAI use for EMS. Following a pre-registered plan, we used exploratory factor analysis to examine the structure of attachment to ChatGPT and evaluated its associations with GenAI-related outcomes. Results: The attachment to GenAI scale constituted a coherent single construct with strong internal reliability (alpha = .92 ). Interestingly, it was not associated with interpersonal attachment anxiety (r =.03, p=.67) or avoidance (r = .02, p= .78). Attachment to ChatGPT strongly predicts ethical trust (ΔR² = .145,p < .001), intention to use (ΔR² = .219, p < .001), and perceived helpfulness (ΔR² = .134,p < .001) of using GenAI for EMS, after controlling for depression, anthropomorphism tendency and big-five personality traits. Discussion: Findings indicate that attachment to ChatGPT is independent of interpersonal human attachment. Yet, this specific attachment strongly associates with ethical trust, perceived helpfulness, and the usage of GenAI for mental health support, above and beyond personality and clinical factors.

Narcissistic Personality Disorder (NPD) has long been considered a challenge in psychotherapy, as clinical notes often describe limited progress (Ronningstam, 2011). Yet, recent empirical findings challenge this impression, showing that patients with NPD can achieve meaningful improvement (Mansour et al., 2025, under revision). This contrast between clinical impressions and outcome raises important questions: What processes are taking place beneath the surface, and how can they be identified? To address this gap, the current study examines nonverbal synchrony as a process-level marker of emotional engagement in psychotherapy. Specifically, it focuses on two distinct channels of synchrony: acoustic synchrony, reflecting moment-to-moment alignment in vocal pitch (F0) as an index of emotional arousal, and facial synchrony, reflecting temporal coupling in facial expressions as an index of emotional valence. Forty-eight patients diagnosed with Major Depressive Disorder participated in a randomized controlled trial (Zilcha-Mano et al., 2018), of whom eight met criteria for NPD using the Structured Interview for DSM-IV. Sessions 1, 4, 8, and 12 were analyzed to examine change over time. Acoustic synchrony was measured via dynamic modeling of F0, and facial synchrony was assessed through automated facial coding and dyadic time-series analysis. We hypothesize that no significant group differences will be observed in acoustic or facial synchrony during the first therapy session. However, we expect a significant interaction over time, such that patients with NPD will exhibit greater increases in both forms of synchrony. These patterns may reflect heightened emotional reactivity and offer insight into nonverbal mechanisms of change in NPD psychotherapy.

Aim: To explore adolescent identity on social media. Rationale: Given the ubiquity and scale of social media engagement for young people today, this study is curious about what appears to be a lack of integration concerning this topic and our psychotherapeutic clinical practice. It seeks to elucidate adolescent identity development online, appraising whether online spaces should be considered alongside other important contexts in our developmental histories, assessments and formulations. Methods: This eye-catching and contemporary doctoral research poster will highlight and elaborate on key findings from a systematic meta-ethnography of qualitative studies that concern adolescent identity in relation to social media platforms, using PRISMA and the eMERGe meta-ethnography reporting guidance. New conceptual interpretations rooted in psychoanalytic thinking will be applied to the synthesized findings and highlighted in the poster. Implications and suggestions for clinical practice will be discussed. Results: The results of this doctoral research project are due for submission in early 2026, followed by completion of the research poster. As such, data analysis is still underway, but first and second order constructs relating to true and false selves, developmental ‘survival’, and split internal states are amongst some of the richest themes emerging so far. Discussion: As above, the discussion will be fully elaborated in early 2026.

Aim. Despite the high prevalence and co-occurrence of adverse childhood experiences (ACEs), evidence linking ACEs to adult attachment in clinical PTSD populations remains limited. Using dimensional models that distinguish between abusive and neglectful experiences, this study examines the relationships between childhood adversity and adult attachment in adults with diagnosed PTSD. Methods. A clinical sample of fifty-nine adults with prolonged traumatic exposure and diagnosed post-traumatic stress disorder (PTSD) completed self-report measures during psychiatric assessment. Childhood adversity was assessed with the Maltreatment and Abuse Chronology of Exposure (MACE). Adult attachment was measured using the CaMir-R, which captures attachment security and insecure attachment-related dimensions. Results. Higher cumulative adversity was associated with lower attachment security (r = −.61, p = .001) and higher avoidant attachment (r = .72, p < .001), as well as attachment-related childhood trauma (r = .75, p < .001). Neglect-related adversities were especially significant: emotional neglect was linked to lower security (r = −.70, p = .001) and higher avoidant attachment (r = .60, p < .001). Emotional abuse was strongly associated with attachment-related childhood trauma (r = .73, p < .001) and lower attachment security (r = −.51, p < .001). Conclusion. In adults with diagnosed PTSD, both neglect- and abuse-related childhood adversities—especially emotional neglect and emotional abuse—are strongly linked to lower attachment security and increased insecure attachment dimensions, emphasizing the developmental importance of emotional maltreatment in shaping attachment experiences in patients with post traumatic stress disorder. Keywords : Attachment, Severe mental Illness, PTSD, Trauma.

Aim: Group therapy alliance is well-linked to a reduction of depressive symptoms, even in problem-oriented therapies where group processes are not the focus. Group dynamics may be especially relevant for depressed older adults, for whom isolation and loneliness can be key contributors to their depression. Group alliance may act to replace sources of emotional support and belongingness that depressed older adults can lose during major life transitions, such as retirement, loss of physical capacity, and bereavement. Thus, there is a critical need to understand the specific effect age has on the alliance-symptom association in group therapies for depression. The current study will examine whether age moderates the effect of group alliance on depressive symptoms. Methods: N=115 participants with major depressive disorder were randomized to receive 8-week online group Cognitive Behavioral Therapy or Acceptance and Commitment Therapy. They were asked to complete treatment diaries assessing group alliance (Group Session Rating Scale) and depressive symptoms (Patient Health Questionnaire-9) weekly. We will run linear mixed-effects models with fixed effects of age and alliance on weekly depressive symptoms, controlling for treatment type and nested random effects of participants within a therapy group. Data were recently collected; analysis will be completed before SPR 2026. Expected Results: We hypothesize that greater alliance will predict reduction in depressive symptoms, and that this relationship will be stronger for older group participants. Discussion: By clarifying the significance of age on the alliance-outcome relationship, this work will provide clinicians with important considerations for client engagement when facilitating age-diverse groups.

Aim Ambivalence is defined as a bi-valent conflict between a self that seeks change and a self that hesitates to change (Engle & Arkowitz, 2006). Persistent ambivalence may function as a barrier to change (Oliveira, 2022), and higher ambivalence among university students has been associated with lower authenticity and poorer mental health (Kanetsuki et al., 2025). However, the role of ambivalence in the realization of self-change remains unclear. This study aimed to examine whether ambivalence predicts subsequent realization of self-change among individuals who desire to change themselves. Methods Participants were 114 Japanese university students who completed two questionnaire surveys at a three-week interval. Data from 85 participants (26 women, 59 men; M age = 18.96 years) were analyzed. At Time 1 (T1), participants reported their desire for self-change and completed the Japanese version of the Ambivalence in Psychotherapy Questionnaire (Kanetsuki et al., 2025), the Reorganization of Conflict Scale (Kanetsuki et al., 2024), an authenticity scale, and the K6. At Time 2 (T2), realization of self-change was assessed. Results At T1, 81% of participants reported a desire for self-change. Compared with those without such desire, these participants showed significantly higher ambivalence and conflict reorganization, and lower authenticity and mental health (p < .01). Among participants who desired self-change, lower ambivalence was associated with greater realization of self-change at T2. Discussion These findings suggest that higher ambivalence may hinder the realization of self-change. Interventions that directly address ambivalence, including the hesitant aspect of the self, may facilitate self-change.

As couple therapy for extramarital affairs has expanded across clinical, social, and public health domains, this study presents a systematic review and bibliometric analysis of 122 peer-reviewed articles. Using bibliometric analysis and thematic synthesis, the review maps research trends, intellectual structures, and evolving foci within the field. Results indicate steady growth in publications, reflecting increasing scholarly attention to infidelity as a relational, social, and health-related phenomenon. Six major thematic clusters were identified: (1) trauma recovery, (2) econometrics, (3) public health and risk, (4) social media and culture, (5) gender and social norms, and (6) motivation and domestic violence. Findings highlight the field’s shift from intrapsychic explanations toward integrative, systemic, and socio-cultural frameworks, offering directions for future research and evidence-informed couple therapy practice. Key words: couple therapy, extramarital affairs, systematic review, bibliometric analysis.

Purpose. This study develops and preliminarily validates the Play Therapy Practice Competency Scale (PCS-PT) to evaluate core skills in child-centered play therapy. Grounded in the RAPT practice model, the PCS-PT conceptualizes play therapy competence through 12 key practice indicators and corresponding scale items. The scale is intended to serve as a structured self-monitoring tool for play therapists, as well as an evaluative instrument for educators and supervisors to assess trainees’ professional development, learning outcomes, and individual strengths and weaknesses. Through repeated self-assessment, the PCS-PT aims to delineate a longitudinal profile of play therapy competency development across supervision stages. Methods. Participants include academic scholars, experienced play therapy practitioners, and trainees or interns currently engaged in play therapy training. The primary instrument is the 46-item revised PCS-PT. Two criterion-related measures are employed for validation purposes: Zhang and Gao’s (2009) Technique Subscale (15 items) and the translated version of the APTCCC competency indicators (2024; 14 items). A total sample size of approximately 230 participants is targeted; preliminary analyses are currently based on an initial sample of 50 respondents. Results and Implications. Confirmatory factor analysis is expected to support a four-factor structure with satisfactory reliability and validity, including Therapeutic Attunement and Following, Practice Preparation and Initiation, Facilitating Responsibility and Competence, and Reflective Awareness and Evaluation. The PCS-PT is anticipated to assist practitioners in clarifying their performance across specific technical domains, such as reflective responding, session setup, and limit setting, while also providing supervisors with a precise framework for targeted feedback and training optimization.

Interpersonal-emotional systems, such as attachment and epistemic trust (ET), are considered key factors in understanding psychotherapy outcomes: Attachment reflects enduring patterns of relating to others and has been linked to engagement and treatment response. ET reflects the capacity to receive and use information from others and has been proposed as a mechanism facilitating therapeutic learning. Both constructs encompass trait-like dispositions and state-like changes over therapy, yet their dynamic contributions to symptom reduction have not been empirically delineated. Building on this framework, the present study examines how baseline trait-like versus state-like changes in attachment and ET contribute to symptom reduction over psychotherapy. A total of 104 patients participated in an RCT and received short-term psychodynamic psychotherapy in either supportive or supportive-expressive. Depressive symptoms were assessed weekly using the Hamilton Rating Scale for Depression (HRSD-17). Attachment and ET were measured at several time-points using the Epistemic Trust Rating System (ETRS), and Client’s Attachment to Therapist (CATS). Three mediation models were constructed to test whether ET mediates the relationship between attachment and symptom reduction: the first examined baseline (between-patient) effects, the second assessed within-patient (state-like) changes, and the third integrated both trait-like and state-like components. Data analysis will be completed by May 2026. If attachment shapes openness to the therapist and ET enables the use of therapeutic input, their dynamic interplay may be central to symptom improvement and personalized interventions. Thus, clarifying how attachment and ET function in therapy may explain variability in symptom response. Keywords: Epistemic trust

Although those in the LGBTQ+ community are more likely to develop psychological distress, Latino LGBTQ+ individuals in the United States experience increased rates of negative mental health outcomes due to the convergence of sexual and gender minority stress, cultural values, and familial expectations (Abreu et al., 2020a; Abreu et al., 2025; Salerno et al., 2024; Teran et al., 2022). Evidence highlights family rejection and traditional gender roles as predictors of higher depression and anxiety among Latino LGBTQ+ individuals (Abreu et al., 2025; Salerno et al., 2024). Conversely, parental and familial acceptance is a significant protective factor, reducing depression and anxiety symptoms and supporting emotional well-being for LGBTQ+ individuals and their caregivers (Abreu et al., 2020a; Abreu et al., 2025; Teran et al., 2022; Vance et al., 2023). This systematic review examines peer-reviewed articles published between 2000 and 2025 that investigate mental health, cultural values, and acceptance processes for Latino LGBTQ+ individuals. Articles were coded for cultural constructs – familismo, machismo, marianismo, caballerismo, respeto, and religion – shown to both help and hinder the acceptance processes of Latino families and communities (Abreu et al., 2020a, 2020b; Abreu et al., 2025; Teran et al., 2022). Overall, emerging patterns underscore the importance of familial and community acceptance in shaping mental health outcomes for Latino LGBTQ+ individuals (Abreu et al., 2020a). Identifying cultural strengths, challenges, and implications for future research can inform culturally sensitive mental health interventions that promote the acceptance and well-being within Latino families. Keywords: Family, Latino Culture, LGBTQ+, Mental Health

Interpersonal difficulties are increasingly recognized as a central domain of change that patients experience as meaningful in psychotherapy, beyond symptom reduction. Such difficulties are common across psychopathology and closely linked to functioning and quality of life, yet the mechanisms supporting change in interpersonal functioning remain unclear. Epistemic trust (ET), the capacity to experience interpersonal input as trustworthy and personally relevant, has been proposed as a key mechanism enabling therapeutic learning and relational flexibility. Importantly, both interpersonal difficulties and epistemic trust comprise trait-like characteristics and state-like fluctuations during treatment. Understanding their association, therefore, requires consideration of both trait- and state-like components of each construct and their interplay over the course of psychotherapy. A total of 104 patients participated in an RCT of short-term psychodynamic psychotherapy. Epistemic trust (ET) and interpersonal difficulties were assessed at four timepoints using the Epistemic Trust Rating System (ETRS) and the Inventory of Interpersonal Problems (IIP-32). The present study examines whether baseline ET is associated with baseline interpersonal difficulties; whether between-patient differences in baseline ET correlates with changes in interpersonal difficulties across treatment; and whether within-patient changes in ET correspond to changes in interpersonal difficulties over the course of treatment. Data analysis will be completed by May 2026. Examining ET in relation to interpersonal difficulties may highlight pathways of therapeutic change that extend beyond symptom reduction. Changes in ET, therefore, may support patients’ capacity to use therapeutic input to revise expectations about themselves, others, and social contexts, thereby fostering interpersonal improvement that generalizes outside the therapeutic relationship. Keyword: Epistemic Trust

Introduction: Joseph Weiss’s Control-Mastery Theory (CMT) is recognized for enabling the optimal individualization of psychotherapy by analyzing patients’ “pathogenic beliefs.” However, CMT is not widely used to analyze sociocultural phenomena, a limitation that a prior study attributed to CMT’s focus on clinical settings. Aim: My recent study elucidated that Weiss himself transcended this limitation in his four writings on “crying at the happy ending” (collectively referred to as “Crying at the Happy Ending”)—examining this phenomenon in three domains of human experience: daily life, romantic movies, and psychotherapy. Methods: The research mainly examined “The Spontaneous Retrieval of New Memories: The Case of Dr. N” (hereafter, “The Case of Dr. N”) as the pivotal case within “Crying at the Happy Ending.” Results: The study found that “The Case of Dr. N” was Weiss’s most radical non-clinical application of CMT, whose innovation lies in the success in providing a deep, individual understanding of the case by identifying Dr. N’s key pathogenic beliefs. (It must be noted that, despite its name’s implication, the case concerns Dr. N’s private life, so it falls entirely within the daily life domain.) In contrast, he gave up on detecting the pathogenic beliefs in the romantic movie domain. Discussion: In “The Case of Dr. N,” Weiss was closest to applying the unified CMT framework to this paradoxical phenomenon, seamlessly across the three domains. This finding suggested that his “Crying at the Happy Ending” can play a crucial role in expanding CMT to encompass the analysis of sociocultural phenomena. Rest of Keywords: Control-Mastery Theory, Crying at the Happy Ending

Epistemic trust has been conceptualized as individual’s openness to the knowledge conveyed by others, however, our findings suggest it may also be impacted by the individual’s sense of epistemic agency and the contextual conditions under which the interaction occurs.The Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ) is the first self-report measure of this construct. This study has two primary obectives: first, to develop and preliminarily validate the Japanese version of ETMCQ (n = 223); and second, to employ a mixed methods approach to explore how quantitatively derived epistemic trust profiles correspond to distinct patterns of receiving, evaluating, and incorporating interpersonal communications on qualitative level (n = 6). Two overaching themes emerged from the analysis as particularly relevant to the conceptualization of epistemic trust: epistemic agency and epistemic injustice. Participants who have high epistemic trust showed openness to other’s knowledge, however, this openness was accompanied by discriminatory processing, clarification-seeking behaviour, suspended judgement, and selective incorporation of information. Those results suggested that high epistemic trust may be contingent on sufficient psychological security and sense of self agency that enable individuals to critically evaluate information rather than passively accept it. Some participants within this group also showed tendencies to disregard opinions of those belonging to social minorities. Considering these points, it is suggested that epistemic trust may be a construct that cannot be adequately assessed without careful consideration of the interactional context in which it is embedded.

Contemporary psychotherapy has increasingly emphasized technique, manualized interventions, and evidence-based protocols. While these developments have advanced standardisation and accessibility, they often overlook a fundamental dimension of therapeutic work: the therapist’s voice. This presentation proposes voice prosody—tone, rhythm, pitch, pacing, and silence—as a central yet under-examined site of psychoanalytic practice. Drawing on psychoanalytic perspective, the paper argues that prosody functions as a primary mechanism of co-regulation, shaping safety, trust, and emotional meaning before verbal content is processed. The therapist’s voice is never neutral; consciously or unconsciously, it carries cultural norms, social power, and institutional authority. As such, prosody plays a critical role in how power is enacted, how emotions are permitted or constrained, and how patients experience recognition or marginalisation within the therapeutic relationship. I suggest that the patient’s voice and the patient’s experience of the therapist’s voice, as distinct from the meaning of the words spoken, can potentially create a primitive, pre-verbal transference in which the client can experience early emotions and material. I intend to use past notes from patients which were taken as a part of normal therapy and include detailed notes of my countertransference experience of the patient. This will be analysed through the methodological approach developed by R. L. Hinshelwood, and use of ‘operationalisation’. Reimagining the therapist as a cultural and ethical agent, this presentation emphasises the importance of cultural reflexivity, power awareness, and highlighting the need to attend not only to what therapists say, but to how they sound when saying it.

Despite the ethical imperative for inclusivity and respect for sexual diversity, sexual prejudices persist in social work practice, potentially compromising the quality and equities of services provided to gay and lesbian clients. Psychological research has revealed a duality in biases: explicit biases are conscious and deliberate, whereas implicit biases are automatic and unconscious. According to the Biases of Crowds Model, biases are not merely individual traits but are shaped by interpersonal, organizational, and structural factors. This cross-sectional study investigated the levels and multilevel correlates of implicit and explicit biases toward gay and lesbian individuals among 321 social workers from Hong Kong and Taipei (mean age = 33.38, SD = 7.27; 63% female; 64% heterosexual; 66% single). Participants completed a survey and the Sexuality–Implicit Association Test to assess their biases. Findings indicated that social workers in Hong Kong exhibited higher levels of both implicit and explicit biases compared to their counterparts in Taiwan. Key factors associated with these biases included professional and personal interactions with gay and lesbian individuals, organizational climate and policies regarding sexual minorities, and socio-cultural values such as social dominance orientation and collectivism. Notably, implicit and explicit biases were associated with distinct sets of correlates. The study underscores the need for targeted interventions, such as diversity training and the promotion of positive intergroup contact among social workers and healthcare providers, to mitigate biases and enhance the equitable provision of services to gay and lesbian clients.

In the U.S., more than 350 languages are spoken, and nearly 1 in 5 residents use a non-English language at home (U.S. Census Bureau, 2023). Meanwhile, increasing numbers of international students and students of color have enrolled in counseling graduate programs, reflecting a growing linguistic and cultural diversity within the counseling profession (Assefa et al., 2023). However, bilingual therapists frequently report inadequate support in training and supervision regarding language and cultural considerations (Pope et al., 2021; Wang et al., 2024). In psychotherapy, language is more than a communication tool; it also organizes one’s experiences, shapes one’s self-focused attention and knowledge, and influences relational dynamics (Santiago-Rivera & Altarriba, 2002; Verkerk et al., 2023). Emerging qualitative studies have explored the distinct experiences and challenges of bilingual therapists (Johal, 2017; Peng et al., 2022), but there has been little synthesis of how these experiences influence therapists’ self-awareness and self-efficacy in clinical work. Considering the positive relationships among self-awareness, self-efficacy, and therapeutic outcomes (Williams et al., 2008; Lent et al., 2006), this literature review aims to synthesize conceptual work and empirical research on bilingual therapists’ experiences of practicing across languages, with particular attention to their self-awareness and self-efficacy. The presentation will discuss how multiple intrapersonal factors, such as language anxiety, and contextual factors, such as language ideology and policy, influence bilingual therapists’ self-awareness and clinical self-efficacy. Furthermore, the presentation will provide future directions for research, supervision, and training to better support bilingual therapists. Keywords: bilingual therapists, multicultural therapy, bi/multilingualism in therapy

Community mental health centres often rely on resource‑constrained, traditional manual matching methods, which can overlook complex interpersonal compatibility and lead to inefficient resource allocation and potential client dropout (Goldberg et al., 2020; Lee et al., 2025). Outcome monitoring in community mental health settings usually depend on aggregate scores from tools such as the Outcome Questionnaire‑45 (OQ, Lambert et al., 1994) to characterize client distress and inform clinical decision‑making. However, these scores are not typically used to inform client‑counsellor matching at intake. Prior research has shown that matching clients to counsellors based on preconceived criteria improves clinical outcomes (Constantino et al., 2021); however, these approaches were limited in scalability and lacked an empirical basis for generating client‑symptom profiles. The goal, then, is to uncover latent structures within item‑level OQ‑45 data from a community mental health population as a means of empirically deriving client‑symptom profiles. These profiles can be used as features in a future matching system. To do this, we employed dimensionality‑reduction techniques such as Non‑Negative Matrix Factorization (NMF), which are effective in low‑rank feature extraction from high‑dimensional data (Saberi‑Movahed et al., 2024) and have uncovered hidden structures within dense real‑world processes (Yan et al., 2026). Average treatment effects were examined across client profiles to provide a clinical basis for potential matching. We used data from over 30,000 clients containing clinical outcomes and item‑level OQ data. All clients completed the OQ‑45 at treatment start and end. Models included Non‑Negative Matrix Factorization, Gaussian Mixture Models, and Random Forests.

OBJECTIVE. Adolescent friendships are critical to mental health outcomes, even into adulthood (Narr et al., 2019). However, newcomer students face significant challenges forming friendships across cultural and linguistic barriers (Guo et al., 2019; Juang et al., 2018; Schachner et al., 2018). While existing research focuses on barriers to intercultural connection, less is known about what facilitates success. Clinicians working with newcomer youth frequently address social challenges, with limited strengths-based research to draw upon (Smith et al., 2023). This study will examine the sources of strength, self-efficacy and resilience that newcomer and Canadian-born high school students utilize when forming cross-cultural friendships. Prior evidence suggests shared time and shared activities assist in friendship formation; these are hypothesized to be important contextual factors (Cowen et al., 2026; Hall, 2019). METHOD. This secondary analysis will examine a subset of interviews from a larger unpublished dataset conceptualized by Principal Investigator Dr. Xu Zhao (Zhao et al., 2017). The original data set includes 60 culturally and linguistically diverse interviews from both newcomer and Canadian-born students, recruited across three Calgary high schools in collaboration with the Calgary Board of Education's Global Learning Services. Interviews describing successful cross-cultural friendships will be isolated. Reflexive thematic analysis will be employed, with themes constructed through iterative researcher reflexivity (Braun & Clarke, 2006). RESULTS. Analysis is expected to illuminate self-efficacy, resilience, and contextual factors supporting cross-cultural friendship formation. CLINICAL SIGNIFICANCE. Findings will inform culturally responsive educator and therapist training and provide a strengths-based framework for helping adolescent clients navigate cross-cultural relationship building.

This poster presentation will detail the existing literature on the effects that chanting and mindfulness currently have on mental health. The presentation will also highlight results from the author’s experiment during his Master’s thesis. This experiment involved having four counselor education students chant the mantra “Nam Myoho Renge Kyo” for 10 minutes to a gohonzon, which is a scroll for Buddhist prayer with Sanskrit characters on it. The four participants filled out an Oxford Happiness questionnaire. The author will share the results of the experiment in his poster presentation as well, which were largely positive such as the average change in score for all participants and all 4 weeks being a 3% increase on the Oxford Happiness Questionnaire. The author will also share future studies that he is hoping to be able to conduct. One example of a future study is the intersection of Nuerocounseling and Chanting, as the author will discuss the possibility of displaying chanting’s efficacy in treating mental health via neurological measurements such as an fMRI.

The objective of this study is to elucidate the phenomenon that people recognize a sort of space-like entity when they post self-authored Tanka―Japanese traditional poetry―and appreciate posts of Tanka on Twitter (currently X). In this study, we define this space-like entity as "Unintended Space." This can be considered a type of virtual space. It emerges naturally and retrospectively as a byproduct of various actions. Specifically, we define Tanka poetry on Twitter as “Twitter Tanka,” and we define the space arising from the practice of Twitter Tanka as "Twitter Tanka Space." "Twitter Tanka" is a novel mode of expression that fuses Tanka with Twitter. This study conducted research and analysis based on three perspectives: visual familiarity, immersion, and infinity. The participants of this study were individuals who had posted or appreciated Twitter Tanka for at least one month. Data was collected via an online questionnaire combining multiple-choice and open-ended items(n=35). As a result of this study, 65.7% of respondents reported recognizing "Unintended Space." Additionally, it was revealed that they recognize a wide variety of "Unintended Space" that relate to the three perspectives and other factors. Posting self-composed Tanka poems on Twitter can be seen as an act of facing oneself and expressing one's own feelings to others. This act shares elements with psychotherapy. Thus, this research may contribute to deepening our understanding of psychotherapy.

Research around race and colorism in Chile has often been analyzed through the lens of comparison to other American countries. This tendency is largely shaped by an ethnocentric, dominant, and colonized approach, as well as by assumptions of similar, if not the same, backgrounds among historically unique Latin American countries. This has contributed to the reliance on external frameworks to define and understand racial dynamics in local Latin American regions. Consequently, only a few studies have focused on Chile’s unique background and history, and the influence and effect (social and psychological implications) this has had on its population and specific minority groups—in this case, Chilean women of color (WOC). The lack of an intersectional and national focus has motivated us to conduct a qualitative study that offers a descriptive account of the experiences of Chilean WOC. Through in-depth, online interviews, we seek a more nuanced and contextually grounded understanding of these experiences. We will use an inductive thematic analysis as outlined by Braun and Clarke (2006, 2023). The study’s research questions explore perceptions of colorism in our participants’ personal and social lives, ways to cope with these experiences, and its impact on satisfaction. This study has IRB approval through Brigham Young University (United States) and through the University of Chile. Interviews will begin soon, and findings will be forthcoming. My poster will include a full literature review and description of the methods used in the research. Preliminary findings may also be available by the time of the June conference.

Introduction: First-generation college students report higher psychological distress than continuing-generation peers, including elevated anxiety, depression, and academic stress (Noel et al., 2023). Yet most research examines the first-generation students as a single group, overlooking distinct stressors among students with minority racial, ethnic, or cultural identities (House et al., 2020). International Asian first-generation college students are particularly understudied. Their experiences may differ from those of Asian American students who immigrated or were raised in the U.S. educational system. This study compares international Asian first-generation college students (IAFGCS) and American Asian first-generation college students (AAFGCS) on their academic distress, social anxiety, and experiences of hostility at intake, final session, as well as change over time. We predict that IAFGCS students will present with greater distress at intake. We also predict that both groups will demonstrate symptom reductions in academic distress, social anxiety, and hostility at the final sessions, and that the extent of improvement will not differ between groups. Methods: Participants were from the Center for Collegiate Mental Health 2013-2023 dataset (n=4796). IAFGCS (n = 1,596) and AMFG AAFGCS (n = 3200). Participants in the two groups will be matched on age, gender, and the number of therapy sessions. Academic distress, social anxiety, and hostility scores from the 34 items of Counseling Center Assessment of Psychological Symptoms will be compared between the two comparison groups. Results and Discussion: The analysis will be completed before the presentation. Key Words: First-generation college students, Asian American, International Asian

Aim: Little is known regarding whether specific psychotherapy factors must align with non-specific ones, that is, whether the conceptual underpinnings of a theoretical orientation must be congruent with the clinician to be effective. The current study examined how clinician confidence is impacted by Congruence between identification with a theoretical orientation and endorsement of its therapeutic principles (H1), and whether Congruence moderates’ association between personality and identification (H2) or confidence (H3). Method: 125 U.S.-based English-speaking participants (76.8% graduate students, 12% early career psychologists, 11.2% experienced) completed measures of theoretical orientation identification and principles, Big Five personality, and clinician confidence. Hierarchical multiple regression models tested moderation effects for the three hypotheses and controlled for career stage. Results: For H1, the model was significant (F(5,119)=5.04, p<.001, R²=.175), as was the Identification × Congruence interaction (b=-0.0009, SE=0.0004, p=.048). Conditional effects showed identification predicted confidence at low (p=.048) and median (p=.030) Congruence levels, but not high. Significance held below Congruence=2.34 (~57th percentile). H2 and H3 yielded non-significant models. Discussion: Findings support conceptual utility for Congruence and suggest a developmental picture in clinician confidence formation: Congruence moderates the Identification/Confidence association in an attenuation pattern. Identification may serve as a compensatory mechanism early in training, helping trainees build self-efficacy amidst partial theoretical fit. In contrast, high congruence renders identification less critical, suggesting more integrated professional identity where confidence is independently robust. Considering confidence was used as a proxy for outcomes, it might be useful to explore whether Congruence has direct or indirect effects on other therapeutic factors.

In the Chinese context, the identity formation and living conditions of sexual minority groups are deeply trapped in the triple tensions of society, culture, and family. Conflicts between the traditional family ethical demands of "continuity of the family line", the social evaluation logic of "mianzi (face) and lizi (substance)", and individuals’ sexual minority identities not only give rise to family confrontation crises after coming out but also drive compromised survival strategies such as contractual marriages, thereby leading to a high incidence of psychological problems including depression, anxiety, and self-stigmatization. Based on the core conclusion of "culturally shaped cognition" identified in studies on Chinese sexual minority groups over the past decade, this paper conducts an analysis and systematically constructs a culturally sensitive counseling and psychotherapy system for sexual minority groups. The research points out that the core of culturally sensitive services lies in anchoring to balance "breaking the constraints of traditional ethics on individuals" and "building a supportive environment relying on the inclusive genes within the cultural core”. The proposed six-step intervention framework breaks through the cultural limitations of Western intervention models and accurately aligns with the interaction characteristics of Chinese families. Its core value lies in integrating "cultural understanding" throughout the entire intervention process, rather than simply promoting "identity affirmation". This framework reveals that coming-out interventions in the Chinese context cannot discuss identity affirmation in isolation from family ethics, but rather need to find a balance point between traditional ethics and individual needs.

Objective: Examine center- and therapist-level factors that may impact suicide ideation outcomes for college students with minoritized identities. Method: Data were drawn from a 2015–2017 data set collected from 136 university counseling centers that were part of the Center for Collegiate Mental Health. This study used a three-level model in hierarchical linear modeling with clients (Level 1; N=122,212), clients nested in therapists (Level 2; N=2,574), and therapists nested in counseling centers (Level 3; N=120). Results: Racially/ethnically minoritized students were 20%, LGBQþ students were 100% more likely, and women students were 20% less likely to have suicidal ideation at the first session, compared to White, male, heterosexual domestic students. LGBQ+ students were 20%, and international students were 50% more likely to have suicidal ideation in the last session, compared to White, male, heterosexual domestic students. Cross-level interactions revealed that when therapists had a higher percentage of international students on their caseload, international students had decreased suicidal ideation. Similarly, when therapists had a higher percentage of male students on their caseload, their male students had decreased suicidal ideation. Conclusions: Findings from this study support the importance of experience and competence in working with minoritized students, as therapists who had more international and men students on their caseload fared better in decreasing the suicide ideation of respective students. This suggests that continued exposure to the unique challenges faced by particular minoritized groups of college students can enhance the quality of care delivered by therapists.

Suicide is a critical public health issue, making it essential to examine effective interventions (Gould, et al., 2021). Crisis lines, particularly text-based services (Budinger, et al., 2015), play a crucial role in reducing suicidality and distress. However, variations in counseling quality remain a significant limitation. The unique dynamics of real-time text-based crisis counseling raise important questions about how message features, such as length and lexical diversity, may influence user outcomes. Due to text-based counselors having the ability to quickly ‘copy and paste’ messages to different clients, these features may vary. Preliminary descriptive analyses indicated that most counselor messages were brief and rarely reused language, reflecting substantial variability in communication style. These patterns prompted the current investigation into how message length and text reuse relate to client engagement across a larger scale of counselors. Using data from a text-based crisis service (2017 to 2024), this study provides a descriptive examination of counselor message length and text reuse; we will also examine the impact of these text features on client engagement.Natural language processing methods (Zhang, et al., 2019) will be used to compute message length and text reuse; mixed-effects regression models will assess their relationship with client engagement. We hypothesize that shorter, more diverse messages will foster higher client engagement, whereas longer, less diverse messages may be associated with diminished outcomes. The findings will inform counselor training and intervention design, offering actionable insights to improve the quality of text-based crisis services for those in need.

Aim: Countertransference refers to clinicians’ conscious and unconscious emotional, cognitive, and behavioral reactions towards patients (Gabbard, 2001). Research shows that suicidal patients often evoke countertransference in clinicians, and the reactions may interfere with judgment and risk appraisal (Michaud et al., 2021). This study investigates the relationship between countertransference and accuracy in suicide-risk assessment during virtual patient intake sessions, as well as the degree to which the patient’s race moderates this relationship. Methods: 154 clinicians conducted clinical interviews with a standardized virtual patient. Following the interview, clinicians assessed the presence and severity of the suicide crisis syndrome using the SCS-C (Suicide Crisis Syndrome Checklist; Bloch-Elkouby et al, 2025) and rated suicidal ideation using the the C-SSRS (Columbia-Suicide Severity Rating Scale; Posner et al., 2011), each on a 1–5 point Likert scale. Clinicians also rated their emotional responses using the TRQ-SF (Therapist Response Questionnaire-Suicide Form; Barzilay et al., 2018), a countertransference measure. Accuracy will be calculated as the absolute difference between each clinician’s rating and expert-derived benchmark scores for the virtual patient scenario. Pearson correlations will be used to examine associations between countertransference scores and suicide-risk assessment accuracy. Anticipated Results: Higher levels of negative countertransference are expected to predict lower accuracy in suicide assessment. Key words: therapeutic alliance, suicide risk assessment, virtual patient

This paper presents an Interpretative Phenomenological Analysis (IPA) study exploring the countertransference experiences of child psychotherapists working with autistic adolescents. Although countertransference is central to psychodynamic and relational practice, empirical research exploring therapists’ emotional and embodied responses working with autistic adolescents remains limited. Drawing on in-depth semi-structured interviews with UK-based child psychotherapists, the study offers an idiographic account of how practitioners make sense of countertransference and use it to navigate therapeutic engagement. The findings reveal a ‘spectrum’ of feelings, clusters of defense mechanism, and bodily cues. Countertransference was experienced as both clinically demanding and a vital source of insight into autistic adolescents’ ways of being and relating. This study contributes to understandings of autism, psychotherapy, and therapist subjectivity through psychoanalytic lens.

Aim: Grounded in the Adaptation to Parenthood Model, this study examined the association between parenting stress and marital quality among new parents, focusing on couple resilience as a shared, dyadic resource during the transition to parenthood. The moderating and dyadic roles of couple resilience were evaluated relative to individual resilience. Methods: Using a cross-sectional design, data were collected from 389 Taiwanese new parents, including 173 heterosexual dyads, all with a firstborn child aged 0 to 3 years. Participants completed measures of couple resilience (Taiwan Couple Resilience Scale; TCRS), parenting stress, marital quality, and individual resilience (Connor–Davidson Resilience Scale; CD-RISC). Moderation analyses and the Actor–Partner Interdependence Model (APIM) were used to examine individual- and dyadic-level processes. Results: Higher parenting stress was associated with lower marital satisfaction and marital stability. Couple resilience significantly moderated the association between parenting stress and marital stability, attenuating the negative impact of stress; this buffering effect was more pronounced for mothers than for fathers. Individual resilience did not show a significant moderating effect. APIM analyses revealed a couple-oriented pattern, such that couple resilience positively predicted both individuals’ own marital quality (actor effects) and their partners’ marital quality (partner effects). Discussion: Findings highlight couple resilience as a central relational resource operating dyadically during early parenthood. Rather than individual resilience alone, the capacity to maintain a sense of “we-ness” under stress appears critical for protecting relationship functioning. These results support psychotherapy approaches that prioritize relational processes and strengthen couple-level resilience when working with distressed new parents. Keywords: Couple resilience; Parenting stress; Dyadic processes; Transition to parenthood

Keywords: Systems-Centered® Training (SCT®) Aim: This study aims to explore the promoting factors and mechanisms by which Systems-Centered® Training (SCT®) facilitates the development of affective empathy—the intuitive and embodied capacity to resonate with another’s emotional state. Because affective empathy has long been considered difficult to cultivate due to its implicit and experiential nature, training for interpersonal support has traditionally focused on cognitive empathy. This study examines whether Systems-Centered® Training (SCT®), a group approach working with individual experience and group dynamics, can facilitate the development of affective empathy. Methods: We conducted online SCT® groups for practitioners in medical, welfare, educational, and forensic settings. Functional subgrouping, a core SCT® method, supported members in exploring their “here-and-now” emotional experiences. Seminar recordings were qualitatively analyzed, focusing on the group structure, leader interventions, and how these facilitated the emergence of emotional resonance. Results: Analysis revealed a process by which the seminar structure and leader intervention promoted the development of affective empathy. Initially, members exhibited emotional reactions based on similarities in objects or experiences. However, following the leader's sustained interventions based on SCT® principles, communication focused on the emotion itself, rather than external objects, began to emerge among members. These shifts were linked to the leader's actions in reinforcing Functional Subgrouping’s discourse rules, particularly the focus on the here-and-now emotional experience. Discussion: The analysis suggested that affective empathy can be educated through structured group processes emphasizing emotional experience rather than shared life events. In interpersonal support contexts where supporters often lack shared experiences with recipients, SCT®-based training methods are considered likely to strengthen supporters' emotional resonance.

Objective Emotion regulation is a protective factor for adolescents living in contexts of violence, inequality, and rights violations. DBT STEPS-A, a program grounded in Dialectical Behavior Therapy, has demonstrated efficacy in school settings; however, its implementation in highly vulnerable and culturally diverse contexts requires adaptations to enhance relevance and acceptability. This study describes the cultural adaptation process of a pilot DBT STEPS-A program (N = 24) implemented in Tijuana, Mexico. Method The cultural adaptation followed the FRAME model (Wiltsey Stirman et al., 2019) to document the type, level, and rationale for the modifications made. Implementation strategies included structured observation, a fidelity matrix, participation records, and student feedback. As a complementary component, the DERS-E was administered to explore changes in emotion dysregulation. Results Cultural adaptations to DBT STEPS-A were systematically documented while preserving the program’s core components and theoretical fidelity. These adaptations strengthened acceptability and cultural appropriateness. Implementation indicators, including active participation and student feedback, suggest meaningful engagement with emotion regulation skills. Exploratory findings indicated improvements in emotion dysregulation. Discussion Preliminary findings suggest that FRAME is a viable and appropriate strategy to guide and document the cultural adaptation of DBT STEPS-A for adolescents in high-vulnerability contexts. Although results should be interpreted with caution due to the small sample size, this study provides methodological evidence to support the cultural adaptation and documentation of evidence-based interventions in socially complex settings. Keyword school-based implementation

Cultural humility (CH) has become an influential framework in psychotherapy supervision, emphasizing lifelong self-reflection, power awareness, and relational reciprocity. However, culturally grounded and empirically informed supervision models remain limited in Asian contexts. In this poster, we present our proposed study, which re-envisions supervision as a co-learning process integrating CH with Taiwanese relational and educational values. Drawing on the Multicultural Orientation in Supervision (MCO-S) and reflective teaching frameworks, we propose a preliminary Cultural Humility Supervision Model organized around three core domains: relationship building, self-awareness, and educational transformation. To empirically develop this model, we will employ a grounded theory methodology. Data sources will include supervisees’ reflective journals and semi-structured interviews, analyzed through iterative coding and constant comparison to construct a culturally embedded supervision framework. Our aim is to explore how CH-oriented supervision enhances relational safety, cultural reflexivity, and mutual growth within supervisory processes. The emerging grounded theory is expected to inform the development of an indigenous, culturally responsive supervision approach relevant to counselor training and clinical education in Taiwan. By situating supervision within Asian relational and cultural contexts, this study seeks to advance psychotherapy innovation through ethically grounded and culturally attuned supervisory practices, contributing to global dialogues on reimagining psychotherapy across cultures.

Aim: We examined whether Black parents’ racism-based trauma symptoms impacted their children’s prosocial, internalizing, and externalizing behaviors via the disruptive effect that racism-based trauma can have on parenting practices—that is, less capacity for positive practices like the use of praise and encouragement, and more use of punitive behaviors including yelling and spanking. We also examined whether parents’ use of cultural socialization (i.e., transmission of cultural history and pride) buffered against the negative indirect effect of parents’ racism-based trauma on children’s outcomes. Methods: We recruited 241 Black parents (61.8% women; mage = 33) from majority low-income backgrounds within the US with children aged 2-8. Parents completed online measures of racism-based trauma symptoms, cultural socialization, parenting behaviors, and children's development. Path analysis and Bayesian estimation was used to test our hypotheses. Results: Parents’ racism-based trauma was associated with less praise/encouragement and greater yelling/spanking. Praise/encouragement and cultural socialization were associated with children’s greater prosocial behavior, while yelling/spanking was associated with children’s lower prosocial behavior. There was a significant interaction between yelling/spanking and cultural socialization on prosocial behavior, externalizing behavior, and internalizing behavior. Specifically, higher cultural socialization weakened the negative influence of parents’ greater yelling/spanking on children’s lower prosocial behaviors and increased externalizing and internalizing behaviors. Discussion: Racism-based trauma can have a disruptive effect on parenting and children’s development. Cultural socialization may moderate the negative impact of compromised parenting on children’s outcomes. Findings highlight the importance of assessing both cultural risk and protective factors in child and family therapy with Black families.

Recent developments in Taiwan’s school mental-health policies have prompted a re-examination of how counseling services are conceptualized and delivered within complex educational systems. The Student Guidance and Counseling Act (SGCA), enacted in 2014 and revised in 2024, reshaped the responsibilities and expectations for guidance teachers—equivalent to school counselors—across elementary, junior high, senior high, and tertiary settings. The 2024 amendment lowered counselor–student ratios and emphasized more comprehensive mental-health support. In response, the Ministry of Education subsequently issued the Regulations on the Division of Labor and Collaboration in Student Guidance Services, which formally introduced case management as a core responsibility for school counselors. Yet, case management has not historically been emphasized in counselor education or supervision in Taiwan, creating a significant gap between policy expectations and professional preparation. Drawing on the first author’s over 20 years of experience in school counseling practice, training, and supervision, this presentation proposes a Context-Sensitive Case Management Model tailored to Taiwan’s educational structures and sociocultural realities. The model delineates how school counselors navigate multiple professional roles—teacher, case manager, counselor, and consultant—and identifies the ethical tensions and boundary challenges that arise from these overlapping functions. A visual framework will illustrate the model’s processes, highlighting ways school counselors engage in collaborative work with teachers, administrators, families, and external professionals. The presentation concludes with recommendations for counselor training and professional development to better bridge the policy–practice gap and to support innovative, system-responsive service delivery in school mental-health settings. Keywords: Case management, School counselor, The Student Guidance and Counseling Act

Intimate partner violence (IPV) remains a pervasive public health concern in the United States, producing significant physical, psychological, relational, and societal consequences. Although Latine individuals comprise approximately 20% of the U.S. population, they remain underrepresented in IPV intervention research and underserved by mainstream service systems. Evidence suggests that IPV prevalence among Latine populations is comparable to or higher than that of other groups, yet experiences of violence and help-seeking are shaped by distinct cultural and structural factors. Cultural values such as familismo, machismo, and marianismo may function as both protective and risk factors, while structural inequities—including language barriers, documentation status, acculturation stress, and limited access to culturally competent services—further constrain intervention engagement. Despite growing recognition of these dynamics, IPV intervention research with Latine populations remains fragmented, and cultural responsiveness is often insufficiently defined or evaluated. This review systematically examines empirical studies that evaluate or describe IPV interventions implemented with Latine individuals and families. The review summarizes (1) intervention types and characteristics, (2) theoretical and methodological foundations, (3) the degree of cultural adaptation or responsiveness, and (4) trends in funding, sample representation, and outcome evaluation. A comprehensive literature search was conducted in PsycINFO and MEDLINE for peer-reviewed articles published in English between January 2000 and March 2025. Forty-nine studies met inclusion criteria. Descriptive analyses synthesized intervention characteristics and trends, as methodological heterogeneity precluded meta-analysis. Findings provide a status report on the current landscape of IPV intervention research with Latine populations and highlight directions for culturally grounded practice and future research.

The role of culture is increasingly important as the number of trainees with diverse racial, ethnic, and social identities increases in clinical psychology training programs in the US. Therefore, the role of culture is increasingly important in supervision, especially in the supervisory alliance between the supervisor and supervisee, yet it remains under-researched. Clinical supervision provides many opportunities for cultural topics and ruptures to arise, which could impact and be impacted by power differentials, microaggressions, and the varying identities of the supervisor and supervisee. Therefore, the first study aims to systematically review the literature to identify studies on the relationship between cultural variables and the supervisory alliance, as well as the impact of cultural ruptures on the supervisory relationship between supervisor and supervisee. The systematic review will also emphasize the need for further research in this area to inform the development of culturally informed training for supervisors and supervisees. The second study will build on the systematic review results and expert opinions of supervisors and supervisees to conduct the first step of a task analysis, developing a rational model for addressing and repairing cultural ruptures in the supervisory alliance. This study will set the stage for future research to test and refine the rational model and move toward an empirical model that can guide supervisors in repairing cultural ruptures in supervision. Keywords: Psychotherapy supervision, Culture, Multicultural, Rupture, Repair, Supervision, alliance

Background: Clinical cut-offs are a widely used and accessible resource in routine clinical practice, particularly in low-resource contexts. Conventional approaches typically assume clear differentiation between individuals who seek psychotherapy and those who do not, an assumption that may be problematic in heterogeneous populations. Aim: To compare traditional and data-driven approaches for differentiating clinical and non-clinical groups and estimating clinical cut-off scores in an Argentine adult sample. Method: A cross-sectional sample (n = 637) was collected, including individuals from the general population and patients initiating psychotherapy, all of whom completed the 10-item Clinical Outcomes in Routine Evaluation (CORE-10). Four clustering strategies (K-Means, Hierarchical Clustering, Gaussian Mixture Models, and Fuzzy C-Means) were tested to derive clinical and non-clinical groupings. Internal and relative clustering validity indices were used to select the optimal solution. Cut-off scores were estimated using receiver operating characteristic (ROC) curve analysis and the Jacobson & Truax (1991) method, and compared with cut-offs derived from groupings based on therapy status (therapy vs. non-therapy). Results: Clustering methods outperformed traditional therapy-status classifications, yielding more consistent and interpretable groupings. The optimal cut-off score derived from K-Means clustering was a CORE-10 mean score of 1.39 (95% CI [1.36, 1.42]). Discussion: These findings identify an optimal cut-off score for detecting clinical cases in an Argentine adult population, supporting the use of clustering-based strategies as a complementary approach for defining clinical cut-offs, particularly in contexts characterized by high heterogeneity. Data-driven methods may provide empirically grounded, low-cost clinical resources for practice and research in the Argentine context.

Abstract: The aim of the study was to investigate the dynamics contributing to existential despair and suicidal attempt in a young adult admitted to the inpatient settings. The study focused on how targeting specific existential narratives contributed to symptom stabilisation. The case was evaluated using a process-based therapy approach, and an Individual-Level network analysis was conducted using the Extended Evolutionary Meta Model. In this single case study, nonlinear interactions between different domains were assessed to understand the existential despair and suicidal attempt. Interventions focused on the identified domains to stabilize existential distress. Identifying critical instabilities in the patient’s emotional intensity also facilitated corrective emotional experience. A transdiagnostic approach incorporating elements from Indian psychology and Buddhist philosophy was used to address existential distress to stabilize the patient’s condition at the initial phase of therapy. The case highlights the importance of the intersession process in the mechanism of change.

Aims This study aims to investigate the challenges of addressing spirituality and religion in therapeutic settings, focusing on Hindu clients. It explores how dominant therapeutic models: Cognitive Behavioural Therapy (CBT) and Person-Centred Therapy (PCT), may lack cultural responsiveness and unintentionally maintain Eurocentric assumptions. The research seeks to highlight the need for culturally competent and socially just approaches in Counselling and Psychotherapy. Methods A critical analysis of existing literature was undertaken, examining CBT and PCT through a decolonial lens. The study reviewed theoretical and cultural perspectives on Hinduism, indigenous healing traditions like Yoga, and critiques of Eurocentric therapeutic models to assess how these frameworks engage with religious and spiritual identities. Results Findings indicate that current therapeutic models often overlook culturally embedded concepts of self and healing central to Hindu worldviews. CBT and PCT were found to inadequately address spiritual needs, resulting in limited support for Hindu clients. Additionally, Hindu practices such as Yoga were frequently decontextualised and commodified, reduced to wellbeing tools without acknowledging their spiritual or philosophical roots, thereby perpetuating cultural minimisation. Discussion The study underscores the need to decolonise Counselling and Psychotherapy by integrating culturally informed perspectives and valuing indigenous spiritual traditions. It argues that without such shifts, therapeutic practice risks reinforcing social injustice and excluding diverse client experiences. Embracing culturally competent frameworks can enhance ethical practice and ensure more inclusive, responsive, and spiritually attuned therapeutic support. Keywords: Spirituality, religion, Hinduism, social justice, cultural competence, Counselling, Psychotherapy, CBT, PCT, yoga

This study explores the efficacy of deliberate practice in enhancing undergraduate students’ ability to address cultural dynamics using the Multicultural Orientation Framework (MCO) in therapeutic contexts. Using a randomized control trial design, 59 participants were assigned to either an MCO workshop or a Motivational Interviewing (MI) workshop control group, each involving video simulations and pre- and post-workshop participant self-assessments. The workshops incorporated deliberate practice exercises with feedback to improve participants' responses to culturally rich client scenarios. Findings indicated significant improvements in cultural humility, comfort, and perceived opportunities for the MCO group compared to the MI group. Self-reports also revealed increased knowledge and skills in addressing multicultural issues, with the MCO group showing slightly greater gains. The results suggest that deliberate practice is an effective training method in enhancing cultural responsiveness and adaptability among novices. Specifically, MCO could be integrated into a broad range of therapy training programs via similar deliberate practice techniques, and clinicians who participate may be better prepared to engage positively with diverse client populations. Future research should investigate the long-term impact of MCO training and its applications in clinical practice.

Objective. Social functioning is a core domain affected by depression, yet empirical knowledge regarding how depressive severity relates to patients’ personal social networks remains limited. This study examined associations between depression severity and social network size, composition, and structure in patients with major depressive disorder (MDD) using Network Canvas. Method. Eleven participants from a randomized controlled trial completed a Network Canvas social network questionnaire at intake. Depression severity was assessed using the Hamilton Rating Scale for Depression (HRSD; M = 11.09, SD = 8.03, range = 1–22). Spearman correlations tested associations between HRSD scores and network size, number of relationship types, perceived closeness to network members, and contact frequency. Results. Higher HRSD scores were associated with larger network size (r = 0.349, p = 0.292) and with a greater diversity of relationship types (r = 0.661, p = 0.027), contrary to hypotheses derived from prior literature. Consistent with hypotheses, higher depression was related to lower perceived closeness to network members (r = 0.59, p = 0.056) and to lower contact frequency (r = –0.27, p = 0.422). Conclusions. Greater depressive severity co-occurred with social networks that were broader and more heterogeneous, yet experienced as more distant and less engaged. This pattern may reflect a compensatory expansion of social ties that does not translate into relational intimacy or behavioral involvement. The small sample limits inference, and replication in larger cohorts is needed, including prospective examination of psychotherapy-related change in patients’ social networks. Keywords: depression severity; social networks; Network Canvas; social functioning

Novice therapists-in-training often experience considerable uncertainty as they navigate the complex demands of clinical practice. This uncertainty stems, in part, from foundational competency gaps, including structuring initial sessions, integrating theory into case conceptualizations, acquiring essential microskills, and conducting risk assessments (Skovholt & Rønnestad, 2003). Although weekly supervision aims to address these gaps through professional development tasks (Hill & Knox, 2023), supervision alone cannot provide the between-session, on-demand support trainees need as challenges arise in clinical work. This temporal mismatch between learning needs and supervisory availability is exacerbated by systemic constraints including resource-intensive training models, limited supervisor capacity, variability in supervision quality, and widespread post-pandemic clinician burnout (Ellis et al., 2014; Hill et al., 2015; Hutman et al., 2023). Emerging research demonstrates that AI-assisted tools can augment supervision by providing flexible, contextualized, and on-demand practice opportunities with particular efficacy for novice therapists (Cioffi et al., 2025; Winkler-Schwartz et al., 2019). In light of this potential, we aim to develop an AI-supported, scenario-based clinical support tool using design-based research (Wang & Hannafin, 2005) to address common, high-impact challenges encountered by novice therapists. Our research team will first develop and iteratively refine a prototype of an AI-supported clinical tool using ChatGPT, featuring core training scenarios (e.g., first-session structure, conceptualization, microskills, risk assessment, managing early clinical anxiety). Following each interaction, ratings and experiential feedback from five clinical supervisors will be used to inform iterative refinements based on the clarity, clinical appropriateness, and perceived training value of the tool’s responses. Keywords: Artificial intelligence

Aim Approximately 70% of children living in child welfare institutions are reported to have experienced abuse (Children and Families Agency of Japan, 2024). Such experiences may foster an affinity toward violence and, in some cases, lead to violent or aggressive behaviors, described as the “cycle of violence” (Wisdom, 1989). This exploratory study aimed to develop and examine an art-based group therapy program focused on reducing violent behaviors and modulating aggressive tendencies among institutionalized children. The study sought to clarify processes underlying reductions in violent behaviors. Methods August 2024-February 2025, an art-based group therapy program was conducted with six children residing in a child welfare institution. The program consisted of six biweekly sessions and was implemented separately by gender. Effects were examined from three perspectives:(1) changes in information-processing patterns observed in children’s artwork based on the Expressive Therapies Continuum (ETC);(2) changes in self-reflection reported through art-making; and (3) changes in behaviors reported by staff. Changes in information processing were analyzed using an ETC-based assessment sheet, and qualitative data were coded. Results Participants were classified into three types. Type 1 (n = 2) showed improvements in information-processing patterns and observed reductions in violent behaviors. Type 2 (n = 3) showed improvements in information processing without behavioral change. Type 3 (n = 1) showed minimal information-processing bias at baseline and no observed change. Discussion Alleviating biased information-processing patterns through art expression may contribute to modulation of aggressive tendencies and observed reductions in violent behaviors. Further research is needed to identify effective techniques.

Objective: With the institutionalization of telepsychotherapy in Taiwan, validated assessment tools are critical. This study adapted the Unified Theory of Acceptance and Use of Technology (UTAUT) into Traditional Chinese for therapists (UTAUT-T) and the public (UTAUT-P) to assess acceptance and usage intention. Methods: The original 21-item UTAUT was adapted through a rigorous translation-back-translation procedure involving clinical experts to ensure linguistic and cultural equivalence. Items irrelevant to the local context (e.g., COVID-specific) were removed, resulting in a 19-item therapist version and a 16-item public version. We recruited 179 therapists and 1,483 community adults online to examine internal consistency. Results: The UTAUT-T demonstrated acceptable reliability (Cronbach’s α = .74) among therapists (Mean age = 35.86; Mean practice years = 2.44). The public sample (Mean age = 37.39), of whom 6.7% had prior telepsychotherapy experience, showed positive preliminary attitudes toward telepsychotherapy. The UTAUT-P demonstrated strong internal consistency (Cronbach’s α= .85). Conclusions: The Traditional Chinese versions of both the therapist and public UTAUT scales show promising psychometric properties with satisfactory internal reliability. These tools provide a foundation for understanding barriers and facilitators to telepsychotherapy adoption in Taiwan. Future work will further examine construct validity and measurement invariance.

Introduction Emotions consist of distinct categories, and alexithymia involves difficulties in emotional identification and expression. This study compared emotional experience and intensity between individuals with and without alexithymia. Method Participants completed the TAS-20 and mDES (N = 315; alexithymia = 43). Analyses included (1) principal component analysis to reduce emotional variables for group comparison, (2) Monte Carlo resampling to address unequal group sizes, (3) polygon area as an index of emotional space, and (4) evaluation of emotional co-activation. Results PC1 and PC2 accounted for 39.33% and 17.34% of the variance, respectively; PC1 loadings followed emotional valence, and PC2 showed uniformly positive loadings. The alexithymia group showed lower PC1 scores (−1.97 vs. 0.31, p < .001, d = −0.87) and higher PC2 scores (0.71 vs. −0.11, p = .006, d = 0.46) than the non-alexithymia group. Area analysis indicated a larger emotional space (28.97 vs. 26.66, p < .001, d = 2.59) and a mean centroid shift (M = 0.25, p < .001). Co-activation was higher in the alexithymia group (2.51 vs. 2.15, p < .001, d = 2.95). Conclusion PC1 contrasted emotional valence, whereas PC2 reflected overall intensity. Compared with non-alexithymic individuals, those with alexithymia showed more negative and stronger emotional responses and a larger intensity-based emotional space. Positive and negative emotions were concurrently activated, yielding a globally heightened pattern of emotional responding consistent with undifferentiated emotional processing in alexithymia. At the psychometric level, this pattern indexes differences in the configurational structure of emotional intensity in alexithymia. Keywords: Alexithymia, Emotional experience, Psychometric analysis, PCA, Monte Carlo resampling

Background Internet Gaming Disorder (IGD) denotes persistent gaming despite harm to daily functioning. Gaming-related harms include preoccupation, social difficulties, sleep problems, negative emotions, and somatic complaints. The GaMe-related Harm Scale (GMHS) assesses these domains (Hata et al., 2025). However, GMHS research has largely focused on individuals with elevated IGD symptoms, leaving it unclear which harm domains are most pronounced compared with a non-IGD group. Aim To examine whether gaming-related harm severity and profiles differ between individuals with and without IGD. Methods This cross-sectional online survey will recruit 1,500 adults (18–39 years) play digital games. IGD symptoms will be measured using Japanese version of the Gaming Addiction Scale (GAS7-J), and harms will be assessed with the GMHS. Participants will be classified using the GAS7-J cutoff (≥4 items rated ≥3 “sometimes”), targeting n=134 per group. A one-way MANOVA (Pillai’s trace) will evaluate group differences across five GMHS subscale scores. If the overall multivariate effect is significant, follow-up univariate comparisons will be conducted for each subscale, and effect sizes will be reported. Expected Results The IGD group may show a higher overall GMHS harm profile than the non-IGD group, with particularly elevated preoccupation, sleep problems, and social difficulties. The poster will display Pillai’s trace, follow-up results, and effect sizes. Discussion Harms selectively elevated in the IGD group may indicate domains of greatest functional impairment and help prioritize assessment and intervention. Domains showing minimal group differences may reflect adverse experiences associated with digital game play irrespective of IGD severity, highlighting targets for prevention.

Aim: Recently, social isolation among adolescents has become a critical issue in South Korea, yet research on the counselors supporting them remains insufficient. Therefore, this study aims to explore the specific difficulties counselors face in this process and describe the essence of their lived experiences. Method: We conducted in-depth interviews with eight counselors experienced in treating isolated and reclusive adolescents. Interviews were conducted non-face-to-face using a semi-structured questionnaire. All sessions were recorded and transcribed, and data were analyzed using Giorgi’s phenomenological method. Results: The analysis identified three super-ordinate themes and nine sub-themes as follows. First, ‘Structural and Environmental Barriers’: structural difficulties in inter-agency cooperation and systemic gaps; hindrance from parental intervention and family dynamics; and lack of professional guidelines and resources. Second, ‘Relational Frustration and Stagnation’: futility from repeated rejection and refusal of contact at "closed doors"; psychological withdrawal in the face of unpredictable behaviors; and frustration with non-progressive, circular communication and communication barriers. Third, ‘Professional Identity Crisis and Burnout’: loss of counseling efficacy and chronic helplessness; emotional exhaustion and cynicism from accumulated failures; and identity confusion driven by unsupportive organizational environments and excessive administrative burdens. Dicussion: Our findings suggest that counselor burnout is accelerated not just by the clients, but by external pressures—including family dynamics, systemic inadequacies, and role overload. Consequently, institutional support systems are urgently needed to support these professionals' role performance and alleviate their burden. Keywords: social isolation and reclusion, adolescents, Giorgi’s phenomenological method, counselors

Background: Advances in mobile technology allow the passive collection of smartphone data that may reflect patients’ mental states. Despite early promising findings, little is known about how digital phenotyping corresponds to patients’ psychological condition, particularly its ability to capture not only between-individual differences but also within-individual change over the course of psychotherapy. Methods: This study explores a series of case studies drawn from a larger randomized controlled trial of patients with major depressive disorder and additional diagnoses. Participants received brief psychodynamic psychotherapy for depression. Automatically collected smartphone data included patterns of social media use and geolocation information. Data were obtained before, during, and after treatment. To assess change in patients’ mental state, digital data were compared with scores on the Hamilton Rating Scale for Depression (HDRS), a clinician-rated instrument measuring severity of depressive symptoms and change over time. Results: Preliminary analyses indicated that patterns of social media use carry detectable signals related to changes in depressive symptoms. Ongoing analyses will further examine how these digital patterns change across treatment phases and will be completed in winter 2026. Discussion: If patients’ mental state can serve as the basis for a measurement that is scalable across many individuals over time with low cost and without requiring active participation from patients, it has the potential to transform the way psychiatric assessment is conducted worldwide. Keywords: digital phenotyping, Hamilton Rating Scale for Depression, depression, psychotherapy process, smartphone data

Background: AI powered virtual patient (VP) system is a novel tool for clinician training. Despite many advantages, the intent-matching based VP system supported by Google DialogFlow exhibits technological disruptions, including intent mismatches that result in nonsense responses and intent no matches that output a fallback request to rephrase. Previous research established that disruptions negatively impacted clinicians’ facial affective behaviors and therapeutic alliance. The current study aims to further explore the impact of technological disruptions on suicidal ideation, suicide crisis, and overall suicidal risk and the differences of impact between Black and White VP. Method: 153 upcoming clinicians each completed one diagnostic interview with the VP. Immediately after the interview, clinicians provided their assessment of the VP on suicidal ideation (C-SSRS), suicide crisis (Suicide Crisis Syndrome-Checklist, SCS-C), and overall suicidal risk (Clinician Prediction Scale, CPS). Technological disruptions were measured by three subject survey questions and the number of intent no match and mismatch, obtained by an analysis on the interaction transcript. Regression analyses analyzed the impact of disruptions and moderation by VP race. Preliminary Results: A preliminary analysis based on incomplete data demonstrated partial support for the hypothesis. Two of the subjective questions (b = 0.212, p = 0.026; b = 0.046, p = 0.047) and being in group black (b = 2.812, p = 0.009) increased the perception of suicidal ideation. Intent-mismatches led to higher perception of SCS-C, b = 0.019, p = 0.021. VP being White exacerbated the impact of disruptions on SCS-C and C-SSRS.

Work plays a central role in adult identity and psychological well-being and with that, adolescents often experience substantial pressure to make “right” career decisions. Career counseling, often integrated within psychotherapy, supports clients in navigating these developmentally and psychologically important decisions. One of the most influential frameworks guiding career counseling practice is Holland (1996)’s vocational interest theory, which conceptualizes both individuals and work environments within a RIASEC structure and links person–environment fit to positive career outcomes. Traditionally, vocational interest assessment has emphasized what individuals like to do. However, interests are inherently bidirectional, encompassing both attraction toward and aversion away from work activities. Drawing on psychological research suggesting that avoidance-related preferences may exert stronger motivational influence than approach-related preferences, this study examines the roles of liking and disliking in vocational interests and career aspirations. Developmental differences are also explored by comparing adolescents and adults. The planned sample includes approximately 300 high school students and 300 adults in South Korea. Participants will complete a Korean translation of the Basic Interest Short Scale (BISS; Hou et al., 2024) and identify and rate 3-5 academic majors and occupational fields they wish to pursue as well as those they wish to avoid. Proposed analyses will examine the structure and relative salience of liking and disliking within the RIASEC framework and test age-group differences in their associations with career aspirations. Findings are expected to inform career assessments and career counseling, with implications for developmentally sensitive and culturally responsive psychotherapy.

Aim: Working alliance (WA) synchrony is critical for psychotherapy outcomes, yet the role of therapist personality on alliance perception remains understudied. This study examined (1) whether novice therapists accurately estimated clients’ WA across sessions and the direction and extent of biases, and (2) whether therapists’ narcissistic personality traits predict the therapists’ estimation accuracy and bias. Methods: 173 novice therapists and 1,848 clients participated in this study. Therapist narcissistic personality was assessed at the beginning of the practicum. After each session, therapists and clients reported their WA ratings, and therapists estimated clients’ WA ratings. Multilevel Truth and Bias Model (TBM) analyses quantified therapists’ overall estimation bias, the impact of clients’ perceptions (truth force) versus therapists’ perceptions (bias force), and examined narcissism as a therapist-level moderator. Results: In the TBM model without the moderator, bias force exceeded truth force, indicating that therapists’ alliance estimates were guided more by their own perceptions than clients’ reports. Therapists also demonstrated a consistent tendency to underestimate clients’ working alliance. When narcissistic personality traits were added, higher narcissism predicted less negative directional bias and stronger bias force, reflecting more favorable, self-referential interpretations of the alliance. Narcissism did not affect truth force, suggesting that sensitivity to clients’ actual alliance levels was unrelated to therapist narcissism. Discussion: These findings suggested that therapists’ alliance perceptions are shaped by underlying cognitive tendencies, which can be influenced by personality traits such as narcissism. This highlights the need for training that helps therapists recognize and manage their own perceptual biases when evaluating WA.

Problematic gaming is a serious global mental health problem, hence the introduction of a new diagnosis of gaming disorder (GD) in the ICD-11. Due to the fact that this is a relatively recently described phenomena and due to the still small number of studies, there are no guidelines for the psychotherapy of GD. The aim of the study was to explore the role psychological mechanisms in problematic gaming, with particular emphasis on desire thinking and (desire to) dissociation. These variables are conceptualised as key factors in current theoretical models such as Compensatory-Dissociative Online Gaming (C-DOG), Interaction of Person-Affect-Cognition-Execution (I-PACE) and metacognitive Self-Regulatory Executive Function (S-REF). The study was conducted on a representative sample of Polish gamers (N=2738). The symptoms of problematic gaming were measured with the Gaming Disorder Test (GDT; Pontes et al., 2021). The prevalence rate of GD was 2.95%, which is consistent with the results of international studies. Currently, 5.9% of participants experienced serious difficulties associated with gaming, which was the reason for seeking help from a psychologist or psychiatrist. Structural equation modeling was applied. In the tested model, the dissociation emerged as a factor contributing to maladaptive cognitive processes associated with problematic gaming. Desire thinking demonstrated the strongest association with problematic gaming symptoms, supporting current theoretical models, which frame it as a perseverative cognitive process sustaining addictive behaviors. The findings contribute to understanding of the cognitive and emotional dynamics of problematic gaming and GD, and suggest potential targets for prevention and intervention strategies.

Dyadic discord has previously been identified as a predictor of depression prognosis, such that dyadic discord in chronically depressed patients has been previously shown to predict a lower likelihood of remission during acute treatment for depression (Denton et al., 2010). However, there remains an open question on relationship between dyadic adjustment on the long term prognoses of recovery and depressive recurrence. We analyzed data from a clinical trial on 108 individuals who were married or cohabiting, and treated for chronic or recurrent depression received with either acute antidepressant monotherapy or antidepressants in combination with cognitive therapy. Patients were then randomly assigned to antidepressant maintenance or withdrawal, and monitored for recurrence over the course of 3 years. Patients completed the dyadic adjustment scale (DAS) at both intake, and at re-assignment to antidepressant maintenance or withdrawal. We found that dyadic adjustment did not significantly predict recurrence risk. However, the interaction between dyadic adjustment and maintenance condition was significant (b = -0.035, z = -2.15, p <.05), such that individuals high on dyadic adjustment experienced a stronger reaction to medication withdrawal vs maintenance compared to individuals low on dyadic adjustment. It thus appears that dyadic adjustment is a moderator of recurrence risk, such that individuals high on dyadic adjustment are more sensitive to medication withdrawal. Our results highlight the importance of dyadic adjustment as a potential moderator of stress than can occur when individuals are withdrawn from antidepressant medications.

Bedtime music is a commonly used self-help approach for insomnia, yet its efficacy remains inconsistent. This study examined the effects of bedtime soothing music combined with sleep hygiene education on sleep quality. In this study, 18 participants (4 males; mean age = 21.0 years) with subclinical sleep-onset difficulties were randomly assigned to either Music Group (n = 10) or Control Group (n = 8). The process consisted of a 1-week baseline, a 3-week intervention period, and a 1-week withdrawal phase. All participants received sleep hygiene education; participants in the Music Group listened to soothing music for 30 minutes at bedtime during intervention, including an ambient ocean-wave track (39 BPM) characterized by stable low-frequency energy (<500 Hz) and a piano–guitar track with bird sounds (80 BPM) featuring dynamic mid-frequency energy (200–2,000 Hz). Sleep outcomes were assessed using sleep diary, actigraphy, and questionnaires, including the Chinese Pittsburgh Sleep Quality Index (CPSQI), Epworth Sleepiness Scale (ESS), and Pre Sleep Arousal Scale (PSAS). Within-group analyses showed significant post-intervention reductions in subjective sleep disturbance and daytime sleepiness in the Music Group, as reflected by decreases in CPSQI (mean reduction = 1.6, p = .016) and ESS scores (mean reduction = 3.3, p = .002). Objective changes did not reach statistical significance; however, trend analyses indicated gradual improvements during the intervention period, followed by a return toward baseline during withdrawal. In conclusion, soothing bedtime music may potentially facilitate sleep initiation, improve subjective sleep quality, and reduce daytime sleepiness in individuals with subclinical insomnia.

Aim: Accelerated Experiential Dynamic Psychotherapy (AEDP) is an attachment-based approach aimed at facilitating emotional and relational transformation. Several case studies have demonstrated AEDP’s potential for C-PTSD. This study compares therapist interventions in two successful and one partially successful case to identify those therapist responses associated with patient improvement. Methods: From a practice-research network study based on a 16-session AEDP, three cases were selected based on pre–post treatment changes on the International Trauma Questionnaire (ITQ). For each case, sessions identified by clients as the most significant were examined. Clients’ emotional states were coded with Transformational Process Scale, while therapist responses were coded with AEDP Therapist Intervention Scale (AIMS), both of which are observer-rated scales grounded in AEDP theory. A cross-case comparison was conducted. Results: In both successful cases, deep emotional experiences were followed by a malleable, change-receptive state in clients. During these moments, therapists supported shifts in meaning-making. Improvements in the real relationship also emerged, supported not only by emotion-focused work but also by relational interventions including therapist self-disclosure. In the partially successful case, only deep emotional work or relational work occurred, but not both. Discussion: Working on both painful and positive emotions were worked through as dyads explicitly focused on the here-and-now relationship. Integrating deep emotional processing with relational processing may be central to therapeutic change in AEDP for C-PTSD.

Domestic violence (including intimate partner violence) remains a major public health and social welfare concern. In Taiwan, official statistics indicate that reported domestic violence cases increased from nearly 150,000 in 2020 to approximately 179,000 in 2024; intimate partner violence accounted for about half of these reports (approximately 85,000), with around 70% of victims being women, and survivors typically enduring violence for an average of 4.2 years before formal reporting. In parallel, global data highlight the substantial scope of the problem: WHO estimates that about 30% of women experience physical or sexual violence by a partner or non-partner during their lifetime, and UNICEF has reported that approximately 275 million children worldwide are exposed to intimate partner violence in the home. Despite growing attention and policy initiatives, notable gaps remain. Existing research and practice have often emphasized etiological factors and perpetrator characteristics, while comparatively less is known about survivors’ recovery trajectories—particularly for women who are mothers and for young children exposed to violence. Additionally, the influence of cultural context on help-seeking and service engagement requires further elaboration. Fragmented coordination among police, healthcare, social welfare, and judicial systems may lead to secondary harm or disrupted support. In clinical practice, many interventions for domestic violence have historically focused on school-aged children through adulthood, leaving the early childhood period relatively under-addressed. Against this backdrop, this review adopts a survivor-centered perspective. It examines Child–Parent Psychotherapy (CPP) as a dyadic, attachment- and trauma-informed intervention that targets parent–child interaction, communication, and the emotional–behavioral sequelae of domestic violence exposure, to support relational repair and overall family functioning. Research Methods This systematic review was conducted in accordance with PRISMA procedures. Electronic database searches were conducted across PubMed, IEEE ASPP, Springer Nature Link, Academic Search Premier, ScienceDirect Online (SDOL), PsycINFO, Google Scholar, and the CEPS Chinese-language database. The search window covered publications from January 1, 2015, through 2025 (the search was executed in late 2025). Search terms were developed using a PICO framework and Boolean operators, combining domestic violence exposure terms (e.g., “domestic violence,” “intimate partner violence,” “family violence,” “child witnesses”) with CPP terms (e.g., “Child-Parent Psychotherapy,” “CPP”). Reference lists of included studies were also hand-searched to increase completeness. Eligibility Criteria Studies were eligible if: (1) participants were young children exposed to or witnessing domestic violence (defined as ages 0–6) and their primary caregivers; (2) CPP was the core intervention in the experimental condition; (3) designs included randomized controlled trials (RCTs), non-randomized controlled studies (e.g., quasi-experimental/CBA), or other quasi-experimental designs; (4) publication dates fell within 2015–2025; and (5) articles were published in English or Chinese. Studies were excluded if they were reviews/meta-analyses, case reports, qualitative-only studies, protocols, did not use CPP as the primary intervention, or did not focus on domestic violence survivor populations. The final corpus included five empirical studies. Screening, Data Extraction, and Quality Appraisal The retrieved records were imported into a reference management software and de-duplicated. Two reviewers independently performed a two-stage screening process (title/abstract and then full-text), resolving disagreements through discussion and, when necessary, adjudication by a third senior reviewer. Data extraction was performed independently by two reviewers using a standardized form to capture bibliographic information, design, sample characteristics, CPP delivery parameters (duration/frequency, as well as comparison conditions), outcomes, and quantitative results. Given the inclusion of multiple study designs, methodological quality was appraised using the Joanna Briggs Institute (JBI) critical appraisal tools (RCT checklist for randomized trials and quasi-experimental checklist for non-randomized studies). Data Synthesis Because the included studies were expected to show substantial heterogeneity in design (RCT and non-RCT), comparison conditions, and outcome measures, the review did not conduct a meta-analysis. Instead, a narrative synthesis was undertaken, organized around: (1) study characteristics and quality; (2) child outcomes (e.g., trauma symptoms, behavior problems); (3) caregiver outcomes (e.g., trauma symptoms, parenting stress, mental health); and (4) parent–child relationship quality. Research Participants / Study Targets Because this is a systematic review, the “participants” are both (a) the included studies and (b) the clinical samples within those studies. The final synthesis included five empirical studies published between 2015 and 2025, primarily conducted in clinical settings in the United States or Europe. Across studies, CPP targeted young children aged 0–6 and their primary caregivers who had experienced or witnessed domestic violence. Reported sample sizes ranged from N = 37 to values not fully specified in the current manuscript draft. CPP, as conceptualized in this review, is a dyadic intervention derived from the traditions of infant–parent psychotherapy. It integrates psychodynamic theory, attachment theory, trauma-informed principles, and social learning theory, and emphasizes corrective emotional experiences within the caregiver–child relationship to reduce child behavioral problems and caregiver trauma-related symptoms. Safety considerations were explicitly noted: CPP for domestic violence-exposed dyads should be implemented under conditions such as the perpetrator not cohabiting with the child and survivor caregiver, and the caregiver not having severe mental illness or brain injury. The intervention process was described as broadly comprising three phases—relationship building/assessment, trauma processing, and termination/future planning—delivered through joint dyadic sessions as well as individual sessions with child and caregiver when appropriate. Key Findings and Results (1) Overall Evidence Profile Methodological quality varied across included studies. While many studies reported adequate treatment integrity and clear follow-up assessments, supporting consideration of longer-term effects, limitations were also prominent, including small sample sizes and the inclusion of non-randomized designs. Consequently, the overall evidence base was judged to be moderate-to-low, and causal inference requires caution, particularly when effects derive from within-group change in the absence of a control condition. (2) Child Outcomes: Trauma Symptoms and Behavioral Functioning Across the narrative synthesis, CPP demonstrated consistently positive effects on child outcomes among young children exposed to domestic violence. In particular, posttraumatic stress symptoms (PTSS) showed significant and sustained reductions following CPP across multiple studies. One study reported that improvements in child PTSS continued at a 6-month follow-up, with a within-group effect size of d = 0.62 (moderate). In the same study, the proportion of children meeting PTSD diagnostic criteria decreased from 78% at baseline to 32% after treatment. Beyond trauma symptoms, CPP was associated with improvements in child behavioral outcomes. Although instruments differed across studies, the direction of findings was consistent with reductions in internalizing and externalizing behavior problems following CPP. (3) Caregiver Outcomes: Trauma-Related Symptoms and Parenting Capacities CPP’s dyadic design targets both child and caregiver recovery. Caregiver trauma-related symptoms (e.g., IES-R) decreased significantly and durably after CPP. One study reported a moderate within-group effect size for caregiver PTSS reduction at 6-month follow-up (d = 0.57). Importantly, symptom interdependence was observed: higher child trauma severity at treatment entry was associated with smaller reductions in caregiver trauma-related stress, highlighting reciprocal dynamics in caregiver–child trauma recovery and underscoring the clinical rationale for dyadic intervention models. Additional findings suggested that CPP can reduce maternal avoidance symptoms and may enhance parenting-related strengths such as parenting self-efficacy and self-compassion in domestic violence survivor populations (as reported in included studies). (4) Parent–Child Relationship Quality: Attachment Repair and Relational Safety A central mechanism of CPP is healing through attachment repair. The included studies indicated that caregiver-reported indicators of disorganized or disrupted parenting behaviors decreased significantly after CPP, with one study reporting a moderate within-group effect size at 6-month follow-up (d = 0.64). These findings align with CPP’s aim to reduce frightening/frightened caregiver behaviors, strengthen caregivers’ capacity to support children’s emotion regulation, and reinforce the parent–child relationship as a protective “buffer” in trauma recovery. Summary Interpretation In synthesis, the evidence reviewed suggests that CPP is a promising, trauma- and attachment-informed dyadic intervention for domestic violence-exposed young children and their caregivers. Across five empirical studies, CPP was associated with (a) reductions in child PTSS and behavioral problems, including notable changes in PTSD diagnostic rates in at least one study; (b) decreases in caregiver trauma-related symptoms with moderate effect sizes and clinically meaningful symptom interdependence; and (c) improvements in relationship quality, including reductions in disrupted parenting behaviors consistent with attachment repair. At the same time, the reviewed evidence base remains constrained by methodological and contextual limitations—small samples, mixed designs, and high heterogeneity that precluded meta-analysis—supporting the need for additional rigorous controlled studies and culturally responsive adaptations for diverse service systems and sociocultural contexts.

Background: Low-intensity CBT based guided self-help (GSH) and guided internet-delivered CBT (GiCBT) have demonstrated equivalent effectiveness and superior cost-efficiency compared to traditional face-to-face CBT (fCBT) for treating depression and anxiety. This study addresses gaps in the current understanding of the effectiveness and cost-effectiveness of various CBT interventions for depression and anxiety within a stepped care model. Methods: A pragmatic multi-center RCT study with four parallel study protocols (the Finnish First-Line Therapies –Initiative study, FLT-step) for examining three widely used CBT interventions in public healthcare using a stepped care approach according to the FLT-Initiative. The study was preregistered in spring 2024, and participant recruitment began in September 2024. We compare the effectiveness and cost-effectiveness of three treatment approaches for depression (protocol 1) and anxiety (protocol 2) in a non-inferiority setting within the Finnish public healthcare: A) stepped care (GSH followed by fCBT for non-responders), B) fCBT, and C) GiCBT. A randomized substudy will examine the effect of waiting time <4 or ≥5 weeks) for the treatment outcomes of depression or anxiety 4), comparing the stepped care model (A) and fCBT (B). In all RCTs, the primary outcome measures are the within-individual change in depression (PHQ-9) or anxiety (GAD-7) symptoms at six months. Secondary outcomes include wellbeing, work and social ability, costs associated with illness, and quality of life. Results: As per 1.12.2025 we have recruited over 950 patients, making this one of the largest-ever psychotherapy RCT:s conducted. We will present the study design, current data collection phase and preliminary results.

In emotion-focused therapy (EFT), establishing a secure therapeutic relationship is essential for facilitating emotional processing, particularly when working through painful core emotions. Building on research demonstrating that early alliance predicts therapeutic outcomes (Flückiger et al., 2018) and Greenberg’s (2014) dual-function model of therapeutic relationships, we examined whether initial session working alliance predicts corrective emotional experiences (CEEs) across early EFT sessions. Method: Participants were 26 Japanese adults (18 female; M age = 35.4) with unresolved emotional injuries receiving 16-session individual EFT. The Working Alliance Inventory (WAI), Session Evaluation Questionnaire (SEQ), and Corrective Emotional Experience Scale (CEES) were administered post-session. Data from sessions 1–5 (127 observations) were analyzed using linear mixed models with random intercepts and slopes to account for the nested data structure. Results: Initial WAI significantly predicted all CEE subscales: emotional transformation (β = .23, p < .001), new understanding (β = .18, p < .01), and core pain (β = .19, p < .01). Time × WAI interactions were non-significant, indicating stable alliance effects across sessions. When SEQ depth was included, initial WAI effects became non-significant, while depth strongly predicted CEEs (β = .58–.76, p < .001). Discussion: Initial working alliance may function as a secure base enabling deeper emotional exploration, consistent with Greenberg’s theoretical framework. The attenuation of alliance effects when controlling for session depth suggests potential mediation, warranting further investigation.

Background: Pregnancy losses and abortions are common reproductive events; miscarriage is the most frequent complication in early pregnancy, and the lifetime prevalence of abortions is estimated at approximately one-third of gestational individuals. While quantitative research has predominantly focused on individual outcomes such as depression or anxiety, interpersonal consequences remain understudied. To date, no comprehensive systematic review and meta-analysis has synthesized quantitative findings on how loss affect interpersonal outcomes. Research Question: Among adults who have experienced a loss, what are the effects on interpersonal family outcomes – such as parental partnership, parent-child relationship, and parenting behavior – compared to participants without such experiences or compared pre-/post-loss within exposed participants? Method: The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251138481). In August 2025, six databases were searched. Eligible studies included adults with a history of loss, applied validated instruments, and used a non-exposed comparison group or pre-/post-exposure design. Risk of bias was assessed using JBI checklists. Results: Of 7,961 records screened, 17 studies met inclusion criteria. Outcomes included partnership, parent-child relationship, and parenting behavior. No consistent significant effects were found. Risk of bias varied. A meta-analysis of five studies assessing prenatal attachment following loss showed no significant pooled effect (g = −0.16, 95%-CI [−0.36; 0.04]). Conclusion: Quantitative evidence on interpersonal consequences of loss remains limited and heterogeneous. Comparative evidence across loss types is insufficient, and abortion remains underrepresented. Overall, the evidence base does not allow robust conclusions, highlighting the need for more rigorous research to clarify effects on family dynamics.

Multiple sclerosis is a chronic inflammatory autoimmune disease. Its anatomical basis consists of areas of demyelination in the central nervous system, causing changes in neural conduction. As a consequence, patients may report symptoms such as cognitive impairments or physical disability (Boesen et al., 2020). Self-management refers to the ability to manage one’s own treatment, the consequences of illness, and the necessary lifestyle changes associated with living with a chronic disease (Kidd et al., 2017). Research shows that interventions focused on strengthening this ability effectively improve quality of life. This is particularly important in the case of individuals with multiple sclerosis, as, according to current knowledge, their subjectively assessed quality of life is lower not only than that of healthy individuals, but also than that of people with other chronic diseases (Kidd et al., 2017). Few studies address individuals with multiple sclerosis who are simultaneously in the period of emerging adulthood. Arnett identified five characteristics defining this life stage: a sense of feeling “in-between” adolescence and adulthood, identity exploration, self-focus, experimentation and possibilities, as well as skepticism and instability (Arnett, 2007). I will present the results of my own research examining whether engaging in self-management behaviors is associated with the quality of life of patients in the period of emerging adulthood. I will also present a review of possible therapeutic interventions supporting the development of desired skills.

Clients differ widely in how they experience and express emotion when they enter psychotherapy, and these differences may be relevant to treatment response. However, early emotional expression is rarely examined as a source of individual variability in outcome, particularly across different diagnoses and treatment models. This study uses archival data from five psychotherapy process–outcome studies that include clients with different diagnoses and who received different forms of psychotherapy (N ≈ 150–200) to examine patterns of emotional expression during early therapy sessions and their relation to treatment outcome. Emotional expression is represented by proportion scores across six emotion states derived from Classification of Affective Meaning States (CAMS) coding conducted in the parent studies. Planned analyses include cluster analysis to identify patterns of early emotional expression, followed by multiple regression analyses examining associations between these patterns and post-treatment symptom change, while accounting for baseline severity and study-level differences. Expected findings include the identification of a small number of subgroups that may differ in the relative presence of global distress, fear/shame, rejecting anger, and more adaptive emotional states such as assertive anger or self-compassion. Patterns characterized by higher levels of adaptive emotion are expected to be associated with greater symptom improvement, whereas patterns dominated by global distress or fear/shame may be associated with less favourable outcomes. Rejecting anger may be associated with variable outcomes. This exploratory study aims to clarify whether early emotional expression represents a meaningful source of individual variability in psychotherapy outcomes across diverse clinical contexts. Emotional Expression, Individual Differences

Aim: Difficulties in emotion regulation are associated with various psychological problems and considered a transdiagnostic factor in affective disorders such as depression and anxiety. This study examined the role of emotion regulation in treatment outcomes within Emotion-Focused Therapy (EFT) in a Japanese sample. Specifically, (1) we compared changes in emotion regulation functioning and psychological symptoms from pre- to post-treatment, and (2) we investigated the relationship between emotion regulation functioning and types and intensity of emotions experienced during sessions. Methods: Data from 33 cases in an ongoing EFT study in Japan were analyzed. Emotion regulation function was assessed using the Self-Compassion Scale (Ishimura et al., 2014), and psychological symptoms were measured with the CES-D (Shima et al., 1985) pre- and post-treatment. Types and intensity of emotions experienced during sessions were measured using self-report scales. Results: Depressive symptoms significantly decreased after EFT intervention. Clients showing a greater change in positive emotion regulation demonstrated significantly lower post-treatment depressive symptoms; no significant differences were observed pre-treatment. Post-treatment, the group showing greater changes in positive emotion regulation had significantly lower depressive symptoms compared to those with smaller changes. Discussion: The study results indicate that changes in emotion regulation functioning after EFT intervention may contribute to reductions in depressive symptoms. These findings highlight emotion regulation as a key process in EFT. Future research should examine the processes by which emotion regulation influences intervention effects, including the types and intensity of emotions experienced during intervention. Keywords: emotion regulation, Emotion-Focused Therapy, treatment process and outcome, Japanese sample

High‑quality healthcare is a universal right, yet disparities in pain assessment and treatment persist across racialized identities. Empathic communication and attunement—fundamental across all clinical settings—are crucial for equitable care. Research shows that Black patients often receive less adequate pain treatment and that their pain is more frequently underestimated compared to White patients, suggesting that empathy likely plays a key role in shaping such differential responses. This work‑in‑progress project seeks to better understand mechanisms contributing to these inequities. In this ongoing study, we examine how clinical psychologists in training respond empathically to pediatric pain expressions from White and Black children. We assess both self‑oriented (e.g., personal distress) and other‑oriented (e.g., empathic concern) emotional responses and analyze whether these differ depending on the child’s racialized identity. We also investigate how these emotional responses manifest in verbal communication. Specifically, we explore whether pain expressions by White children elicit more other‑oriented supportive feedback, whereas pain expressions by Black children evoke more self‑oriented, distress‑based communication. The study employs an experimental design in which participants are randomly assigned to either an experimental group receiving an empathy‑enhancing intervention or a control group receiving no intervention. This design allows us to evaluate whether the intervention improves communication skills and reduces racialized differences in empathic responding. As this work is still in progress, preliminary results will be available at the time of the conference, offering early insight into mechanisms underlying racial disparities in pediatric pain care and informing future interventions aimed at advancing equity in clinical practice.

Background Domestic and sexual violence remain pervasive public health issues in Taiwan, with survivors often experiencing complex trauma and barriers to help-seeking. Trauma-informed care (TIC) emphasizes understanding trauma responses and avoiding re-traumatization through the principles of realizing, recognizing, responding to, and resisting re-traumatization. However, undergraduate counseling curricula rarely provide structured, competency-based training for supporting survivors of domestic and sexual violence. This study evaluated a TIC-infused course, “Sexual Assault and Domestic Violence Prevention,” which integrated simulated cases, peer practice, and an Objective Structured Clinical Examination (OSCE) to enhance students’ counseling competencies. Methods Approximately 70 senior counseling majors enrolled in a one-semester, 18-week course at a university in Taiwan. The course combined didactic sessions on domestic and sexual violence, trauma, and TIC with weekly skills practice, standardized client simulations, and professional supervision. Data sources included: (a) pre- and post-course counseling self-efficacy measures specific to working with domestic and sexual violence survivors; (b) OSCE performance ratings using a structured rubric developed from TIC and counseling competency literature; and (c) brief written reflections following the OSCE. Quantitative data were analyzed using paired-sample t-tests, with effect sizes and correlations examined between self-efficacy and OSCE scores. [Please insert the exact names of instruments and statistical details.] Results Preliminary analyses indicated significant increases in students’ counseling self-efficacy from pre- to post-test, particularly in trauma-informed assessment, emotional regulation support, and safety planning with survivors. OSCE results showed that most students met or exceeded the predetermined competency threshold (e.g., ≥80% of the rubric score), with the strongest performance in building safety and rapport and areas for improvement in managing intense affect within time-limited sessions. Higher post-course self-efficacy scores were moderately associated with better OSCE performance. [Please insert exact statistics: n, means, standard deviations, t-values, p-values, and effect sizes.] Conclusions Integrating trauma-informed principles with OSCE-style assessment into an undergraduate counseling course appears feasible and effective in strengthening students’ competencies for working with domestic and sexual violence survivors. The combination of structured skills training, standardized clients, and competency-based evaluation may help bridge the theory–practice gap and provide a more robust quality-assurance mechanism before students enter practicum and frontline work. Implications for scaling this model to other counseling and helping-profession programs will be discussed.

Subclinical depression is known to carry a high risk for developing major depressive disorder, making individuals with subclinical symptoms an important target group for preventive interventions. Equine-Assisted Biographical Work (EABW) intends to reduce depressive symptoms and decrease risk of major depression. Participants explore significant life themes across developmental stages—from childhood to adulthood—while the horse is used as a supportive medium to facilitate emotional access, reflection, and engagement. Findings from a randomized controlled trial with individuals aged 50 and older with subclinical depression are presented. Fifty participants were randomly assigned either to eight weekly EABW sessions or to a no-treatment control group. A follow-up assessment was conducted after three months. The primary outcome was change in depressive symptoms measured with the Beck Depression Inventory-II (BDI-II). Secondary outcomes included anxiety levels, behavioral avoidance, and general health as assessed by the SF-36. Results showed that participants receiving EABW experienced significantly greater reductions in depressive symptoms compared to the control group at both post-treatment and follow-up, with large effect sizes. EABW also led to greater improvements in anxiety, behavioral avoidance, and general mental health on the SF-36. No group differences were found for physical health. Overall, participants benefited from EABW, demonstrating stable improvements over time. The findings suggest that EABW may be an innovative preventive approach for individuals with subclinical depression, supporting emotional well-being, reducing anxiety, and enhancing quality of life. The presence of the horse appeared to serve as a gentle and effective facilitator of therapeutic processes.

Increasing evidence suggests that multisensory urban environments influence residents’ psychological health. This study investigates how sensory stimuli (sound, smell, touch, and visual impressions) in Warsaw’s city districts relate to well-being and mindfulness. In a quantitative mapping study (N=1062), participants reported the sensory qualities of their neighborhoods and completed standardized measures of well-being (WHO-5), mindfulness (MAAS, SMS), affect (PANAS), and life satisfaction (SWLS). We then conducted a controlled experiment (N=60) in a Warsaw city garden, comparing a 10-minute multisensory walk to a control activity, with mood and mindfulness assessed before and after the intervention. Results indicate that districts rated higher in sensory quality—characterized by natural sounds, greenery, tranquility, and pleasant odors—had significantly higher scores on mindfulness, emotional well-being, and life satisfaction. Areas with dense, overstimulating urban features were associated with lower psychological outcomes. In the experiment, participants exposed to the multisensory walk reported significant increases in positive affect and state mindfulness compared to the control group. These findings suggest that well-designed sensory environments can act as everyday therapeutic spaces supporting psychological resilience and subjective well-being. Urban planning implications include integrating sensory-rich elements such as vegetation, tactile surfaces, quiet zones, and natural soundscapes into city design. Promoting such environments may strengthen residents’ capacity for recovery, satisfaction with life, and day-to-day mental health. By prioritizing sensory quality, cities can become more mindful, inclusive, and supportive of collective well-being.

Aim PTSD symptom clusters may exhibit unique change patterns, offering an opportunity for improving treatments. To identify potential treatment adaptations, we examined dynamics of PTSD symptom change across two trials of prolonged exposure and/or sertraline. Method Six bivariate dynamic structural equation models examined longitudinal, session-by-session, within-person associations between PTSD symptom (PSS-SR, PTCI) pairs across treatments (N = 291). Results Avoidance reductions predicted arousal ( = .22, SE = 0.04, p < 0.001), reexperiencing ( = .17, SE = 0.03, p < 0.001), and negative cognition reductions ( = .41, SE = 0.03, p < 0.001). Arousal reductions predicted avoidance ( = .31, SE = 0.04, p < 0.001), reexperiencing ( = .19, SE = 0.03, p < 0.001), and negative cognition reductions ( = .72, SE = 0.03, p < 0.001). Reexperiencing reductions predicted avoidance ( = .25, SE = 0.04, p < 0.001), arousal ( = .11, SE = 0.03, p < 0.001), and negative cognition reductions ( = .35, SE = 0.04, p < 0.001). Negative cognition reductions predicted avoidance reductions ( = .05, SE = 0.02, p = 0.012) but not reexperiencing or arousal (ps > 0.05). Discussion Avoidance-arousal, avoidance-reexperiencing, and arousal-reexperiencing exhibited reciprocal but small predictive relationships. Cognition change followed and exerted minimal power as a driver of other-symptom change. Moderate-to-large effects occurred only for predictors of cognition change, suggesting cognitive updating and emotional processing occurs later. Findings contextualize existing literature implicating cognitions as a between-person driver of symptom reduction and can inform within-person-level treatment adaptations.

Gender and ethnic disparities in mental health service access and experiences of loneliness persist among U.S. college students, with minoritized populations facing compounded barriers to care (Sigal & Plunkett, 2024). This proposed quantitative study examines gender and ethnic differences in the frequency and severity of self-reported loneliness and perceived social support using archival Counseling and Psychological Services intake data collected over the past five years at a predominantly White and Christian university. Self-report measures routinely administered at intake, including the Counseling Center Assessment of Psychological Symptoms (CCAPS-62), the Outcome Questionnaire (OQ-42), and standardized intake documentation, will be used to compare patterns of loneliness-related symptom endorsement and perceived social support across gender and ethnic groups. Prior research suggests that male students demonstrate higher self-stigma, less favorable attitudes toward psychological help, and lower rates of service utilization despite evidence of elevated loneliness, particularly in individualistic cultural contexts (Barreto et al., 2021). In contrast, women are more likely to report psychological distress and engage in help-seeking, yet continue to exhibit unmet treatment needs. Racial and ethnic minority students, including Asian, Black, and Latin populations, consistently report higher levels of stigma, greater mistrust of mental health services, and lower utilization relative to White students, even in the presence of clinically significant distress (Sigal & Plunkett, 2024). By examining loneliness and perceived social support, this study aims to clarify how intersecting identities and cultural environments shape patterns of symptom reporting and access to care, with implications for developing culturally responsive, stigma-informed interventions in counseling settings.

Aim: Despite increasing awareness of mental health disparities among ethnic minority groups, Pacific Islanders (PIs) remain underrepresented in psychological research. Understanding cultural dynamics can help mental health providers develop culturally responsive interventions (Allen et al., 2016). By examining the interplay between anxiety, help-seeking intentions, advice-seeking, and psychotherapy expectations, this study aims to contribute to the broader discourse on mental health factors among PIs. Methods: The sample for this study included 593 PIs in the US. We used a Pearson bivariate correlation analysis to compare the study variables. Next, we ran regression analyses to assess whether anxiety predicted intentions to seek counseling for academic, psychological and interpersonal concerns, and if advice-seeking predicted expectations for positive therapeutic outcomes. Finally, we ran a regression analysis to determine whether advice-seeking predicted the expected outcome of therapy. Results: Anxiety was positively correlated with intentions to seek counseling for academic concerns (r = .42, p < .001) and psychological and interpersonal concerns (r = .35, p < .001). Expectations of positive psychotherapy outcomes were positively associated with advice-seeking (r = .51, p < .001). Anxiety significantly predicted intent to seek counseling for academic concerns (R2 = .181, p < .001) and interpersonal concerns (R2 = .122, p < .001). Advice seeking in therapy significantly predicted expected outcomes of therapy (R2 = .259, p < .001). Discussion: PIs may keep mental health problems private, which may prevent them from seeking therapy. Also, it appears that anxiety may be a factor for PIs to seek out professional help.

Research has found that maladaptive perfectionism can lead to feelings of inadequacy and higher levels of suicidal ideation and suicide (Brennan-Wydra et al., 2021; Christman, 2012; Kiamanesh et al., 2015). In some circumstances, religion may lead to a lower sense of psychological well-being. Cross-sectional and longitudinal studies have shown that individuals with negative religious coping styles are likely to experience depression, anxiety, and excessive stress (Ano & Vasconcelles, 2005, Mohammadzadeh & Najafi, 2020, Zarrouq et al., 2021). Multiple studies have found that maladaptive perfectionism is likely to be present in LDS members with scrupulosity (Allen & Wang, 2014; Allen et al., 2015; Allen et al., 2021; Wang et al., 2018). Scholars discovered that scrupulous individuals in the LDS population are likely to have lower levels of life quality and experience anxiety and depression; this may be because individuals feel constant guilt and shame from persistent feelings of not measuring up (Allen & Wang, 2014). Our study examines intersecting variables across scrupulosity, maladaptive perfectionism, suicidal ideation, and self-compassion. Furthermore, our study specifically inquires if self-compassion mediates the relationship between scrupulosity and suicidal ideation. Participants: Ninety-nine (N = 99) individuals completed surveys (66 females, 33 males; Mage = 22; age range =18–34 years). Participants were recruited from a private religious institution. Methods: To assess maladaptive perfectionism, scrupulosity, self-compassion, & suicidal ideation we used the following instruments; The Almost Perfect Scale-Revise; The Penn Inventory of Scrupulosity; The Self-Compassion Scale Short-Form; and The Beck Scale for Suicide Ideation. Data analysis involves CFA and SEM.

Background Accelerated Experiential Dynamic Psychotherapy (AEDP) is an integrative psychotherapy model whose unique features include a focus on positive emotions and relational experiences. Previous psychotherapy research suggests that in-session emotional and relational processes play an important role in therapeutic change. However, few empirical studies have examined AEDP using statistical models that accurately reflect the hierarchical structure of psychotherapy data. Aim This study aims to examine treatment outcomes (i.e., symptom and functional improvement) in AEDP using multilevel modeling, and to test how session-level therapeutic processes (e.g., emotional experience and therapeutic relationship), client-level background and relational characteristics, and therapist-level professional and process-related characteristics predict these outcomes. Method Data were drawn from an AEDP Research Group dataset collected as part of an ongoing psychotherapy research program.　Session-level process measures had been collected after each session from both clients and therapists. Client measures assessed session impact, alliance, emotional experience, undoing aloneness, transformational affects, therapeutic presence, acceptance-based processes, and relational experience. Therapist measures included parallel assessments of alliance, emotional processes, transformational affects, the real relationship, and AEDP-specific affective change processes. A three-level multilevel model was applied, with sessions at Level 1, clients at Level 2, and therapists at Level 3. Expected Results The study is ongoing, and this will be an interim report. clients are expected to show improvement across sessions regardless of initial symptom severity. At the session level, deeper emotional experience, stronger alliances, and positive affective changes are expected to be associated with better outcomes. Therapist-level differences are also expected to influence trajectories of change. Discussion By examining symptom and functional improvement over time, this study seeks to clarify mechanisms of therapeutic change within the AEDP framework. The use of multilevel modeling allows for a rigorous secondary analysis of psychotherapy process data and is expected to provide further empirical support for AEDP as an evidence-based psychotherapy.

This study examined the predictive relationships between multidimensional psychological symptoms and both negative and positive mental health indicators among higher-education students. Using the Chinese version of the Counseling Center Assessment of Psychological Symptoms (CCAPS), eight symptom domains—Depression, Generalized Anxiety, Social Anxiety, Academic Distress, Eating Concerns, Family Distress, Hostility, and Substance Use—were employed to predict four outcome variables: life satisfaction, psychological distress, subjective well-being, and self-esteem. A total of 313 valid questionnaires (usable response rate = 99.4%) were analyzed, comprising a heterogeneous sample in terms of gender, age, and educational level. Multiple regression analyses revealed that the overall models for all four outcomes were statistically significant. Across analyses, depressive symptoms emerged as the most consistent and robust predictor, significantly predicting lower life satisfaction, poorer well-being, reduced self-esteem, and higher psychological distress. In addition, academic distress uniquely predicted life satisfaction, family distress was negatively associated with subjective well-being, and social anxiety significantly predicted lower self-esteem. Psychological distress was primarily explained by depression and generalized anxiety, with hostility also contributing incremental predictive value. Overall, the findings support a dual-continuum perspective of mental health, demonstrating that psychological symptoms are differentially associated with both distress-based and well-being–oriented outcomes. The results highlight the clinical utility of CCAPS as a comprehensive assessment tool in university counseling settings and underscore the importance of addressing depressive symptoms alongside contextual stressors such as academic, familial, and interpersonal difficulties. Implications for assessment-driven intervention and future longitudinal research are discussed. Keywords: Counseling Center Assessment of Psychological Symptoms (CCAPS), College Counseling,

Aim: Young queer men of color (YQMC) experience intersecting forms of racism, homophobia, and social marginalization that contribute to disproportionate mental health challenges. Despite these disparities, there is limited psychotherapy research examining culturally relevant coping strategies for this population. Self-compassion has been linked to improved psychological well-being across diverse groups. This study explored the preliminary mental health benefits, acceptability, and implementation considerations of self-compassion interventions among YQMC. Methods: Semi-structured interviews were conducted virtually with 11 YQMC aged 19-30, representing diverse sexual orientations, gender identities, racial/ethnic backgrounds. Participants experienced three guided self-compassion activities, lasting approximately thirty minutes in total. Interviews explored participants’ experiences of the exercises and their meanings and were transcribed verbatim and analysed using a thematic analysis approach. Results: Preliminary findings indicated that participants found the self-compassion exercises acceptable and satisfactory, with reported increases in emotional awareness and self-kindness. Participants expressed strong support for developing accessible self-compassion tools to reach a wider segment of the community. Thematic analysis identified prevalent myths about self-compassion, including beliefs that it promotes self-indulgence. Engagement in the exercises appeared to challenge these assumptions and reframed self-compassion as an active and practical coping practice. Participants also offered concrete recommendations for implementation, such as using culturally responsive language and providing neurodivergent-affirming options. Discussion: Self-compassion appears to be a promising, acceptable, and culturally relevant approach for addressing the psychological impact of stress and discrimination among YQMC. The findings extend existing self-compassion literature by highlighting how these practices are interpreted and adapted within the sociocultural contexts of YQMC.

Intimate partner violence (IPV) is a major public health issue worldwide. Although both women and men can perpetrate IPV, most reported cases in recent years have involved male perpetrators, and studies indicate that men tend to use more severe forms of violence. Traditional masculine ideologies may partly explain why men repress distress and adopt aggressive behaviors when feeling vulnerable. Emotions like sadness and shame, described as a painful emotion that attacks the sense of self, can trigger defensive reactions. Research has shown a link between shame and aggression in men, and within couples, shame may be a central emotion predicting violent behavior. Despite that, research on IPV perpetrators remains limited. Few studies have focused specifically on perpetrators’ emotional experiences preceding violent acts. To address this gap, this study will explore the emotional experiences of men who have perpetrated IPV through a qualitative design using interpretative phenomenological analysis. We aim to see whether shame or other vulnerable emotions emerge. Participants will be heterosexual adult men (18+) from a clinical population — men who have used violence in a past or current relationship. Sixty-minutes semi-structured interviews will be conducted and recorded for transcription. Recruitment and data collection will take place in a Montreal community center offering services for violent men. A better understanding of these men’s experience will offer new therapeutic targets for psychotherapeutic work with this population and increase the potential for IPV prevention. This research is ongoing, and the more recent findings will be presented at the meeting.

Objective This study aims to explore the difficulties counselors experience during the early stages of counseling within the Korean context, and to examine how these experiences suggest the need for psychoeducation as a form of preparatory support prior to counseling. Method A phenomenological qualitative approach was adopted. Practicing counselors in Korea participated in one or two in-depth interviews (approximately 90 minutes each) after providing informed consent. The interviews focused on what the counselors directly experienced in initial counseling sessions. Using phenomenological methods, the data were analyzed to identify shared meanings and structures of experience related to challenges in early sessions and preparatory needs. Results The analysis showed that counselors frequently encounter interpretive and emotional complexities in initial counseling sessions. These challenges are closely related to cultural expectations regarding emotional expression, communication styles, and the purpose of counseling. Counselors reported difficulties in navigating indirect emotional expression, implicit relational cues, and clients’ expectations for rapid problem resolution, while simultaneously trying to build rapport and clarify the counseling framework. These experiences highlighted the need for a clear preparatory understanding to support initial counseling encounters. Discussion The findings suggest that psychoeducation can serve as an important conceptual foundation for supporting counselors’ work in the early phase of counseling. Rather than focusing solely on counselor-centered training, psychoeducation is conceptualized as preparatory support that promotes a shared understanding of the counseling process and culturally responsive engagement. This study emphasizes the importance of developing psychoeducational frameworks that are sensitive to the cultural and emotional characteristics of Korean clients and that contribute to the quality and stability of early counseling relationships.

Psychotherapist educators have long struggled with the effective teaching of professional ethics, partly due to the complex structure of ethics itself. While professional ethics are hypothesized to be founded on personal ethics and morals, little is known about the origin of professional ethics. This study explores the origins of professional ethics from the perspective of novice students. Fourteen master's students participated as informants. Semi-structured interviews were conducted using two primary questions: "What do you believe psychologists should value most?" and "What has influenced your understanding of this value?" Interview transcriptions were analyzed using a qualitative method. As a result, five concepts were emerged: (1) Past painful experiences, (2) Putting oneself in someone's shoes, (3) "The least I can do," (4) Learning from practical procedures, and (5) Being instilled by education. These concepts were evaluated on a quadrant defined by the dimensions of "experience–knowledge" and "personal self–professional self." Results showed that concepts (1) and (2) aligned with the personal self, whereas (4) and (5) aligned with the professional self; concept (3) was located at the center. These results suggest two types of origins of professional ethics: personal life experiences and professional education. It is hypothesized that both types of origin are grounded in a willingness to help others. The results suggest that professional ethics education should be based on this willingness to help others, and encouraging students to reflect on their own ethical sources could be an effective approach to teaching professional ethics. Keywords: Professional ethics, Willingness to help others

Major depressive disorder (MDD) is the leading cause of disability worldwide, with social functioning majorly affected. These deficits often persist following psychotherapy. Social functioning can be measured through social networks, which include size, diversity, closeness, and contact frequency. A novel approach for assessing these components is the Network Canvas platform, which, has not yet been applied in individuals with MDD. The current study examined associations between social network components and depression severity using this platform. Based on literature indicating that individuals with MDD report social deficits, we hypothesized that higher depression severity would be associated with smaller, less diverse, less close networks with less frequent contact. Eleven participants were recruited from the pilot phase of a larger ongoing study. Depression severity was assessed with the Hamilton Rating Scale for Depression, and participants reported on their social networks using Network Canvas. Pearson correlations indicated that hypotheses were partially confirmed. Size was not significantly correlated with depression severity; however, the correlation was opposite to the hypothesis, with higher depression severity potentially reflecting larger networks. Diversity was significantly correlated with depression severity, also opposite to the hypothesis, with higher depression severity potentially reflecting more diversity. Closeness and contact frequency were not significantly correlated with depression severity, though both in the hypothesized direction, suggesting higher depression severity may indicate less close and less frequent contact. These findings highlight the importance of social functioning as a mechanism underlying MDD and demonstrate the potential of Network Canvas as a tool for monitoring social functioning in MDD.

Aim Non-suicidal self-injury (NSSI), prevalent among adolescents, is associated with maladaptive emotional regulation. For some, verbally expressing thoughts and feelings is difficult. Expressive therapy through music reduces intrusive and self-conscious constraints of verbal communication via a non-verbal avenue. This study investigates therapeutic changes of an adolescent with NSSI through music as therapy. Methods Sixty-four (64) music-mediated expressive therapeutic sessions were implemented then thematically analyzed to present a single-case qualitative study of a 13-year-old female adolescent with NSSI, manifested by the bereaving grief, pervasive shame, and self-directed aggression with reflexivity and triangulation. Results The analysis identified five themes reflecting the adolescent’s trajectory: (1) the initial unfolding of emotional space, (2) music the protective shield from overwhelming affect, (3) the gradual re-engagement with past experiences, (4) the emerging autonomy within the therapeutic process, and (5) the expressional generalization from singing toward speaking. These themes were interrelated and co-constitutive within the therapeutic process, with Theme 1 more prominent than the others. Discussion The adolescent’s emotional transformation through music, from being insulated to becoming receptive, mirrored the growth of her lived experience. Music lyrics and structures provided for references to access previously unreachable memories. The music-based therapeutic interventions, consistent with prior research findings, non-intrusively facilitated the emergence of unconsciousness, in forms of repressed, unspoken experiences, for further process/reframing. Music contained, symbolized, and organized unformulated inner experiences, as a scaffold, for the initiation and gradual development of more specific verbal expression. Keywords expressive therapy, music therapy, non-suicidal self-injury, emotional regulation

Background Emotion-Focused Therapy (EFT) uses chair dialogues to facilitate emotional transformation and reduces symptoms and increases self-compassion (Paivio & Greenberg, 1995). For clients with maladaptive shame, EFT explores core shame based schemes such as of fundamental personal defectiveness. For shame-sensitive clients, chair dialogues may heighten self-consciousness and hinder task engagement (Nishikawa, 2024). Interventions at this level, thus, require close monitoring and support (Elliott & Shahar, 2017). This study compared chair-dialogue processes in EFT among Japanese clients with higher versus lower shame-proneness to identify therapist interventions that facilitated chair work with highly shame-prone clients. Method This study employed discovery-oriented task analysis. We selected chair work tasks starting from the therapist’s proposal of chair work and ending with resolution or no-resolution ending. Segments were divided into turns and grouped into process units that captured clients’ task performance and shifts in emotional experiencing, together with the therapist’s interventions. Result & Consideration We found that high-shame clients felt embarrassed about expressing emotions in chair dialogues. The therapists suggested that they approach chair work as an “experiment,” re-inviting them to express feelings. Later in the same dialogue, clients reported feeling inhibitory emotions such as intense guilt and to shut down emotional expression. It is suggested that shame-prone clients may need chair work to be framed as gradual exploration with a higher level of therapist support, and that addressing inhibitory emotions is crucial for helping clients stay engaged in chair dialogues.

Aim In routine care, psychotherapists often base treatment decisions on specific theoretical orientations or clinical experience. Process-Based Therapy (PBT) offers an alternative framework for clinical decision-making by emphasizing empirical and rational criteria for the selection of interventions. PBT draws on data collected via Ecological Momentary Assessment (EMA), incorporates feedback from dynamic network analyses, and supports intervention selection based on individualized network models. This study examines whether PBT can be implemented by trained psychotherapists in a naturalistic setting. In addition, the study investigates the acceptability of PBT and provides preliminary evidence regarding its effectiveness compared to routine psychotherapy. Methods The study was a feasibility trial with two parallel treatment conditions. Forty patients were recruited from outpatient practices and randomly assigned to PBT or routine therapy in a within-therapist design. Feasibility was assessed via patients’ perceived usefulness of core PBT components and treatment acceptability from both patient and therapist perspectives. Additional measures included treatment expectations, dropout rates, and therapists’ self-rated adherence. Clinical outcomes (distress, depression, anxiety, quality of life) were assessed to provide preliminary evidence of effectiveness. Results Preliminary findings indicate that therapists and patients perceive process-based therapy and its individualized assessment approach with the use of dynamic network models for case conceptualization as feasible in routine practice. Data collection will be completed by the conference, and full results will be presented. Discussion This study provides initial evidence for the feasibility of implementing process-based therapy in outpatient practice and offers insights into the use of idiographic network models for individualized case conceptualization.

Aim: Several values and attitudes have been recognized as essential for helping professionals serving clients from diverse sociocultural backgrounds, including social justice orientation (Ratts et al., 2016) and trauma-informed practice attitudes (Knight, 2015; Ranjbar et al., 2020). Recent scholarship also highlights interconnectedness, a core concept in Buddhist psychology emphasizing mutual influence and interdependence among all beings, as a potential contributor to greater social advocacy and reduced social distance toward minoritized populations (Yu et al., 2020, 2021). To date, little is known about how each of these approaches contribute to practitioners’ self-efficacy in working with socioculturally diverse clients, especially within contexts that emphasize social harmony and collectivism. Method: This cross-sectional study examined the unique contributions of three sets of professional values to practitioners’ self-efficacy in serving diverse clients. A sample of 261 pre- and in-service helping professionals in Hong Kong (Mean age = 33.74, SD = 8.23), including social workers, counselors and psychologists, completed measures of social justice orientation, trauma-informed practice attitudes, interconnectedness, self-efficacy in managing relationship conflict in psychotherapy, and a scenario-based scale assessing self-efficacy in serving diverse clients. Results: Regression analyses indicated that trauma-informed practice attitudes and interconnectedness uniquely accounted for 9.1% and 6.4% of variance in self-efficacy for serving diverse clients, and 5.5% and 2.8% for managing relationship conflict, beyond therapist’s identity, clinical experience and training. Social justice orientation was non-significant in multivariate models. Discussion: These findings provide initial evidence for incorporating interconnectedness in counseling education to strengthen practitioners’ self-efficacy in working with clients from diverse sociocultural backgrounds.

Title From Classroom to Practice: A Critical Incident Study of Counseling Students’ Learning, Practice, and Transformation in a Trauma-Informed Domestic and Sexual Violence Course Background Undergraduate counseling students often report feeling anxious, overwhelmed, and unprepared when working with survivors of domestic and sexual violence, even after completing courses on counseling theories and basic skills. Trauma-informed education emphasizes not only knowledge and technique, but also students’ capacity to regulate their own emotional responses and to offer safe, non-judgmental support. This study used the critical incident technique to explore how counseling students experienced, practiced, and transformed their learning in a trauma-informed course that incorporated simulated cases and OSCE-based assessment. Methods Participants were approximately 70 senior counseling majors enrolled in the course “Sexual Assault and Domestic Violence Prevention” at a Taiwanese university. During a six-week practice phase, students were asked to submit weekly critical incident reports, each describing an important learning event that occurred during skills rehearsal with peers or standardized clients (e.g., moments of success, difficulty, or surprise). After completing the OSCE at the end of the semester, they also wrote an integrative reflection on their overall learning, focusing on perceived changes in their attitudes, skills, and professional identity in working with survivors. All texts were de-identified and analyzed using a critical incident technique combined with reflexive thematic analysis. The analysis focused on how learning experiences were enacted in practice and how they contributed to students’ perceived transformation. Credibility was enhanced through peer debriefing, iterative coding, and discussion of discrepant cases. Results Four overarching themes captured students’ learning and transformation: (1) From fear of “saying the wrong thing” to grounded empathy—students shifted from performance anxiety and avoidance to a survivor-centered, listening stance; (2) Practicing co-regulation in real time—students described how using grounding and regulation strategies allowed them to stay present while containing survivors’ intense emotions; (3) Making trauma-informed care concrete—students translated abstract TIC principles into specific micro-skills, such as pacing disclosure, offering choices, and explicitly negotiating safety; and (4) Reconstructing professional identity and boundaries—students moved from “rescuer” or “expert” positions toward more collaborative roles, while recognizing the importance of boundaries, supervision, and self-care. Many critical incidents occurred in high-tension moments during simulations or the OSCE, which served as catalysts for integrating theory with practice. Conclusions Using the critical incident technique revealed how trauma-informed teaching can support not only skill acquisition but also more profound shifts in counseling students’ professional identity and relational stance with survivors of domestic and sexual violence. Systematic reflective writing on critical incidents, combined with OSCE-based practice, appears to create powerful spaces for students to examine their fears, values, and capabilities and to transform their learning into more grounded, ethical practice. Implications for designing trauma-informed, competence-oriented curricula in counseling and related helping professions will be discussed. Keywords Trauma-informed education; domestic and sexual violence; critical incident technique; counseling students; professional identity development; reflective practice

Background: Measurement-Based Care (MBC) has matured into a standard for monitoring treatment progress, yet its potential to prospectively guide clinical decision-making remains underutilized. The "next generation" of MBC requires a shift from simply tracking progress to trajectory prediction, the cornerstone of precision mental health. Current predictive models often fail to account for heterogeneity, treating all patients as equally "modelable" and assuming the same variables predict outcome for everyone. This study applies Machine Learning (ML) within a high-dimensional, naturalistic dataset to advance two key frontiers: (1) Personalization, i.e., identifying which process features (e.g., alliance vs. synchrony) best predict outcome for specific patient phenotypic signature; and (2) Predictability, i.e., distinguishing between patients whose outcomes can be accurately forecasted versus those with "chaotic" trajectories that defy algorithmic classification. Methods: Data were drawn from a large university-based outpatient clinic. The sample comprised 400 patient-therapist dyads, totaling approximately 10,000 treatment sessions (average length: 25 sessions). The dataset combines routine outcome monitoring with granular session-by-session assessments. Features include: (a) Patient Phenotype (psychopathology, interpersonal problems, emotional regulation, affect, attachment style, resilience, satisfaction, and psychological needs); (b) Therapist Traits (empathic accuracy, professional experience, therapeutic orientation, and conflict resolution styles); and (c) Process Dynamics (alliance, early symptomatic and functional change patterns, and emotional congruence during the first 3-5 sessions). We employed ensemble ML algorithms (e.g., Random Forest, XGBoost) with nested cross-validation to manage non-linearity and high dimensionality. Beyond standard regression, we performed a "predictability analysis" to identify baseline features that characterize patients for whom MBC data yields high predictive accuracy versus those for whom it does not. Results: Preliminary model training suggested that dynamic features (e.g., early change patterns and alliance fluctuations in the first sessions) outperform static intake symptoms in predicting final outcomes. We uncovered substantial heterogeneity in feature importance across the sample, supporting a personalization hypothesis. Initial clustering suggests that for certain patient profiles, dyadic and process markers carry significantly higher predictive weight than symptom reporting alone. Furthermore, "predictability analysis" differentiates a subset of patients with high volatility who display "low modelability" compared to the majority of the sample. The final results will map these distinct profiles, offering a hierarchical ranking of which predictors matter most for which types of patients. Conclusion: This study answers the call for diverse extensions of MBC by transforming routinely collected data into actionable, personalized intelligence. By moving beyond a "one-size-fits-all" predictive model, we demonstrate that the utility of MBC feedback depends on matching the right monitor to the right patient. This precision not only enhances clinical decision-making but also promises to reduce the burden on both patients and therapists by focusing assessment efforts solely on the most predictive metrics for each therapeutic dyad. Implications for the next generation of feedback systems include tailored alerts that direct therapist attention to specific process markers based on the patient’s profile.

This analytic autoethnography examines how U.S.-based multicultural counselor training shaped my subsequent psychotherapy training/teaching in Taiwan and articulates a “Taiwanized” multicultural training model that foregrounds locally salient power dynamics, including national identity. Data include retrospective reflections and critical-incident vignettes from graduate training (beginning in 2007) at a Texas predominantly White institution; observation notes of classroom and departmental interactions; positionality–affect memos; and post-return teaching artifacts (syllabi, assignments, teaching reflections) with thematized summaries of anonymous student feedback. Narrative vignettes were integrated with thematic analysis using a context–position–power–emotion–action framework. Credibility was supported through an audit trail, reflexive memoing, and peer debriefing of codes and interpretations. Three themes emerged: (1) positionality shifts (non–U.S. citizen, Asian woman, financially constrained trainee, non-Christian) made institutional racism and intersecting sexism, classism, heterosexism, and ageism more visible; (2) legitimacy policing of faculty of color and international trainees co-occurred with defensiveness when naming White privilege; and (3) identity reconstruction under geopolitical non-recognition positioned national identity as a lived axis of vulnerability and meaning-making that travels into clinical training. Findings support a “Taiwanized” multicultural training approach embedding Taiwan’s historical–political context and national identity within an intersectional, social-justice framework. Pedagogical innovations include structured dialogue for addressing defensiveness, experiential activities linking positionality to clinical ethics and alliance ruptures, and cultural humility practices that translate critical consciousness into ethically responsive psychotherapy training across cultures. This approach strengthens trainees’ capacity to identify power-laden alliance ruptures, respond to defensiveness with cultural humility, and enact ethically grounded repairs.

Introduction Researching mental health and psychotherapy among men who have sex with men (MSM) living with HIV requires entering social, affective, and sexual circuits that shape access to psychological care but remain largely invisible in traditional clinical research. This poster presents a methodological, ethical, and clinical reflection on fieldwork conducted in nocturnal and digital sex-affective contexts, understood as sites where subjectivity, stigma, and help-seeking are produced. Objective To describe and examine the researcher’s experience of accessing spaces such as drag cabarets, gay bars with and without darkrooms, sexually charged parties, and messaging groups where men coordinate erotic encounters, within a study on mental health, stigma, and trajectories of seeking psychotherapy among MSM living with HIV. Method An autoethnographic and participant-observation approach was employed as part of a broader quantitative study. Field scenes, researcher positionality, ethical tensions (boundaries, consent, confidentiality, and personal risk), and emotional and countertransference effects of conducting research in eroticized environments were documented and analyzed. Expected results The study identifies ethical, affective, and clinical dilemmas involved in sustaining a professional role in sexually charged contexts, and how these environments shape the ways men approach, negotiate, or resist psychotherapy. These settings also illuminate the relationships between sexuality, stigma, subjectivity, and mental health help-seeking. Conclusions The findings suggest that researching psychotherapy among MSM living with HIV requires moving beyond traditional clinical settings and rethinking implicit models of access, therapeutic alliance, and help-seeking. Attending to the subjective impact of fieldwork on the researcher is essential for producing ethically grounded knowledge.

Aim: Beyond diagnosis and case conceptualization, therapeutic assessment emphasizes using the assessment interview to enhance clients’ mental health awareness. Grounded in attachment theory, we developed the Gaining Security Psychological Assessment Interview (GS-PAI) to support emerging adult men. This study examined how the GS-PAI promotes men’s mental health awareness. Methods: Eight emerging adult men (M_age = 25.4; four students and four employed adults) completed one GS-PAI session (approximately 50 minutes). Using a phenomenological design, transcripts were analyzed with thematic analysis. Results: Three themes were identified. (1) Recognizing masculinity’s influence: masculinity norms acted as a double-edged sword—protecting men from shame related to earlier attachment relationships, yet fostering emotional suppression. (2) Increasing awareness of emotion-regulation ruptures: limited childhood experiences of being emotionally regulated (i.e., gaining security with caregivers) were linked to reduced capacity to co-regulate romantic partners; some men substituted advice-giving or lecturing (i.e., “mansplaining”) for emotional engagement. (3) Expressing care through caregiving: men more readily communicated love through instrumental caregiving behaviors rather than direct emotional disclosure. Discussion: In Chinese cultural masculinity, gaining-security experiences in parent–child relationships may inadvertently legitimize emotional over-inhibition, weakening men’s emotional expression and mental health awareness. The GS-PAI may help emerging adult men trace how masculinity norms developed from childhood attachment experiences, thereby strengthening mental health awareness.

Therapists are not exempt from the emotional impact of grief, and returning to work following a loss may leave them vulnerable (Worden, 2018). As therapists support grieving clients, their losses may shape their therapeutic engagement, enhancing empathy and confidence (Kouriatis & Brown, 2013; Swinden, 2023), while activating complex emotional processes (Hayes et al., 2007). However, how therapists navigate their grief in practice and how it shapes clinical presence and relational processes remains understudied. This qualitative study examined therapists’ experiences of grief, guided by the research question: “How do grieving therapists work with clients who present with grief?” Participants were recruited through listservs of professional psychotherapy associations and regulatory bodies in Canada. Semi-structured interviews explored participants’ experiences of loss and its influence on clinical work. Braun and Clarke’s (2021) six-step thematic analysis guided codes and theme development. The analysis revealed that therapists who have experienced grief encounter both supportive and challenging internal responses when working with grieving clients. Emerging themes suggest significant factors influence the interplay between personal grief and professional practice, offering insights into how to navigate complex internal processes. This study addresses a gap in the literature by exploring how therapists process and integrate their grief within clinical work. These insights contribute to understanding how therapist and client experiences of grief intersect and the factors that influence interventions. The benefits of examining these perspectives will extend to clients, as understanding therapist use of self in grief contexts will support healthier grief discussions to optimize a client’s therapeutic experience.

Aim: It is time for evidence-based practice in the living environment of children. This study, part of the Urban Mental Health (UMH) project at DZPG Bochum, evaluates whether a low-threshold intervention by "well-being coaches" (trained students applying principles of positive parenting and validation) can improve social behavior in the classroom Methods: In a 5-week-intervention program, bachelor students (the well-being coaches) engaged with fourth grade students exclusively in positive matters during their school day. Affect and cognition, both for children and teachers, was inquired through self-reports; behavior was measured through observation and noise measurement. Data was analyzed through single-case analysis and multilevel modeling. Results: Child self-reports: Single-case analysis showed mixed results, indicating only within-class differences. Teacher self-reports: Single-case analysis showed consistent results for decreasing stress during intervention, increasad positive affect, increased task-related engagement and reduced non-compliant behavior during and after intervention. Behavioral observations: MLM showed increased task-related engagement and reduced non-compliant behavior, though with high unexplained variance. Discussion: The findings provide initial indications of behavioral change and potential teacher stress reduction. However, clear intervention effects across al levels were not observed. The study demonstrates that real-world laboratory research is a feasible approach for urban mental health. Future research should utilize experimental designs to validate these preliminary results.

Contemporary global crises, e.g. climate change and armed conflicts, expose individuals to potentially traumatic experiences. Recent research emphasizes the importance of identifying contextual resources that support post-crisis adaptation. One potentially overlooked factor may be place attachment: the emotional bond people form with meaningful environments. Place attachment becomes particularly salient in situations of place disruption, such as environmental destruction or forced displacement. We conducted two studies to examine whether place attachment serves as a protective or risk factor for post-crisis well-being. Study 1 involved individuals affected by flooding in Poland (N = 630), and Study 2 included Ukrainian refugees residing in Poland (N = 1,016). In first study, stronger attachment to the locality of residence was associated with lower PTSD symptoms and higher life satisfaction and posttraumatic growth (PTG). In the second study, stronger attachment to hometown was linked to higher PTSD symptoms and lower life satisfaction. However, attachment to a new place of residence in Poland was positively associated with life satisfaction and PTG. Importantly, perceived similarity between the former and current places of residence facilitated the development of attachment to the new environment. These findings suggest that place attachment may serve as a resource that helps individuals cope with crisis-related disruptions. Integrating clients’ emotional relationships with places into psychotherapeutic process and intervention may help reduce distress and foster adaptive responses to crises. Supporting the reconstruction of place attachment and fostering continuity may be particularly beneficial when working with individuals affected by displacement, migration, and other crisis-related disruptions. Keywords: Crisis adaptation, place attachment based intervention, PTSD, PTG

This program evaluation examined the efficacy of a group support intervention for foster caregivers of maltreated infants and toddlers. It investigated whether integrating Mentalization enhanced caregivers' capacity for sensitive, developmentally appropriate responses to trauma, thereby advancing an Infant Mental Health (IMH)-informed caregiving model. A mixed-methods design evaluated outcomes between April 2019 and December 2021. The intervention comprised twelve 3-hour group sessions based on Trauma-Informed Care and Mentalization. Quantitative outcomes were measured annually using a 4-point scale to assess perceived meaningfulness. Qualitative data were collected from social workers' pre-intervention needs assessments and post-group interviews. The group established a safe, reflective environment that promoted sensitive caregiving aligned with the IMH model. Quantitative findings showed 93.75% of participants reported increased vitality. Qualitative analysis revealed enhanced mentalized caregiving, as evidenced by shifts from anxious reactions to attuned accompaniment and effective reframing of separation and loss, illustrating the strengthening of appropriate responses and affective competence. This initial application of IMH principles shifted the care focus toward relationship repair and enhanced professional quality in Taiwan. Findings support mentalization's efficacy in guiding caregivers toward sensitive responses, which are essential for preventing infant retraumatization. However, results are preliminary due to the program's observational nature. Given resource limitations and the small number of eligible caregivers, future research needs to invest in systems to enable a comparison group and strengthen causal inference.

Introduction: There is a well-recognised intersection between mentalization and early relational trauma. While several established psychotherapies primarily focus on symptom reduction, they may not fully address the relational and personality-level difficulties associated with traumatic experiences. Mentalization-Based Treatment for Trauma (MBT-TF) was developed to address this gap by targeting relational sequelae of trauma. However, the literature on applying MBT or broader mentalization-based approaches within trauma contexts remains limited and fragmented, thereby needing a mapping of the existing evidence. Aim: This scoping review aims to synthesise and map the existing empirical and conceptual literature on the application of MBT and mentalization-informed approaches in trauma-exposed populations. Methods: The review is being conducted in line with PRISMA-ScR guidelines. A systematic search of Scopus, CINAHL, PsycINFO and PubMed yielded 823 records. Title and abstract screening were completed, with 66 articles progressing to full-text review. Full-text review will be conducted independently, with discrepancies resolved through discussion. Data will be synthesised narratively, focusing on intervention characteristics, settings (geographical context; individual or group formats), therapy duration and structure, trauma profiles of the population, and reported adaptations to the treatment. The review protocol is registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/MB3K4 Results & Significance: Preliminary findings suggest a small but growing body of literature applying MBT to trauma-exposed populations with heterogeneity in formats, populations and adaptations to standard MBT models. This review thus aims to identify key gaps in literature and inform future research, clinical adaptation and theory development.

Aim: Receiving a cancer diagnosis has a profound psychological impact on patients and their loved ones. However, patients frequently report that their psychosocial symptoms fail to be adequately addressed. Due to rising cancer rates and limited global investment in psychosocial oncology, there is an unprecedented demand for clinical care. Clinical practice guidelines (CPGs) are well-placed to improve the quality and efficiency of existing services; however, little is known about their use and perception in the field. The present study explored the perspectives of Canadian clinicians working in psychosocial oncology on their use of CPGs. Methods: A cross-sectional survey was developed to assess the use, perception, and barriers and facilitators to CPG implementation among clinicians providing direct psychosocial care in a range of settings. A multi-step, online recruitment strategy was utilized to recruit a diverse Canadian sample. Results: A total of 172 participants were included in the final sample. Findings revealed low to moderate use of existing CPGs, with participants identifying a range of barriers to implementation such as a lack of formal training on CPGs, limited applicability to local contexts, and a lack of organizational support such as high workloads and limited time. Discussion: Clinician perspectives are paramount to informing efforts to disseminate and implement psychosocial oncology CPGs. Current findings suggest that CPG implementation may be further supported by developing accessible training programs, ensuring easy access to CPGs, adapting recommendations to local healthcare contexts, and fostering greater community-based support to encourage usage of these critical tools.

Aim: The use of science in clinical practice is critical to the professional and ethical obligations of psychologists; however, studies suggest that psychologists often fail to stay up-to-date with research and with the implementation of evidence-based approaches. Clinical practice guidelines (CPGs) are designed to address this gap by guiding the decisions of clinicians across a range of settings, including psychosocial oncology. A recent environmental scan identified 23 existing CPGs addressing the psychosocial challenges associated with cancer; however, little is known about their quality. The present study conducted a systematic quality appraisal of these CPGs. Methods: All 23 CPGs were independently evaluated by four trained appraisers using the AGREE-II tool, which consists of 23 items across six domains: Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence. Composite domain scores (0-100%) were generated from appraiser scores, with higher scores indicating higher quality. A cutoff score of 60% was used to determine acceptable quality. Results: Findings revealed that all 23 CPGs met the acceptability threshold (M=76.45, SD=12.35). Average scores across the six domains ranged from 33.83–96.26%, with the highest scores for Clarity of Presentation (M=96.26, SD=6.25) and Scope and Purpose (M=87.38, SD=19.55) while Applicability received the lowest score (M=33.83, SD=10.72). Discussion: Accessing high-quality CPGs is critical to the provision of best practice care. Findings suggest that psychosocial oncology CPGs are specific and clear but may benefit from integrating more applicable tools to better support psychologists in providing psychosocial care to patients with cancer.

The emergence of generative artificial intelligence (AI) has opened new dimensions in how humans form emotional bonds with technology. As AI becomes increasingly integrated into daily life, interactions are evolving beyond functionality toward emotional engagement. In a recent survey, 62% of U.S. adults reported interacting with AI several times a week (Kennedy et al., 2025). Similarly, over 85% of U.S. high school students use AI, with 42% seeking emotional or mental health support and 19% reporting romantic involvement, particularly among those using AI for diverse purposes (Laird et al., 2025). In line with these trends, a growing number of individuals engage with AI platforms as friends, companions, therapists, or romantic partners (Robb & Mann, 2025; Tran et al., 2025). Although research increasingly examines human–AI emotional attachment through the lens of Attachment Theory (Heng & Zhang, 2025; Hu et al., 2025), findings remain fragmented, underscoring the need for theoretical integration. Thus, we conducted a scoping review to examine theoretical approaches to human–AI relationships, explore how attachment has been conceptualized and measured, and identify key trends and research gaps. Following PRISMA-ScR guidelines (Tricco et al., 2018), we conducted a comprehensive search of peer-reviewed articles published between 2020 and 2025 in PsycINFO, Web of Science, and Scopus. Inclusion criteria comprised empirical and theoretical studies examining human–AI relationships through attachment frameworks, particularly those involving generative AI, AI companions, or therapeutic AI systems. Of 959 articles identified, 76 met eligibility criteria after screening. Preliminary findings indicate that most studies employed attachment theory and identified factors that promote or hinder human–AI relationship development (e.g., anthropomorphism, perceived empathy, loneliness, and trust). These findings highlight the need for cohesive frameworks to guide future theoretical and empirical research on human–AI attachment.

In the United States, gender and sexual minority (GSM) college students experience higher rates of depression, anxiety, suicidality, and substance use compared to their cisgender heterosexual peers (Borgogna et al., 2019; Lipson et al., 2019), yet also face greater barriers to accessing psychotherapy (Allen & Mowbray, 2016; Conner et al., 2023). Although previous research documents disparities in mental health outcomes and service utilization, less is known about how social–relational and wellness factors, specifically loneliness, sense of belonging, perceived stigma, and flourishing, shape help-seeking and utilization of psychotherapy services among GSM students who use substances. The present study will analyze data from the initial 2023–2024 Healthy Minds Study (N = 104,729) to examine how these four variables are associated with help-seeking intentions and utilization of psychotherapy services. In addition, we will determine whether these associations significantly differ between GSM and non-GSM college students. We hypothesize that higher ratings of loneliness and perceived stigma will be associated with lower help-seeking, whereas higher ratings of belonging and flourishing will be associated with greater help-seeking intentions and psychotherapy utilization. The present study will utilize MANCOVA procedures to identify significant relationships between independent and dependent variables, as well as to detect any significant between-group differences. Findings may clarify the relational and well-being processes that influence help-seeking that either hinder or facilitate treatment engagement among an at-risk population, GSM college students. Data cleaning is underway. Analyses, results, and implications will be described and presented at the 2026 annual conference.

Background: Somatic comorbidities and unipolar depression (UD) are frequent comorbidities and can lead to some diseases being overlooked, complicating treatment and recovery.Patients with UD die on average more than 10 years younger than those in the overall population. No study has evaluated the association between somatic comorbidities and mortality in the progression of UD using a clinical staging model. We assessed the prevalence of somatic comorbidities in a sample of inpatients with UD at different stages of progression and the mortality rates after a 10-year follow-up, identifying the underlying causes and predictors of mortality. Methods: Longitudinal study with 151 inpatients with UD, evaluated at hospital admission and 10 years after discharge. The UD progression was assessed using the clinical staging model of UD. The t-test and chi-square test were used to compare the groups' survival and mortality rates. A multivariable Poisson regression model with robust variance estimation was used to evaluate mortality risk and predictors. Results: Of the 151 patients, 28 (19%) died after 10 years of follow-up. The most frequent underlying cause of death was cardiovascular diseases (32%).Somatic comorbidities were more prevalent in the residual (67%) and recurrent (71%) stages of UD. Age (p=0.000) and the number of somatic comorbidities (p=0.000) were predictors of mortality. Conclusions: The majority of patients exhibited somatic comorbidities, which were more prevalent in the residual and recurrent stages of UD. Somatic diseases, especially cardiovascular diseases, were the leading causes of underlying mortality. Moreover, the number of comorbidities significantly predicted mortality among inpatients with UD.

Objectives Grounded in the principles of Practice-Based Evidence and Implementation Science, this study addresses the gap between psychotherapy research and clinical practice in private-care settings by implementing a digital system for process and outcome monitoring accessible to independent therapists without institutional affiliation or research training. The objective is to evaluate the feasibility and acceptability of this system when integrated into naturalistic private-practice contexts. Methods A digital Routine Outcome Monitoring system was implemented to be used by independent clinicians, many without prior research experience, using a longitudinal, multivariate structure assessing transdiagnostic variables and the therapeutic alliance. Patients completed measures throughout treatment, and therapists received feedback reports with the results. In parallel, indicators such as adoption, adherence, perceived usefulness, and reported barriers and facilitators were tracked to assess engagement, usability, and contextual factors influencing uptake and sustainability. Preliminary Results The poster presents preliminary clinical data and insights derived from collaborative work with the clinicians who use the system. Emergent themes related to the implementation of monitoring in naturalistic and private-practice contexts are described, identifying challenges and facilitators for adoption and sustainability. Conclusions The study demonstrates the feasibility of implementing a Routine Outcome Monitoring system in independent private-practice settings and shows that such tools can be integrated into naturalistic workflows while providing clinically useful feedback. Digital monitoring supports informed decision-making and generates ecologically valid data that reflect real-world practice conditions. The findings also underscore the value of collaborative networks between researchers and independently practicing clinicians for advancing locally relevant practice-based evidence.

Psychotherapy quality management systems have been developed and implemented worldwide in a range of clinical service delivery settings. Though specific outcome measures and procedures vary across systems, a central purpose of all these systems is to identify patients who are non-responding or deteriorating in treatment as early as possible, provide this information to therapists in real time, and support therapists in making needed changes to treatment that improve outcomes. Though psychotherapy quality management systems have been empirically demonstrated to improve patient outcomes (across orientations, modalities, and settings), the use of such systems has not yet become common practice in the culture of many academic training clinics. The current study investigated the implementation of a psychotherapy quality management system into an integrated mental health academic training clinic in a large academic health sciences institution in the United States. Participants included 36 graduate student therapists across three disciplines (Psychology, Marriage and Family Therapy, and Social Work) practicing from a range of theoretical orientations. Therapists were trained in the use of the OQ Analyst, a psychotherapy quality management system with demonstrated effectiveness designed to assess patient progress each session using the Outcome Questionnaire-45 (OQ-45) and provide real time feedback to therapists on OQ scores, critical items, and patient progress. Preliminary results indicate that therapists in training view the OQ Analyst psychotherapy quality management system favorably and consider real time feedback as a necessary and valuable tool in improving outcomes of non-responding and deteriorating patients. Implications for patient outcome are also discussed.

Aims: The proposed poster aims to shed light on the process of creating and maintaining positive psychological growth from psychotherapy. This will be done through examining psychotherapy process variables that are hypothesized to collectively form a pathway from pre-treatment to greater outcomes at 3-month follow up. The specific variables being examined are client’s pre-treatment outcome expectancy, middle-of-treatment therapeutic alliance and follow up outcomes of meaning in life and resilience. By examining meaning and resilience as outcomes, a secondary aim is to identify these positive, growth-oriented variables as modifiable facets of individuals’ psychology from psychotherapy that can have lasting well-being implications. Methods: A sample (N=124) of young adults (ages 18-25) with identity distress were recruited for this study. Each participant received 12 sessions of individual psychotherapy delivered virtually. Measures were administered to participants pre-treatment, after each session and then at 3-month follow up. Mediation analysis, accounting for nested data structure, will be used to examine the hypothesized pathway from outcome expectancy to meaning and resilience through the mediating effect of therapeutic alliance. Results: As hypothesized, support was found for therapeutic alliance being a mediator between client outcome expectancy and greater improvement in meaning and resilience 3 months post treatment. Discussion: These findings identify individual and relational process variables that connect to contribute to increased lasting psychological growth from psychotherapy. This study’s focus on growth and flourishing rather than psychopathology also highlights an important direction for psychotherapy practice and research to further expand, especially in supporting individuals in the transition to adulthood.

Australia is a multicultural country with a culturally and linguistically diverse (CALD) population, creating a need for bi- and multilingual healthcare services. The Australian Health Practitioner Regulation Agency (AHPRA) recently revised its Code of Conduct and Professional Competencies for psychologists, placing greater emphasis on cultural safety and responsiveness, particularly when working with CALD communities. This study aimed to provide a snapshot of language diversity within the current Australian psychologist workforce. We conducted an observational, descriptive analysis using publicly available, de-identified AHPRA data on languages spoken by psychologists over five years and reviewed publicly accessible psychologist directories for language and/or ethnicity filter options. The top ten languages spoken by psychologists in 2021 broadly aligned with Australian Census data. Mandarin was the most commonly spoken language after English. While some psychologist directories include language/ethnicity filters, their utility for CALD service users remains uncertain. While AHPRA’s updated Code of Conduct and Professional Competencies highlight cultural safety, genuine structural change requires more than policy. There are serious deficiencies in how data regarding psychologists’ culture, ethnicity, and languages spoken is collected and presented. Improving both data collection and access can support true culturally responsive psychological services by helping the CALD community connect with practitioners who meet their cultural and linguistic needs.

Disordered eating behaviours are common in college settings, with a considerable proportion of students endorsing food restriction, bingeing, or compensatory behaviours at clinical and subclinical levels. Such presentations can fail to meet criteria for specialist treatment whilst also posing challenges to university counselling services. Emotion-Focused Therapy has shown promise as an intervention for eating and body related concerns. The present poster provides an update on two related studies investigating the application of individual and group EFT to the treatment of eating and body related concerns in a student population. Participants are university students, aged 18 or older, presenting to a student counselling service with a primary presenting issue of eating and/or body related concerns. The individual EFT protocol is an adaptation of a transdiagnostic model of EFT manualised by Timulak & Keogh (2022). The group modality is an adaptation of the model manualised by Thompson & Girz (2018). Participants complete a range of self-report measures pre, post and at 3 months follow-up; stability of BMI is assessed mid-therapy, post therapy and at follow up; individual therapy sessions are video recorded for analysis; and participants are interviewed about their experience of therapy. Outputs from the study will include qualitative analysis of participant experiences of both modalities, case studies of across therapy emotional transformation, task analyses of problematic self-treatment focused two-chair dialogues, and case conceptualisation studies. It is hoped that this research will contribute to the development of EFT as an evidence based intervention for eating and body related presentations.

Background/Hypotheses Motivational Interviewing (MI) aims to enhance intrinsic motivation for behavior change. Little is known about how integrating MI may impact heart rate variability biofeedback (HRVB). HRVB is a behavioral intervention that trains individuals to regulate autonomic functioning through paced breathing and real-time physiological feedback. We hypothesized that HRVB combined with MI would lead to greater improvements in autonomic regulation and reduction in symptoms of anxiety and depression when compared to HRVB without MI. Methods Thirteen undergraduate research assistants were trained to deliver MI during HRVB sessions, with fidelity assessed using the Motivational Interviewing Skill Code (MISC). Sixty participants are currently completing five sessions of HRVB and are randomly assigned to HRVB as usual or HRVB combined with MI. HRV outcomes (RMSSD and HF-HRV) are assessed during in-person biofeedback sessions. Psychological outcomes include depressive symptoms measured using the Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms measured using the Generalized Anxiety Disorder-7 (GAD-7). These psychological measures are administered at baseline and following completion of the intervention. Linear mixed-effects models will be used to examine the effects of MI on HRV outcomes (RMSSD, HF-HRV) across sessions and on pre–post changes in depressive and anxiety symptoms. Results/Conclusion Data collection is ongoing. We anticipate that participants receiving MI-enhanced HRVB will demonstrate greater improvements in HRV across sessions and larger pre–post reductions in psychological symptoms. If supported, these findings would suggest that MI may strengthen engagement and effectiveness in HRVB interventions, with implications for scalable, low-burden enhancements to biofeedback-based treatments.

Aim This brief literature review examines traumatic stress in adolescence, emphasizing symptom presentation, family system influences, and the effectiveness of family-involved trauma interventions. Methods Peer-reviewed empirical studies, randomized controlled trials, and meta-analyses were reviewed to evaluate adolescent posttraumatic stress symptoms, family functioning, and evidence-based interventions, including trauma-focused cognitive behavioral therapy (TF-CBT) and the Child and Family Traumatic Stress Intervention (CFTSI) (Dorsey et al., 2017; Smith et al., 2019). Results Traumatic stress in adolescents commonly manifests as intrusive memories, avoidance, hyperarousal, and functional impairment, with symptom expression differing from that of younger children (Dorsey et al., 2017; Smith et al., 2019). Family functioning is associated with symptom severity, with higher cohesion, communication, and emotional support linked to lower PTSD symptoms, while family conflict predicts greater severity (Ye et al., 2022). TF-CBT demonstrates consistent evidence for reducing PTSD symptoms, producing meaningful effect sizes across studies (Dorsey et al., 2017; Gkintoni et al., 2024). Early family-based interventions, such as CFTSI, reduce the likelihood of meeting PTSD diagnostic criteria at short-term follow-up (Berkowitz et al., 2011). Parental PTSD and experiential avoidance are associated with poorer adolescent outcomes, indicating intergenerational pathways of trauma risk (Brand et al., 2011; Polusny et al., 2011). Discussion Although evidence underscores the importance of family relationships in mitigating adolescent traumatic stress, gaps remain. Most studies emphasize short-term outcomes, with limited data on long-term effectiveness. Biological research suggests early life stress may program stress-response systems and increase PTSD vulnerability through mechanisms interacting with family environments (Pervanidou et al., 2020).

Suffering—a profound aspect of human experience (Anderson, 2013)—is a central concern of psychotherapy (Gantt, 2000), yet within many Western traditions it is primarily conceptualized as a problem to be reduced, alleviated, or transcended. While scholars have distinguished Western and Buddhist views of suffering (Tyson & Pongruengphant, 2007), less attention has been given to how suffering itself is culturally and historically organized within specific psychological traditions. In East Asian and Korean traditions, for example, suffering is understood as an inevitable part of life, arising not from change itself but from resistance to impermanence and attachment to fixed states (Kim, in press). This suggests that individuals with different cultural worldviews may understand and experience suffering differently, offering insights for clinical work with culturally diverse clients. Thus, this literature review reexamines implicit assumptions about suffering by focusing on its conceptualization within Korean cultural and psychological contexts. Specifically, we explore (a) how suffering has been understood within East Asian and Korean psychological traditions; (b) how culturally grounded forms of psychotherapy have developed in response to culturally specific understandings of suffering within these traditions; and (c) how culturally and historically shaped emotions, particularly han (한 恨)—a culturally salient emotion of enduring sorrow and unresolved grief (Park, 2022)—have emerged in relation to experiences of suffering in Korea. By situating suffering within a Korean perspective, this review demonstrates how suffering can be understood and experienced differently, inviting a rethinking of psychotherapeutic approaches beyond symptom reduction toward culturally and historically grounded, relational understandings of suffering.

Mental health disorders pose a critical global challenge, affecting millions and imposing substantial socio-economic burdens. Traditional one-size-fits-all interventions often fail to capture the complexity of individual mental health trajectories, highlighting the urgent need for more personalized approaches. Digital phenotyping, which leverages multimodal data from smartphones and other sensors, offers a promising avenue for advancing mental health care. However, existing research largely relies on single-modality approaches or “black-box” machine learning (ML) models, limiting both interpretability and clinical applicability. This poster introduces a clinical demonstration that integrates multimodal digital markers -including text, acoustic signals, facial expressions, physiological data, and behavioral patterns - to refine mental health assessment and intervention. This demonstration illustrates how distinguishing between trait-like markers (relatively stable, individual-specific characteristics) and state-like markers (within-individual changes over time) is crucial for understanding psychopathology and therapeutic change. We demonstrate how multimodal analysis of automated markers can offer novel insights into mental health mechanisms, by trait-like components predicting treatment prognosis and state-like components tracking real-time therapeutic progress. This approach enhances the precision and personalization of mental health interventions, bridging the gap between digital phenotyping and clinical practice. While advancing personalized, mechanistic insights into mental health, this demonstration illustrates a more effective, scalable interventions that move beyond symptom tracking to actively transforming therapeutic outcomes.

Background/Hypotheses Motivational Interviewing (MI) aims to increase intrinsic motivation for change. Little is known about a) training required to provide effective MI and b) effects of MI+psychotherapy on home-practice and psychological outcomes. In a two-part study, we hypothesized that a) targeted training would help undergraduate research assistants reach moderate MI fidelity, and b) compared to a control group, when combining MI with heart rate variability biofeedback (HRVB), clients would practice more and show improved mood and sleep across sessions. Methods Part One: 13 research assistants were trained to use MI during biofeedback sessions. We assessed MI fidelity using the Motivational Interviewing Skill Code (MISC). Part Two: We are currently collecting data from 60 participants over five sessions of HRVB, randomly assigned to HRVB as usual or HRVB+MI. Practice data come from the Inner BalanceTM app; mood assessed each session via Scale of Positive and Negative Experience (SPANE); sleep assessed pre-post via the Pittsburgh Sleep Quality Index (PSQI). Results Part One: Undergraduates achieved moderate MI fidelity (1.06 reflections/questions, 70% open questions, 98% MI consistent responses, 65% client change talk, MI spirit 5.15/7) after training. Two: Using mixed models, we will examine the effect of MI on HRVB practice sessions, and whether number of practices is related to improvements in mood and sleep across sessions. Conclusions It is feasible to train students to administer MI in conjunction with HRVB. If MI does improve practice, mood, and sleep, it would be highly useful to combine MI with other psychotherapies to improve between-session practice.

Aim: Although many patients desire integration of religion and spirituality (R/S) in mental health care, structured training remains limited. This study examined the implementation of Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) delivered by psychiatry residents and chaplains in a large urban academic health system, with a focus on changes in clinicians’ R/S competencies. Methods: Clinicians completed a structured SPIRIT training and delivered group psychotherapy sessions on two inpatient psychiatric units over one academic year. Perceived R/S competencies were assessed at baseline, 1-month, and 6-month follow-up using the Religious/Spirituality Integrated Practice Assessment Scale (RSIPAS), measuring attitudes, feasibility, frequency, and self-efficacy. Descriptive statistics and non-parametric tests with false discovery rate correction were conducted. Results: Eight clinicians (three psychiatry residents, four chaplain residents, one chaplain administrator) delivered 118 group sessions to 685 psychiatric inpatients. Across clinicians, mean scores increased over time for all RSIPAS domains, particularly self-efficacy and frequency of R/S integration. Psychiatry residents, who reported no prior R/S training, demonstrated substantial gains and convergence with chaplains by 6 months. Chaplains reported higher baseline frequency and self-efficacy, while psychiatry residents showed greater relative improvement. Although most changes were not statistically significant after correction, clinically meaningful upward trends were observed. Discussion: Findings support SPIRIT as a feasible interdisciplinary training model that enhances R/S competencies and group psychotherapy skills among trainees. Embedding spiritually integrated psychotherapy training within residency programs may strengthen culturally responsive, whole-person care. Future research should evaluate patient-level outcomes, long-term skill retention, and scalability across diverse training and clinical settings.

Single-session consultation (SSC) interventions are a promising approach for increasing access to timely evidence-based mental health care. Aim: This manuscript describes the early implementation, including feasibility and acceptability, of an SSC intervention in a community-based gender-responsive mental health program at an academic medical center in the United States. Method: Six clients completed a 45–60-minute SSC intervention that identified individualized goals, action steps, internal and external supports, and coping strategies. Pre- and post-session measures assessed psychological symptoms, hopelessness, agency, and satisfaction with care. Results: Illustrative case studies are presented for two transition-aged youth. Across both cases, the young women collaboratively completed the SSC and their post-session feedback indicated that the intervention helpful and aligned with their goals. Clinicians found the service easy to be trained in, viable to implement, and effective. Initial/preliminary results suggest the SSC intervention is feasible and acceptable for use in a free, community-based outpatient clinic serving young women and gender expansive youth. Discussion: Findings highlighted increases in hopefulness mirroring findings from previous SSC studies. Implementation challenges included lower-than-expected uptake, including difficulty re-engaging youth who did not attend their SSC. Lessons learned included the importance of flexible delivery, structured action planning, and intentional engagement strategies for successful implementation.

Aim: Ambiguity is an inherent quality of psychotherapy, which can be challenging for trainees and seasoned clinicians alike. For Applied Psychology graduate students (APGS), ambiguity may be particularly problematic. APGS are at increased risk for depression and burnout, and hence, ambiguity may add sufficient additional stress to decrease their clinical efficacy and threaten well-being. While some ambiguity is central to psychotherapy, ambiguity can also arise from unnecessary sources, such as unclear expectations in their training and unexpected changes in supervision. To date, the impact of ambiguity on APGS is not well understood, nor are strategies they use to manage ambiguity. Personal values may provide APGS with clarity in the face of ambiguity. This study explores how APGS experience ambiguity in their training, and how they employ personal values to cope. Method: Qualitative data was collected via online survey of APGS across Canada. Data analysis is on-going using Reflexive Thematic Analysis. Results: Initial results suggest that graduate students do experience a great deal of unnecessary ambiguity in their training, especially from unclear or inconsistent expectations in their training programs. Students report that this ambiguity negatively impacts their well-being, and contributes to anxiety. Participants reported that these experiences of ambiguity both clarified and strengthened their values. They also reported that values were a source of guidance and certainty when facing ambiguity. Discussion: These initial results suggest that graduate programs should offer clear guidelines wherever possible, and may offset risk by supporting students in clarifying and enacting their values throughout their training.

Objective This study examined the impact of having one or multiple physical long-term conditions (LTCs) on engagement and outcomes following psychological treatment, while also exploring potential clinical and treatment-related moderators. Methods A retrospective cohort design was applied to routine data from 44,957 patients discharged from seven NHS Talking Therapies services in England between 2021-2024. Logistic regression analyses assessed the impact of LTC status (having none, one, or multiple LTCs) on reliable recovery (defined as reliable and clinically significant improvement in depression and anxiety scores), and on treatment engagement (operationalised as having a planned discharge versus dropping out of treatment). Moderation analyses explored the influence of provisional diagnosis, baseline functional impairment, treatment intensity (low or high), and mode of therapy delivery (remote vs in-person). Results 47.5% of patients reported having at least one LTC, with 9.4% reporting multiple LTCs. Patients with LTCs had significantly lower odds of reliable recovery (OR = 0.83), with further reductions observed among those with multimorbidity (OR = 0.71). Conversely, having an LTC was associated with significantly higher odds of planned discharge (OR = 1.28). Provisional diagnosis was found to moderate the relationship between LTC status and reliable recovery, with the negative relationship being less pronounced among those patients with depression (OR = 1.21), compared to those patients with anxiety-related disorders. Conclusion Having an LTC is associated with poorer clinical outcomes despite higher treatment engagement, with this effect being more pronounced for patients experiencing multimorbidity. Tailored care pathways are needed to better support patients with LTCs.

Background: PTSD has been associated with negative long-term consequences, including social and occupational impairments. Yet, a clear understanding of the interplay between PTSD symptoms and distinct domains of impairments on a short-term basis (weeks/ months) at the within-person level remains underexplored. Methods: Using a large sample (n wave 1 =1096, n wave 7 =304) of UK healthcare workers assessed across seven assessment waves during the COVID-19 pandemic (spaced 6 weeks apart), we employed exploratory graphical vector autoregression models (GVAR) models to discern within-person temporal (across time) and contemporaneous (within same time window) dynamics between PTSD symptoms and functional impairment domains. Results: The contemporaneous network highlighted strong co-occurrences between different symptoms and impairments. The temporal network revealed a mutually reinforcing cycle between intrusion and avoidance symptoms. Intrusion symptoms showed the highest out-strength (i.e., most predictive symptom), predicting avoidance symptoms, elevated sense of current threat, and various functional impairments. Avoidance symptoms, elevated after increased levels of intrusions, predicted work impairments that in turn were associated with difficulties in fulfilling other obligations. Conclusions: Our findings underscore the dynamics between perceived threat and intrusions, and the role intrusions may play in predicting a cascade of adverse effects. Targeted interventions aimed at mitigating intrusions may disrupt this negative cycle.

Aim: To prevent frequent and unnecessary psychiatric readmissions, clinicians need to identify who is likely to readmit, predict when, understand why, and deliver patient-specific interventions during the early stages of treatment. To overcome the limitations of existing methods, our previous study introduced an innovative “pattern-focused approach”, identifying five distinct types of long-term readmission patterns. The current study examined whether these patterns corresponded to meaningful differences in patients’ profiles, clinical presentations, and treatment outcomes, detectable from their first admission. Methods: Retrospective analyses were conducted using archived psychiatric inpatient records (N = 3,422; grouped into the five readmission patterns, plus a comparison group of patients with only one readmission). Patient-, symptom-, and treatment-related variables measured during the first and second admissions were analysed using appropriate tests of group difference with adjusted post-hoc comparisons. Results: The patterns demonstrated distinct combinations of differences across the measures, suggesting that specific readmission risks may be identifiable prior to patients’ first readmission (a capability not previously demonstrated). Higher admission-frequencies involved more complex presentations, greater symptom severity, and higher treatment needs. Stable and episodic patterns were primarily differentiated by interpersonal measures. Discussion: Early clinical characteristics differentiated long-term readmission trajectories, underscoring the clinical utility of the pattern-focused approach. Findings provide preliminary profiles for the readmission patterns, identify potential underlying mechanisms, and propose integrative explanations to clarify discrepancies across the literature. This research opens avenues for predictive modelling and the development of time-sensitive, personalised interventions to prevent unnecessary readmissions, strengthen quality of care, and improve long-term outcomes.

Background: The clinical and psychosocial heterogeneity among outpatient psychotherapy patients presents significant challenges in anticipating treatment response. Early response within the first sessions has been consistently associated with long-term therapeutic success. Identifying, from treatment onset, patient subtypes with higher likelihood of early non-response could facilitate personalized interventions and more efficient allocation of therapeutic resources in clinical settings. Objective: To identify clinical and psychosocial subtypes associated with early non-response to psychotherapeutic treatment using supervised and unsupervised machine learning techniques. Method: This prospective study included 226 adult patients initiating outpatient psychotherapy. Comprehensive baseline assessment encompassed sociodemographic variables (sex, age, occupational and educational level, previous treatments, medical comorbidity, family psychiatric history) and validated instruments measuring depressive symptoms (PHQ-9), anxiety (GAD-7), general symptomatology (DSM-5 Level 1), childhood adversity (CTQ-SF), personality functioning (LPFS, OPD-SF), emotion regulation (DERS), resilience (BRS), and perceived social support (EMAS). Early change in psychological distress was assessed using the CORE-10 administered before the first three therapeutic sessions. Supervised learning models (penalized logistic regression and random forest) will identify relevant predictors of early non-response, followed by unsupervised clustering techniques applied to the most influential variables to characterize distinct clinical and psychosocial subtypes among non-responders. Results: The presentation will report variables most strongly associated with early non-response and characterize identified patient subtypes among early non-responders, providing clinically interpretable typologies. Discussion: This study provides empirical evidence regarding patient characteristics associated with poorer early response to standard psychotherapeutic interventions, informing clinical decision-making for patient-tailored interventions and contributing to precision mental health approaches in psychotherapy research.

Background Breast cancer (BC) is the most prevalent cancer among women in the U.S., with over 3.8 million survivors in 2024. Survivors frequently face psychological challenges such as depression and fatigue, alongside symptoms like chronic pain, all of which impair quality of life. Evidence-based psychosocial interventions are needed. Art Therapy (AT), a psychotherapeutic approach using art making, has shown promise in enhancing emotional processing and reducing distress in cancer patients. This study examined AT’s mechanisms of change, focusing on emotion processing, heart rate variability (HRV), and cytokines as mediators of symptom reduction. Methods 240 women diagnosed with BC within the past year, and post-chemotherapy were randomized to an 8-week AT intervention or a sham Mandala coloring group. Sessions (1.5 hours) included rapport-building, art-making, and group discussion. Emotional processing, assessed via a performance measure and self-reports, as well as depression, pain, fatigue, HRV and cytokines were measured at baseline, post-intervention, and follow-up. Results Depression decreased only in the AT group. Both groups improved in emotional awareness and had reduced pain and fatigue. AT showed greater emotion acceptance and approach coping gains, but these did not mediate the intervention effects on depression. HRV and cytokines did not change significantly. Discussion AT appears effective in enhancing emotional processing, however, surprisingly, so is Mandala coloring. Both AT and Mandala coloring, as part of psychotherapeutic interventions, may be beneficial for reducing pain and fatigue. AT may also help reduce depressive symptoms. Further research is needed to understand AT mechanisms and optimize psychotherapy for cancer survivors.

Aim: Poor sleep can negatively affect performance in various jobs. However, these adverse effects may be amplified in certain occupations. Considering that the two primary emotional consequences of insomnia are difficulty in emotion regulation and negative mood, it can be argued that psychotherapists, whose work constantly demands high levels of empathy and emotional processing, represent a group particularly vulnerable to the detrimental effects of insomnia. Methods: The sample of present cross-sectional study consisted of 202 psychotherapists (female: 87.62%, Mage = 35.46, SD = 8.32, Mclinical experience = 8.62 , SD = 7.51). The participants completed measures of demographic information, insomnia severity, difficulties in emotion regulation, negative affect during psychotherapy practice, and individual work performance. A mediation analysis was conducted to evaluate the mediator roles of difficulties in emotion regulation and negative affect in the relationship between insomnia severity and individual work performance. Results: The preliminary results showed that direct effect of insomnia severity on individual work performance was not significant (β = 0.02, p > .05). However, the indirect effect of insomnia severity on individual work performance via difficulties in emotion regulation (β = -0.05, p < .05) and negative affect during sessions (β = -0.04, p < .05) was significant, suggesting a full mediation. Discussion: Interventions aimed at improving psychotherapists' sleep quality (e.g., sleep hygiene practices) and alleviating insomnia severity (e.g., cognitive behavioral therapy for insomnia) may enhance their professional functioning and performance. Keywords: Insomnia, sleep, emotion regulation, negative affect, work performance.

Aim: According to the instrumental model of emotion regulation, emotional goals shape regulatory behaviors by increasing the likelihood of selecting strategies aligned with one’s desired emotional state. Consistently, pro-hedonic emotional goals are theorized to promote the use of adaptive positive emotion regulation (PER) strategies, such as increased savoring and reduced dampening. In contrast, lower pro-hedonic goals, commonly observed in depression, may contribute to maladaptive patterns in PER. However, no prior study has directly examined how pro-hedonic emotional goals relate to the use of PER strategies in daily life, nor how this association may be influenced by depressive symptomatology. Methods: Using an Ecological Momentary Assessment design over 10 days (n=157), we examined whether pro-hedonic goals prospectively predicted the momentary use of savoring and dampening strategies, and whether these associations varied by depression severity using Multilevel Vector Autoregressive (VAR) models. Results: Findings revealed that higher pro-hedonic goals significantly predicted increased subsequent use of savoring strategies. Notably, although individuals with low and high levels of depressive symptoms reported similar average levels of pro-hedonic goals, the predictive association between pro-hedonic goals, savoring and dampening emerged only among those with fewer symptoms. Discussion: Pro-hedonic emotional goals were significantly linked to greater subsequent use of savoring strategies, which in turn, predicted increased positive emotions and reduced use of dampening, thus supporting the instrumental theory of emotion regulation. Notably, in depression the difficulty may not lie in a diminished desire to feel good, but rather in a reduced capacity to translate pro-hedonic emotional goals into effective PER.

According to the Center for Collegiate Mental Health report, the average number of clients per standardized counselor in university counseling centers (UCCs) increased by approximately 18% from 2020–2021 to 2021–2022. Increased clinical load requires clinicians to take on additional duties, heightening the risk of burnout. Prior findings suggest that burnout among mental health care providers detrimentally affects treatment quality and outcomes. However, despite being a high-demand clinical setting, no studies to date have examined the associations between clinical load, client outcomes, and retention in UCCs. This study examines the effects of elevated clinical load on client outcomes and dropout in a UCC characterized by a high Clinical Load Index (CLI). We will examine both within- and between-therapist effects using a multidimensional CLI that accounts for the number of direct clinical hours accrued per week prior to each client session. In addition, given that triage services are more resource-intensive than standard sessions, clinical load will be weighted to account for differential resource consumption. Data are drawn from an urban university counseling center in the Southern United States between 2022 and 2025 and include counselor-level clinical load, CCAPS Distress Index for treatment outcome, and client dropout information. Using a multilevel modeling approach, this study examines how clinical load affects treatment outcomes and client retention. The results of the study are expected to be available in early 2026, before the SPR Annual Meeting. Findings are expected to inform evidence-based staffing and service decisions in UCCs.

Aim: Intensive longitudinal assessment methods—such as ecological momentary assessment (EMA) and wearable-based digital phenotyping—enable real-time monitoring of affective, behavioral, and interpersonal fluctuations during psychotherapy. Assessing their feasibility and acceptability is essential before integrating these tools into routine care. To explore therapists’ acceptance and experiences after completing a two-week digital monitoring protocol, and to evaluate its feasibility, usability, and acceptability for patients initiating psychotherapy. Methods: Eleven psychotherapists completed a two-week protocol involving six EMA prompts per day via mPath and continuous use of a Garmin Vivosmart 5, followed by focus groups analyzed with Consensual Qualitative Research (CQR) guided by UTAUT constructs. In the patient phase, approximately ten adults starting psychotherapy will complete the same protocol and a brief UTAUT-based interview, whose qualitative data will also be analyzed using CQR. Results: Therapists described the protocol as clinically valuable, noting its potential for enhancing emotional awareness, detecting behavioral patterns, and supporting therapeutic dialogue. Reported barriers included high prompt frequency, occasional item ambiguity, cognitive load of the 0–100 sliders, and concerns about privacy and the social visibility of the device. Suggested improvements involved reducing EMA frequency, clarifying item meaning, onboarding, and ensuring technical support. For patients, the study is expected to yield data on EMA response rates, satisfaction with the wearable, perceived burden, and feasibility indicators. Discussion: Therapists' feedback indicates both clinical value and practical challenges requiring refinement before patient implementation. Forthcoming patient data on feasibility and usability will guide protocol adjustments and support its integration into routine clinical practice.

Aim: Improving predictive models of psychotherapy outcomes can enhance progress-feedback implementation and, by extension, clinical results. The incorporation of Ecological Momentary Assessment (EMA) adds dynamic and context-sensitive information to these models. However, the field lacks a gold standard regarding EMA implementation, raising the question of how much information is minimally sufficient to obtain a stable and representative picture. This gap generates important methodological and implementation challenges. To analyze and compare different EMA time cut-offs (i.e., daily sampling, every three days, and the first one and two weeks of data) in order to determine the minimal data collection window required to reliably predict early change. Methods: A simulation study will be conducted to evaluate the association and performance of each time cut-off. Simulations will be based on active data (collected through a mobile app) and passive data (collected through a smartwatch) from multiple samples. We will compute correlations across time-cut-off conditions and fit linear models to examine their relationship with early change on the PHQ-9. Additionally, machine-learning models will be employed to test whether predictive accuracy decreases when using different EMA time cut-offs compared to the full dataset. Results: We expect to identify general patterns in the degree to which shorter EMA time cut-offs preserve the information contained in longer assessments, and tendencies in how different windows affect predictive performance. Discussion: Implications for general EMA implementation, and specifically for outcome prediction and personalization, will be discussed.

Aim: Participation and adherence in intensive monitoring studies such as Ecological Momentary Assessment (EMA) are critical for both research quality and clinical insights. However, little is known about which patients choose to engage in EMA and, among those who participate, who is most compliant or likely to discontinue the monitoring. Understanding these patterns is important because initial willingness to participate may reflect underlying traits related to treatment engagement and study adherence. Methods: N = 195 Patients were invited to participate in an EMA and passive sensing study, of whom n = 115 agreed to participate and n = 80 declined. All participants completed a baseline diagnostic assessment, and during the first 14 days of therapy the participating patients received EMA questionnaires six times per day while continuously wearing a fitness tracker for passive data collection. Patients were free to discontinue their involvement at any time without any consequences. Results: Initial analyses show that patients who declined EMA participation were more likely to drop out of therapy than those who agreed to participate. Planned analyses will examine, within EMA participants, who is most compliant and who is at risk for discontinuing the monitoring. Discussion: EMA participation appears to reflect patient characteristics related to treatment engagement, with non-participants showing higher therapy dropout rates. This underscores that initial willingness to engage in digital monitoring carries clinically relevant information beyond baseline assessments. Planned analyses of compliance among EMA participants may further clarify factors influencing engagement and inform the design of future monitoring studies.

Aim: Current findings show that about 50% of patients do not benefit from psychotherapy, and around 5% experience symptom deterioration (Cuijpers et al., 2021). These results have intensified the call for personalized treatment approaches to better understand which interventions work for whom (Lutz et al., 2022). A central step toward precision mental health is increasing data precision. Ecological Momentary Assessment (EMA) can complement retrospective cross-sectional assessments by capturing experiences in real-time and in daily life, thereby providing insights into psychological and physiological dynamics. Although EMA is increasingly used in psychotherapy research (Mink et al., 2025), it remains unclear which EMA-derived parameters improve the prediction of therapy outcomes beyond cross-sectional predictors. This study introduces an EMA study assessing self-reports and passively sensed physiological parameters at the beginning of psychotherapy to examine whether these parameters improve outcome prediction. Methods: 150 patients from the Trier University outpatient clinic participated. Over two weeks, affect and interpersonal well-being were assessed six times daily. Simultaneously, patients wore wearables to capture physiological parameters (heart rate, activity, sleep). Symptom severity was assessed before and after treatment using the PHQ-9. Data was split into a training and a holdout test set. Variable selection was performed using Elastic-Net regularization with 20-fold cross-validation. Model performance was evaluated using R². Results: Adding EMA predictors improved the prediction of therapy outcomes compared to a model including only cross-sectional predictors. Discussion: The potential of EMA for predicting therapy outcomes and informing personalized psychotherapy is discussed, along with implications for EMA-based interventions and cross-cultural validity.

Given the high global incidence of suicide and the substantial number of males affected by suicide, understanding the specific experiences and outcomes for men is crucial, particularly in the context of observed gender differences in suicide rates, mental health outcomes and males' place in society. Many of the males seen in my practice are suffering from depression arising from their alienation from their children and the lack of recognition both from society and themselves with respect to how important they are in their children’s lives. Fathers' engagement with their children, particularly with their sons, from a very early age makes for critical differences in a child's language acquisition, reading ability, engagement with school, and behaviour. It is important to recognise that the father-child relationship is potentially an important one and, in some cases, more influential than the mother-child relationship, especially for the young child & adolescent as they try to make more sense of the outside world, where they may see the father as more representative of how to cope with the outside world. Children’s school behaviour is strongly linked with educational attainment, and a father’s influence on that behaviour is not only significant but may be more significant than a mother’s. I will speak about how and in what ways evidence-based research indicates how fathers make a significant difference throughout childhood, from birth to adulthood, especially for their sons and how to help them recognise their importance and to fulfil their roles even when separated from their children.

Aim: Recent work has examined how rupture and repair processes, as well as therapist ‎interventions aimed at resolving ruptures, influence the therapeutic alliance in adults. ‎However, only a few studies have directly investigated these processes in children. This ‎study examined rupture and repair processes in child psychotherapy, with a focus on ‎therapist-reported resolution strategies and their relation to child alliance. In addition, the ‎role of parental alliance and diagnostic profile in shaping rupture type and severity was ‎investigated.‎ Methods: Ninety-four child psychotherapists participated in workshops of rupture and resolution ‎strategies adapted to children. Then they reported on a single therapy session with ‎children aged 3–13. Therapists completed measures of child and parent alliance, ‎identified rupture type and severity, and recorded interventions using a child-adapted ‎version of the Rupture Resolution Rating System (3RS). Diagnostic categories included ‎internalizing, externalizing, and neurodevelopmental disorders.‎ Results: Parental alliance was the strongest predictor of child alliance, underscoring the ‎importance of the family context in children’s engagement. Therapist interventions also ‎contributed positively, particularly reflection and validation strategies. Unexpectedly, ‎rupture severity was positively associated with child alliance, suggesting that effectively ‎repaired ruptures may strengthen relational trust. More severe ruptures elicited a greater ‎number of therapist interventions. Confrontation ruptures were more frequent among ‎children with externalizing disorders, whereas withdrawal ruptures predominated in ‎internalizing disorders. ‎ Conclusion: Findings emphasize parental alliance and developmentally adapted rupture repair ‎strategies as central predictors of therapeutic alliance in child psychotherapy. Further ‎research, including neutral observer coding, is needed.‎

Background and Aim: Child anxiety problems are among the most prevalent mental health difficulties worldwide, beginning at a young age and continuing into adulthood if not addressed early on. Few families access support for their child’s anxiety, but digital treatments such as Online Support and Intervention for child anxiety (OSI), help to increase access. OSI is a therapist-guided programme in which parents learn CBT techniques and implement them at home with their child. Several large trials have shown OSI to be clinically and cost effective, plus acceptable to families and clinicians, but little is known about which families benefit less and how to optimise the intervention. Recent quantitative studies have identified factors linked to poorer outcomes, such as the child’s primary anxiety problem and parent-clinician alliance. The present study aims to qualitatively explore why and how these factors may influence outcomes, from the perspectives of both clinicians and parents. Methods: Purposively sampling of clinicians and parents is being used to ensure that a diverse range of participants are included. We are being guided by the concept of ‘information power’, but anticipate recruiting between 30 and 40 participants in total, split roughly in half for each group (clinicians and parents). Semi-structured, one-to-one interviews will be conducted and analysed using template analysis. Results and Discussion: Recruitment is ongoing, and preliminary findings from clinicians and parents will be presented, highlighting key insights. Findings will be used to inform adaptations to OSI in order to optimise clinical outcomes for as many families as possible.

Introduction: This follow-up study extends previous work on peripartum maternal depressiveness and anxiety using the now complete four-time point longitudional dataset (uncleaned N ≈ 298) from the COMPARE-Interaction study. It examines how depressive and anxiety symptoms jointly predict mother-infant bonding quality and maternal attachment security across the first two years postpartum, refining the original thesis-based conclusions. Methods: Mother in Germany were allocated to theree groupd based on DSM-5 diagnoses: healthy controls, mothers with peripartum depression without comorbid anxiety, and mothers with peripartum depression and comorbid anxiety. Peripartum depressiveness was assessed with the Edinburgh Postnatal Depression Scale (EPDS) and perceived maternal anxiety with the AKV across four postpartum time points. Mother–infant bonding impairment and maternal attachment insecurity were measured with the PBQ‑16 and VASQ. Group comparisons and longitudinal path models tested group differences and the joint predictive value of depressive and anxiety symptoms for bonding and attachment trajectories. Results: Depressed mothers are expected to show poorer bonding and higher attachment insecurity than CG at all time points, with minimal differences between PD and PDCA in overall impairment. Maternal depressiveness (EPDS) is anticipated to remain the strongest predictor of impaired bonding, whereas depressiveness together with agoraphobic cognitions and avoidance is expected to predict greater attachment insecurity over time. Conclusion: Extended models are expected to indicate detrimental effects of peripartum depressiveness on bonding and that attachment persist into the second year postpartum, with anxiety-related processes maintaining relational vulnerability and highlighting the need for integrated screening and interventions targeting both depression and anxiety.

Aim Caring for an adolescent with AN places substantial emotional and practical strain on parents, which can hinder treatment progress. Innovative, scalable tools are needed to support caregivers’ crucial role within family-based treatment. This project aimed to develop and evaluate an AI-supported digital serious game designed to enhance caregiver skills and confidence. Methods Intervention development was informed by focus groups with caregivers (n = 10), individuals recovered from adolescent-onset AN (n = 4), and clinicians (n = 8), alongside existing treatment manuals and literature, and in collaboration with a parent advisory panel. We are conducting a randomized controlled pilot trial including 60 families. Primary outcomes focus on improvements in caregiver skills, self-efficacy, and coping, alongside reductions in caregiver burden and distress. To evaluate user experience and real-life implementation processes, we are conducting qualitative interviews. Results Participants highlighted several challenges faced by caregivers, particularly around managing mealtimes. Through an interdisciplinary iterative process, we designed an authoring tool to personalize the gaming experience. Large language models were integrated to dynamically generate dialogues within the game, resulting in a scenario-based serious game intervention where parents can explore ways to support their child in a safe, engaging environment, complementing ongoing therapy. Discussion This intervention demonstrates how AI and interactive storytelling can be integrated into psychotherapy-adjacent tools to empower caregivers, reduce burden, and support treatment outcomes. This pilot study will provide initial effect sizes, paving the way for a larger trial, and aims to improve accessibility and optimize healthcare resources amid strained clinical services.

Objective: This study examined how transgender and nonbinary young adults in China experience gender-identity conversion practices (GICP) and how these experiences shape their psychological well-being, help-seeking, and therapeutic needs. Method: In-depth, semi-structured interviews were conducted with nine Chinese transgender and nonbinary young adults with lived experience of GICP. Interviews were analyzed using reflexive thematic analysis to identify psychological, relational, and contextual processes. Results: Participants described five primary modalities of GICP—psychiatric, psychological, religious, correctional school–based, and family-driven interventions—each embedded in cultural and institutional stigma. Parental pressure to enforce gender conformity emerged as the dominant interpersonal driver. Across modalities, participants reported significant psychological consequences, including chronic fear, shame, identity confusion, trauma symptoms, and disrupted attachment and family relationships, as well as social impairments such as school withdrawal and financial instability. Many participants described long-term mistrust of mental health providers stemming from prior coercive or pathologizing encounters. Conclusions: Findings highlight the profound psychological harms associated with GICP and the ways these experiences shape clients’ expectations of therapy and engagement with mental health systems. The study underscores the need for culturally responsive, gender-affirming psychotherapy practices in China, as well as specialized training to help clinicians recognize, repair, and work through trauma associated with conversion efforts. Implications extend to global psychotherapy practice, where providers may encounter clients carrying similar histories of coercive or stigmatizing interventions.

Social workers are on the frontlines of delivering psychological and social services to lesbian, gay, and bisexual (LGB) clients to help mitigate distress caused by stigma. Developing competence in LGB-affirmative practice, which includes acceptance of LGB identities and attention to the harmful effects of stigma-related stressors, is essential for effective service provision. However, research in this area has often relied on self-report surveys, which are prone to social desirability bias. Moreover, organizational factors such as religious affiliation, inclusion and diversity policies, and the presence of an LGB-friendly climate have received relatively little attention. This study aimed to assess LGB affirmative practice competence and examine its correlates in a non-probability sample of social workers practicing in Hong Kong and Taipei/New Taipei City. Between March and August 2024, a total of 321 social workers (mean age = 33.38, SD = 7.27; 67% female; 36% non-heterosexual) participated in an online survey and vignette-based assessment. The vignette responses were evaluated by multiple coders to assess participants’ case conceptualization and reflexivity in working with LGB clients. Findings revealed an overall low to moderate level of LGB affirmative practice competence among participants. Significant correlates included the number of LGB-related training hours received and the number of LGB clients served. The study demonstrates the utility of vignette-based assessments in measuring practice competence and suggests training and simulation as effective strategies for enhancing social workers’ LGB affirmative practice competence.

Aims. Minority stressors (e.g., discrimination, rejection, structural stigma, etc.) generate disproportionate rates of mental health burden among sexual and gender minorities (SGMs). Moreover, morally injurious experiences (MIEs) from minority stressors can foster trauma-related symptoms and moral injury in SGMs. Critically, MIEs can also alter brain connections, especially in the amygdala and insula. Here, moral injury-related alterations in the amygdala and insula have been shown previously to be linked to differences in emotional and brain-body processing and mental health outcomes. However, research investigating neurobiological, trauma, and moral injury-related outcomes of minority stress in SGMs is scarce. Therefore, we aimed to investigate resting-state brain connectivity patterns of the amygdala and insula before and after the recall of minority-stress-related morally injurious memories, and evaluate associations with minority stress experiences and mental health. Methods. Sixty SGM adults (18-70 years old) completed self-report questionnaires assessing trauma, moral injury, discrimination, rejection, dissociation, and emotional regulation difficulties. Participants completed resting state fMRI scans before and after the recall of minority stress-based morally injurious memories. Results. Resting-state seed-based functional connectivity analyses of the amygdala and insula (pre vs. post memory-recall paradigm) will be performed on fMRI data. Correlational analyses will examine the relationship between the questionnaire and fMRI brain connectivity data. Discussion. Findings can illuminate underlying neurobiological mechanisms affected by minority stress-related moral injury and trauma experiences, contributing to mental health difficulties among SGMs. This knowledge can be translated to develop neurobiologically informed, 2SLGBTQIA+ affirming psychotherapy practices to enhance mental health and resilience among SGMs.

Aim Trans and non-binary youth frequently report discriminatory or inadequate psychotherapy experiences, resulting in treatment dropout, weak therapeutic alliance, and low satisfaction. Despite partly progressive health care policies in Germany, structural barriers and ethical challenges impede competent, needs-based care. This study explored how experienced psychotherapists who work with trans youth understand and translate competent care into practice. Methods Using Charmaz’s constructivist grounded theory, 15 semi-structured interviews were conducted with psychotherapists in Germany working with trans and non-binary youth (ages 11–25). The analysis explicitly centered the broader contextual factors shaping clinical practice through heterogenous expert backgrounds and exploration of social and institutional contexts. Results The resulting grounded theory conceptualizes competent care as navigating complex tensions shaped by structural, institutional, and familial conditions. Therapists continuously negotiate and prioritize between four intersecting areas of loyalty: (1) clinical guidelines, (2) institutional demands, (3) parental interests, and (4) principles of social justice. While the weighting of these varies depending on therapists’ personal positioning and the broader healthcare context, “neutrality” is consistently experienced as practically and ethically impossible. Discussion Findings show that therapists are both actively positioned and structurally situated within broader systems. While all emphasize the importance of reflexive engagement with positionality and power, they diverge in how this should be made visible: some see outward positioning and advocacy beyond the therapy room as integral, whereas others view this as contradicting their therapeutic practice and instead frame their open, growth-oriented relational stance with trans clients as the benchmark for therapeutic practice more broadly.

What does it truly mean to be responsive to another person? Definitions often invoke empathy, sensitivity to another’s needs, and behaving in ways that feel fitting or attuned to that particular individual. In psychotherapy, responsiveness refers to the therapist’s ability to adapt and fine-tune interventions and therapeutic processes to the patient’s specific problems, needs, goals, and sensitivities. A meta-analytic review of research on patient preferences in psychotherapy demonstrates robust evidence that allowing patients to shape their treatment by expressing their preferences leads to improved clinical outcomes (Swift et al., 2018). Similarly, Norcross and Wampold (2019b) emphasized that “adapting therapy to the entire person improves success and decreases dropouts; the power of responsiveness exceeds that associated with Treatment Method A for Disorder Z; this represents not clinical lore but established fact” (p. 6). Yet despite this “established fact,” many therapists—and most training programs—continue to emphasize adherence to evidence-based protocols or standardized techniques validated for specific diagnoses. Responsiveness, however, can be understood from two vantage points: the actor’s intention and the partner’s perception. A substantial body of evidence indicates that perceived partner (patient) responsiveness is far more consequential than intended actor (therapist) responsiveness. Drawing on research from relationship science, patient surveys, and psychotherapy process studies, this presentation argues that responsiveness is best understood—and most meaningfully practiced—when viewed through the patient’s eyes.

In recent years, responsiveness has been considered one of the more important factors for understanding how therapists contribute to the outcome of treatment. However, a shared operational definition of the components of responsiveness is still lacking. Control-Mastery Theory (CMT) can provide a coherent and empirically supported theoretical frame for understanding what a responsive psychotherapist does. According to CMT, patients come to therapy with a plan to pursue healthy and adaptive goals; to disprove the pathogenic beliefs that obstruct this pursuit; to better master the traumas and adverse experiences that gave rise to these beliefs; to have corrective emotional experiences; and to gain new insight into their problems. A responsive therapist is a therapist who is able to understand this plan and help their patients to carry it out. Clinical and empirical data supporting this perspective will be provided.

Objective: Personality functioning is an important indicator of psychological wellbeing, particularly among young adults struggling with identity difficulties. The degree to which youth can enhance their reflectivity may contribute to improvement in personality functioning through treatment. According to control-mastery theory, sufficient safety, achieved via the therapist's responsiveness, is key to facilitating reflectivity. The present study examined young adults’ subjective experience of therapist responsiveness as a predictor of change in reflective and personality functioning, including pre- to post-treatment change in reflective functioning as a mediator to improved personality functioning at 3-month follow-up. Method: This study used a sample of young adults (age 18-25) with identity distress who completed brief psychotherapy via the Zoom videoconferencing platform. The sample combined randomized trial (n=79) and cohort (n=33) components. Therapy was based on individual case formulations informed by the Plan Formulation Method. The present study examined patients’ self-reported personality functioning at pre-treatment and 3-month follow-up, aggregated perceptions of therapist responsiveness (from the four middle-phase sessions), and self-reported reflective functioning at post-treatment. Results: Ratings of therapist responsiveness across the middle phase of therapy were associated with improved reflective functioning at post-treatment, which in turn was associated with improved personality functioning at follow-up three months after the conclusion of treatment. Discussion: Findings indicate that young adults' experiences of therapist responsiveness are linked with their ability to enhance reflective functioning over the course of brief, formulation-based psychotherapy. Moreover, responsiveness indirectly contributed to improved personality functioning, through enhanced reflectivity. Implications of these relationships, including the facilitation of safety in therapy for young adults with identity difficulties, will be discussed.

Therapeutic collaboration is a central process variable associated with psychotherapy outcomes and treatment retention, particularly during the early sessions, which have been consistently identified as critical for premature termination. Despite extensive research on dropout, fewer studies have examined early therapist-client interactions at a moment-to-moment level to identify proximal mechanisms preceding dropout. Aim: This multiple case study investigates the unfolding of therapeutic collaboration during the first four sessions of cognitive-behavioral therapy, comparing three early dropout cases with three good outcome completers. The primary objective is to identify early interactional patterns and relational dynamics that differentiate clients who terminate prematurely from those who remain engaged in treatment. Methods: Therapeutic collaboration was examined using the Therapeutic Collaboration Coding System (TCCS), which sequentially codes therapist interventions as supporting or challenging and client responses as validation, invalidation, or ambivalence. Two trained judges independently coded videotaped sessions, with discrepancies resolved through consensus and subsequent auditing. Dyadic interaction patterns were analyzed using State Space Grids and Hidden Markov Models to capture shared therapist-client states and transition probabilities over time. Results: Data analysis is ongoing. We expect dropout cases to display more rigid and less flexible interactional patterns, particularly following ambivalence or non-collaborative episodes. In contrast, good outcome completers are expected to demonstrate greater interactional flexibility and more frequent repair sequences following moments of interactional strain. Discussion: Findings aim to advance psychotherapy process research by identifying early interactional markers of dropout risk and informing clinical strategies to enhance engagement during the initial phase of treatment.

Therapists’ ability to recognize and repair alliance ruptures constitutes a critical ingredient of psychotherapeutic change. Alliance ruptures represent a privileged clinical context in which key therapeutic skills are enacted. Despite extensive research on rupture-repair processes, few studies have examined rupture–resolution sequences using micro-analytic approaches sensitive to moment-to-moment fluctuations, relational nuances, and the immediate effects of these skills. Aim: To characterize patterns of alliance rupture and resolution in adult psychotherapy sessions based on therapists’ facilitative interpersonal skills (FIS) and reflective function (RF), and examine their association with immediate treatment outcomes. Method: Ten brief psychotherapies were analyzed using the 3RS Manual (v.2022) to identify ruptures-resolution patterns by trained independent raters. A phase-stratified sampling was conducted, selecting three early, middle, and final sessions from each therapy (n = 90). Rupture–resolution sequences were categorized according to their presence and degree of success and subsequently evaluated using the Therapist In-Session Rated Facilitative Interpersonal Skills (FIS-IS) and the Reflective Function Scale (RFS) to examine associations between therapeutic skills and successful rupture resolution patterns. Results: Successful rupture–resolution sequences are expected to be associated with higher levels of therapists’ FIS and RF, as well as greater symptom improvement. In contrast, unresolved sequences are expected to show lower levels of FIS and RF, and less symptom improvement. Discussion: The findings contribute to microprocess research by examining therapists’ skills in critical clinical situations and the specific features of rupture–resolution sequences, providing an empirical basis for more efficient training models focused on transferable therapeutic competencies across approaches.

Background: What does the therapist do when patient vulnerability creates relational pressure? In the case examined, the patient repeatedly tested whether the analyst could 'handle' her aggression, criticism, and demands. She feared direct engagement would destroy the analyst or provoke retaliation. This created a dilemma: interpretations risked becoming another demand the patient must passively receive, yet remaining neutral confirmed her fear that the analyst was fragile or unavailable. Method: Using Dialogical Sequence Analysis (DSA), we examined five consecutive psychoanalytic sessions from the extensively researched case of Amalia X. DSA traces how speakers position themselves toward referential objects and addressees, enabling detailed examination of the analyst's moment-to-moment responses during sequences of intense patient vulnerability. Results: The analyst navigated this pressure by: (1) using metaphorical formulations that acknowledged the patient's experience while introducing new perspectives; (2) directly confronting the patient's view of activity as dangerous, demonstrating trust in her capacity; (3) making himself available for 'use' by stepping into dream material. The decisive factor was not interpretation content but how the analyst was 'there' - going first into territory the patient feared, showing that directness need not be destructive. Conclusions: Analyst action under pressure involved embodying a stance that countered transference expectations. As the analyst demonstrated he could tolerate the patient's activity without collapsing or retaliating, the patient developed capacity to engage with her own vulnerability. The findings highlight how therapist presence - the 'how' of being there - forms the relational foundation upon which technical interventions become effective.

Aim: Ruptures and ethical challenges in personal therapy during training represent potential risks and critical opportunities for professional growth. Given the dual dependency of trainees on their therapists and institutions, such experiences may expose vulnerabilities and foster reflective capacities. This study examines how psychodynamic trainees navigate ruptures and ethical challenges and how these experiences contribute to their competence development, ethical awareness, and professional maturation based on data of a mixed-methods study on competence development and maturation along personal therapy during psychodynamic training. Methods: Seventeen semi-structured interviews were conducted with candidates in psychodynamic psychotherapy training. The data were analyzed using Mayring’s (2015) qualitative content analysis to identify recurring patterns in experiences, coping strategies, and consequences. Results: Participants reported encountering a range of relational ruptures and ethical challenges, from subtle emotional misattunements to more explicit boundary violations. Dealing with the boundary violations was characterized at all levels by different forms of defense and was accompanied by a variety of personal and professional consequences for those affected. Consequences encompassed emotional distress, impaired professional identity development, mistrust toward institutional structures but also reflective integration, maturation and ethical awareness, hence competence development. Discussion: Findings suggest that ruptures and boundary challenges, when adequately processed, can serve as formative experiences in psychotherapist development. Training structures that provide reflective space, ethical guidance, and supervision can transform potentially harmful dynamics into opportunities for learning. Implications include enhancing institutional transparency, reflective training, and integrating ethics discussions. Future research should examine longitudinally how personal therapy experiences improves therapeutic skills and identity.

Aim Observational learning, or modelling, is an important part of psychotherapy training. Most modelling involves observing experts conduct psychotherapy (e.g., APA videos). However, seeing negative models may also help trainees discern what to avoid. Additionally, rating models using established scales and discussing ratings may further enhance learning. The present study examines the effects of observing and evaluating different types of models on trainees’ learning outcomes. Method Practicum trainees were assigned to three groups: Positive and negative (mixed) models (n=46), positive models (n=43), and controls (n=20). Before seeing practicum clients, trainees in both modelling groups watched videos of respective models, rated models using the Therapist Empathy Scale (TES) and discussed them, while controls only read and discussed the TES. All trainees completed measures of therapist anxiety and counseling self-efficacy before and after training and provided feedback on training received. Results Therapist anxiety decreased after training among trainees who observed mixed (t(45) =2.78, p = .008) or positive models (t(42) = 2.94, p=.005), but not among controls (t(19)= -0.88, p=.39). Self-efficacy in handling relationship conflicts in therapy also increased after training among those who observed positive models (t(42) =-3.53, p = .001). Trainees reported that watching videos illustrated how therapists applied specific skills and deepened their understanding, while rating the videos enhanced their appreciation of empathy’s multiple, overlapping dimensions. Discussion Data collection is almost complete. Further analysis will be conducted on trainees’ outcomes at the end of practicum and their clients’ ratings of session quality and therapist empathy.

Aim The Evidence-Based Treatment Principles (EBTP) is a self-report assessment of therapeutic process rated for a clinician-chosen “difficult session”, e.g., when working with clients with personality disorder diagnoses. Content was developed through review of treatment literature and is summarized in Critchfield (2012), as well as Critchfield & Benjamin (2005, 2006). The resulting measure has 23-items focused on the (1) Quality of the Therapeutic Relationship, (2) Clarity of the Therapeutic Focus, (3) Intervention Quality, (4) Intervention Impacts, and (5) Support for the Therapist. Method The present work describes construct, psychometric, and validity properties of the instrument using self-ratings made by N = 71 psychology graduate students in the context of a training clinic. Results Strong internal consistency is observed among EBTP scales, which tend to be intercorrelated. Validity is evidenced via competency ratings made by supervising faculty, as well as by comparison to self-reported use of CBT and PDT elements assessed via the CPPS (Hilsenroth et al. 2005). Regarding the impact of training, those who received a year of supervision using Benjamin’s approach to treatment, Interpersonal Reconstructive Therapy, were shown to increase significantly in use of evidence-based principles compared to those receiving other supervision approaches. Discussion Implications for research and training will be discussed, with particular focus on the implications of viewing psychotherapy training via the lens of specific theoretical orientations versus integrative or transtheoretical principles of change.

Aim Clinical psychology training has become increasingly uniform in theoretical orientation. This trend may influence trainee’s openness to learning diverse approaches to treatment, subsequently limiting the possible treatment options for their patients. This study examines student experiences learning a new psychotherapy approach (psychodynamic therapy) and its impact on their clinical identity and practice. Method This mixed methods study surveyed 29 students at the end of a doctoral psychodynamic psychotherapy course. The survey included the Comparative Psychotherapy Process Scale as well as several open-ended questions about students' theoretical orientation and beliefs about clinical technique. Results When blindly asked about their specific clinical technique–as opposed to their theoretical orientation–students reported utilizing significantly more psychodynamic (M= 4.22, SD = 1.12, t(31) = 19.57, p < .001) versus cognitive-behavioral (M = 3.85, SD = 1.37, t(31) = 14.51, p < .001) technique. Only 9% of the students surveyed self-identified psychodynamic as their primary theoretical orientation at the end of the course. Although some negative perceptions lingered, students qualitatively reported several positive changes in their perceptions. Discussion This discordance between theoretical identity and actual practice speaks to lingering bias against psychodynamic therapy even among those who use psychodynamic techniques in their practice. Implications for clinical psychology training will be discussed with an emphasis on increasing diversity of theoretetical orientation in training at multiple levels (e.g. coursework, supervision, faculty orientation, etc.)

Background Interpersonal temporal coordination refers to the alignment of signals between interacting individuals in rhythmically matched or predictably coupled patterns. Movement synchrony is a central component of this coordination, supporting effective communication, emotional attunement, and therapeutic engagement. This study uses the Nonverbal Interpersonal Communication Exploration (NICE) Toolbox (https://nice.is.tue.mpg.de/), an automated video-based software for analysing naturalistic interactions. We are using NICE to quantify interpersonal temporal coordination, specifically movement synchrony, as an indicator of interaction quality in parent–child psychotherapy. Research Question (1) How does interpersonal temporal coordination manifest as movement synchrony in parent–child dyads during free-play versus structured-play, and (2) to what extent can the NICE Toolbox reliably quantify genuine synchrony as opposed to coincidental covariation? Methods Sixteen parent–child dyads undergoing psychotherapy at our university outpatient clinic completed two short interaction tasks: free-play versus structured-play activity. Thirty-two videos were analysed using the NICE Toolbox, which extracted frame-by-frame kinematic displacement scores based on x/y coordinates for different body joints that were assessed using an automated body-pose estimation algorithm. Temporal movement coordination was quantified using windowed cross-correlation. External validity was tested by comparing (1) observed synchrony with pseudo-synchrony as well as (2) the two different play situations. Results Observed synchrony was significantly higher than pseudo-synchrony, indicating genuine interactive coupling. Structured-play elicited greater synchrony than free-play, a pattern supported by bootstrap resampling. Conclusion The NICE Toolbox provides a robust, scalable method for capturing naturalistic dyadic coordination. Shared goals and clearer interactional structure seemingly enhance nonverbal coordination in clinical parent–child interactions.

Aim Previous studies showed that the sign of correlations between initial symptom load, synchrony and symptom reduction depend on the used movement synchrony measure leading to a critical discussion on the validity of synchrony measures. This study investigates the convergent and criterion validity of measures for movement synchrony and facial synchrony. Methods The mainly non-clinical sample includes N=83 participants undergoing an attachment interview, personality functioning interview and systemic intervention (in sum N= 249 videos of online sessions). On MEA and OpenFace time series multiple synchrony measures were applied. Convergent validity was investigated with correlations and factor analyses. For criterion validity, correlations between synchrony measures, symptom load (depression) and empathy ratings as well the ability to differentiate between different situations were considered. Results In facial synchrony and movement synchrony, the factor analysis revealed two distinct synchrony facets: correlation-based indices and frequency-based indices. Convergent validity within each facet was satisfactory. However, convergent validity across the two facets was limited, indicating only partial convergent validity. Contrary to expectations, no significant associations with depression were found for either facial or movement synchrony. However, several facial synchrony indices showed positive correlations with empathy, whereas only a few movement synchrony indices were related to empathy. ANOVA results indicated that most facial synchrony measures differentiated between conditions, whereas only three movement synchrony measures did so. Discussion Findings suggest that, similar to previous work on movement synchrony, facial synchrony can also be understood in terms of distinct facets. Results should be interpreted with caution due to methodological limitations.

Background: Interpersonal synchrony is a central construct in psychotherapy process research. However, prior studies using observational data revealed that movement synchrony algorithms show limited convergent validity and yield inconsistent associations with clinical variables such as depression and change of interpersonal problems. The present study aims to validate multiple synchrony measures across behavioral and physiological modalities using an experimental design. Methods: N=30 dyads are randomly assigned to one of four instructional conditions prior to the conversation: (a) be reserved, (b) act naturally, (c) be empathic, (d) be over engaged. These instructions serve as an experimental manipulation to assess whether synchrony values systematically correspond to the intended interpersonal orientation. Each dyad is recorded in a face-to-face interactions and an online conversation. All conversations are video-recorded to extract movement (MEA) and facial-expression (OpenFace). Physiological data (heart-rate variability) are recorded simultaneously. Convergent validity is examined by correlating synchrony indices across modalities (movement, facial expression, physiology). Criterion validity is tested through associations with pre-session depressive symptoms (PHQ-9, empathy (German Interpersonal Reactivity Index), and post-session empathy observer ratings. Results: Data collection and preprocessing are ongoing; first analyses will be presented at the conference. Conclusion: The project tries to overcome the limited knowledge on the validity of synchrony measures by providing a external criterion for the algorithms as well as extends the focus to behavioral and physiological data. Findings will inform future psychotherapy process research and methodological standardization of synchrony quantification.

Interpersonal synchrony—the temporal coordination of behavior, physiological responses, and affective states between individuals—is a fundamental mechanism in psychotherapy. Investigating the determinants and consequences of synchrony, however, is often limited by the complexity and variability inherent in human-human interactions. Socially Interactive Agents (SIAs), encompassing virtual agents and embodied robots capable of real-time multimodal interaction, provide a controlled and reproducible platform to study synchrony. By systematically manipulating agent behaviors, movement patterns, timing, and responsiveness, SIAs allow researchers to explore causal relationships between interactional cues and the emergence of synchrony. Additionally, the ability to standardize agent input across participants reduces confounding variability and enables the systematic investigation of factors such as nonverbal mimicry, turn-taking, and temporal alignment. In this presentation, we will showcase Visual Scene Maker 2.0, a scientific authoring tool to create research projects with SIAs including modelling and controlling their interactive multimodal behavior and the general narration on a detailed level. The creation process employs Artificial Intelligence tools such as Large Language Models allowing the creation of interactive projects in natural language (English). The tool furthermore supports systematic evaluation by enabling precise experimental control, repeatable interaction scripts, and detailed logging of behavioral and temporal parameters for quantitative analysis. Overall, SIAs and the Visual Scene Maker 2.0 provide a scalable, flexible, and scientifically rigorous platform for advancing our understanding of the mechanisms underlying interpersonal synchrony.

Background. The integration of AI-based digital technologies in mental healthcare represents a transformative shift, especially with regards to chatbots, and avatar-based interventions. A central component of the success of AI-based digital mental health interventions has to do with the level of acceptance of this new technology; the degree to which stakeholders perceive a technology as useful, user-friendly, and worth adopting. We aimed to establish the level of acceptance of AI-based digital mental health interventions (AI chatbot, AI avatar-based interventions) compared to the acceptance levels of teletherapy via videoconferencing among clinicians, patients, and a representative community sample (i.e., potential future patients). We also explored the extent to which these difference towards these technologies might be explained by individuals’ attitudes towards AI in general. Methods. Clinicians (N= 658), patients (N= 451), and US census-based community sample (N= 520) completed standardized measures of everyday artificial intelligence use, general attitudes towards AI, and acceptability of digital technology use for mental health interventions. Results. We found that community participants are most optimistic about AI-based mental health tools (chatbots and avatars), whereas clinicians consistently express more skepticism, especially regarding usability. In our sample, general attitudes toward AI (both positive and negative) were highly associated with acceptance of chatbot and avatar-based interventions, more than their professional role or demographic identity. Discussion. These findings might carry clinical implications for the design, deployment, and integration of these technologies into mental health services.

Artificial intelligence is increasingly incorporated into psychotherapy, yet the psychological and cultural factors shaping acceptance of AI-based care remain insufficiently understood. Grounded in self-determination theory, this study examined whether satisfaction of basic psychological needs predicts acceptance of three psychotherapy technologies, AI avatars, AI chatbots, and teletherapy, and whether these relationships are moderated by professional role or cultural context. Survey data were collected from 2,227 participants in the United States (n = 1,742) and China (n = 485), including clinicians and patients,. Separate regression models were estimated for each technology Results revealed technology-specific effects of self-determination. Self-determination was not associated with acceptance of AI avatars (β = 0.008, p = .635), showed a small positive association with acceptance of AI chatbots (β = 0.048, p = .006), and demonstrated a moderate negative association with acceptance of teletherapy (β = −0.132, p < .001). Professional role did not moderate these relationships across either Chinese or USA samples. (all ΔR² < .005). In contrast, cultural context robustly moderated the relationship between self-determination and acceptance across all technologies, with significant interaction effects for AI-avatars (β = −0.334, p < .001), AI chatbots (β = −0.258, p < .001), and teletherapy (β = −0.291, p < .001), indicating relatively stronger or more positive associations in China than in the United States. These findings suggest that acceptance of AI-assisted mental health interventions is shaped more by cultural context and technology type than by professional identity.

Objectives. This scoping review aimed to comprehensively map and synthesize empirical evidence on patient preferences for stand-alone digital mental health interventions (DMHIs), which do not involve a human clinician. The goal was to identify the scope and nature of research in this area, building on previous reviews by including a wider range of technologies and providing an updated synthesis. Methods.A systematic search was conducted across multiple academic databases following PRISMA guidelines. Quantitative studies reporting on adult patients' or potential users' preferences, attitudes, or acceptability of unguided DMHIs (e.g., chatbots, mobile apps, online self-help, virtual reality) were included. Study selection and data extraction were performed by independent reviewers. Results. The review included 96 studies. While attitudes towards unguided DMHIs were generally positive, patients consistently preferred guided or in-person treatment options when available. Preferences improved after direct experience with a DMHI or after brief educational interventions. Key factors influencing preferences included digital literacy, symptom severity, and the DMHI's features, with interactive and personalized elements being valued. Discussion. Unguided DMHIs are viewed as accessible but are not the preferred treatment modality. Enhancing their appeal requires focusing on usability, personalization, and integrating acceptance-facilitating information. Future research should employ standardized measures, include diverse populations, and explore preferences for emerging AI-based tools to align DMHI development with patient needs and optimize engagement.

Much of the emerging research proposing the integration of AI into the therapy process envisions systems with live feedback or post-session feedback components to the therapist. This kind of integration into the therapy process could fundamentally change the existing patient-clinician system in nonlinear and non-intuitive ways. For example, in the triadic system of patient-AI-clinician, core processes of self-disclosure and vulnerability in the therapy relationship could shift to accommodate the AI-support system. Without a theoretical or conceptual model to map these potential changes dynamically, there is a risk of unintended consequences. In this presentation, Dr. Tonge will present work resulting from a community-based system dynamics (Hovmand, 2014) workshop with 16 mental health providers and mental health consumer stakeholders. Participants constructed models reflecting a shared understanding of existing dyadic therapy process emphasizing how vulnerability and self-disclosure unfold in an initial therapy session and how the same models shifted in triadic AI-supported therapy. These mental models form preliminary causal maps that illuminate how the therapy therapy dynamic adapts around the introduction of AI in the therapeutic relationship and provide a foundation for future computational or qualitative models of therapy systems with and without AI.

Aims: Residents of Israel’s southern periphery face high exposure to trauma and loss, contributing to posttraumatic stress, prolonged grief, anxiety, and depression. This study aims to evaluate the feasibility and preliminary impact of a culturally adapted Acceptance and Commitment Therapy (ACT)-based group intervention in enhancing resilience, reducing distress, and examining physiological markers of stress. Methods: Thirty adults experiencing trauma- and grief-related symptoms were randomized to an ACT-based group intervention or waitlist control. The intervention was adapted to local sociocultural realities, integrating communal values, collective identity, narratives of ongoing loss and threat, and contextually meaningful metaphors. Participants complete standardized self-report measures at baseline and post-intervention, including the Posttraumatic Stress Disorder Checklist (PCL), International Trauma Questionnaire (ITQ), Patient Health Questionnaire-9 (PHQ-9), PHQ-15, Generalized Anxiety Disorder-7 (GAD-7), Comprehensive Assessment of ACT Processes (CompACT), and Connor-Davidson Resilience Scale (CD-RISC). Biomarkers of stress (CRP, cortisol) are also collected. Qualitative feedback captures participants’ experiences of the intervention. Results (preliminary/ongoing): Data collection is ongoing. The study is designed to assess changes in psychological flexibility, resilience, posttraumatic stress, depression, anxiety, and somatic symptoms, alongside stress biomarkers. Qualitative data are being gathered to explore participant experiences, including engagement with collective narratives, culturally meaningful metaphors, and acknowledgment of ongoing social and political stressors. Analyses will evaluate feasibility, acceptability, and preliminary impact on both psychological and physiological outcomes. Discussion: This study highlights the potential of culturally adapted ACT to support resilience in communities exposed to chronic trauma and loss. Integrating collective narratives and sociocultural context may enhance relevance and engagement, with implications for developing culturally responsive group psychotherapy.

AIM: The objective of this investigation was to assess the efficacy of an Acceptance and Commitment Therapy (ACT)-based group psycho-educational intervention within Japanese school environments, administered by psychologists, for early adolescents in Japan. METHODS: The effectiveness indices measured in this study were ‘clarification of value and commitment (CVC)’ and ‘experiential avoidance (EA)’ as indicators of psychological flexibility of ACT, and self-esteem and self-determination disposition as outcome indices related to well-being. The participants in this study were Japanese junior high school students with a mean age of 14.85 years (SD = 0.86), 112 in the intervention group and 143 in the control group, who completed questionnaires at three time points: before the program (pre), after attending the program (post) and three weeks after the posttest (follow-up). RESULTS, & DISCUSSION: The intervention program, which consisted of three short-term sessions, was shown to be effective in the CVC, self-esteem, and self-determination disposition scores. Conversely, the group-time interaction did not yield a notable impact on the persistence of avoidance behaviors and EA scores, suggesting a potential avenue for refinement in intervention methodologies regarding these domains. These findings offer insight into the potential effectiveness of ACT-based group psycho-educational endeavors in school settings led by psychologists.

Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral intervention that targets psychological flexibility through acceptance, mindfulness, and values guided action. Although ACT has demonstrated efficacy across diverse populations, its application and cultural adaptation within sub–Saharan Africa have not been synthesized. This systematic review summarized ACT and ACT informed interventions in sub–Saharan Africa, emphasizing intervention characteristics, cultural adaptations, and outcomes. Following PRISMA guidelines, searches were conducted in PsycINFO, PubMed, ProQuest, Scopus, and the Association for Contextual Behavioral Science website. Eligible records included peer reviewed articles and theses evaluating an ACT or ACT informed intervention in sub–Saharan Africa. Data were extracted using a structured form capturing study design, delivery format, provider type, outcomes, ACT processes, outcome measures, and adaptation descriptions. Eighteen studies met inclusion criteria across five sub–Saharan African countries. Populations included youth and adults in clinical, educational, community, humanitarian, and performance settings. Interventions were commonly group-based and frequently delivered by non-specialist or paraprofessional providers. Across studies, ACT was generally associated with improvements in psychological flexibility, mental health symptoms, psychosocial functioning, and performance outcomes, though rigor varied. Cultural adaptations were often present but inconsistently reported and most frequently involved language simplification, metaphor modification, contextual tailoring of delivery methods, and stigma sensitive framing. Western normed outcome measures were used in all studies. ACT shows promise as a flexible intervention in sub–Saharan Africa. Future research should strengthen study rigor, systematically document cultural adaptation processes, and validate culturally relevant assessment tools to support equitable implementation at scale.

AIM People from historically oppression racial groups are often met with psychotherapeutic approaches that provide empathy rather than tools to navigate deleterious affects. The current intervention builds on previous research on ACT as effective in helping individuals navigate self-stigma. METHODS A group (six 90-min sessions) intervention aimed at decreasing internalized/appropriated racial oppression will be presented. The sessions focus on mindfulness and acceptance, cognitive defusion, and self-compassion. RESULTS Data will be analyzed from groups from multiple racial backgrounds. Data previously analyzed for groups with Black women (n= 21) resulted in significant pre/post decreases in depression, anxiety and stress symptoms (t = 5.97(18) p = .00,) internalized oppression (t = 2.93(19) p = .02), internalized shame (t = 1.69 (19) p = .01), and strong Black woman attitudes (t = -2.14(16) p = .05). DISCUSSION This intervention is feasible to embed within other therapeutic approaches or can be presented as a stand-alone offering. The decrease in variables that have been correlated with negative mental health outcomes in previous research is noteworthy. Therefore, this intervention is a promising adaptation of ACT principles and practices.

AIM: To compare the experiences of patients who discontinued long-term psychodynamic psychotherapy versus those who continued it until the end. METHOD: As a part of the Helsinki Psychotherapy Study (HPS) trial, adult outpatients suffering from depression were randomised to a long-term psychodynamic psychotherapy condition, intended to last approximately 3 years, and conducted 2-3 times a week. The patients were interviewed at 7, 12, 24, and 36 months after initiation of treatments. Content analysis was conducted. RESULTS: On average, patients who dropped out described the therapeutic interaction more negatively than completers. One completer was also dissatisfied with his/her therapist. Completers who were satisfied with and benefited from therapy described the therapist as actively but subtly bringing out important issues and gaining insights into their problems. Those who discontinued therapy described their therapist as too reserved in interaction and wishing more articulation of what was being discussed. In addition to problems in the relationship or the perceived lack of therapeutic benefit, reasons for discontinuing therapy included its time-consuming nature and other practical difficulties. The patients' work in therapy was guided by their pre-therapy images and preferences. Those who completed therapy hoped to have a longer intensive therapy session, while one of those who dropped out would have preferred a shorter therapy session. All patients wished for an actively talking therapist. Two out of three of the patients who dropped out of therapy felt that the therapy had triggered a thought process to work through their experiences even after they had left therapy. None of the patients reported at the time of leaving therapy or in the interview after leaving therapy that they felt worse than before therapy. CONCLUSION: Drop-out alone does not define therapy as a failure.

AIM: Deliberate Practice (DP) is described as a promising form of training for psychotherapists that leads to more effective therapist skills than those attained in traditional supervision. However, little is known about how the skills developed through DP differ from those developed in traditional supervision, or how a therapist’s learning process is affected when DP elements are added. The aim of the study is to explore what characterizes the learning process of psychodynamic therapists who receive supervision with and without DP elements. METHOD: As a sub-study within the The Nordic Psychotherapy Training Study (NORTRAS), the data consists of four therapy-supervision dyads of novice therapists in psychodynamic training that include video recordings of psychodynamic supervision with and without DP elements, and psychotherapy sessions with the same therapists. Questionnaires and Interpersonal Process Recall (IPR) interviews are conducted with supervisors, therapists, and patients. The material is analyzed qualitatively using reflexive thematic analysis. RESULS: The study explores how microprocess data from supervision and corresponding therapy sessions, qualitative interviews, and questionnaires, can yield similarities and differences in learning processes of therapist trainees in supervision sessions with or without DP training. CONCLUSION: The project results are examined with respect to how the course of therapists’ development and their learning are influenced by the incorporation of DP elements into supervision – and how the learning processes of therapists in different therapies can be observed and described across different forms of supervision.

AIM: To explore how novice trainees learn to work in the transference – in particular, to study what kind of transmission processes can be analysed in the behaviour between the therapist and the patient in the therapy and the therapist and the supervisor in the supervision. To our knowledge, there has not been empirical research investigating specifically trainees’ learning to understand and deal with evoked transference processes based on a combination of video recorded therapy and supervision sessions and IPR interviews. METHOD: As a sub-study within the Nordic Psychotherapy Training Study (NORTRAS), we analyse qualitatively video-recorded therapy and corresponding supervision sessions in three psychodynamic training cases, in combination with Interpersonal Process Recall (IPR) interviews with the participants in each case (patient, therapist, and supervisor), using reflective thematic analysis (RTA). RESULTS: A single case is already published; in the results, we describe a transformative learning process in which the therapist gradually developed the ability to put into words emotions that initially had been expressed as anxiety, projection, somatization, and avoidance, and to begin addressing these feelings with the patient. The supervisor facilitated this change through containing presence, psychoanalytic listening and expertise, and by offering concrete suggestions for intervention. Here, we present preliminary results of an extended analysis containing additionally two psychodynamic training cases. We describe potential similarities and differences in the observed transmissions of learning across cases, with a particular focus on the learning process of the trainees. Key themes include which types of transference phenomena external observers interpret to be present; how trainees and supervisors address transference phenomena during supervision; and how trainees use supervision to work with these processes in subsequent therapy sessions. CONCLUSION: In the discussion, we address the difficulties in finding a methodology to investigate such complex phenomena that by nature is internal processes difficulty to analyse by empirical methods; the variations and similarities of the learning processes across cases; and possibilities to boost the learning processes of trainees.

AIM: The internet and social media are central to adolescents’ social lives and identity. Engagement with digital risks (e.g., content that promotes risky behavior or facilitates sexual abuse or criminal acts) can exacerbate or trigger mental health problems. In addition, adolescents’ use of AI as a source of information, support, and supervision may sometimes provide advice that encourages harmful behavior. This study aims to increase understanding of how digital risks engagement may challenge the therapeutic alliance in therapy, and the transference dynamics in the therapeutic relationship in psychodynamic therapy. METHOD: Data were collected through in-depth qualitative interviews with adolescents (12–18 years) and young adults (18–23 years) receiving treatment for mental health problems, including self-harm and suicidal ideation. Analysis followed the steps of reflexive thematic analysis. RESULTS: Participants’ experiences of engaging with digital risks while in treatment revealed three themes: (1) non-disclosure or concealment of digital activity; (2) disclosure that is minimized or trivialized by the patient; and (3) disclosure that is acknowledged and integrated into treatment as a risk behavior. CONCLUSION: Findings are discussed in relation to research on therapeutic alliance, clinical approaches to risk behavior, and transference dynamics in the therapeutic relationship. Clinical implications for how to address and integrate engagement in digital risks and AI in treatment in general, and psychodynamic therapy specifically, are suggested.

Although meta-analytic evidence supports the efficacy of Routine Outcome Monitoring (ROM), the specific mechanisms through which feedback influences treatment outcomes remain largely unidentified. Research has increasingly pivoted toward implementation science, yet without a clear theoretical understanding of the variables explaining the relationship between feedback and clinician behavior. This presentation advocates for a return to foundational theoretical frameworks, including Feedback Intervention Theory (FIT) and Contextualized Feedback Intervention Theory (CFIT) and presents newer concepts like Clinical Performance Feedback Intervention Theory (CP-FIT). We argue that these theories and models offer rich, underutilized resources for hypothesizing potential mediators of effect. By revisiting these theories, researchers can identify specific mechanisms that explain how feedback works. We conclude that grounding future research in these established theories is essential for moving beyond simple effectiveness trials to a nuanced understanding of ROM’s active ingredients.

Routine outcome monitoring and feedback systems have become a prominent area of psychotherapy research. While meta-analyses have consistently demonstrated the overall effectiveness of feedback, the specific components and mechanisms behind these effects remain unclear. This article aims to lay the foundations for programmatic research focused on how systematic feedback works. Existing theoretical models and empirical evidence were examined to propose a comprehensive conceptual framework for conducting studies on feedback in psychotherapy. The proposed framework outlines the main components in feedback process: routine outcome monitoring system features that may facilitate some ways of use and not other, therapists’ and clients’ engagement with feedback, interpretation of the feedback information, therapists’ cognitive and emotional response to feedback, therapeutic interventions influenced by feedback, activation of psychological change mechanisms, and treatment outcomes. It also specifies potential therapist-, client-, treatment-, and institution-related factors and summarizes variables that already received some empirical support or have been theorized to play important role in the feedback process. This framework provides a roadmap for future research and enables researchers to design studies and formulate testable hypotheses on feedback effects and mechanisms.

Routine outcome monitoring (ROM) is considered a facilitator of psychotherapy outcome. Several conditions should be achieved to optimize the utility of ROM and its ability to reduce treatment dropout and increase overall effectivity. These conditions broadly include the session-by-session measurement, the use of a designated system which can identify not-on-track patients, the ongoing monitoring of outcomes by therapists, the use of clinical decision-making tools, and many others. Nonetheless, in many circumstances, these conditions might be difficult to achieve. Furthermore, many mental healthcare facilities face unique challenges with ROM implementation, and require personalized and tailor-made solutions. In this presentation we will introduce the concept of stratified monitoring, aimed at developing a model which includes guidance to different ROM implementation strategies, while utilizing a stratified approach to its dissemination. The utilization of the model will be examined through the lens of monitoring trauma focused treatments in the unique context of mass trauma. Based on previous research, we will outline the unique needs of trauma units in the context of assessment and measurement, and how these needs can be met in a stratified model. Specific considerations for adults and children and adolescents' monitoring will be presented and discussed. Finally, we will address the question of ROM utility in the sub-optimal conditions, and will provide a stratified model for ROM in optimal versus sub-optimal settings.

Feedback systems in psychotherapy have most often been operationalized as routine outcome monitoring (ROM), emphasizing standardized symptom change over time. In complex intensive outpatient settings—particularly those treating substance use alongside impairments in personality functioning—clinical decision-making often depends on dynamic patterns (sleep–mood coupling, behavioral reinforcement loops, interpersonal context) that are not always well captured by periodic global measures alone. This presentation proposes a conceptual and methodological extension of feedback-informed care from “outcome scores” to multimodal, idiographic feedback loops, integrating passive and active data as a collaborative therapeutic tool. Drawing from implementation in intensive outpatient services at Silver Hill New York, I describe a model that combines (1) passive sensing (sleep and activity via Apple Watch), (2) Ecological Momentary Assessment (brief mood and context check-ins delivered through a personalized clinic app), (3) assessment of personality functioning to guide interpretation of data and tailor intervention targets, and (4) individualized client-generated items to track what matters most for each client. Methodological considerations include managing missingness and nonadherence as meaningful clinical signals, balancing precision with burden, and translating time-series outputs into session-by-session clinical hypotheses. Feedback is not only informational but relational: reviewing data together can strengthen shared case formulation, support treatment planning (e.g., identifying high-risk times and antecedent states), and enhance client agency. Importantly, with the risk of hesitancy or refusal to use wearables/apps, feedback tools can become opportunities for rupture–repair, negotiating autonomy, trust, and meaning.

Aims: Psychotherapy research has long sought to identify the active elements and mechanisms that drive change, yet progress has been constrained by imprecise measurement of what occurs during treatment. Digital therapies offer a solution by delivering evidence-based techniques with consistent structure while capturing data on user interactions. We present and demonstrate a framework for measuring therapeutic element delivery and application in digital interventions and linking these measures to symptom outcomes. Methods: We demonstrate the framework using digital therapy modules for conditions such as PTSD that include free text exercises. Platform logs capture completion patterns and metadata that help operationalize delivered elements. Participants' text is characterized by creating features such as alignment with intended techniques, emotional engagement, and elaboration. These features provide information on applied elements. We relate these engagement measures to symptom trajectories assessed biweekly using longitudinal models. Results: The approach provides scalable indices of therapeutic delivery and application that extend beyond traditional adherence and dose metrics. These measures differentiate participant trajectories even when exposure to intervention content is similar. Patterns of completion and engagement with specific modules correspond to symptom change in ways consistent with theory. Discussion: Digital therapies can function as measurement systems for studying treatment processes during routine delivery. By quantifying participants' engagement with specific therapeutic elements and relating those signals to symptom change, this approach enables more precise evaluation of which treatment activities drive outcomes. This supports theory-driven hypothesis testing and intervention optimization.

Aims: Social anxiety is common in adolescents and impairs their psychosocial functioning. This study evaluated the efficacy of the guided digital mental health intervention (DMHI) SOPHIE for adolescents with subclinical social anxiety or Social Anxiety Disorder (SAD) and qualitatively analysed their user experiences. Methods: A total of 133 adolescents (11–17 years) were randomised to the intervention or a care-as-usual control condition. Assessments were carried out at baseline, mid-intervention (4 weeks), post-intervention (8 weeks), and follow-up (5 months), complemented by Ecological Momentary Assessments during and after the intervention. Intervention effects were examined using linear mixed-effects models, and post-intervention qualitative interviews were conducted. Results: The intervention produced a significant medium-to-large effect at follow-up (d = 0.67, 95% CI [0.32, 1.02]). In subgroup analyses, adolescents with subclinical social anxiety showed significant follow-up effects (d = 1.07, 95% CI [0.41, 1.74]), whereas those with SAD did not. Social functioning improved significantly at post-intervention and follow-up, with medium-to-large effects (post: d = –0.73, 95% CI [–1.08, –0.37]; follow-up: d = –0.32, 95% CI [–0.66, 0.02]). Qualitative analyses identified four themes: therapeutic relationship, factors influencing engagement, reflections on change, and evaluation of intervention content. Participants generally found the programme engaging, though some struggled with exposure exercises and wished for additional support. Discussion: The DMHI SOPHIE was effective, particularly as an indicated prevention approach. Findings support the longer-term efficacy of theoretically derived DMHIs for adolescent social anxiety, especially for subclinical presentations, and highlight the need for personalisation to address diverse user needs.

Aim: This study aims to evaluate the efficacy and scalability of digital mindfulness interventions (MIED) through two large randomized controlled trials conducted in China. Methods: The first trial evaluated a facilitator-supported mindfulness-based self-help (MBSH) intervention combined with treatment as usual (TAU) for 302 patients with emotional disorders, compared to a TAU-only group. Assessments were conducted at baseline, weeks 3 and 5, immediately post-intervention, and at 3-month follow-up. The second trial tested an 8-week hybrid digital mindfulness intervention, building on the MBSH model by adding live sessions led by trainee instructors under supervision, using a train-the-trainer (TTT) model. This intervention, compared to Services as Usual (SAU), was conducted with 1,281 adults experiencing psychological distress, with assessments at baseline, weeks 2, 4, 6, and immediately post-intervention. Results: In the first study, the MBSH+TAU group showed significantly greater improvements in self-reported depression, mindfulness, stress, and physical symptoms compared to the TAU-only group, with improvements sustained at 3 months (Cohen’s d=0.20-0.34). In the second study, the MIED+SAU group demonstrated significant reductions in psychological distress, depression, and anxiety by week 8 (Cohen’s d=0.52-0.53). Short-term cost-utility analyses indicated high cost-effectiveness. Discussion: Both studies demonstrate the effectiveness and scalability of digital mindfulness interventions. The first shows that facilitator-supported MBSH provides rapid symptom relief for emotional disorders. The second adds live sessions led by trainee instructors, forming a hybrid model that reduces distress and offers economic value. Together, these findings highlight digital mindfulness as a resource-efficient strategy to expand psychological care, especially in systems with workforce constraints.

Aims: Suicidal risks fluctuate rapidly and often occur outside of clinical hours, making them hard to detect. This study aimed to use digital phenotyping that combined active Ecological Momentary Assessment (EMA) and passive sensing data to monitor and predict near-term suicidal risk in a high-risk population. Methods: Military service members with recurrent suicidal ideation or a suicide attempt in the past month (N=86) completed daily EMA surveys and wore a wearable sensor (Fitbit) for 28 days. Multilevel models compared active versus passive sleep metrics in predicting next-day suicidal urges, depression, and PTSD symptoms. Change-Point Detection (CPD) algorithms were applied to passive data to predict acute suicidal events (suicide attempts, preparatory behavior, self-harm) within a 72-hour window. Results: Active sleep data consistently outperformed passive sleep data in predicting next-day suicidal urges and mental health outcomes. More severe nightmares and poorer sleep quality assessed by EMA predicted next-day suicidal urges, depression, and PTSD symptoms. Passively assessed sleep duration deviation significantly predicted next-day maximum suicidal urges. Passively assessed sleep regularity index predicted next-day depression. The CPD model on passive data was highly accurate at detecting suicidal events (suicide attempts: AUC=0.90; suicidal preparatory behavior: AUC=0.85; nonsuicidal self-injury: AUC=0.82), but less accurate for suicidal urges (AUC = 0.59). Discussion: Passive behavioral data effectively predict suicidal behaviors, while active reports effectively capture subjective symptoms. The study validates the use of passive wearables for continuous, unobtrusive monitoring of suicide risks in real-world settings, enabling automated early-warning systems that extend mental health support beyond traditional clinical settings.

Aim: The Core Conflictual Relationship Theme (CCRT)-based therapy is a brief psychodynamic psychotherapy based on the CCRT assessment method originally developed by Luborsky and colleagues. It identifies an interpersonal wish (W), an anticipated response from other (RO), and a response of self (RS) given this RO, with the latter two interfering with the wish actualisation. The goal of CCRT-based therapy is the actualization of a progressive interpersonal wish by alleviating the opposing force of the RO and RS. This study aimed at assessing the impact of CCRT-based therapy on depression, anxiety, symptom distress, self-esteem, interpersonal problems, and defensive functioning. Method: CCRT-based therapy was delivered to 24 patients by doctoral students supervised by a registered psychologist. Interpretive work was conducted mostly from an object relations and a self-psychology perspective. Outcome measures were administered pre- and post-therapy. Results: patients received an average of 21 sessions. Paired t-tests with Holm correction showed that depression, anxiety, symptom distress, and self-esteem significantly improved. Overall interpersonal problems also improved, mainly due to reductions in overly controlling, overly accommodating, and intrusive/needy behaviour. Use of mature defences marginally increased, but neurotic and immature defences remained stable. Discussion: CCRT-based therapy is effective at improving psychological functioning when delivered by therapists in training. However, improvements in defensive functioning may require more focused defence interpretation.

Aim: Corrective relational experiences (CREs) occur specifically within the therapeutic relationship and are perceived by patients as distinct and meaningful. Despite their potential importance in facilitating therapeutic change, CREs received limited theoretical, clinical, and empirical attention. The present study aimed to identify different types of CREs and to examine whether they suggest distinct mechanisms of change. Methods: Post-treatment semi-structured qualitative interviews were conducted with 57 patients diagnosed with major depressive disorder (MDD) following short-term supportive-expressive psychodynamic psychotherapy. Results: Analyses uncovered 21 CREs. Four ideal types were identified: Experiencing empathic Engagement, Experiencing nonjudgmental acceptance, Experiencing new understanding or Insight, and Experiencing encouragement and empowerment. All patients who reported a CRE also described intrapersonal growth, and most reported an improved relationship with their therapist following the CRE. Discussion: Our findings highlight the enduring impact of these experiences, even years after the conclusion of therapy, providing a more nuanced understanding of how they may drive positive change in the treatment of individuals with MDD.

Aim: Brief self-report measures assessing mentalizing and personality functioning are increasingly used in psychodynamic research, yet evidence regarding their structural validity and measurement invariance remains limited. The present study investigated factor structure, reliability and measurement invariance of the German Certainty About Mental States Questionnaire (CAMSQ-20) and the German Operationalized Psychodynamic Diagnosis Structure Questionnaire Short Form (OPD-SFK). Methods: In an ongoing online study, German adults (N=113 currently) completed the CAMSQ-20, OPD-SFK and additional questionnaires. We conducted exploratory and confirmatory factor analyses (EFA, CFA), and investigated reliability and measurement invariance across gender with SEM. Results: For the CAMSQ-20, the EFA supported the assumed two-factor structure, but not all fit indices of the CFA were acceptable (CFI=.981; TLI=.978; RMSEA=.088). Reliability was high (α=.89–.90). Metric invariance across gender was supported (ΔCFI>.01), while scalar invariance was not present. For the OPD-SFK, the EFA supported a three-factor solution, but the assignment of numerous items to the scales diverged from the intended OPD personality functioning domains. The model fit indices of CFA for the original factor structure were partially acceptable (CFI=.983; TLI=.978; RMSEA=.089), but included very high factor correlations (up to r=.95). Reliability was acceptable (α=.70–.80). Configural invariance across gender was not supported. Discussion: The preliminary findings highlight the importance and challenges of measuring psychodynamic constructs. They suggest that the CAMSQ-20 is suitable for clinical studies, while the short form of the OPD Structure Questionnaire faces challenges in operationalizing personality functioning in brief self-ratings, which can possibly be overcome by reformulating a few items.

This work presents the main insights derived from designing a brief interoception-centered intervention for treating anxious distress in a Latin American context. Based on a systematic review and a multiple-baseline design study, the author identifies that most anxiety interventions do not address interoception as a multidimensional process, which limits their clinical impact. Focusing is proposed as a promising strategy to support interoceptive reorganization through receptive attention to the felt sense of the body. Key lessons include the importance of integrating subjective and physiological measures, accounting for daily variability in interoceptive processes, and designing brief and scalable interventions that explicitly incorporate work with internal bodily signals. These considerations are particularly relevant for mental health systems in Latin America, where accessibility, cultural diversity, and the need for low-intensity interventions shape the development of innovative psychotherapeutic approaches.

This study examines core components of the real therapeutic relationship in child psychotherapy from the perspectives of school-age children and the adults involved. Although adult psychotherapy research documents the effectiveness of the therapeutic relationship, these processes are less defined in childhood due to methodological challenges. We describe an expressive-participatory qualitative device, primarily retrospective and participatory, combining photo-elicitation, video recording, and artistic production with semi-structured interviews with children, therapists, and caregivers (N = 18). Narrative discourse analysis, complemented by grounded theory, is used to characterize relational dynamics beyond the traditional therapeutic alliance (agreement on goals, tasks, and bond) and to identify clinically meaningful moments as experienced by children. Situated within Latin American mental health contexts—often marked by service constraints, social inequality, and diverse caregiving arrangements—the project also adopts a reflexive stance on how local conditions shape access, participation, and meanings attributed to psychotherapy. It highlights ethical commitments to protection, voice, and reciprocity. By foregrounding children’s agency and using methods that reduce adult-centric asymmetries, the study aims to inform culturally responsive, child-centered interventions and methodological standards for psychotherapy research in the region.

This paper reflects on my experience analyzing simulated psychotherapy sessions from a training program in which I also participated, highlighting the lessons learned from simultaneously inhabiting the roles of student-therapist and researcher. The training took place during the fifth semester of a Psychology undergraduate program in Brazil. Later, I conducted a micro-analytic examination of three role-play sessions from the same program, this time performed by another student-therapist. To guide the analysis, I integrated the Person-Centered and Experiential Psychotherapy Scale–10 (PCEPS-10), the Narrative-Emotion Process Coding System 2.0 (NEPCS 2.0), and the framework of cultural opportunity windows, which enabled a minute-by-minute description of both therapist interventions and client narrative-emotion processes. The contrast between doing the therapy and analyzing the therapy deepened my understanding of the challenges inherent in early clinical practice, revealed interventions that could have been carried out with greater precision, and prompted reflections on how my cultural identity shaped my interpretation of the clinical process. Key insights include a heightened sensitivity to narrative-emotional markers, the importance of integrating cultural dimensions into training, and reflections on clinical training in the Latin American context.

From a training perspective, the research process emphasized the importance of cultural sensitivity, situated listening, professional self-reflection in clinical work, and the specificities of the Latin American context.. Contact with sexual and gender minorities allowed for deeper reflection on the therapist's role in the face of discrimination and prejudice, as well as on the need to create safe and affirming therapeutic environments. Methodologically, qualitative analysis enriched the understanding of the complexity of intersubjective dynamics and the particular characteristics of therapeutic processes with LGBT individuals. On a personal level, the conduct of this study was influenced by motivations linked to my own identity, which strengthened my commitment but also added emotional tension. Likewise, adjusting to extended deadlines and feedback that I perceived as hostile generated additional pressure and questions about my research experience. These difficulties strengthened my understanding of the researcher's role, highlighting the importance of self-care and critical reflexivity.

Aim: Disability competence is an essential yet underdeveloped component of multicultural psychotherapy training. Despite global calls to reimagine psychotherapy through culturally expansive and equity-oriented frameworks, disability is often siloed, medicalized, or omitted entirely from counselor education. This mixed-methods study examined how counselors-in-training (CITs) develop disability awareness, knowledge, and skills, and how training contexts shape their preparedness to work effectively with people with disabilities. Methods: We analyzed quantitative data from 170 master’s and doctoral CITs in CACREP-accredited programs, examining a structural model predicting disability competence from disability status, attention to disability within multicultural counseling coursework, and internal developmental processes (awareness-knowledge-skill). Complementing this, qualitative interviews with 18 CITs were analyzed using interpretive phenomenological analysis to explore how training programs foster (or fail to foster) disability-affirming awareness, applied knowledge, and clinical skill. Results: Quantitative findings supported a developmental progression: disability status and curricular attention predicted higher awareness, which predicted knowledge, which in turn predicted skill. The final model explained 54% of variance in disability skills. Qualitative themes paralleled this structure, highlighting (1) disability experience as foundational awareness, (2) program preparedness, and (3) active application and advocacy despite training gaps. Discussion: Together, findings position disability competence as a teachable, developmental, culturally situated process. Implications extend internationally: inclusive psychotherapy requires expanding multicultural frameworks to meaningfully integrate disability, embedding content across coursework, and structuring supervised clinical experiences that model disability-affirming practice.

This study examined how therapists experience and navigate shame and guilt to improve dialogue across different therapy orientations. It explored how these emotions manifest, influence practice, and offer growth opportunities, enhancing understanding of therapist development. Methods: Sixteen therapists from varied orientations participated in semi-structured interviews coupled with drawing tasks, wherein they visually depicted their experiences of shame and guilt. The incorporation of art-making served as a projective, embodied, and culturally adaptable technique that facilitated access to implicit emotional layers that are often challenging to verbalize. Data derived from both modalities were analyzed using Interpretative Phenomenological Analysis, supporting a comprehensive, multisensory exploration of therapists’ meaning-making. Results: Three overarching themes emerged. (1) The nature of shame and guilt: Therapists described these emotions as deeply intertwined yet experientially distinct, often shaped by professional norms, cultural expectations, and internalized ideals of the “competent therapist.” (2) Impact on the therapeutic process: When unprocessed, shame and guilt disrupted presence, attunement, and clinical judgment, and could contribute to burnout or withdrawal from the profession. When acknowledged and metabolized, these emotions fostered humility, ethical sensitivity, and stronger therapeutic engagement. (3) Coping and regulation strategies: Therapists relied on reflective self-dialogue, supervision, peer consultation, and compassion-based practices to regulate these emotions and transform them into sources of learning. Discussion: Findings highlight shame and guilt as common, complex, and culturally mediated experiences that shape therapeutic practice across orientations. Integrating reflective and relational approaches to managing these emotions may support therapists' well-being and promote innovation in psychotherapy training, supervision, and intercultural dialogue.

Background: Psychotherapeutic diagnostics currently relies on assessment instruments developed within clinical psychology and medicine. While these tools offer reliability and standardization, they remain limited in capturing the relational, narrative, intersubjective, and culturally situated dimensions that constitute the core of psychotherapy. Recent work has emphasized the growing tension between medical-model diagnostic practices and the contextual, meaning-oriented conceptualization of psychotherapy. It becomes particularly visible in outpatient settings, where symptom-oriented frameworks risk obscuring biography, relational patterns and personal meaning-making. These diagnoses may carry implications of stigmata as well as the problematic situation regarding financial and institutional support. Objective: This project is reconceptualizing the field of psychotherapeutic diagnostics. It aims to introduce a narrative- and context-sensitive diagnostic framework designed to strengthen therapeutic attunement, cultural responsiveness, everyday diagnostic practice, and the development of a coherent psychotherapeutic professional identity. Methods: Based on a systematic literature review, question domains will be condensed and identified, examined in evaluation interviews with diagnostic experts, and analyzed using qualitative content analysis. The guideline will be tested and evaluated in several internal iterative cycles, with recorded interviews being qualitatively analyzed to ensure functionality and diagnostic value. Discussion: This qualitative study, a self-developed structured anamnesis guideline will be further enhanced to develop a new approach for psychotherapeutic diagnostics. The expected contribution is a shift from diagnosis as labeling toward diagnosis as dialogical exploration, supporting therapeutic alliance, enhancing cultural attunement, and aligning diagnostic practice with the fundamental mechanisms and ethos of psychotherapy. keyword: diagnostics

Aim: Extreme experiences mark the limits of human subjectivity and yet are often understood in psychotherapy research as pathological deviations from an assumed norm. This paper aims to reconceptualize extreme experiences as multidimensional psychological and cultural phenomena that can have destructive, adaptive or transformative potentials. The aim is to develop a theoretical model that enables us to define, perceive and distinguish extremes from clinically relevant deviations. Methods: A comprehensive conceptual analysis was conducted, integrating historical sources, cultural materials, psychological theories and empirical findings from research on trauma, peak performance, altered states of consciousness and deviant behavior. Particular attention was paid to distinguishing between objective indicators of extremity (e.g. statistical rarity, intensity, cultural records) and subjective evaluations shaped by personal experiences, cultural narratives and individual characteristics. Central dimensions of extreme experiences were identified through iterative synthesis. Results: The resulting model describes extremes along six interrelated dimensions: Intensity, Impact, Demand, Control, Novelty and Identification. These dimensions illustrate how extremes arise in the interplay of objective conditions and subjective attribution of meaning. Theoretical insights show that positively evaluated extremes often correspond to concepts of performance psychology, while negatively evaluated extremes tend to touch on clinical thresholds. In addition, the discrepancy between desired objective extremity and subjective labeling becomes visible, which varies culturally and individually. Discussion: The re-evaluation of extremes as multidimensional phenomena opens up new perspectives for psychotherapeutic research, diagnostics and culturally sensitive practice. The model promotes the dialog between theoretical traditions and supports the differentiation between normative extremes and potentially psychopathological states.

Background: Shaped by Confucian heritage and rapid industrialization, Korean society emphasizes external evaluation over inner exploration. Accordingly, clients may appear to seek quick solutions, while holding deeper psychological needs for relational acceptance, resonance (gongmyeong), and the restoration of a coherent sense of self. Western counseling theories grounded in verbal and analytic reasoning show limitations in engaging with the somatically expressed emotional experiences common among Korean clients. In response, the Areumsari Counseling Psychology Model was developed as a culturally responsive and indigenous approach. Theoretical Framework: The Areumsari model is grounded in person-centered theory and focusing-oriented experiential theory. It facilitates the reconstruction of self-meaning within a relational context based on clients’ bodily felt-sense language. The model includes a preliminary psychoeducation phase followed by four cyclic stages—Pausing, Exploring, Resonating, and Articulating—designed to promote experiential change and self-understanding. Methods and Research Questions: This study received IRB approval from Duksung Women’s University (2025-011-024-A). Given the model’s early developmental stage, expert evaluation was conducted using a Delphi method. Twenty counseling experts with over ten years of experience participated in two survey rounds and supplementary semi-structured interviews. The study examined: (1) clinical validity of the model process, (2) its reflection of body-based emotional experiences (felt sense), and (3) elements needed for practical application. Expected Contribution: Findings are expected to provide foundational data for culturally responsive counseling models addressing somatically expressed emotional experiences in East Asian contexts, including Korea’s Hwa-byung, Japan’s Amae, and the Filipino concept of Nervios.

This paper introduces the Motivated Cue Integration (MCI) model as a clinical framework for psychotherapy integration that centers on restoring experiential access. MCI reconceptualizes self-regulation not as behavioral control but as an experiential, phenomenologically grounded process shaped by three regulatory gates: (1) the motivational-identity gate, which filters experience based on needs, values, and self-definitions; (2) the sensory-emotional gate, which governs access to bodily and emotional signals; and (3) the epistemic trust gate, which determines whether internal experiences are granted validity and allowed into conscious awareness. Blockages at any of these gates can result in emotional disconnection, confusion, or self-invalidation. The MCI model translates these gates into three corresponding clinical axes, offering a structured yet flexible approach to case formulation and intervention. Motivational blockages are addressed through work on identity, meaning, and values; sensory-emotional blockages through somatic and experiential techniques; and epistemic disruptions via validation, attunement, and relational trust-building. By mapping the location of experiential blockages, clinicians can select targeted interventions that restore inner coherence and psychological flexibility. The model is trans-theoretical and practice-oriented, allowing integration across modalities without sacrificing conceptual clarity. Clinical vignettes illustrate how MCI guides real-time decision-making and deepens therapeutic impact. By distinguishing between motivational, sensory, and epistemic layers of experience, the model helps clinicians tailor care with greater nuance and depth. MCI thus offers a unifying clinical framework that enhances access to subjective experience, supports deeper emotional integration, and promotes sustainable therapeutic change across diverse client presentations.

Aim: This paper proposes a unified ‘Humanistically oriented CBT’ approach, arguing that CBT can be strengthened through an explicit commitment to humanistic principles without abandoning its theoretical foundations. We address concerns that CBT can be experienced as overly technique led and clarify how relational depth and client centred understanding can sit alongside collaborative empiricism in practice. Methods: We conducted an integrative conceptual synthesis of CBT and humanistic traditions, mapping areas of compatibility and tension. A practice framework was developed around key clinical tasks: collaborative assessment, strengths-based goal setting, flexible formulation, cognitive and behavioural interventions, embodied and grounding techniques, and a social justice informed stance. Humanistic holism is operationalised through an intersectional lens, attending to how differences across identity markers and their intersections shape therapeutic engagement and meaning making. Findings: The synthesis yields a model comprising: (1) a relational foundation (empathy, transparency, shared power); (2) ‘collaboration-first’ assessment and formulation that retain CBT structure while remaining client centred and contextual; (3) compassion infused cognitive methods (e.g., Socratic dialogue; meaning focused restructuring); (4) client led behavioural experiments and exposure with autonomy oriented activation; and (5) grounding, mindfulness, and soothing strategies as transdiagnostic supports. Discussion: ‘Humanistically oriented CBT’ offers clinicians a practical integration that may increase acceptability and support fidelity by strengthening responsiveness, therapeutic presence, and contextual sensitivity while retaining core CBT mechanisms. As a conceptual contribution, it is limited by outcome data at this stage; next steps include manual development and training evaluation within this proposed scientific and reflexive model.

Aim: While Compassion-Based Interventions (CBIs) are effective, some individuals experience Fear, Blocks, and Resistances (FBRs) that hinder therapeutic progress. Addressing these barriers is essential for reimagining psychotherapy for resistant populations. This paper presents three studies to deepen the understanding of FBRs and propose a comprehensive framework for assessment and intervention. Methods: Study 1 developed an assessment for FBRs in 145 university students and proposed a new model enhancing CBI efficacy, based on the Compassion Response Scale model (Ishimura et al., 2024). Study 2 conducted a comparative experiment with a high-FBR group to examine the effectiveness of two modalities: writing tasks versus imagery exercises. Study 3 utilized a questionnaire to identify specific exercises where high-FBR individuals encounter difficulties. Results: Study 1 confirmed the validity of the assessment and model. Study 2 revealed that while the writing task was effective for the high-FBR group, the imagery exercise showed no significant effect. Study 3 found that high-FBR individuals struggled across all types of exercises, including breathing, mindfulness, and imagery, indicating a generalized difficulty in engaging with standard CBI practices. Discussion: The findings suggest that standard CBIs are often inaccessible for clients with high FBRs. Since direct experiential exercises (e.g., imagery, soothing breathing) can trigger resistance, clinicians should prioritize writing-based approaches as a safer entry point. Furthermore, given that difficulties span all exercises, a carefully scaffolded, step-by-step pedagogical approach is required. These studies offer an evidence-based roadmap for tailoring compassion interventions to overcome FBRs.

Background: Dropout remains a persistent challenge in the psychotherapeutic treatment of obsessive–compulsive disorder (OCD), compromising treatment effectiveness and generating negative consequences for patients, clinicians, services, and research. Although previous studies have examined potential predictors of dropout, their applicability to everyday clinical practice is limited due to the controlled nature of research settings. Method: The sample comprised 72 patients with a primary or secondary diagnosis of OCD recruited from a university outpatient clinic in Germany. For comparative purposes, patients with depressive disorders (N = 602) and anxiety disorders (N = 207) were also included. Machine learning methods, specifically the Boruta feature selection algorithm, were applied to identify relevant predictors of treatment dropout within each diagnostic group. Results: Low general well-being emerged as a consistent predictor of dropout across all diagnostic groups. Overall, psychological distress was relevant for dropout in both OCD and depression, whereas social inhibition predicted dropout in OCD and anxiety disorders. In depression, additional disorder-specific predictors were identified, including depressive symptom severity, interpersonal distress, social distress, and work incapacity. Suicidal distress predicted dropout in both depression and anxiety disorders. No demographic variables and no personality traits beyond social inhibition and work incapacity were confirmed as relevant predictors of dropout. Discussion: These findings suggest that transdiagnostic indicators of subjective well-being and psychological distress, rather than demographic characteristics or broad personality traits, play a central role in understanding treatment dropout in routine psychotherapeutic care for OCD.

Aims: Explore paradoxical therapy outcomes in a naturalistic university sample comparing symptom-based outcome categories (i.e., deterioration, no change, and improvement) to clients’ subjective progress of therapy. Methods: Data is from a naturalistic routine outcome monitoring dataset from a university counseling center (n = 968). Measures included PHQ9, GAD7, Client Critical Experiences in Therapy Scale (CCETS), Cultural Comfort Scale (CCS), and Cultural Humility Scale (CHS). Jacobson-Truax reliable index scores were calculated for the combined PHQ+GAD score to define symptom-based outcome categories (i.e., improved/felt better, non-improvement/felt the same, or deteriorated/felt worse). Subjective progress categories were defined by an item asking clients about their subjective progress in therapy since intake (i.e., felt better, felt worse, or felt the same). Logistic regression with Sidak corrections were used to explore how the CHS, CCS, and the CCETS predicted the symptom-based outcome categories and subjective outcome categories. Results: Symptom-based categories based on PHQ+GAD scores showed 75.2% of clients were in the deterioration or non-improvement categories, with 24.8% of clients in the improvement category. Client subjective improvement category was 84.3% of the sample, with 15.7% in the subjective deteriorating or non-improvement categories. Only 9.4% of the sample had congruent symptom-based and subjective progress categories. Logistic regression analyses showed that CHS, CCS, and two subscales of the CCETS were significant predictors of subjective progress, but not symptom-based progress. Discussion: These results highlight the importance of defining outcomes in psychotherapy studies beyond symptom reduction to capture client experience more accurately in research and clinical settings.

Objective: Routine Outcome Monitoring (ROM) has proven to be a tool for improving psychotherapy treatment. Although research shows a positive effect of ROM on psychotherapy outcomes, few therapists use it in their practice. One of the reasons for this is the therapists’ concerns about challenging or negative feedback they might receive. We aim to examine this issue in more detail, to understand how therapists process feedback and, ideally, to suggest possible steps for approaching challenging feedback. Method: Interviews with psychotherapists are being collected and will be subjected to qualitative analysis using the grounded theory method. Findings: Categories identified in the analysis will be reported. Conclusions: The clinical relevance of the findings will be discussed.

Aim: Routine Outcome Monitoring (ROM) has been shown to improve psychotherapy outcomes; however, its effects remain moderate. Moreover, successful implementation and clinical impact are strongly associated with therapists’ training and experience in using these systems. Similarly, the use of Artificial Intelligence (AI) has increased exponentially in recent years. This growth has opened up multiple potential applications in psychotherapy, including treatment personalization. In this changing scenario, there is a clear need to explore therapists’ perceptions of technology use in psychotherapy and how they can be improved. Therefore, the aim of this study was to analyze and compare therapists’ attitudes toward ROM and AI following before and after a workshop on these topics. Methods: Thirty clinicians with training and experience in ROM and thirty clinicians without such experience attended a workshop on the clinical use of ROM and AI in psychotherapy, delivered by experts in the field. Before and after the workshop, participants completed a survey including sociodemographic questions and a questionnaire assessing attitudes toward ROM and AI. Results: We will compare both groups of therapists regarding both demographic characteristics and clinical experience. Specifically, we will examine changes in therapists’ attitudes toward ROM and AI before and after the workshop. Discussion: We will discuss potential strategies to improve the implementation and use of ROM in clinical practice. Regarding AI, we will consider its impact on psychotherapy treatments, therapists’ attitudes toward its use, and how these attitudes may influence future psychotherapeutic practices. Additionally, implications for deliberate practice and psychotherapy training will be discussed

Child sexual abuse (CSA) is highly prevalent among children and adolescents, and international research supports the efficacy of psychological treatments for such cases. However, little is known about the interventions in community mental health settings. This study examines the clinical strategies used in psychotherapies delivered to children who have experienced CSA within specialized community care centers in Chile, analyzing their relationship with the therapeutic interactional context, child and therapist characteristics. A Q-Methodology design with descriptive, relational, and longitudinal components was employed to observe therapeutic processes across 45 video-recorded individual sessions from five cases, spanning early to mid-treatment. Sessions were coded using the Child Psychotherapy Process Q-Set (CPQ). To explore how strategies unfold within therapeutic interactions, an exploratory factor analysis with varimax rotation was conducted on all sessions. A six-factor solution emerged, explaining 43.73% of the variance. These factors, interpreted as Interaction Structures (IS), represent recurring therapist–child relational patterns that integrate clinical strategies, therapist stance, child characteristics, and dyadic dynamics. Findings reveal a diverse range of therapeutic approaches, from structured and directive interventions to emotionally attuned and relationally oriented strategies. Several IS illustrate beneficial therapeutic interactions characterized by harmonious connection, emotional engagement, and developmentally sensitive attunement. Conversely, IS such as relational avoidance or failed engagement highlight moments where strategies did not match the child’s needs, negatively affecting the therapeutic process. Overall, the results underscore the complexity and individualized nature of psychotherapy with CSA survivors, emphasizing the importance of flexible, responsive strategies that foster safety, emotional expression, and relational trust.

Intergenerational transmission of trauma is a recurrent phenomenon in child sexual abuse (CSA) and constitutes a critical factor shaping therapeutic processes and outcomes. This convergent mixed-methods study examined psychotherapeutic change in children aged 4 to 9 attending CSA-focused treatment in Chile, integrating quantitative longitudinal analyses with an in-depth qualitative exploration of caregivers with intergenerational trauma. The quantitative component included 78 therapeutic cases assessed at three time points. Repeated-measures ANOVAs were conducted to evaluate symptomatic change across general symptomatology (SDQ) and posttraumatic (PEDS) symptoms, comparing children whose caregivers reported intergenerational trauma (CTQ) with those who did not. In parallel, a qualitative longitudinal study analyzed four caregiver–child dyads using reflexive thematic analysis, focusing on how caregivers’ trauma histories shaped their engagement with the therapeutic process. Results revealed distinct trajectories of change between groups. Children whose caregivers had intergenerational trauma showed stagnation in internalizing symptom improvement, contrasting with more consistent gains in the comparison group. Mixed-methods integration suggests that these quantitative patterns can be better understood through two qualitative themes. “Triadic exclusion and immobilization” captured caregivers’ experiences of feeling marginalized within the therapeutic triad, limiting opportunities to develop deeper understanding of the child’s internal world. “Forgetting has a memory” illustrated caregivers’ avoidance or hyperarousal when facing their children’s traumatic responses. Findings highlight the importance of early identification of caregivers’ trauma histories and the need for therapeutic models that actively navigate relational resistance, strengthen triadic engagement, and support reflective functioning to foster more robust change in CSA interventions.

Few studies have included the perspectives of children aged 3 to 6 who have experienced CSA regarding their psychotherapy processes. This study aims to understand how young children make sense of their psychotherapeutic experiences, through the analysis of the narratives of a 5-year-old girl, her mother, and the psychotherapist who worked with them. The participants attended a specialised centre in Chile, with both online and in-person sessions. Individual interviews were conducted with the therapist and the mother, along with the observation of an online session with the child and an interview with her that included puppets and a drawing technique. The data were analysed using reflexive thematic analysis and a narrative perspective, informed by insights from childhood studies. The findings reveal divergent understandings regarding the purposes and ways of communication in therapy: for the adults, therapy is a space for talking; for the young child, it is a space to play. The narratives suggest that the child resists adult understandings of her therapeutic process and expresses agency aimed at ensuring her own expectations are taken into account. Moreover, while the adults perceive a loss of control in the online setting, the young child shows that in-person sessions validate her expectations of play, allowing her to experience greater control over her therapy experience. The discussion highlights the contributions of a clinical approach that recognises children’s agency within the therapeutic space, and it addresses methodological and ethical considerations for including children’s perspectives in psychotherapy research from a child-centred relational perspective.

Making mistakes and experiencing clinical regrets in clinical work is a common occurrence among counselor trainees (Klinger et al., 2012; Knox et al., 2022). Clinical regret in this study is defined as “a specific event or short series of events that includes actions or inactions on the trainee therapist’s part that they wish had not happened as they did.” Clinical regrets can be experienced as both emotionally intense (e.g., feeling ashamed, embarrassed, uneasy) and as an opportunity to enhance clinical learning and development, increase awareness, and make changes (Veseth et al., 2024). It is essential not only to understand the types of clinical regrets that occur in clinical work but also to comprehend how clinical regret manifests in trainees and its impact on their clinical work, training experience, supervision, and professional development. Against this backdrop, this presentation is based on qualitative findings from 84 trainees’ responses describing instances of clinical regrets and the strategies they used to work through them. Preliminary analysis, based on input from two coders, reveals that trainees frequently regretted events including induced negative client reactions, unwanted or unintended presentations to clients, inadequate or ineffective interventions, a lack of cultural responsiveness in treatment, failing to follow through on client care, and inadequate clinical skills and training. Trainees reported the strategies they utilized to work through clinical regrets, including follow-up with clients, engaging in personal reflection, discussing issues in supervision or consultation, engaging in preparation for future sessions, making changes in their approach when working with clients of specific concerns, engaging in physical or emotional self-care, or other forms of support (e.g., journaling, attending personal therapy, engaging in physical exercise, and talking with friends or families).

A genuine self-forgiving process following interpersonal transgressions has been found to be helpful for clients (Carroll et al., 2024; Cornish et al., 2020) and it is reasonable to suspect it could also be beneficial for supervisees following clinical regrets. Drawing from other work (Woodyatt & Wenzel, 2013; Cornish & Wade, 2015), we conceptualize genuine self-forgiveness in the context of psychotherapy training as a process in which trainees take accountability for their role in the clinical regret, engage in restorative behaviors (e.g., repair the relationship with client, change clinical behaviors, etc), and emotionally ‘move on’ from the regret. For new psychotherapists, however, may be a challenging process to undertake on own’s own. Yet, there is overlap between genuine self-forgiving process and common supervisory activities (e.g., exploring what happened, soothing supervisees’ self-criticism, focusing on skill development and how to address the issue in the next session with clients, etc). In addition, research shows the importance of supervisory working alliance in supporting supervisee (see Bernard & Goodyear, 2019) and client outcomes (DePue et al., 2022). We hypothesized that trainees’ genuine self-forgiving process would explain the relationship between supervisory alliance (specially, supervisory rapport) and supervisee outcomes (specifically, increased self-awareness and growth). Using a mediation model, we demonstrate that psychotherapy trainees’ genuine self-forgiving process following a specific clinical regret does statistically fully mediate the relationship between supervisory rapport and increased supervisee growth and self-awareness following that regret. We conclude with application of this self-forgiveness framework to guide supervision interventions in the clinical regret case example.

This presentation will focus on supervisory responses to trainee cultural missteps and clinical regrets, with a particular focus on strengthening both trainee and supervisor competence through a cultural humility framework. We begin by outlining an applied model of cultural humility for supervision, emphasizing its relevance for addressing complex trainee competence concerns that arise in multicultural clinical practice. Foundations for this supervision practice include integration of the four tenets of cultural humility (accurate self-reflection, other orientation, interpersonal curiosity, and intrapersonal incorporation; Hook et al., 2025) to facilitate intentional, developmentally attuned supervisory processes. Specifically, we will highlight how the framework can a) reduce trainee and supervisor hesitancy to address cultural missteps in supervision (Hunter & Schwartz-Mette, 2023), b) support the identification and cultivation of trainees’ cultural strengths through deliberate practice and skill-building approaches (Davis et al., 2025), and c) promote a communitarian training culture that enhances training effectiveness by prioritizing high-quality clinical practice, constructive feedback, and active engagement with challenging cultural situations (Lee et al., 2025; Mendoza-Newman & Erickson Cornish, 2023). This supervision framework provides both a corrective process for addressing trainee cultural missteps and clinical regrets and a proactive developmental strategy that fosters reflexive capacity, accountability, and ethical responsiveness in clinical work. The presentation will conclude with an applied, participant-engaged exercise using the clinical regret case example. Attendees will have the opportunity to apply the cultural humility supervision framework, deepening their understanding of how to operationalize these principles in real-time supervisory dialogue and decision-making with clinical trainees.

Psychological distress and suicidality in transgender youth manifest themselves in heterogeneous ways, forming distinct clinical profiles of risk and protection. In Chile, there are no studies that characterize the clinical profiles of transgender adolescents who enter specialized public programs such as the Gender Identity Support Program (PAIG). Aim: To identify clinical profiles of severity in transgender adolescents treated at the PAIG at the beginning of psychological support and to describe their early trajectories of psychological distress and suicidal ideation. Methodology: Quantitative observational study with 88 transgender adolescents (aged 10–17) who were users of two public hospitals. Psychological distress (YP-CORE), suicidal ideation (Okasha Scale), previous suicide attempts, family affirmation, transphobic bullying, and stage of the identity process were assessed. Hierarchical cluster analysis was performed using Gower's distance and Ward's method. Exploratory descriptions of the trajectories of psychology distress and suicidal ideation during the first five sessions were provided. Results: Three profiles were identified: (1) moderate risk with high family affirmation; (2) high clinical and psychosocial risk, with greater distress, suicidal ideation, multiple previous attempts, widespread bullying, and low family affirmation; and (3) low relative risk, with fewer symptoms and high family affirmation. The high-risk profile showed more unstable trajectories. Psychological distress; Suicidal ideation; Clinical profile

Reflective functioning (RF) plays a central role in the regulation of affect. However, little is known about whether RF operates primarily as a stable vulnerability marker, or whether short-term fluctuations also contribute to dynamic changes in suicidal ideation. Seventy-three patients undergoing psychodynamic psychotherapy at an Austrian outpatient clinic provided session-by-session assessments of RF (Mentalization Questionnaire, MZQ) and suicidal ideation (PHQ-9 item 9), yielding 2,586 sessions. We examined between- and within-person associations through repeated-measures correlations, group comparisons (patients with and without suicidal ideation), and multilevel models. For the latter, MZQ scores were decomposed into each individual’s mean RF level and their session-specific deviations from this mean. We estimated linear mixed models of concurrent and prospective suicidal ideation, performing ordinal mixed models as sensitivity analyses. Repeated-measures correlations showed a significant positive association between RF deficits and suicidal ideation (r = .27). Patients reporting suicidal ideation at some point during the observation period had poorer average RF. In mixed models, both worse RF at the person-level and within-person breakdowns of RF predicted more severe concurrent suicidal ideation. Lagged analyses demonstrated that RF deficits also prospectively predicted higher next-session suicidal ideation, even after adjusting for autoregressive effects. Across models, random effects indicated substantial between-patient variability in baseline suicidal ideation and in the strength of coupling of RF and suicidal ideation. Findings suggest that RF deficits function both as a stable vulnerability factor and as a dynamic, session-to-session mechanism implicated in elevations of suicidal ideation. This supports theoretical accounts of “mentalizing collapse” in suicidal crises and highlights RF as a clinically actionable target within ongoing psychotherapy.

Objective: This study aims to predict positive outcomes in group psychotherapy, with a particular focus on the potential for guilt reparation. This process is relevant in the treatment of patients with personality and neurotic disorders with different histories of trauma and varying levels of envy. The study additionally investigated whether there were significant differences in results between the beginning and completion of treatment. Method:. A retrospective analysis was conducted between 2022 and 2024 on 164 patients who completed time-limited group psychotherapy during that period. The intensity of envy and the capacity for guilt reparation were assessed using the Neurotic Personality Questionnaire (NPQ), the Scale to Assess Therapeutic Relationship - patient version (STAR-P), and the Inventory of Personality Organisation - Polish version (IPO-PL). Results and conclusion: Based on the results of the Mann–Whitney analysis, no differences were found between patients treated with pharmacotherapy and those who were not. Regression analysis revealed that the level of envy is a strong predictor of guilt. Significant predictors were also found for the quality of the therapist-patients relationship, including indicators of personality. A one-way repeated-measures ANOVA demonstrated a significant decrease in patient–therapist relationship scores from pre- to post-treatment following three months of intensive psychodynamic group psychotherapy. These findings can be applied in clinical practice and could support the prediction of treatment outcomes.

Changes in personality and symptoms’ domains in patients treated with group psychotherapy. Aim To measure changes in selected personality domains associated with neuroticism in patients undergoing group, predominantly psychodynamic psychotherapy. Methods 92 patients (54 women and 38 men) treated with very intensive, short-term (approx. 150-210 sessions; 3 months), predominantly psychodynamic group psychotherapy were included in the study. Measurements were performed during treatment qualification and at the end of therapy. The symptoms’ domain was assessed using the Symptoms Questionnaire, which included 135 items. Neurotic personality traits were measured using the Neurotic Personality Questionnaire KON-2006 (24 scales). Reliable Change Value was used to reflect the clinical significance of the findings. Results About 1/5 of the treated population had a clinically significant reduction in personality traits associated with neuroticism, whereas 2% had clinically significant deterioration (an increase in the intensity of these traits). Symptoms intensity had significantly reduced in over half of the treated population, whereas deterioration was observed in about 10% of patients. Discussion Intensive short-term predominantly psychodynamic psychotherapy (150-210) can be effective in reducing not only symptom intensity, but also underlying disturbances in personality functioning. Although the results suggest quite high safety of the treatment, some patients may not clinically significantly benefit within a three-month program. Nevertheless, a reduction in symptom intensity can be expected in most patients. Keywords: group psychotherapy, neurotic personality traits, effectiveness, psychodynamic psychotherapy

This study evaluates the effectiveness of a group counseling program grounded in the Good Lives Model (GLM) for male inmates with substance addiction in Kinmen Prison. By integrating Motivational Interviewing, Career Construction Theory, and the spirit of 12-Step groups, the intervention established a comprehensive protocol covering six distinct themes: (1) motivation assessment and facilitating, (2) physical and mental rehabilitation, (3) relationship improvement, (4) life arrangements, (5) resource linkage, and (6) character reflection and self-identity. The program incorporated Acceptance and Commitment Therapy (ACT), psychodrama, and art materials to specifically address the low mood, resistance, and lack of self-efficacy often observed in involuntary clients during recovery. Spanning five years (2021-2025), the project comprised nine groups with 72 total participants. Efficacy was measured using the Beck Depression Inventory-II (BDI-II) and University of Rhode Island Change Assessment (URICA), yielding 65 valid responses, triangulated with qualitative feedback from prison administrators and social workers. Results indicate the program effectively alleviated depressive symptoms and reduced suicidal ideation in high-risk cases. URICA results demonstrated a significant promotion of change motivation, guiding participants from Pre-contemplation to Contemplation and Preparation stages. Participants exhibited concrete behavioral changes, including disciplined exercise plans, initiating family contact for relationship repair, and discussing post-release resources. Interestingly, self-efficacy did not show statistical significance; some participants experienced a decline. Consistent with Su, Wu, and Hsu (2024), this suggests that as motivation and self-awareness increase, participants may set higher personal standards, resulting in a temporary dip in perceived self-efficacy. The presentation will demonstrate structured activities and discuss future research implications.

Cultural minorities in Germany frequently endure significant acculturative stress, a condition often intensified by psychological inflexibility—the rigid dominance of internal reactions over value-driven behaviors (Hayes et al., 1999; Lee & Kim, 2014). Although Acceptance and Commitment Therapy (ACT) is effective for such challenges, access to culturally sensitive counseling remains scarce, necessitating the exploration of scalable, low-intensity alternatives. Since therapeutic efficacy is deeply rooted in experiential learning (Hayes et al., 2012; Kolb, 1984), immersive art presents a novel pathway to enhance self-awareness and foster psychological flexibility; however, research intersecting these fields remains limited. This qualitative study investigates the subjective experiences of minorities engaging with an ACT-based immersive art exhibition. We designed a four-station installation (30 minutes journey), with each station embodying a core ACT process: Creative Hopelessness, Acceptance, Cognitive Defusion, and Values Clarification. Semi-structured interviews (30 minutes) were conducted with 10 recent immigrants (residency under five years) following their engagement, and data were analyzed using reflexive thematic analysis. Four primary themes emerged: The translation of ACT concepts through immersive aesthetics; The experiential outcomes of engagement; The mechanisms of impact; and The limitation of reconstructing cultural identity. Findings indicate that the exhibition’s multisensory nature provided a vital "container" for participants to confront suppressed thoughts, facilitating the process of "making space" for difficult emotions. While promising as a low-intensity intervention, limitations regarding privacy and the abstraction of cultural challenges were noted. Consequently, future iterations should incorporate greater interactivity and personalized audio elements to deepen relevance and ensure psychological safety for diverse populations.

Aim: Therapists often experience clients with avoidant personality disorder (AvPD) as passive and hard to reach, yet client agency is crucial for therapeutic progress. We aim to understand how clients with AvPD are agents in daily life and therapy, and how therapists can facilitate their agency. Methods: 56 people with AvPD responded to a qualitative internet survey. We analysed the results with reflexive thematic analysis. Results: Respondents’ primary motivation is avoidance of judgment, which leads to isolation, self-constraint, and over-adaptation. In self-protection, motivations such as affiliation and mastery are suppressed. Prolonged neglect of emotions and needs weakens the sense of self, which impedes agency. This dynamic is also evident in therapy: fearing rejection, participants avoid vulnerability and allow therapists to direct sessions. Some participants, however, gradually engage more through collaboration. When therapists and group members are perceived as authentic, reassuring, and validating, relational safety increases, accelerating engagement. Understanding oneself through formative experiences enhances self-compassion. Experiences of self-expression without anticipated reprimand foster mastery and agency. Discussion: Our findings reveal a paradox: the very strategies that protect people with AvPD from anticipated criticism actively undermine the agency needed for therapeutic change. Agency in AvPD seems mainly oriented towards self-protection. To pursue other motivations, a certain level of relational safety must be established. This appears to be a slower and more relational process than classic exposure therapy: negotiating gradual self-expression in a transparent and authentic atmosphere with room for failure.

Measurement is a cornerstone of evidence-based mental health research and practice. Validated self-report measures require respondents to translate lived experience into standardized numerical scores that are assumed to be meaningful and comparable. Yet little is known about how respondents actually arrive at these scores, or whether standard interpretations reflect the meanings respondents intend. Using qualitative methods, this study empirically examines meaning-making processes in self-report scoring to critically evaluate assumptions underlying score validity. Fifty-three respondents with and without depression completed the Beck Depression Inventory–II. Reflexive thematic analysis was applied to data capturing ‘real-time’ meaning-making via a thinking-aloud method and ‘recalled’ meaning-making elicited through subsequent cognitive interviews. Scoring involved active and individualized meaning-making. Respondents frequently encountered well-documented psychometric issues, including confusion about item meaning and poor fit of response options (Theme 1), as well as variation in referenced contexts and timeframes (Theme 2). Marked between- and within-respondent differences were observed in how these issues were resolved, indicating that identical scores can reflect substantially different meanings. In selecting response strategies, respondents demonstrated awareness of anticipated score interpretation and actively attempted to ensure valid understanding by the test administrator (Theme 3). These findings challenge two assumptions underpinning psychometric validity: that respondents systematically score as intended, and that standardized response formats ensure consistency within and between respondents. Instead, meaning emerges through an ongoing hermeneutic process between respondent, questionnaire, and administrator. Mental health measurement should therefore be approached as an interpretative practice, requiring continuous empirical reflection on the validity of score interpretation in specific contexts.

This opening presentation frames the session and introduces the World Café as a rigorous, relational qualitative method suited to the persistent challenges of implementing measurement-based care (MBC)/routine outcome monitoring (ROM). After a brief introduction to the panel and purpose to promote SPR 2026 themes of collaboration, dialogue, and shared meaning-making, we briefly outline key barriers to ROM/MBC implementation and the need for participatory research methods that generate actionable, context-sensitive insight. We then introduce the four core elements of the World Café (community, curiosity, cross-pollination, and iterative dialogue) and summarize its empirical foundations and applications in a variety of industries (Löhr et al., 2020; Schiele et al., 2022). We highlight sampling decisions, facilitation practices, data-capture strategies, and analytic approaches that support methodological rigor. Finally, we review implementation use cases, including stakeholder engagement, system learning, and strengthening feedback cultures. This framing equips participants with a grounded understanding of why dialogic methods matter for advancing psychotherapy science and practice.

This experiential session immerses participants in a structured World Café designed around current ROM/MBC implementation challenges. We establish norms for psychological safety, rotation, and shared inquiry before guiding participants through three rounds of table conversations. Round 1 explores a focal question about core obstacles to ROM/MBC integration; Round 2 builds on cross-table insights to consider near-term implementation opportunities to build feedback culture; and Round 3 synthesizes perspectives to identify emerging patterns. Participants use structured note-taking templates to capture ideas, illustrating how real-time qualitative data can be produced through facilitated dialogue. This live experience demonstrates how collaborative conversation can deepen insight, strengthen partnerships, and generate situated knowledge that supports both research and implementation efforts.

This session models how researchers can conduct rapid, participatory analysis following a World Café. Table hosts first share highlights from the three rounds of conversation, surfacing themes related to organizational feedback cultures, clinical needs, and system-level constraints. The presenters then facilitate a brief thematic synthesis, demonstrating analytic moves such as clustering, contrasting perspectives, identifying tensions, and articulating emerging hypotheses. We illustrate the value of rapid sense-making for implementation research, particularly when working with multi-stakeholder groups or resource-constrained settings. By making analytic reasoning transparent, this segment highlights how participatory interpretation can enhance credibility, deepen engagement, and support practice leadership of ROM/MBC implementation challenges.

The final presentation integrates insights from the World Café and considers implications for future psychotherapy research. We outline how themes generated during the session can inform study design, qualitative inquiry, and research methods (including hybrid effectiveness-implementation designs) aimed at improving ROM/MBC uptake and integration in practice settings. We address methodological considerations for incorporating participatory approaches—including ethics, cultural responsiveness, and the value of shared ownership in interpretation. We also discuss opportunities for extending World Café–generated insights into researchable questions, system-level interventions, and collaborative scholarship. Participants are invited to offer reflections, identify next-step applications, and consent to contribute co-generated materials to a pooled qualitative dataset. We will conclude by emphasizing how dialogic methods foster connection and shared learning, advancing the SPR mission of strengthening psychotherapy science and practice.

Counsellors and psychotherapists are uniquely positioned to hear, understand and respond to how the climate emergency impacts people’s mental health and, as a result, their professional organisations can provide a rich source of information about what therapists are encountering and what is being done to support and address their needs. This project brings together researchers from the International Association for Counselling, The Canadian Counselling and Psychotherapy Association, the British Association for Counselling and Psychotherapy and the Open University (UK). It investigates the work of counselling/psychotherapy organisations globally to understand climate change challenges faced by their members and their clients/patients and how they seek to address these to support effective responses. A global online survey of counselling/psychotherapy organisations explores their climate-related initiatives including training events, policy statements, awareness-raising activities and ethical guidelines, as well as challenges raised by their members such as the impacts of climate change on clients, practice, standards, advocacy, training needs and research opportunities. Data collection is ongoing. Responses will be analysed to produce descriptive statistics about respondent organisations including membership size and geographical location, with thematic analysis used for open-ended responses and will be ready for presenting in June 2026. Findings from the project will be used to co-ordinate a digital hub to share information, resources and best practice regarding culturally appropriate counselling approaches in the face of ongoing and escalating challenges of climate change. Additionally, the project is intended as a first step in fostering further collaborative research and climate responsive counselling initiatives.

Aims: Sally Weintrobe's "culture of uncare" (2020) describes how contemporary society undermines our capacity to face climate and ecological emergency (CEE), framing resilience as an individual trait—bouncing back, coping, adapting. We have been exploring relational resilience: the capacity to engage sustainably with existential threat that emerges not within individuals but between them. This practice-based contribution presents three Finnish interventions attempting to build relational contexts, and reflects on what we learned about the distance between tools and cultures. Methods (Interventions): Three interventions at different scales: (1) a nationwide digital self-help program (Mielenterveystalo.fi) offering psychoeducation and structured reflection, emphasizing that one need not face climate distress alone; (2) a Cognitive Analytic Therapy-based Climate and Ecological Emergency Booklet mapping procedural patterns - traps, dilemmas, snags -that maintain disconnection, designed for therapeutic and community settings; (3) workshops applying large-group psychology to address obstacles to cooperation on climate issues among different actors. Results (Reflections): Outcome data is not currently available: we offer practitioner reflections and thoughts about the research and evaluation implications arising from these interventions. We consider what seemed to support relational engagement and what we learned about the gap between individually-accessed interventions and genuinely relational practice. Discussion: Building cultures of care may require relational infrastructures beyond what any single intervention provides. Rather than presenting solutions, we bring questions we cannot answer alone, inviting collective reflection on what climate psychology practice might become.

Introduction: As global climate change continues to alter environments worldwide, prospects for timely mitigation decline due to political inaction. This results in increased climate worry and grief, sometimes leading to acute anxiety, prolonged despair, and a loss of hope. A group of patients worldwide seeks help for feelings of overwhelm, anxiety, and despair related to the bleak environmental and social consequences of climate change. Methods: Based on four qualitative studies involving psychotherapy patients, university students, and teachers who study or teach about climate change, I explore the lived experience of climate anxiety and helpful factors both within and outside of psychotherapy. Results: The samples in these qualitative studies come from Poland, Sweden, and Norway. The focus is on normalizing climate-related emotions, reframing hope and action, and applying existential and humanistic approaches in psychotherapy to emphasize meaning-making and connections, while also providing a holding space for the inevitable tensions of the modern climate crisis. Discussion: While not offering simple hope, this paper discusses interventions that help manage climate anxiety in psychotherapy and daily life. I also discuss the cultural specificity of climate anxiety and the need for dialogue between the global north and south regarding environmental emotions and their impact on mental health.

Introduction: Defence mechanisms have been conceptualised as implicit forms of emotion regulation (ER). Mature defences align with functional ER strategies, whereas immature defences correspond to dysfunctional strategies. Factor-analytic evidence supports this parallel. Heart rate variability (HRV), a physiological marker of regulatory flexibility, is likewise associated with functional ER, with higher resting HRV and smaller stress-related decreases reflecting more adaptive regulation. This study addresses this gap by investigating whether individuals who predominantly use mature defence mechanisms display higher trait HRV, attenuated HRV reactivity during climate-change-induced anxiety, and enhanced HRV recovery within a controlled randomised experimental paradigm. Methods: Using a mixed between-within subjects design, participants completed the study individually under standardised laboratory conditions across three time points (baseline, anxiety induction, recovery). Eco-anxiety was elicited through a video on European heat waves, whereas a relaxing video served as the control condition. Recovery was facilitated through an audio-guided stabilisation meditation. HRV was continuously assessed as the primary physiological outcome. Potential confounders, including political orientation, connectedness to nature, among others were measured. Results: Data collection is ongoing, with 98 participants having completed the experiment thus far (N = 130 planned according to power analysis). Discussion: By examining defence mechanism maturity as a moderator of both HRV reactivity and recovery, this study contributes to understanding the physiological basis of implicit ER when confronting locally relevant climate-related threat. In line with the conference theme, the project integrates clinical, experimental psychophysiological research and the study of stabilisation practices relevant to everyday encounters with climate stressors.

Cultural humility is emphasized in psychotherapy training, yet training-centered research has rarely examined how Asian and Asian American therapists in training conceptualize and practice cultural humility across therapy, supervision, and classroom learning. Using a constructivist qualitative design, we will share preliminary themes derived from semi-structured interviews with Asian and Asian American master’s and doctoral trainees from accredited programs in the United States. Guided by Multicultural Orientation, Asian Critical Race Theory, and Minority Stress Theory, we will discuss (a) how trainees conceptualize cultural humility from their positionalities, including links between culturally patterned humility in daily life (for example, saving face concerns, harmony, and avoiding standing out) and professional learning, and (b) how Asian and Asian American trainees make context-based decisions about cultural humility when navigating cultural conflict, discrimination, microaggressions, potential alliance ruptures, and self-protection needs. Data will be analyzed using reflexive thematic analysis. Findings will inform culturally responsive training and supervision practices that better support Asian and Asian American psychotherapy trainees.

Therapist multicultural orientation (MCO) is critical to foster given the impact of therapist attendance to cultural contexts in sessions on symptom improvement and premature treatment termination. Systematic, targeted feedback on MCO could reduce mental healthcare inequities among clients from historically marginalized communities. While there are tools that provide immediate feedback on specific interventions from therapy session recordings, there are none that provide similar feedback surrounding MCO. To center community member voices in the development of a MCO feedback tool, and to gain a multifaceted understanding of factors that would impact uptake, we interviewed 24 mental health agency leaders, supervisors, therapists, and queer people of color with previous or current therapy experiences surrounding their views on multiculturally oriented care, and what they would desire in a MCO therapist feedback tool. We analyzed interviews using thematic analysis. Preliminary themes center on systemic, agency, and therapist factors that impact provision of multiculturally oriented care, the importance of strength based, behaviorally grounded feedback, and implementation factors surrounding uptake of a MCO feedback tool.

Professional guidelines and psychotherapy research emphasize the importance of addressing clients’ cultural identities and sociocultural context in treatment. However, there is no observational research on how therapists engage in these conversations within sessions. The present study introduces and evaluates a brief observer-rated measure for identifying therapists' engagement in cultural and identity-related conversations. Trained observers coded 166 audio-recorded and transcribed psychotherapy sessions (37,857 therapist talk turns) using a three-item system capturing 1) exploration of client identities, 2) therapist identity disclosure, and 3) discussion of systems of power and privilege. Interventions were coded at both the talk turn and session levels. Interrater reliability was calculated for overall tallies and for individual talk turns. In total, there were 428 (1.13%) total talk turns (51 sessions; 30% of sessions) that included at least one coded intervention. Reliability for session-level tallies was excellent (ICC(2, k) = .91-.98), while talk-turn level agreement was moderate (κ = .43-.51). Findings suggest that although culturally responsive interventions were relatively infrequent at the utterance level, they occurred in a substantial proportion of sessions and can be reliably identified. This instrument offers an initial approach for observing how therapists address cultural identities and social context in practice. Future applications may support research on clinical processes, provide performance-based feedback, and inform training focused on multicultural responsiveness.

In 2021, the American Psychological Association (APA) declared a commitment to becoming an “actively antiracist discipline;” however, white individuals have been found to experience discomfort when race talk emerges that may interfere in how this comes to fruition in applied settings (Sue, 2015; Tatum, 1997). The present study explored if white identified psychotherapists were more adept at meeting this commitment than white identified college students. Psychotherapists receive training in multicultural counseling, but is this training sufficient to override deeply embedded racial norms and patterns of responding? Furthermore, does the therapist's identity and desire to maintain the working alliance override the need for antiracist intervention? These questions motivated our work. One hundred and twenty-five white psychotherapists and seventy-five white college students viewed one of eight videos portraying a client speaking directly to them and communicating some form of racial bias (based on Sue et al.’s (2007) taxonomy of microaggressions). They were then asked to respond in vivo. We developed a coding manual based on existing literature to support data analysis that contains global codes assessing clarity, relational stance, and corrections. It also includes 26 individual-level codes that relate to psychotherapy skills (e.g., validation, Socratic questions) and strategies white individuals use during race talk. We will discuss our coding process and compare the results from both groups of participants. Implications for understanding the way antiracist conversation is socialized in training programs and more broadly will be discussed.

Introduction: This study examines linguistic minority status as a structural determinant of health and health care in the United States. Linguistic minorities—people who speak a non-dominant language at home—often face barriers in accessing care and navigating health care systems. Building on prior evidence of language-related disparities, this study tested whether linguistic minority status is associated with differences in health care access, mental health, and functional outcomes, and whether these associations vary by age and sociodemographic context. Methods: Data were drawn from the 2021–2023 National Health and Nutrition Examination Survey (NHANES), a nationally representative multistage probability survey in the U.S.. Linguistic minority status was defined as speaking a language other than English at home. Outcomes included insurance coverage, mental health visits, depression, and functioning. Analyses were stratified by age (5–17 vs. 18+) and estimated average treatment effects using survey-adapted targeted maximum likelihood estimation, adjusting for key demographic and socioeconomic covariates. Findings: Among youth, linguistic minority status was associated with significantly lower insurance coverage and fewer mental health visits compared with English-dominant peers, with no evidence of differences in functional disability. Among adults, linguistic minority status predicted higher insurance coverage, more mental health visits, and higher functional disability; depression did not differ by language status. Stratified results suggested additional variation by country of birth and race/ethnicity. Discussion: Linguistic minority status functions as an important but nonuniform structural determinant of health care. Results highlight age- and context-dependent language-related disparities and underscore the value of language as a policy-relevant lens for health care equity.

Introduction: Asian Americans underutilize mental health services despite elevated distress and significant sociocultural barriers. Cultural values such as familism (prioritizing family obligation and interconnectedness) may shape stigma processes in nuanced ways. Thus, this longitudinal study explores the relationships among familism, self-stigma, interdependent stigma, and help-seeking attitudes among Asian American adults. Method: Asian American adults completed surveys at two time points spaced four months apart. A total of 412 individuals completed T0, and 307 completed both T0 and T1; analyses included only those with complete data across waves. At T0, participants reported familism, along with covariates (age, subjective SES). At T1, participants reported self-stigma of seeking help, interdependent stigma, and help-seeking attitudes. Using structural equation modeling (ML estimator), we examined longitudinal mediation pathways from familism (T0) to help-seeking attitudes (T1) through stigma mediators (T1), controlling for age, subjective SES and T0 outcomes. Results: Higher familism at T0 predicted significantly lower interdependent stigma at T1 (β = –.28, p < .001) and was marginally associated with lower self-stigma (β = –.12, p = .05). In turn, self-stigma showed a strong negative association with help-seeking attitudes (β = –.58, p < .001), whereas interdependent stigma did not uniquely predict attitudes when self-stigma was included (β = .07, p = .26). Familism did not directly predict help-seeking attitudes (β = .03, p = .61). The indirect effect of familism on help-seeking attitudes via self-stigma was statistically significant (indirect = .08, SE = .04, p = .06), suggesting that higher familism may be linked to slightly more favorable attitudes toward help-seeking via lower self-stigma. The model explained 3% of the variance in self-stigma, 14% in interdependent stigma, and 32% in help-seeking attitudes. Conclusion: Results underscore the importance of leveraging cultural strengths (e.g., familism’s emphasis on mutual care and responsibility) in future interventions aimed at reducing stigma and supporting mental health service engagement in Asian American communities.

Purpose: Clinicians’ Facilitative Interpersonal Skills (FIS) are important in achieving good treatment outcomes. However, human raters who conduct observer ratings of clinical skills often differ in their perspective on what response is highly competent and what is less competent. It is possible that cultural differences between human coders, and the therapists they rate play an important part. It thus remains unknown whether the human observer coding of clinical skills itself is influenced by the coders’ race and participants’ race. This study, as a secondary analysis, aims to explore the effect of coders’ race when they rate participants’ FIS performance. Method: The FIS performance-based task and rating method was used to assess the influence of cultural differences in what is deemed clinically competent. Clinicians respond to a set of mock patient clips as if they were the therapist, and these responses are rated by humans on the eight dimensions of FIS (e.g., empathy, warmth, hope etc.). The study employed a matched-sample design from a larger pool of clinicians. Our sample consisted of 20 clinicians by pairing 10 Asian participants with 10 White participants who were comparable on matching variables, including age, years in practice, licensure status, and overall FIS score. Their responses were independently rated by at least two Asian and two White coders. Results: The Linear Mixed-Effects Models revealed a significant main effect for Coder Race (p < .001) and Participant × Coder Race interaction (p < .001). This interaction suggests that the magnitude or direction of coder bias differed depending on the race of the participant being rated. Specifically, there are same-race rating preferences that Asian coders rated higher for Asian participants (p < .001) and White coders rated higher for White participants (p = .005). Discussion: Findings reveal a systematic same-race bias in the measurement of clinicians’ facilitative interpersonal skills. It suggests that the potential rating bias is caused by race; thus, the cultural background of both coders and participants should be taken into account in the measurement to ensure validity and equity.

Bilinguals vary across their languages in how they communicate, experience emotions, and recall past events. Yet, mental health services are centered on monolingual models of care that contribute to inequity for linguistically and culturally minoritized populations. In this study, we examined whether Japanese-English bilinguals reported symptoms of anxiety and trauma differently when assessed across their two languages. We recruited 189 Japanese-English sequential bilingual speakers (167 females, 20 males, 2 non-binary, Mage = 54.83, SDage = 10.42, range = 40 to 91 years old; Medu = 16.74, SDedu = 3.40). Participants completed online measures of anxiety (State-Trait Anxiety Inventory; Spielberger et al., 1970, Iwata et al., 1998) and trauma (Posttraumatic Stress Disorders Checklist; Belvins et al., 2015; Ito et al., 2019) in Japanese and English across two consecutive days. The order of language was counterbalanced across participants. Bilinguals reported higher total anxiety scores in their first language Japanese than in second language English, whereas total PTSD scores did not differ by language. Item-level analyses revealed higher ratings of avoidance (items 6 and 7), self-harm (16), hypervigilance (17) and startle response (18) in Japanese. In contrast, symptoms were higher in English for positive feelings (14), difficulty concentrating (19) and sleep disturbance (20). Notably, avoidance symptoms (Cluster C) was rated higher in Japanese. Bilinguals may express psychological symptoms differently as a function of language, due to varying degrees of emotional reactivity across languages and associated cultural norms. We conclude that clinicians must consider multilingual assessments to implement equitable and effective mental health services.

Borderline Personality Disorder (BPD) is characterized by maladaptive interpersonal patterns of behaviour (e.g., heightened rejection sensitivity, impulsivity), which often emerge during emotionally challenging moments in therapy. A strong alliance can serve as a precondition that aids the therapeutic dyad in effectively navigating ruptures that arise in-session; however, there is limited research on the specific therapist repair strategies used in dialectical behaviour therapy (DBT) for BPD. Accordingly, this study investigates the roles of baseline alliance quality and specific therapist interventions in alliance rupture-repair in an early session of DBT for BPD. Specifically, we examine the relationships between baseline alliance quality, in-session alliance quality, rupture salience, and rupture-repair effectiveness. We also examine which therapist repair strategies were used in-session, whether strategy use differed depending on rupture salience and type (confrontation versus withdrawal), and whether repair strategy use predicted effective rupture-repair. This study is a secondary analysis of the FASTER study, a randomized controlled trial comparing 6- versus 12-months of DBT. In a subsample of 60 dyads, the Working Alliance Inventory – Short Revised (WAI-SR; Client Version) was used to assess baseline working alliance quality (averaged over sessions 1-4). Trained observers coded one early treatment session (session 6) using the Rupture Resolution Rating System (3RS) to assess alliance rupture and repair, and the Working Alliance Inventory – Observer (WAI-O) to assess alliance quality in that same session. Data will be analyzed using multilevel modelling. Clinical and research implications will be discussed.

Objective: Peers with lived experience of recovery from Borderline Personality Disorder (BPD) as co-therapists may increase engagement, reduce stigma and strengthen hopefulness. Remission and recovery from borderline personality disorder (BPD) is difficult, yet achievable, yet not all people benefit meaning alternative methods and approaches are warrented. Methods: Over 6 weeks, the group developed good alliance and rapport with both members and facilitators. Therapy tackled self-stigma, improving self-compassion, developing creative ways to discover and express identity, and other topics discussed together in the group setting to support recovery goals. Eighty-three participants (88% female, M age = 36yrs) were randomised into either AIR Peers therapy (n = 43) or treatment as usual (TAU; n = 40). Results: Intention to treat multilevel modelling analysis indicated that the AIR Peers group showed a significant reduction in BPD symptoms (primary outcome) and improvement in mental health ratings (secondary outcome), whereas no change was present in the TAU group. In the AIR peers arm, 86% rated the treatment as helpful and 97% recommended the treatment to others. The study provides initial support for the efficacy of peer and clinician co-delivered group therapy models for BPD using novel topics specifically designed to enhance recovery.

Background: Major depressive disorder (MDD) frequently co-occurs with narcissistic personality disorder (NPD). Despite the clinical relevance of this comorbidity, little is known about the efficacy of short-term depression-focused treatments for individuals with comorbid NPD. This study examines whether individuals with comorbid MDD and NPD benefit from treatment and whether NPD diagnostic status changes during therapy. Method: One hundred patients in a randomized controlled trial (RCT) were assessed for NPD (n = 14) using the Structured Interview for DSM-IV. Participants were randomly assigned to supportive therapy or supportive-expressive therapy. Depression severity was measured throughout therapy by the Hamilton Rating Scale for Depression (HRSD). Multilevel models were used to assess treatment efficacy and changes in NPD prevalence. Results: Patients with comorbid MDD and NPD demonstrated significantly greater depressive symptom reduction than those without NPD. However, no significant changes were found in NPD diagnosis status across therapy. Conclusion: These findings challenge the assumptions that NPD is a negative prognostic factor for depression treatment. Rather, they suggest that short-term psychodynamic interventions may effectively reduce depressive symptoms for patients with comorbid NPD, highlighting the need for further research into treatment mechanisms and patient subtypes.

Background: Specific interventions predict session-by-session outcome, as well as distal outcomes in psychotherapy (Hill & Norcross, 2023). So far, only a few studies have focused on the links between specific intervention groups and process and outcome in psychotherapy for borderline personality disorder. The present study aims at using the French version of the MULTI (McCarthy & Barber, 2009) in the prediction of the therapeutic alliance over time and outcome in psychiatric intervention facing borderline personality disorder. Methods : The study reanalyses data from N = 60 patients from a randomized controlled trial on brief psychiatric intervention, comparing individualized vs standard treatments. The first session of the treatment was videotaped and analyzed using the MULTI (McCarthy et al., 2009). The therapeutic alliance was assessed at every session using the WAI, and the outcomes were assessed using OQ-45 at three datapoints over time. Hierarchical Linear Modelling were used to model effects over time of the different MULTI sub-scales on the therapeutic alliance and symptom progression, by taking into account the effect of the case formulation. Results : Reliability of the French version of the MULTI was excellent. Results are consistent with the hypotheses, and Discussion : Interventions consistent with common factors are a particularly relevant category to explain process and outcome in treatment for borderline personality disorder. From an integrative viewpoint, it may be important to train psychotherapists in specific interventions, by taking into account the impact of case formulation on the process of change.

Objectives: This study aimed to identify pre-treatment predictors or treatment response, in order to construct expected recovery curves and guidelines for progress feedback. Method: A routinely collected data set of 26,761outpatients (77% female; M_age = 38.8 years [SD = 12.7]) who had received cognitive behavioral therapy in a multi-site mental health care organization was analyzed comparing a classic expected treatment response (ETR) model and a random forest (RF) classifier model. The dependent variable was the total score on the Symptom Questionnaire (SQ-48). Results The RF model achieved a precision of 0.56, recall of 0.50, and an F1-score of 0.53. The ETR model demonstrated a higher precision of 0.63, but lower recall of 0.37, resulting in an F1-score of 0.46. Conclusion: Different prediction models were constructed for the SQ-48. The ETR model provided a better trade-off between identifying true non-recovery cases and minimizing false positives. These models can aid in early identification of patients who are not responding to treatment.

Background: Patient-reported outcome monitoring (PROM) systems typically rely on observed symptom change, making it difficult to evaluate whether change is attributable to psychotherapy itself. We present a counterfactual PROM approach that compares patients' observed trajectories to their expected change without psychotherapy. Method: Using the Synthetic Waiting List (SWL) method, we trained causal machine learning models to estimate individualized potential outcomes under "no treatment" and contrasted these with observed weekly Short Emotional Disorder Inventory (SEDI) scores. The method was applied to N = 431 adults receiving routine cognitive-behavioral therapy (CBT). Patient-specific induced improvement, deterioration, and off-track signals were derived by comparing current SEDI scores to the expected natural course. Results: At post-treatment, 203 patients (47%) showed outcomes consistent with CBT inducing improvement beyond their predicted natural course, whereas 95 (22%) showed outcomes consistent with worsening relative to the counterfactual benchmark. During therapy, 232 patients (54%) entered an induced off-track state at least once, typically for 1-4 consecutive sessions. Most patients (88%) showed induced early improvement lasting 2-11 sessions. The mean induced improvement (observed - predicted no-treatment outcome) was estimated at -0.48 SEDI points. Conclusion: Counterfactual PROM offers a conceptually clear assessment of treatment-induced change that can complement traditional observed-change criteria. It enables individualized detection of meaningful improvement or stagnation relative to a patient's expected natural trajectory and may refine clinical feedback and decision making.

Background: Routine outcome monitoring (ROM) and feedback-informed therapy (FIT) require valid measures, but self-reports can create burden and bias. Recent advances in artificial intelligence (AI) enable the extraction of clinically relevant information directly from psychotherapy sessions, offering low-burden alternatives. Prior work suggests that Large Language Model (LLM)–derived information relates meaningfully to treatment processes and outcomes. This study examines whether an LLM Rating Scale approach can estimate symptom severity from session transcripts and whether audio- and video-derived affective features further improve prediction. Methods: Using 214 HiTOP-based prompts, LLM-derived symptom ratings from 1,907 psychotherapy transcripts (358 patients) were generated using a locally run Llama 3.1 8B model. A multimodal subsample (806 sessions; 138 patients) included additional vocal affect features from EmoWav2Vec and facial affect embeddings from EmoNet. Symptom severity was assessed each session using the HSCL-11. Data were split into 80% training and 20% test sets. Within the training set, glmmLasso models accounting for nested data structures were used for variable selection and prediction. Model performance in the test set was evaluated by correlating predicted and observed symptom severity. Results: Text-derived LLM ratings showed substantial correlations with patient-reported symptoms. The best text-only model used eleven features and explained 19.95% of symptom severity variance (R = .446). In the multimodal subsample, predictive accuracy increased to R² = .259. Conclusions: Findings demonstrate the feasibility of automated, privacy-preserving outcome estimation in psychotherapy. LLM- and multimodal approaches show promising accuracy and may reduce response burden while supporting routine outcome monitoring and data-informed decision-making in psychotherapy.

There is a great variety of feedback tools available to clinicians, adapted to many clinical practices and regions. In some cases, a single outcome variable is targeted across many patients, while in others, many different targets are tracked over time. This leads systems to choose a balance of specificity and breadth. In this project, we will present analyses based on the observation that one size does not fit all: while some patients are best served by having a very simple measure, others productively use a more complex one. To explore this we will use a large (N = 18,000) observational sample of patients in specialist mental health and substance use clinics in Norway who completed the Norse Feedback. Using gradient-boosted decision trees, we will predict risk of treatment dropout across this diverse data set including both simple negative affect scores and narrower scale and item responses. Variability in the explanatory models will be described using Shapley additive explanation (SHAP) scores, and compared across clinic, provider, and patient levels. We expect that results will demonstrate a strong and consistent value of a broad negative affect score, with several subpopulations showing additional (not exclusive) value from narrow dimensions. We anticipate that the variability in the predictive power will be substantially explained by treatment location.

Background: Anxiety disorders are highly prevalent and disabling. Diagnosis mostly relies on self-reported questionnaires and clinical judgement. Objective: To evaluate the validity and reliability of autonomic biomarkers derived from heart rate variability (HRV) to correctly classify cases with and without anxiety disorder symptoms. Methods: This was a multi-center, diagnostic cross-validation study. 124 participants were drawn from university and local general populations at two research labs in Sheffield and Sussex. Participants were exposed to a lab-based anxiety induction paradigm lasting 9 minutes across three phases (3 min. rest, 3 min. induction, 3 min. recovery). Participants completed validated measures of anxiety (GAD-7) and depression (PHQ-9) prior to the lab task. Their HRV was measured continuously using two devices: [1] an industry-standard electrocardiogram (ECG) and [2] a miniaturized photoplethysmography (PPG) biosensor. Correlations between [1] and [2] were examined. A machine learning classifier was developed using ECG and PPG-derived features in a training sample from Sussex (n=89) to identify cases with anxiety disorders (GAD-7 ≥8). Classification accuracy was examined using the area-under-the-curve (AUC) in the validation sample from Sheffield (n=36). Correlations using dimensional scores were used to evaluate the machine learning model’s convergent (GAD-7) and discriminant validity (PHQ-9). Results: HRV features from PPG and ECG were strongly correlated in the full sample (n=125) across all three phases (r ≥ .88, p < .001). An ECG-based machine learning classifier generalized to an external validation sample (AUC = .71), correctly classifying anxiety disorder cases with adequate sensitivity (88%) and specificity (61%) and outperforming a PPG-based classifier. As expected, the classifier had stronger correlations with GAD-7 (r = .51) than PHQ-9 (r = .47). Conclusions: Biomarker data processed using a machine learning algorithm could help to inform the diagnostic process for anxiety disorders.

Aim: Heightened negative affect is a core feature of serious mental illness. Over 90% of American adults own a smartphone, equipped with an array of sensors which can continuously and unobtrusively measure behaviors (e.g., activity, location, and phone usage patterns) which may predict increases in negative affect in real-time in individuals' daily lives. Methods: Sixty-eight adults with a primary mood or psychotic disorder completed daily emotion surveys for over a year, on average (mean 465 days; total surveys=12,959). At the same time, semi-continuous collection of smartphone accelerometer, GPS location, and screen usage data, along with accelerometer tracking from a wrist-worn wearable device, was conducted for the duration of the study. A range of statistical approaches, including a novel personalized ensemble machine learning algorithm, were compared in their ability to predict states of heightened negative affect. Results: A personalized ensemble machine learning algorithm outperformed other statistical approaches, achieving an area under the receiver operating characteristic curve (AUC) of 0.72 (for irritability) - 0.79 (loneliness) in predicting negative emotions. Smartphone location (GPS) variables were the most predictive features overall. Critically, there was substantial heterogeneity between individuals in the association between smartphone features and negative emotional states, which highlights the need for a personalized modeling approach. Discussion: Findings support the use of smartphones coupled with machine learning to detect states of heightened negative emotions. The ability to predict these states in real-time could inform the development and timely delivery of emotionally beneficial smartphone-delivered interventions which could be automatically triggered via a predictive algorithm. Time permitting, we will briefly discuss a new project that extends this work with additional sensors (e.g., data from calls/texts, social media, and a smart ring).

Aim: Adolescent depression remains a major public health concern, and Behavioral Activation (BA) offers a promising treatment aimed at reducing avoidance and increasing engagement in rewarding activities. Yet, the core therapeutic process, activation, is rarely captured in daily life using scalable, low-burden, and ecologically valid tools. This presentation will present a proof-of-concept study examining whether behavioral activation, the core therapeutic target of Behavioral Activation (BA) therapy, can be measured in adolescents’ daily lives using scalable digital tools. Method: Adolescents (n = 38, ages 13–18) receiving a 12-week BA intervention for anhedonia completed daily ecological momentary assessments (EMA) with open-text entries, and a subsample (n = 13) contributed passive smartphone sensing data (accelerometer activity, GPS-derived mobility). Results: Large language model (LLM; GPT-4o) ratings of activation derived from EMA text were positively associated with both self-reported activation and sensing indicators such as number of places visited and time spent away from home. Within-person increases in LLM-rated activation predicted higher positive affect and lower negative affect, while passive sensing features forecasted weekly reductions in anhedonia and depressive symptoms. Discussion: Together, these findings support the feasibility and validity of using smartphone sensing and LLM-based text analysis to capture dynamic changes in activation as therapy unfolds. The presentation will discuss how these multimodal methods can help identify early markers of therapeutic change and move toward data-informed, personalized interventions for adolescent depression.

Background: This presentation discusses a data-informed clinical decision system ranging from single-item applications to a multimodal dynamic network model that supports the delivery of personalized feedback to therapists at the beginning and throughout psychological therapy. The presentation will focus on the most advanced element: the development of an AI-based multimodal model that identifies the core elements of psychological distress and resources. This model also enables the quantification and integration of multiple dimensions of distress, such as ecological momentary assessments (including bio-behavioral markers such as physical activity levels, sleep patterns, or physiological signals) and video or audio recordings. Research Question: How can psychological distress and resources be extracted from digital phenotyping and session transcripts, and then integrated into clinical support tools and adaptive treatment planning for therapists? Method: A total of approximately 1,400 session transcripts from 287 patients were analyzed using a large local language model to provide therapists with feedback, linking emotional and cognitive parameters to symptom distress levels for each session. Additionally, a sample of 150 patients was assessed four times a day using EMA and a digital wristband. Validation was conducted through the daily empirical assessments, as well as at the session level. Results: Natural language processing of bio-behavioral, emotional, interpersonal, and cognitive distress is predictive of psychological symptoms assessed via questionnaires. This demonstrates that transcript information is a valuable additional data source. Several case examples illustrate how personalized clinical implications can be derived from individual distress parameters, as well as how this information can be presented to therapists in a graphical format to support clinical decision-making. Conclusion: New digital assessment methods may provide empirical support for personalized clinical tools, therapy planning, and therapist feedback. However, further validation studies are needed before these methods can be implemented on a large scale.

Objective: This study focuses on two objectives: revising and validating the Supervisory Style Inventory (SSI; Friedlander & Ward, 1984) for use in China, and examining how supervisory style match predicts trainee clinical performance manifested by their client symptom outcomes. Methods: Participants included 173 beginning therapist trainees who saw 1916 clients under the supervision of 73 supervisors in a Chinese mental health counseling training program. Clients completed measures of their symptom distress before every session; trainees completed the SSI for their expected supervisory style at the beginning of practicum and their perceived actual supervisory style at the end of the practicum; supervisors completed the SSI at the beginning of practicum to report their self-rated supervisory style. Results: (1) factor analysis reduced the 33-item SSI to 21 items with two subscales: Task-Focused and Organized (TFO) and Relationship-Focused and Supportive (RFS). This structure demonstrated measurement invariance across trainee and supervisor versions. (2) Trainee-perceived RFS scores significantly predicted greater client symptom improvement, while supervisor self-rated RFS scores negatively correlated with client outcomes. No significant effects were found for TFO scores. (3) Regarding supervisory style match, greater mismatch between trainee-expected and supervisor self-rated styles predicted poorer client outcomes. Mismatches between trainee-expected and trainee-perceived, or trainee-perceived and supervisor self-rated styles did not significantly predict client outcomes.

Aims: Exploring the methodology of using a "standardized supervisee" in supervision training to train and assess supervision competencies among trainees. Methods and Procedure: We first developed five “standardized supervisees” based on the literature review and our observations regarding common challenges experienced by supervisors in training. Five researchers who have received a two-year long supervision training were trained to play the standardized supervisees and receive “supervision” from study participants (who are supervisors in training). Two independent raters followed the scoring manual that was developed for the study and rated the video recordings of the supervision to assess the competency levels of participants in four evaluation dimensions: Persuasion and Collaboration, Countertransference Management, Specific Knowledge (Conceptualization) and Skills, and Supervisory Alliance. There were 16 scoring points in each dimension. Participants: Forty-two supervisors in training from a two-year long US-China collaborative supervision training program. Results: The scores that participants received showed good reliability among the two raters, and high face validity in terms of reflecting perceived experience level of the participants in supervision. Further, satisfactory criterion validity of the results was established using scores from the Supervision Style Questionnaire, Supervision Satisfaction Questionnaire, and Supervision Alliance Scale completed by standardized supervisees. Discussion. Supervision training is in high demand in China, and training programs are challenged to provide high quality and efficiency of training. Tools and methods for systematically assessing supervisors' competence that are not solely self reports are very much needed. This study fills a gap.

Aims: To promote the understanding that effective supervision has to be culturally rooted. Methods and participants: This is a collaborative ethnographic study involving 13 Chinese practicing psychotherapists who are currently enrolled in a two-year long supervision program and members of a six-month long supe-of-supe group. All participants and the group facilitator co-authored this study. First a group meeting was held as the closing session of the group and members shared their learning and insights regarding supervision in China and for Chinese. After the meeting, all participants agreed to put their thoughts in writing, which would be used as the initial data for the current study. With the help of ChatGpt 4, a theme analysis of the data was conducted. Results: Centered on the theme of empowerment, this study identifies key trends in contemporary Chinese supervision practice. 1. Paradigm shift: From correction toward empowerment. 2. Safe relationships: The foundational condition for empowerment. 3. Cultural wisdom: The unique soil from which empowerment emerges. 4. Relational connection: The core mechanism of empowerment. 5. Clinical implications: Empowerment promotes the mutual growth of both supervisees and clients. Discussion: The findings suggest that the effectiveness of supervision does not lie in technical correction, but in empowering supervisees to discover their own resources and potential within a safe relational context.. Overall, this study reveals a central trajectory in supervisory practice: a shift from correction to empowerment, from technique to relationship, and from Western-dominated frameworks toward integrative Eastern–Western models.

Aim: This study examined how supervisors’ case conceptualizations of clients influence supervisees’ clinical self-efficacy and perceptions of clients, including hope, compassion, and evaluations of psychological well-being. Method: A total of 149 participants in China, including counselors-in-training and early-career counselors, were recruited for this online analogue study. Participants read a clinical vignette involving a hypothetical client case and a supervisor’s case conceptualization. A 2 × 2 × 2 factorial design was employed, with supervisor perspective (strength-based vs. deficit-based), attribution of the client’s presenting concern (personal vs. contextual), and case difficulty (low vs. high) as independent variables. Dependent variables included supervisees’ clinical self-efficacy, hope for the client, compassion, and ratings of the client’s overall psychological well-being. Results: A preliminary multivariate analysis of variance (MANOVA) indicated a multivariate main effect of supervisor perspective at a borderline level of statistical significance (p = .065). Follow-up univariate analyses revealed that participants in the strength-based condition reported significantly higher levels of hope for the client and higher ratings of the client’s psychological well-being compared to those in the deficit-based condition. Additionally, participants in the low-challenge case condition rated the client’s psychological well-being higher. Discussion: Findings suggested that supervisors’ case conceptualizations may influence supervisees’ perceptions of clients, though in a limited capacity. Implications for supervision practice and training are discussed, along with study limitations and directions for future research.

This study explores whether reasoning large language models (LLMs) can recover meaningful process trajectories from long-term psychotherapy under sparse outcome measurement. We use a naturalistic student-clinic dataset comprising dynamic and integrative therapies with up to 50 sessions per case. Symptom measures are collected at the beginning and end of treatment, while process measures (e.g. working alliance) are obtained at several time points during therapy. Session transcripts are presented to an LLM together with the timing and values of these measures. Using an explanatory, hypothesis-generating procedure, the model proposes candidate descriptions of what changes within and across sessions that might account for both intermediate process ratings and symptom differentials. These candidates are examined for coherence and systematic covariation with questionnaire data. The study positions reasoning LLMs as a new tool for scalable, interpretable modelling of temporal change patterns in psychotherapy.

Previous research has identified notable associations between interpersonal synchrony (IS), therapeutic alliance, and therapy outcomes. IS is typically measured using statistical approaches that segment or ‘window’ time-series, such as Windowed Cross-Correlation (WCC), which assume local stationarity across fixed intervals. A key methodological concern here is that such fixed intervals may contain underlying behavioural shifts, and that averaging across these shifts risks smoothing distinct dynamic activities into lower-granularity estimates. In this study, we apply an unsupervised machine learning framework to address this issue. By clustering multimodal features (movement & acoustic), we first segment the session into distinct interaction states of varying duration (e.g., separating a short moment of laughter from a long period of silence). We then calculate the level of synchrony within these data-driven segments. Initial results indicate that synchrony levels fluctuate according to the behavioural context, reinforcing the view of synchrony as a dynamic, evolving process. Consequently, this study highlights the utility of methodological approaches capable of capturing such temporal variability, rather than relying on aggregate measures.

This pilot study evaluated the feasibility and utility of an AI-based assessment framework applied to two contrasting psychotherapy cases: an unsuccessful 8-session treatment and a successful 16-session treatment. Using natural language processing and machine-learning–derived process markers, we analysed session transcripts for indicators of therapeutic alliance, emotional expression, linguistic change patterns, and therapist–client interaction quality across time. Findings suggest that AI-assisted analysis can meaningfully differentiate therapy trajectories and reveal process-level dynamics that are difficult to detect through traditional methods. This pilot supports the potential of AI-based tools as scalable, objective supplements for psychotherapy research, training, and outcome evaluation.

The presentation will give a preliminary example of an AI-feedback tool for psychotherapy education and will discuss how AI feedback intersects with core competencies like empathy and attunement, alliance building, attachment patterns related to intervention selection, or therapist responsiveness. Strenghts but also limitations of this kind of external feedback during training will be discussed as well as possible ethical issues.

Empirical findings indicate that facial-emotion synchrony correlates with the therapeutic bond (Atzil-Slonim et al., 2023; Merten et al., 1996; Rasting & Beutel, 2005). However, the assumption that “more synchrony is always better” is debatable, and in some cases synchrony may even relate negatively to the alliance (Reich et al., 2014; Wiltshire et al., 2020). The objective of this presentation is to offer a theoretical rationale for extending the InSync model (Koole & Tschacher, 2016). We refer to this extension as the InSync+ model, with the “+” denoting added moderators. We propose that the valence and the target of emotions moderate the relationship between emotional synchrony and the therapeutic alliance. Specifically, we postulate that synchrony in negative emotions directed toward the therapist or toward the patient’s own self should be considered dysfunctional, in contrast to synchrony in negative emotions directed toward the external world or synchrony in positive emotions. This hypothesis has received preliminary support in our study, which showed that synchrony of anger, disgust, and confusion during brief psychological conversations predicted a weaker bond (Styła et al., 2024). Clinical experience aligns with this view: synchrony with a patient’s negative emotions directed at the therapist or at the patient’s self tends to be unhelpful. For instance, if a therapist synchronizes with a client’s self-directed anger, the client may perceive the therapist as unsupportive or unaccepting, which can undermine the alliance.

Nonverbal synchrony is discussed as a predictor of therapeutic alliance in psychotherapy. A popular way to asses nonverbal synchrony is via motion energy analysis, where windowed cross-lagged correlations are computed on participant’s movement signals. To obtain a single synchrony measure for an entire interaction, these correlations are aggregated over time. Despite nonverbal behaviour being highly context-dependent, this aggregation step does not take into account any notion of conversation context. In this work, we propose a novel approach to compute nonverbal synchrony conditional on conversation context. To this end our approach introduces a weighted average in the aggregation step of nonverbal synchrony computation. Weights are dependent on context descriptors extracted from a conversation transcript, and are learned via backpropagation to increase the correlation between the final synchrony score and therapeutic alliance measurements. Preliminary experiments on a dataset of psychotherapy interactions demonstrate the effectiveness of our approach.

Objective: In daily life, people are constantly falling in and out of synchrony in interpersonal interactions, but what makes synchrony curative remains an open question. Today, most of the literature is based on the "the more is the merrier" approach, in which the higher levels of synchrony are inherently beneficial, but empirical findings in recent years have painted a more complicated picture. The current study adopts a personalization approach and understanding of synchrony, according to which each individual has their own way of getting into synchrony. The overarching goal of this series of case studies is to investigate whether people have a multimodal trait-like individual synchrony signature that characterizes them beyond different dyads and contexts. Method: In a series of 10 cases, we implemented the Synchrony Interaction Paradigm (SIP) in which participants shared problematic interactions with four distinct dyadic partners: a family member, a best friend, a romantic partner, and a previously unmet individual. Self-report measures were collected before each conversation, and automatic measures of motion, facial expression, physiology, and acoustics were collected during the conversation. All cases have already been enrolled and all data collected. Analyses are now conducted and will be presented at the SPR conference. Conclusion: This is the first study to explore the existence of a multimodal trait-like synchrony signature. If it exists, it will change the way synchrony is understood, advancing science into personalized understanding of synchrony.

Background: Interactions between patients and therapists take place on various levels (e.g., verbal and nonverbal communication). While there is a growing number of studies using NLP to analyze transcripts from psychotherapy sessions, there is a need for more in-depth investigation of vocal characteristics. In example vocal-synchrony might be a promising aspect in building better prediction models. Method: 4,302 sessions are analyzed and linked to ratings of the alliance as well as of alliance rupture and repair processes. Models with varying numbers of features, derived from different methods as well as the corresponding synchrony models are determined. They are estimated as hierarchical mixed-effects models using GPBoost. Voice features are weighted-mean aggregated per session. All models are compared with regard to their performance on prediction and explained variance. Results: Preliminary results indicate no different performance between models with features derived by different methods, nor they show different performance between models with or without synchrony. Also, no voice model differed distinctly from a baseline model with only random effects or a control model with additional control variables. Conclusion: Voice features, independently where they were derived from and if they map synchrony or not, do not qualify for the prediction of alliance quality and rupture-repair occurrence. This could be accounted to methodological problem by aggregating time varying voice features to one value per session because of weighted mean aggregation or to strong random effects.

Aim: Dropout is a major problem in psychotherapy research and practice. Approximately one in five patients with a depressive disorder terminates treatment prematurely, which limits their chance of improvement and threatens the validity of trial findings by introducing bias in estimated effects. Identifying predictors and moderators of dropout may help prevent early termination by flagging individuals who require additional support or closer monitoring, and by clarifying which treatment conditions are more likely to promote retention for specific patients. This project, therefore, aimed to investigate predictors and moderators of dropout in short-term psychodynamic psychotherapy (STPP) for depression, an under-researched treatment, using individual participant data (IPD) meta-analytic methods. Methods: Systematic literature searches identified eligible randomized controlled trials and observational studies of STPP for depression. Individual participant data were requested from study authors and analyzed using mixed-effects logistic regression. Sensitivity analyses assess the robustness of findings. Results: IPD were obtained from 43 studies on STPP for depression, comprising 4,155 participants. Results from the predictor and moderator analyses will be presented. Conclusions: This project provides a unique opportunity to examine dropout in STPP for depression across a large, international database. The results are expected to help clinicians offer additional support to patients at higher risk of dropout and guide decisions about which treatment is more likely to facilitate continued participation.

Aim Understanding patients’ lived experiences is essential for refining psychodynamic treatments for complex mood and personality disorders. Although qualitative studies have proliferated, their findings have not been explored systematically. This review taimed to synthesise qualitative evidence on adults’ experiences of long-term psychodynamic psychotherapy (LTPP) to identify cross-cutting challenges, experiential processes, and implications for practice and research. Methods Systematic searches of Embase, MEDLINE, and APA PsycInfo identified eligible qualitative studies. Ten studies met inclusion criteria. Using JBI meta-aggregation, 64 findings were extracted, appraised for plausibility, organised into 14 categories, and synthesised into five overarching statements. Results Five synthesized findings emerged: starting therapy is often difficult, though early acceptance and trust support engagement; therapeutic change is nonlinear and affectively demanding; group MBT brings distinct interpersonal challenges but offers a crucial space for practising mentalizing; gaining new perspectives—greater flexibility, revised assumptions, improved communication—is a key outcome; and ending therapy is emotionally complex, marked by sadness, ambivalence, and the task of carrying therapeutic gains into everyday life. Conclusions Patients’ experiences exhibit strong fidelity to psychodynamic accounts of change, underscoring the roles of mentalizing, insight, and relational processes. Clinically, the findings highlight the value of early-phase psychoeducation to ease initial uncertainty; the need to recognise and support the distinctive challenges and opportunities of group-based psychodynamic work; and the importance of a structured, collaborative approach to termination. Future research should diversify qualitative work beyond MBT-heavy samples, employ comparative designs to clarify which mechanisms are specific to LTPP, and examine longitudinal trajectories of mentalizing, insight, and relational change following treatment.

Background: Although loneliness has increasingly become a focus of empirical (psychotherapy) research in recent years, its proposed counterpart — the feeling of connectedness — has remained comparatively under-conceptualized. This stands in contrast to patients’ wishes for psychotherapy to not only alleviate symptoms but also improve their relationships. In particular, studies examining the association between loneliness and connectedness, their temporal dynamics, and their dependence on between-person differences, such as personality functioning, are lacking. Method: N = 91 inpatients participated in a ten-day Ecological Momentary Assessment (EMA) protocol. The EMA captured momentary feelings of loneliness, connectedness, and positive and negative affect; sociodemographic and clinical characteristics, including personality functioning, were assessed at baseline. Based on 4,928 individual observations, we analyzed mean levels, variability, associations among loneliness, connectedness and affect ratings, as well as their relations to the level of personality functioning. Results: The correlation between loneliness and connectedness at the same measurement point was r = -0.56. Both variables showed high intraclass correlations, with 70% of the variance in loneliness and 62% of the variance in connectedness attributable to stable between-person differences rather than within-person fluctuations. Greater deficits in personality functioning were associated with higher mean loneliness, lower mean connectedness, and greater instability in both. Loneliness and connectedness independently predicted positive and negative affect at the respective next measurement point. Discussion/Conclusion: The findings suggest that loneliness and connectedness are not perfectly negatively correlated and, therefore, should not be understood as two sides of the same coin. Instead, they appear to be subjectively experienced affective states with complex determinants and potentially distinct implications for mental health and well-being.

Aim: Traumatic experiences affect most individuals worldwide, and a considerable proportion develop persistent symptoms such as PTSD, anxiety, and depression. Expressive Writing (EW) has been studied as a low-cost and scalable intervention for trauma-related distress, yet empirical findings remain mixed. Emerging evidence suggests that incorporating principles from Emotion-Focused Therapy (EFT) into EW—termed Emotion-Focused Expressive Writing (EFEW)—may strengthen emotional processing and improve psychological outcomes. This study aims to evaluate the efficacy of EFEW relative to standard EW and to clarify the mechanisms underlying change. Methods: This ongoing project employs a process–outcome design to compare EFEW and standard EW in trauma-exposed adults. It will examine whether emotional processing mediates changes in trauma-related symptoms and assess psychophysiological indicators of emotional engagement, including heart-rate variability and skin conductance. Participants complete three consecutive days of writing, with repeated self-report, session-level, and physiological assessments. Results: As data collection and analysis are currently underway, no empirical results are available at this stage. Planned analyses include multivariate latent change models and psychophysiological signal processing to evaluate both symptom change and moment-to-moment emotional engagement. Discussion: Although results are forthcoming, this project is expected to advance understanding of how emotional processing contributes to therapeutic change in EW-based interventions. By identifying mechanisms that enhance or hinder improvement, this research seeks to inform the development of accessible, empirically supported interventions that promote trauma recovery across diverse populations. Keywords: emotional processing; emotion-focused therapy; expressive writing; trauma.

Innovative Moments (IMs) are markers of change proposed by Gonçalves and colleagues (2009) that capture novel episodes in clients’ narratives in which problematic patterns are challenged and alternative meanings emerge. IMs evolve from simple to more complex forms and appear more frequently in successful therapies, where they are linked to more stable outcomes. Although the Innovative Moments Coding System (IMCS) has shown reliability in individual psychotherapy and has been extended to group contexts, its application in couple therapy remains limited. This study applies the IMCS to Emotionally Focused Couple Therapy (EFCT, Susan Johnson) in a successful case to analyze how IMs evolve throughout a single in-person EFCT process. It also identifies the typology of emerging IMs in the dyad, and examines the different foci (self, other member of the couple, and couple as an unit) toward which change is directed within a relational context. To capture the temporal dynamics of narrative change, IMs will be analyzed using a longitudinal descriptive approach, taking therapy sessions as the unit of analysis, in order to identify patterns and trends in change trajectories across the intervention. The case is part of the treatment group from the E(f)FECTS clinical trial -Efficacy of Emotionally Focused Therapy among Spanish Speaking couples- which evaluates EFCT outcomes in this population (Rodríguez-González et al., 2022). It is expected that IMs will progressively emerge across the therapeutic process, increasing in proportion and complexity as EFCT advances, and that the relational nature of couple therapy will generate distinct foci of change.

Self-criticism is a transdiagnostic process associated with psychological distress and poorer psychotherapy outcomes. This study examined the efficacy of a brief Emotion-Focused Therapy (EFT) Two-Chair Dialogue intervention targeting self-criticism, compared with a Cognitive Behavioural Therapy (CBT) Cognitive Restructuring protocol, in a mixed clinical and non-clinical sample. A randomised controlled trial was conducted with 103 participants (EFT n= 52; CBT n =42) across six individual sessions. Self-criticism was assessed using the Forms of Self-Criticising and Self-Reassuring Scale (FSCRS), alongside depression (PHQ-9), anxiety (GAD-7), distress (CORE-10), self-compassion (SCS), self-esteem (RSES), affect (PANAS), and mental wellbeing (MHC-SF). Assessments were conducted at baseline, before each session, post-intervention, and at 1- and 3-month follow-ups. Both interventions produced significant reductions in self-criticism, with large effect sizes for Inadequate Self by follow-up and small-to-medium effects for Hated Self. The only differential effect concerned Reassured Self, where CBT showed earlier gains and EFT a more gradual trajectory, converging by 3-month follow-up. Both groups showed significant improvements across all secondary outcomes — including depression, anxiety, distress, self-esteem, self-compassion, affect, and mental wellbeing — with small-to-large effect sizes and no between-group differences on any measure. Clinical and non-clinical participants showed comparable reductions, supporting transdiagnostic applicability. These findings suggest that brief EFT Two-Chair Dialogue is as effective as CBT Cognitive Restructuring in reducing self-criticism and producing broad clinical and wellbeing improvements within six sessions, maintained at follow-up. Results highlight the value of brief focused interventions targeting self-criticism across presentations and severity levels.

Anxiety Regulation in Light of Wolpe’s Desensitization Principles Aim: Contemporary integrative psychotherapy increasingly focuses on identifying shared therapeutic goals as a basis for developing cross-theoretical (transtheoretical) understandings that can serve as a foundation for informed integrative interventions. This paper examines anxiety tolerance as a unifying therapeutic goal, based on an analysis of psychodynamic content related to emotional regulation. Methods: The study employed a qualitative metasynthesis methodology. Within this framework, 40 peer-reviewed psychoanalytic articles addressing conceptual discussions of emotional regulation were reviewed. The articles were analyzed by examining the relationships between categories (RBC) of emotional regulation and additional categories that appeared in the texts, with particular attention to transtheoretical processes. Results: The analysis identified four central categories associated with emotional regulation in psychodynamic psychotherapy: desensitization, gradual exposure, containment, and transference. Discussion: The findings indicate that psychodynamic treatment of anxiety operates in accordance with evidence-based principles aligned with the mechanisms underlying Wolpe’s model of behavioral systematic desensitization, albeit with two key differences. First, exposure in psychodynamic therapy is gradual but not systematic; second, conditioning is oriented toward containment rather than relaxation. Whereas relaxation provides a tool applicable outside therapy, containment involves the creation of a new conditioning experience within a facilitating interpersonal context that counteracts the original transferential context in which the difficulties developed. The findings contribute to the growing literature on the cumulative value of integrating clinical and theoretical insights from different therapeutic approaches in the treatment of anxiety.

Theoretical background: Mentalization-based parenting interventions such as the Lighthouse Parenting Programme (LPP) have shown promise in alleviating parental stress and enhancing parent-child interactions amidst various parental psychological stressors. Although mentalization deficits are assumed to be present in functional somatic disorders, further development of the LPP is required in this area of psychopathology. Research question: This study examines the extent to which the LPP can be adapted and implemented in a psychosomatic clinic. Specifially, it explores whether the programme is suitable for addressing risks for children of parents with functional somatic disorders. The primary question is whether the intervention can be considered feasible in terms of adherence, acceptance, and satisfaction among parents and practitioners. Secondary objectives include examining whether participation leads to changes in the parent-child relationship, parental stress, parental mentalizing ability and the psychological symptoms of parents and children. Method: A single-arm pre-post feasibility study was conducted with n = 22 parents undergoing inpatient or day-care treatment at a psychosomatic clinic, with a child aged 0 to 16 years who reported difficulties in the parent-child relationship. Data on adherence, acceptance and satisfaction were analysed using t-tests and ANOVAs. Regression and correlation analyses were used to examine the changes and correlations in the other parent- and child-related variables collected, including parental stress and mentalizing ability. Results: Data collection is currently ongoing. The analysis will be carried out in January 2026. Preliminary analyses indicate a high level of acceptance, adherence and satisfaction among the participating parents and the clinic's treatment team. Conclusion: Preliminary results suggest that the LPP could be suitable for parents with functional somatic disorders. The programme has the potential to improve reflection on the role of one's own psychosomatic symptoms in the parent-child relationship for parents in inpatient and day-care treatment. These results will form the basis of a randomised controlled trial.

The therapeutic relationship is widely recognized as one of the strongest predictors of successful psychotherapy outcomes. The present study explores how psychotherapy trainees conceptualize and perceive the develop of relational skills throughout their training. Using a qualitative research design based on structured interviews with 47 psychology trainees, a thematic analysis identified four core themes: (a) the plurality of definitions of relational skills, (b) the important role of supervision for relational skills training (c) the central role of patient feedback in validating perceived competencies, (d) the highly individualized nature of self-awareness for clinical orientation, and (e) the presence of relational difficulties linked to specific patient groups. Findings suggest that trainees primarily evaluate their relational competence through external validation rather than through internal reflective processes or supervision. Implications for psychotherapy training models are discussed. Keywords Relational skills; psychotherapy training; therapeutic relationship; self-awareness; qualitative research

Key words: strengths-oriented coaching, middle managers, grounded theory Aim: Corporate middle managers face significant "sandwiched pressure" and leadership isolation. This qualitative study investigates the transformative process of strengths-oriented coaching (N=11) in reconstructing professional identity and managerial efficacy through a strengths-based perspective. Methods: The intervention comprised four structured sessions: (1) assessment, (2) Holland-based style exploration, (3) strengths inquiry, and (4) integration. Data from post-intervention semi-structured interviews were analyzed using Grounded Theory, incorporating within-case longitudinal analysis to construct a substantive theory of transformation and identify critical mechanisms of change. Results: A three-stage model emerged, mapping interventions to outcomes: 1. From "Armor" to "Sanctuary": A non-evaluative alliance allowed managers to shed professional "armor" and offload emotional burdens. 2. Cognitive Reframing through Strengths: By exploring innate traits (e.g., Holland types), managers shifted from self-criticism to a strengths-based reinterpretation. This allowed for "Separation of Tasks," where managers viewed their sensitivity or prudence not as weaknesses, but as unique leadership assets, reducing managerial self-blame. 3. Strengths Toolization: Managers successfully "instrumentalized" abstract strengths into practical management tools for recruitment, motivation, and differentiated leadership. Discussion: Findings indicate that strengths-oriented coaching provides a vital psychological buffer by reframing perceived "deficits" into functional "resources." Unlike traditional deficit-fixing training, this approach empowers managers to align innate strengths with leadership demands. Practically, efficacy is optimized when interventions focus on the strategic application of strengths to pragmatic workplace challenges.

Background Literature on racial disparities in mental healthcare suggests that diagnostic discrepancies may exist between White and Black patients. This poster presents updates from an initiative to determine how patients’ race impacts clinicians' thought processes when conducting interviews. Methods 150 clinicians were randomly assigned to interview a Black or White virtual patient with severe suicidal ideation and asked to share their conceptualization of the patient’s case. Five researchers parsed the responses’ contents into general domains, sub-domains, and core ideas using principles of Hill and colleagues’ (2005) Consensual Qualitative Research (CQR). Results: Content about plans for suicide were significantly less frequent in case conceptualizations of the Black patient (M = 0.22, SD = 0.42) compared to those of the White patient (M = 0.41, SD = 0.50), t(88.45) = -2.05, p= 0.043, d = -0.42. Content about academic issues was significantly more frequent in conceptualizations of the Black patient (M = 0.15, SD = 0.36) compared to those of the White patient (M = 0.022, SD = 0.15), t(72.75) = 2.37, p = 0.021, d = 0.45. The presence of suicidality across groups was significantly predicted by implicit racial bias, b = 0.64, SE = 0.27, β = 0.25, t(94) = 2.33, p = 0.022, as well as the interaction between implicit racial bias and therapy recommendations, b = -1.86, SE = 0.61, β = -0.34, t(94) = -3.06, p = 0.003. These results suggest that race plays a role in nuanced aspects of clinicians’ clinical judgement.

Aim: Sandplay is primarily used in psychotherapeutic one-on-one settings; however, its expansion to collaborative creation in pairs or groups has potential. This study examined sandplay's potential as a nonverbal tool for fostering mutual understanding among people from different linguistic and cultural backgrounds. We explored the role of facilitators and Al tools in mediating conflicts and communication difficulties between co-creators. Methods: A sandplay workshop lasting two hours was conducted with two Japanese and two Finnish participants. One cycle consisted of (1) nonverbal co-creation, (2) reflection, where participants described in their native languages the world they attempted to create using a questionnaire, and (3) sharing, where all participants read the translated responses. In the second and third cycles, participants further developed the world based on the sharing process. During sharing, an AI tool (Gemini) provided third-party impressions of the created world. Results: Analysis of participants' reflections revealed a process where meaning and narratives were collaboratively generated within a chaotic sandplay world. Communication occurred non-verbally through inferring others' intentions and complementing actions via item placement. Participants sought to reinforce meaning while avoiding disruption to their existing world. The AI tool helped them share impressions written in their native languages. Discussion: These findings support sandplay's potential as a tool for fostering mutual intercultural understanding. The suggested facilitator and AI roles include providing linguistic support, highlighting subtle participation forms, and offering prompts when collaboration becomes stagnant.

Eating disorders (EDs) have traditionally been studied through frameworks centred on the thinness ideal, which has contributed to the underdetection of these disorders in men and, particularly, in high-performance athletes. This study aimed to examine how male identity and the demanding context of high-level sports influence the detection of ED-related symptoms, using both a traditional assessment measure, the Eating Disorder Examination Questionnaire (EDE-Q), and a muscularity-oriented instrument, the vigorexia subscale of the Eating Disorder Assessment for Men (EDAM). A quantitative, descriptive-correlational, cross-sectional study was conducted with 33 high-performance male athletes. Results showed low to moderate EDE-Q scores, generally below clinical cut-off points, whereas EDAM scores indicated higher levels of muscularity-related concerns and body control. A moderate positive correlation was observed between the two measures, suggesting some degree of overlap, although each captures different dimensions of body-related distress. No significant differences were identified based on competitive level, training hours, or supplement use. These findings support the “double camouflage” hypothesis, whereby masculinity norms and high-performance culture normalize dysfunctional behaviors that may obscure the presence of an ED. The study highlights the need to adapt assessment tools for this population by incorporating indicators sensitive to muscle dysmorphia (vigorexia), and it proposes clinical and preventive considerations aimed at improving early detection in male sports contexts. Keywords: eating disorders; muscle dysmorphia; vigorexia; men; high-performance athletes; sport; assessment.

Research objectives: 1.To validate and standardize the Adverse Childhood Experiences (ACE) questionnaire for the Georgian population, including establishing its norms and diagnostic parameters. 2.To examine the impact of adverse childhood experiences on the level of happiness. 3.To study the relationship between certain personal and additional variables (gender, age, therapeutic experience, use of psychotropic medication) and the level of happiness. Research Methods: 1.Adverse Childhood Experiences (ACE) questionnaire 2.Oxford Happiness Questionnaire 3.Personal and additional variables registration form 4.Full package of statistical data analysis methods Participants: Control Group 1: 200 participants for the adaptation of the ACE questionnaire in the Georgian population Control Group 2: 242 participants who do not report adverse childhood experiences Target Group: 365 participants who do report adverse childhood experiences Research Results: 1.The reliability and validity coefficients of the ACE questionnaire were statistically reliable (Cronbach’s alpha = 0.775, Gutmann = 0.787), and normative data were established for the Georgian population. 2.Adverse childhood experiences negatively affect the level of happiness. Participants who reported such experiences demonstrated significantly lower happiness scores compared to the control group. Additionally, an increase in childhood traumatic exposure significantly decreased the level of happiness (Ttest = 6.85, p = 0.000; Ftest = 10.1, p = 0.002; Regression coefficient = 0.348). 3.Statistically reliable negative correlations were found between the degree of childhood traumatic exposure and the level of happiness—both in the combined dataset and for each questionnaire item separately (R = –0.305, R = –0.365, R = –0.245, R = –0.235, etc.).

Background. Discrepancies between students’ understanding of science and that taught at university are associated with frustration, predicting study satisfaction and dropout intentions. Simultaneously, student mental health has received increased attention since the COVID-19 pandemic. However, a systematic investigation of psychology students’ mental well-being and its relation to discrepancies in understanding science is still lacking. The transition into university, as part of emerging adulthood, may involve identity exploration rather than consolidation. How this phase relates to personality functions—the capacity to regulate inner experiences and interpersonal relationships—has not yet been examined in this population. Questions. (1) To what extent are there (a) discrepancies between students’ own understanding of science and the academic understanding of science at the beginning of their studies, and (b) introductory programs that prepare first-year psychology students for study programmes? (2) What are initial levels and trajectories of mental health among first-year psychology students? (3) How do personality functions change over the course of the first Bachelor year? (4) How do psychology students evaluate studyability and their career aspirations after the legal reform in Germany? Methods. A longitudinal online survey will be conducted with approximately 1,000 psychology students who began their studies in the 2025/26 winter semester at state-run German-speaking universities in Germany, Austria, and Switzerland. At the Annual Meeting, two of three planned measurements during the first year are completed. Annual follow-ups across the standard period of study are planned. Results. Results from the first survey wave will be presented at the 57th International Annual Meeting.

Aim: In psychotherapy research, personality disorder diagnosis is expected to inform case formulation and guide therapeutic strategies. Blatt’s two-polarities model conceptualizes relatedness and self-definition as fundamental dimensions organizing personality development and psychopathology. This study examined whether the ICD-11 model of personality disorders - the level of personality pathology and maladaptive traits - adequately predicts symptoms associated with these polarities. We also tested whether including need frustration specific to Blatt’s polarities enhances the clinical utility of ICD-11 diagnosis.
 Methods: The sample consisted of 138 psychiatric patients (65% diagnosed with a personality disorder; 87% women; age 18–67). Participants completed the Personality Disorder Severity – ICD-11 Scale, the Personality Inventory for ICD-11, and measures of content-related symptoms. Relatedness was assessed using separation anxiety and separation-related guilt, whereas self-definition was operationalized through perfectionism and guilt. Frustration of autonomy and relatedness needs was measured with the Basic Psychological Need Satisfaction and Frustration Scale.
 Results: Hierarchical regression analyses showed that personality pathology severity and maladaptive traits weakly or nonsignificantly predicted symptoms characteristic of both polarities. In contrast, frustration of relatedness needs significantly improved prediction of separation anxiety and separation-related guilt, while frustration of autonomy/self-direction needs increased prediction of perfectionism and guilt, demonstrating incremental validity beyond ICD-11 indicators. Discussion: Although ICD-11 dimensional models underpin contemporary personality disorder diagnosis, they may not fully capture clinically meaningful content dimensions emphasized in psychodynamic theories. Psychotherapy should therefore address not only the level of personality pathology but also tailor interventions to dominant manifestations of relatedness and self-definition polarities.

Based on the preliminary work of the European Psychotherapy Consortium (EPoC) which developed, translated in 13 different languages, and standardized the Emotional and Psychological Outcome (EPO-1) single item, this study aims to discuss the convergent validity of the EPO-1 with other outcome measures collected at the baseline in two Italian samples. The first sample is composed of about 800 university students requesting individual counseling, a short intervention aimed at supporting students in their developmental crisis related to personal and academic problems. The second sample comprises about 200 patients requesting psychotherapy for psychological symptoms, intrapersonal and interpersonal problems to five Italian training clinics. Both university students and patients filled in EPO-1 and CORE-OM at baseline. Moreover, university students were also administered the SInAPSI Academic Engagement Scale (SAES), a measure to evaluate the students’ academic engagement and sense of belonging to the university context. Patients in psychotherapy, instead, filled in GAD-7 and PHQ-9. Firstly, descriptive analysis and correlations between EPO-1 and CORE-OM on the total sample will be presented; then, correlations between EPO-1 and specific measures for each sample, namely SAES for university students and PHQ-9/GAD-7 for patients, will be discussed. Implications for facilitating practice-based evidence and data-informed psychological therapy through EPO-1 in heterogeneous contexts of psychological interventions will be discussed.

With the goal to develop a core-process outcome module for child and adolescent psychotherapy, it is necessary to have evaluated, short, and open-access instruments. One such instrument is the EPO-1-child version, a single item measure. First, the German version was adapted as an age-appropriate version for children and a caregiver version. Next, the child version (EPO-1-Child) was validated using a sample of N = 500 school children and adolescents, with a mean age of 14. Test-retest reliability was assessed within 30 minutes. The questionnaire battery for validity included the YP-CORE, the Strengths and Difficulties Questionnaire (SDQ), a self-efficacy scale, and the KIDSCREEN, which assesses quality of life. The data are currently being analyzed. Results will be presented and discussed.

Background: The Emotional and Psychological Outcome (EPO-1) is a single-item measure developed by the European Psychotherapy Consortium (EPOC) to standardize therapy outcomes and explore the feasibility of combining datasets across diverse clinics. This study investigates its psychometric properties within a UK university student population. Aims: This study aimed to profile a large UK student sample using the EPO-1 and provide initial validation by exploring its underlying factor structure in relation to established mental health and wellbeing measures. Methods: Data were collected via an online cross-sectional survey (Nov 2023–June 2024) from UK university students (n =4,979). Participants completed the EPO-1 alongside six widely used measures: PHQ-9, GAD-7, CORE-OM, CCAPS-62, GP-CORE, and WEMWBS. A series of Exploratory Factor Analyses (EFAs) using maximum likelihood extraction and direct oblimin rotation were conducted to examine construct validity. Results: EFAs demonstrated that the EPO-1 consistently loaded onto the same latent factors as established clinical measures but in the inverse direction. The EPO-1 showed strong negative loadings with the PHQ-9 (-.717), GAD-7 (-.627), and the general distress factor of the CORE-OM (-.711). Conversely, when paired with the WEMWBS, it loaded strongly and positively (.735) onto a single wellbeing factor. Analysis with the GP-CORE uniquely yielded a two-factor solution where the EPO-1 formed a distinct factor with a subset of items, suggesting it captures a wellbeing dimension distinguishable from general psychological problems. Conclusion: These preliminary findings suggest the EPO-1 may bridge symptom-focused and wellbeing-focused assessment. These findings also suggest that the EPO-1 appears to be a promising, ultra-brief tool for university support services. Its ability to capture inverse psychopathology and positive wellbeing supports its potential for routine monitoring and standardized data sharing across international contexts without adding measurement fatigue.

Background: The Emotional and Psychological Outcome (EPO-1) is a measure designed to assess current emotional and psychological well-being and is being used in an ongoing longitudinal study at the University of Sheffield, UK. This study assesses its psychometric properties within a UK university student population, with an emphasis on temporal stability and sensitivity to within-person change across longitudinal assessments. Aim: The study aims to (1) profile a large UK student cohort using a battery of measures, including the EPO-1 and (2) provide initial validation by exploring its underlying factor structure in relation to established mental health and well-being measures, both cross-sectionally and longitudinally. Method and Results: Data are collected at four time points across each academic year. The present analyses draw on two completed waves (T1: N = 515; T2: N = 267). Students completed the EPO-1 alongside the PHQ-9, GAD-7, CORE-10, and WEMWBS. Planned analyses include evaluating whether the EPO-1 captures short-term fluctuations in emotional well-being to the extent of established measures, through longitudinal modelling (e.g., bivariate latent change score models to examine the covariance between change factors) of within-person change. These analyses are forthcoming, and results will be presented at the conference. Conclusion: This study will provide initial evidence regarding the validity and utility of the EPO-1 for assessing emotional and psychological well-being in UK university students. Findings are expected to inform the measure’s suitability for longitudinal monitoring and its potential integration into student mental health research and practice.

We examined whether structured multi-party collaboration promotes convergence among stakeholders’ perceptions of students’ emotional cultivation during school-based group counseling. Drawing on interpersonal convergence theory and ecological collaboration models, we compared three BEAR group formats: counselor-only groups (BC), teacher–counselor collaboration (TC), and parent–teacher–counselor collaboration (PC). Collaboration was facilitated through a culturally embedded “counseling progress journal” enabling weekly shared reflections. Participants included 1,193 students (ages 8–19) nested within 205 counseling groups in Taiwanese elementary and secondary schools. Emotional cultivation was assessed by three informants (students, counselors, teachers) using the Emotional Cultivation Scale across multiple sessions, yielding 3,579 observations. A three-level location–scale model was applied to estimate both changes in mean emotional cultivation (location effects) and changes in within-member variance across raters (scale effects), indexing convergence over time. Results revealed a significant linear increase in emotional cultivation, indicating overall intervention effectiveness. However, convergence did not occur uniformly with time alone. Scale modeling demonstrated that group collaboration format significantly predicted both overall informant variance and its change over time. Groups with broader collaboration exhibited stronger convergence, with the greatest reductions in within-member variance observed in PC groups, followed by TC groups, with minimal convergence in BC groups. These findings suggest that convergence among stakeholders requires structured and sustained collaboration rather than natural exposure to shared interventions alone. The collaborative journaling system appears to provide a low-burden, culturally grounded alternative to resource-intensive convergence-oriented frameworks such as Measurement-Based Care and PBIS, offering a practical approach to enhancing assessment coherence. Keywords: cross-system collaboration, emotional cultivation or regulation, group counseling and psychotherapy, children and adolescents, location-scale model

Background: Research has shown that strengthening the therapeutic alliance in group therapy result in better outcome. Therefore, better understanding moments of rupture of alliance seems to be crucial. Despite extensive research on rupture-repair in dyadic psychotherapy, less research has focused upon rupture-repair in group therapy. However, better understanding rupture-repair dynamics in groups might inform group therapists. Objective: Therefore, the study at hand focuses on the validation of a preliminary German adaptation of the observer-based Rupture Resolution Rating System (3RS; Eubanks & Muran, 2022) for group therapy. The aim is to eventually provide a manual that should help in identifying the degree of the working alliance, rupture and repair in groups accounting for the different relationship levels. Method: Five consecutive group therapy sessions of three groups (average group size: N = 13) were filmed with a camera trolly to capture each person. The videos were coded based on a preliminary 3RS-Group manual using 5-minute segments. Additionally, patients and therapists filled out questionnaires on perceived relationship quality (Group Questionnaire) before and after and items on session evaluation (Session Evaluation-Questionnaire) after each session. Also, patients answered global items on mood and arousal and additional symptom-related items (Patient Health Questionnaire-4). Results: Descriptive analysis are presented along with preliminary results regarding the effect of rupture-repair dynamics in groups on relationship quality, session evaluation and symptoms. Discussion: Limitations and clinical implications are discussed. The goal of the study is to test an observer-based rating system of rupture-repair dynamics in groups to inform psychotherapeutic practice and research. Keywords: Rupture, repair, cohesion, alliance, group psychotherapy, observer-based rating system

Leader responsiveness is a key factor in group psychotherapy (Wang et al., 2022), yet little is known about how congruence between member and leader perceptions of relationship relates to therapeutic outcomes. Previous research suggests that greater congruence in perceptions is an indicator of greater leader self-awareness (Atwater &amp; Yammarino, 1992). This study used polynomial regression and response surface analysis (PRRSA) to examine how congruence and discrepancy between group members’ and leaders’ perceptions of leader responsiveness predicted members’ internalizing and externalizing behavior problems (IBP/EBP) in emotional cultivation groups. Participants were 162 Taiwanese elementary and junior high school students with emotional difficulties and Adverse Childhood Experiences (ACEs), nested within 31 BEAR emotional cultivation groups. All variables were assessed by both members and leaders at four time points. Data were partitioned into within-person, between-person, and between-group levels. Results revealed level-dependent dynamics. First, when leaders and members agreed on high levels of responsiveness, it consistently predicted lower IBP and EBP across within- and between person levels. However, a reversal occurred regarding leader overestimation: while leaders perceiving themselves as more responsive than members did predicted lower symptoms in leaders’ own reports at within-person level, it predicted more member-rated IBP at between-person level and EBP at between-group level. Finally, although more discrepancy was linked to fewer symptoms at within- and between-person levels, higher agreement between leaders and members served as a protective factor for student-rated IBP at the between-group level. These findings suggest that leader–member agreement is not uniformly beneficial, and leader overestimation may pose risks.

Aim: Although research consistently demonstrates the effectiveness of couples therapy, comparatively little is known about the mechanisms and processes of change. This presentation reports the findings of a grounded theory study examining the process of change in couples therapy from the clients’ perspective. Method: To investigate the process of change, we used a constructivist grounded theory design to longitudinally study five couples engaged in couple therapy. Data were collected through in-depth post-session interviews after every therapy session, interpersonal process recall interviews using video playback of impactful sessions, and termination interviews. In total, 49 interviews were analyzed using open, axial, and theoretical coding procedures to identify core change processes and patterns grounded in participants’ accounts. Results: Analysis resulted in a grounded theory of change characterized by two reciprocal processes: making space for change and expanding relational interactions. Making space involved cognitive, emotional, and attitudinal shifts that created openness to change; expanding relational interactions reflected couples’ increased ability to communicate and relate more effectively. Therapist interventions and a supportive therapeutic environment facilitated these processes, which occurred both within therapy sessions and in couples’ interactions outside of therapy. Discussion: Our findings suggest that therapeutic change in couple therapy is not driven by interconnected cognitive, emotional, behavioral, and relational processes. The results highlight the importance of interventions that facilitate reflection, emotional softening, interpersonal change, and mutual recognition of effort. This integrative model offers clinically useful guidance for treatment planning and supports the notion that diverse therapeutic approaches may facilitate common underlying change processes.

Aim. Therapeutic alliance is consistently linked to outcomes in couple therapy and preliminary research indicates that, like in other therapy formats, unresolved ruptures in the alliance are associated with negative outcomes. Ruptures are traditionally identified using observational coding. While useful for identifying and studying ruptures in research settings these practices are not feasible for practicing clinicians. In this presentation we will identify and explore ruptures in the therapeutic alliance using self-report alliance scores. Methods. Data for this project come from the Marriage and Family Therapy Practice Research Network (MFT-PRN). Couples complete a measure of the expanded therapeutic alliance (IAM-C; Intersession Alliance Measure-Couple version) prior to each session. We developed a reliable change index of 15 points for the IAM-C, and identified a rupture as a reliable deterioration in the alliance total score that occurred over the course of one session. A repair is defined as a reliable improvement in total IAM-C score that occurs within 3 sessions of the rupture. Results. Results indicate that ruptures using the current definition are relatively rare. Only 730 ruptures (2.7%) were detected across 20,771 sessions of treatment. 69.9% of clients do not experience ruptures or significant 1 session improvements in alliance, 10.8% experience ruptures that were subsequently repaired, and 7.4% experienced ruptures with no repair. Discussion. While it is likely that this method does not capture all of the ruptures that occur during therapy, it can alert therapists to significant ruptures that occur and signal to the therapist a need to repair.

Aim: This study classified couples in therapy using Latent Class Analysis (LCA) based on relationship satisfaction, depression, perceived stress, adverse childhood experiences, socioeconomic status, and race. Next, the change rates of each class were examined. Method: The study included 2,351 clinical couples. Variables were dichotomized using clinical cutoffs, and race and income were coded as minority/non-minority and above/below the poverty level. Class selection used on AIC, BIC, and Class interpretability. Following the LCA, multilevel models examined changes in couple relationship satisfaction across therapy sessions. Results: Three classes emerged. Class 1 (42.9%) represented high-stress couples, characterized by elevated stress but relatively few additional problems. Class 2 (36.0%) included high-stress/multi-problem couples with elevated depression, ACEs, and socioeconomic risk. Class 3 (21.1%) was comprised of couples with depression and multiple additional problems. A multilevel model predicting CRS scores over time showed significant improvement across sessions (b = 0.51, p < .001). Class membership predicted initial CRS scores: compared to Class 1, both Class 2 (b = –12.71, p < .001) and Class 3 (b = –13.75, p < .001) began treatment with substantially lower satisfaction. Interaction effects indicated that Class 2 improved most rapidly (b = 1.64, p < .001), followed by Class 3 (b = 0.98, p < .001). Discussion: High-risk couples—those with elevated depression, stress, and contextual strain—entered therapy with lower satisfaction but demonstrated faster improvements. These findings suggest substantial progress potential even among highly distressed couples and highlight the value of tailoring interventions to class-specific risk profiles.

Aim: Relationship satisfaction is an important indicator of relational health and a primary focus of couple therapy. Understanding its association with sleep is essential, given that most adults sleep with a partner and partners’ sleep patterns influence one another. This study, therefore, examines the relationship between specific sleep domains and relationship satisfaction among couples in therapy. Methods: Multilevel models were estimated to examine the effects of sleep domains on couple relationship satisfaction (CRS) across therapy sessions 1 through 8, and the moderating role of distress level on couple satisfaction (P1 = more distressed; P2 = less distressed), using a sample of 199 couples. Results: P1 partners scored 13 points lower on CRS at baseline than P2 partners. There was a significant change across time (b = 0.95, p < .001) in the base model. The next model introduced an interaction between distress level and time, which was significant (b = 1.15, SE = 0.25, p < .001). This indicates that more distressed partners demonstrated steeper improvements in CRS across time compared to less distressed partners. Among tested sleep domains, worse sleep latency (b = –1.03, SE = 0.49, p = .034) and day dysfunction due to sleepiness (b = –1.92, SE = 0.62, p = .002) predicted lower relationship satisfaction, while sleep duration and sleep quality did not (p > .36). Discussion: These findings suggest that integrating sleep assessment and targeted sleep interventions into couple therapy may improve treatment outcomes, particularly for more distressed partners.

Aim This study examined whether previously observed effects of strength- versus symptom-oriented priming on psychotherapists’ early clinical impressions can be replicated in psychology students and whether these effects differ between the two groups. Methods A total of 189 psychology students completed either a symptom-oriented or strength-oriented recall task before evaluating two patients with generalized anxiety disorder on psychopathology, resilience, global functioning, and expected therapeutic bond. For an exploratory comparison, student data were contrasted with data from the previously published psychotherapist study (N = 64) that served as the basis for the present replication. Multilevel modeling was used to examine priming effects and whether these were moderated by group and conscientiousness. Results Compared with the symptom-oriented condition, the strength-oriented prime was associated with lower ratings of psychopathology (b = -0.14), higher resilience (b = 0.19), higher global functioning (b = 1.79), and stronger expected therapeutic bond (b = 0.12). Effect sizes were small across outcomes. Discussion The pattern of findings in psychology students largely resembled that previously observed in psychotherapists, although the priming effect on resilience was stronger among psychotherapists. Conscientiousness did not significantly moderate judgment formation. These findings suggest that early clinical impressions are subtly but consistently shaped by attentional bias in both psychology students and psychotherapists, underscoring the importance of bias awareness in clinical training and practice. Keywords: early clinical impression formation, cognitive bias, strength-focused priming, diagnostic judgment, Rosenhan experiment

Theoretical Background: Our understanding of which therapeutic processes contribute to therapeutic change, and through which mechanisms they exert their effects, remains limited. A central component is the close and systematic assessment of what actually occurs within therapy sessions. The present work introduces a new brief measure for capturing therapeutic processes that distinguishes interventions across three domains of therapeutic focus: Emotional, cognitive, and behavioral. Research Question: How much variability in therapeutic interventions occurs at the session level, the patient level, and the therapist level? Method: In the outpatient clinic in Osnabrück, standardized session questionnaires were completed by both patients and therapists before and after 6,834 sessions conducted with 302 patients by 39 therapists. For both perspectives, exploratory factor analyses were performed on the intervention items to evaluate the construct validity of the session questionnaire. The resulting factors were modeled using three-level models (sessions nested within patients nested within therapists), and variance components were quantified using intraclass correlations (ICCs). Results: The analyses revealed interpretable factor structures, moderately positive associations between patient and therapist ratings, and substantial variance components at the session, patient, and therapist levels. Conclusion: These findings suggest that therapeutic interventions vary flexibly across sessions while also differing systematically between patients and therapists. Valid assessment of intervention strategies thus provides an empirical basis for subsequent research on process–outcome relations, psychotherapy personalization, and therapeutic flexibility. Keywords: variability of therapeutic interventions, session-by-session ratings, multilevel modeling

Background: Psychotherapy is a delicate interplay of social and biological processes. Recent research emphasizes the potential importance of hormonal systems and the therapeutic alliance for treatment effectiveness. While both oxytocin and cortisol have been linked to alliance formation and symptom change, little is known about their combined dynamics during treatment and how they relate to outcomes. Methods: One hundred thirty patients with major depressive disorder (MDD) participated in a randomized controlled trial (RCT) of 16-session short-term psychodynamic psychotherapy. Salivary cortisol and oxytocin were measured before and after sessions across four sessions. Surface analyses modeled nonlinear interactions among concurrent hormonal levels, within-session changes, Working Alliance Inventory ratings (WAI), and depressive symptoms (HRSD), with gender. Results: When controlling for gender, Extreme congruent within-session hormonal decreases predicted weaker therapeutic alliances, without RSA effects on subsequent depressive symptoms. When examining gender as a moderator, distinct patterns emerged: In women, pre-session imbalance (low oxytocin, high cortisol) linked to weaker alliances, while opposing within-session changes (one increasing, the other decreasing) were associated with relatively stronger alliances compared to congruent decreases (no symptom effects). In men, congruent pre-session elevations of oxytocin and cortisol were associated with worse depressive symptoms at the subsequent session; synchronized within-session changes (both increasing or decreasing) forecasted worsening depression, while opposing changes (one increasing, the other decreasing) predicted improvement. Conclusions: These findings reveal gender-specific oxytocin-cortisol dynamics that influence therapeutic alliance and depressive outcomes, supporting the integration of biological and relational factors to enhance personalized psychotherapy. Keywords: Oxytocin, Cortisol, Therapeutic Alliance, Treatment Outcome, Depression.

Objective The therapeutic alliance is a strong predictor of treatment outcome. Recent research emphasizes distinguishing between trait-like and state-like alliance. This study used the Social Relations Model (SRM) to analyze the variance attributable to the different trait and state components. Specifically, we focused on the bond component of the alliance and examined the extent to which SRM elements - Perceiver effect (evaluating relationships consistently), Target effect (being consistently perceived by others), and Relationship effect (influences specific to the dyad) contribute to the bond variance, and their associations with treatment outcome. Method Bond ratings of 118 patients with major depressive disorder receiving psychodynamic psychotherapy, and three treatment-agents (therapists, case managers and interviewers) were analyzed, using the Working Alliance Inventory. Outcomes were assessed using the Hamilton Rating Scale for Depression. Results Variance partitioning of the elements showed that the perceiver effect accounted for the largest proportion of bond rating variance for patients and treatment-agents. The relationship effect (of patients and treatment-agents) emerged as a significant predictor of treatment outcome. Conclusion Applying SRM across psychotherapy advances understanding of trait/state-like bond contributions to outcomes. Our findings underscore the potential of the unique relationship to capture processes of change, beyond stable patients’ and therapists’ characteristics. Keywords: Therapeutic alliance, Social Relations Model

Background: Although research on interpersonal synchrony in psychotherapy has increased, studies addressing cross-modal synchrony remain scarce. Focusing on couple therapy, we examined synchrony processes across two modalities: physiological activation and behavioral engagement. Behavioral engagement manifests verbally and nonverbally, shifting as participants alternate between speaking, listening, becoming absorbed in their thoughts, or withdrawing. These modalities are likely to fluctuate during sessions with thoughts, emotions, and experiences evoked by conversation. Aims: This study examined whether cross-modal (i) intrapersonal and (ii) interpersonal synchrony occurs in the participants’ sympathetic nervous system activity and engagement behaviors. To our knowledge, this has not been previously studied in the context of couple therapy. Methods: The data consisted of 21 video-recorded couple therapy sessions during which electrodermal activity (EDA) was registered. Verbal and nonverbal engagement behaviors were annotated from videos. Surrogate Synchrony (SUSY) was used to calculate intrapersonal and interpersonal synchrony across modalities. ANOVA and t-tests were applied. Results: Higher engagement behaviors within one individual were associated with greater physiological activation. Dyadic analyses revealed anti-phase interpersonal synchrony: when one participant engaged more, the other’s physiological arousal decreased. This systemic pattern was most evident in client dyads but appeared also in client–therapist and therapist–therapist pairs. Discussion: Couple therapy involves synchronized physiological and behavioral processes at both intra- and interpersonal levels. Findings highlight the systemic nature of couple therapy and call for further research on cross-modal synchronization patterns.

Aim. Movement synchrony (MS) represents a central variable in clinical as well as healthy parent-child interaction. One pervasive every-day interaction context in families is play, for example parents playing with their children. Our objectives were to (1) determine whether MS during parent-child play interaction goes significantly beyond what could be expected by chance and (2) investigate differences in MS in two standardized play conditions. Methods. The present study applied MEA to video recordings of parent-child interaction in an outpatient psychotherapy sample (22 dyads) in two distinct standardized play situations: structured play and free play. The play situations differ fundamentally in their instructions and materials leading to very different potentials to elicit different dyadic interaction dynamics and subjective experiences. We used windowed cross-correlations and pairwise comparisons to test differences between the assessed play conditions. Results. First, across both play situations, parents and their children showed MS levels beyond what could be expected solely by coincidence/chance (p < .001; d > 0.5). Second, we found large significant differences between the two play conditions with free play showing significantly lower MS (p < .001; d > 1.5). Third, descriptive analyses hinted at leader-follower patterns (i.e., children leading) that could not be substantiated inferentially. Discussion. We discuss the potential of using our novel standardized play paradigm to repeatedly assess parent-child MS in the sense of routine outcome monitoring and how different interpersonal contexts and situations, such as playing, may facilitate more - or less - thriving interactions.

Mental health conditions can be conceptualized as disorders of flexible functional synchronization - disruptions in the coordinated dynamics across neural, physiological, behavioral, and interpersonal systems. This presentation integrates theoretical frameworks with clinical innovation to address synchronization dysregulation in youth mental health. Drawing on dynamical systems theory, we propose that Complex Emotional Needs (CEN) reflect distinct patterns of synchronization dysregulation across four phenotypic presentations: Hypervigilant (rigid over-synchronization), Collapsed (reduced synchronization capacity), Chaotic (unstable, fragmented coordination), and Balanced (flexible, context-appropriate synchrony). These patterns manifest across multiple timescales and modalities, from autonomic nervous system dysregulation to disrupted interpersonal coordination. To address these coordination failures, we developed IDEAS (Interventive Dynamic Emotion Assessment and Skills) - an 8-week modular intervention designed to restore flexible functional synchrony through targeted therapeutic tools. Each module addresses specific synchronization domains: emotional regulation, interpersonal coordination, cognitive-affective integration, and behavioral flexibility. Pilot data (N=48 youth with CEN) demonstrated significant improvements across outcome measures with large effect sizes maintained at 3-month follow-up. Clinical improvements corresponded with restored coordination capacity across emotional, behavioral, and interpersonal domains. This work exemplifies "Dynamical Systems Treatments" - interventions explicitly designed to restore proper coordination rather than targeting isolated symptoms. Implications include reconceptualizing psychopathology through coordination dynamics, developing treatments that restore synchronization flexibility, and bridging neuroscience-informed theory with pragmatic clinical application.

Aim. Empirical psychotherapy studies have assessed patient-therapist physiological synchrony as an important marker of the interpersonal co-regulation process between patient and therapist, hence the process deemed essential for developing the therapeutic alliance. Research on synchrony and its relationship with the therapeutic alliance is still scarce, sometimes with inconsistent findings. The present study aimed to analyze the association between electrodermal synchrony, a signature of coordinated sympathetic activation, and the quality of the therapeutic alliance throughout the therapeutic process. Methods. Twenty-one therapeutic dyads were recruited, consisting of patients with a diagnosis of major depressive disorder or social anxiety disorder, who were treated by six therapists. For each dyad, electrodermal activity was recorded during all 16 sessions of Cognitive-Behavioral Therapy. The Working Alliance Inventory and the Session Evaluation Questionnaire were administered after each session to monitor the quality of the alliance and the respective session. Symptomatic improvements were measured with outcome questionnaires. Results. We found clear evidence for the presence of in-phase electrodermal synchrony of therapists and patients. Additional results were that patient-leading synchrony was significantly more pronounced than therapist-leading synchrony, and that this leading role of patients in their sympathetic interactions during sessions was positively linked with the quality of the therapeutic bond as rated by the therapist, and negatively linked with patients' distress. Discussion. These findings address global, session-wide synchrony. Unpublished additional work shows that the synchronies of short within-session passages vary widely. These new sources of information are discussed to indicate the prevalence of synchrony ruptures.

Aim: The study aimed to examine how causal attributions for mental illness are related to psychotherapy expectations. Method: A total of 304 participants were recruited at a university on the west coast of the United States. They completed online questionnaires on the Qualtrics platform, including the Mental Illness Attribution Questionnaire, the Expectations of Active Processes in Psychotherapy Scale, the Individualism-collectivism Scale, and demographic information. Results: Multiple linear regressions were conducted to examine how mental illness attributions predicted expectations for psychotherapy across the seven factors. All models were significant (F = 5.48–10.54, p < .001), with R² values ranging from 0.12 to 0.21. Social/stress (β = .19–.35) and biological (β = .15–.27) attributions were consistent significant predictors of all factors of psychotherapy expectations, except for factor 2 (verbal processing of therapeutic relations), which was uniquely predicted by supernatural (β = .22) and personal weakness (β = .21) attribution. Moreover, correlational analyses of cultural orientations showed that collectivism was more related to therapy expectations than individualism, while cultural orientations overall had weak correlations with mental illness attributions with some exceptions. Discussion: Findings suggest that individuals’ causal beliefs about mental illness shape their expectations for psychotherapy, with social and biological attributions exerting the strongest influence. Cultural orientation also appears to play a modest role. Clinicians should consider patients’ causal beliefs and cultural orientation when discussing therapy goals, as understanding these perceptions may enhance engagement and therapeutic alliance.

Aims: Despite substantial government subsidies that make psychotherapy widely accessible in Korea, utilization rates remain low. To better understand help-seeking facilitators, this study examined factors influencing Koreans’ attitudes toward psychotherapy. Methods: Participants completed a survey including measures of mental health, mental illness attributions, expectations of active processes in psychotherapy, mental help-seeking attitudes, individualism–collectivism, belief in a just world, and demographics. Data of 240 Korean adults were analyzed using multiple regression analyses to identify factors associated with attitudes toward psychotherapy. Results: Mental health status was positively associated with older age, higher horizontal collectivism, lower vertical individualism, stronger belief in a just world for others, lifestyle-based mental illness attributions, and stronger expectations regarding healing in psychotherapy (all p < .05). Mental illness attributions were related to cultural orientations and overall mental health status, with collectivistic orientations showing consistent associations across attribution domains (all p < .05). Expectations of active processes in psychotherapy were higher among individuals with stronger horizontal individualism and horizontal collectivism, better mental health, and prior psychotherapy experience (all p < .05). More positive mental help-seeking attitudes were associated with older age, stronger expectations of active psychotherapy processes, better mental health, and egalitarian cultural orientations (all p < .05). Discussion: These findings suggest that psychotherapy-seeking attitudes in Korea are shaped less by structural access and more by cultural orientations and psychological readiness. Horizontal individualism and horizontal collectivism, reflecting egalitarian values, together with better mental health and stronger expectations of active psychotherapy processes, emerged as key facilitators of psychotherapy utilization.

Objective: The primary aim of this study is to examine whether clients' psychotherapy preferences shift between the first and fifth sessions. A secondary aim is to explore whether the magnitude of any observed preference change is related to client and therapist demographic characteristics, therapists’ theoretical orientation, therapists' years of professional experience, and clients’ initial severity of symptoms. Method: The data are collected within a routine process and outcome monitoring application (DeePsy). Cooper-Norcross Inventory of preferences version 1.1 (C-NIP; Cooper & Norcross, 2016) will be used to measure clients’ psychotherapy preferences. We will conduct a confirmatory factor analysis to test the measurement model of the C-NIP and the longitudinal invariance between the first and fifth session, including the differences in latent means. Furthermore, we will conduct a multilevel linear regression analysis to predict changes in clients’ preferences between the first and fifth therapy sessions in a within-subject manner. Findings: Changes on the C-NIP dimensions of clients’ psychotherapy preferences and their predictors will be reported. Conclusions: Implications of the findings for research practice will be discussed.

Objective: This study examined how clients’ outcome expectations (OE; belief about positive outcome of counseling session) was associated with working alliance and symptom relief longitudinally in a sample of Chinese beginning therapist trainees and their clients. Despite cumulative research on OE, working alliance, and client outcome, critical limitations exist in a) the lack of differentiation of between-person and within-person effects, and b) the lack of longitudinal evidence regarding the temporal/causal directionality between these variables. Methods: Participants included 204 Chinese therapist trainees and their 1,214 clients who provided data for 11,198 sessions. Before every therapy session after intake, clients reported their symptom severity level and OE; after every session, clients reported their perceived working alliance quality. The Latent Curve Model with Structured Residuals (LCM-SR; Curran et al., 2014) was utilized to disentangle the between-person (average client differences) and within-person (session-by-session fluctuations) effects and test the temporal directionality between the three variables of interest. Results: At the between-person level, clients who began treatment with more positive OE reported stronger alliances and lower symptom at the beginning of therapy; and clients who increased their OE during treatment showed greater alliance growth and faster symptom reduction over time. At the within-person level, a cyclical pathway emerged where higher OE before a session temporally led to higher working alliance rating after that session, which subsequently led to higher OE at the next session; however, results did not support the OE-working alliance-symptom mediation model, nor the bidirectional associations between client OE and symptom relief.

Objective: Transdiagnostic psychotherapies are increasingly promoted as efficient and scalable approaches for addressing the high rates of diagnostic comorbidity observed in real-world clinical settings. Partially supporting this view, research has demonstrated that transdiagnostic treatments, such as transdiagnostic behavior therapy (TBT), are non-inferior to disorder-specific treatments (DSTs) for patients with affective disorders (e.g., posttraumatic stress disorder, depression, anxiety disorders). Yet, less is known about whether transdiagnostic approaches empirically outperform DSTs for patients with greater psychiatric comorbidity. Testing this question, this study evaluates whether diagnostic comorbidity moderates the efficacy of TBT compared to diagnosis-matched DSTs among patients with various affective disorders. Method: Patients were 304 treatment-seeking veterans with one or more affective disorders, recruited from a large Southeastern Veterans Affairs health system. Patients were randomly assigned to receive 12 sessions of either TBT or a corresponding DST that was matched to their primary diagnosis. Baseline comorbidity was assessed with a diagnostic interview. Patients completed assessments of disorder-specific and transdiagnostic symptoms and functional impairment at baseline, mid-treatment, and posttreatment. Results: To account for the nesting of timepoints within patients, we will use multilevel modeling to test the hypothesized treatment by comorbidity interaction effects. Conclusions: By replicating and extending earlier trials in a new clinical population, this study will clarify the generalizability of TBT’s efficacy, particularly for patients with greater comorbidity. Furthermore, results could illuminate one way to optimize treatment selection for patients with greater diagnostic comorbidity—a population that is often at risk for poorer outcomes.

Therapists can vary in their effectiveness depending on the sociocultural identities of the patients they treat, including racial/ethnic and gender identities. Notably, some therapists exhibit effectiveness disparities when treating marginalized patients, others achieve similar outcomes across patients, and some are even more effective when treating marginalized patients. Sexual minority (LGB+) individuals represent another vulnerable group for which therapists may exhibit within-caseload disparities, yet only a few studies have examined this question, all in college counseling contexts. These studies found no average outcome disparity for LGB+ patients, but there was significant therapist-level variability in the sexual orientation–outcome association. More research is needed to corroborate the presence of such variability in other settings and delineate specific therapist effectiveness patterns. Accordingly, this study characterizes the extent to which therapists demonstrate reliable patterns of differential (or equitable) effectiveness when treating LGB+ versus heterosexual patients in a community outpatient clinic. Patients were 733 adults (73% heterosexual; 27% LGB+) treated by 69 therapists. Patients reported their sexual orientation at baseline and rated their symptomatic/functional impairment at baseline and posttreatment. Multilevel models revealed a small, non-significant average outcome disparity for LGB+ patients (γ10 = 0.20, 95% CI [-0.01, 0.37]). However, the sexual orientation-outcome association varied significantly across therapists (τ11 = 0.26, 95% CI [0.11, 0.66]). Among a subsample of 35 therapists with sufficient within-caseload variability in patient sexual orientation, 17% demonstrated medium-to-large disparities disadvantaging LGB+ patients, whereas the rest exhibited more equitable outcomes. Findings inform personalized training efforts and data-informed case assignment to therapists’ multicultural competencies.

Individual therapists vary in their effectiveness treating different clinical problem domains (e.g., depression, anxiety). Yet, research indicates that therapists are no better than chance at predicting their own problem domain-specific effectiveness (based on multidimensional, patient-reported outcomes data; Constantino et al., 2023). However, it is unknown whether such therapist self-perception inaccuracies derive from a lack of awareness of their relative strengths and weaknesses or from a more general self-perception bias toward overestimating their skills (across domains). Addressing this gap, this study tested whether therapists’ forced choice rankings of their self-perceived domain-specific strengths and weaknesses when treating different mental health problems predicts their actual relative, measurement-based effectiveness on these same domains. Data derived from 60 community therapists who each treated an average of 28 patients (total patient N = 1,685) who completed a multidimensional routine outcomes measure (Treatment Outcome Package [TOP]; Kraus et al., 2005) at pre- and posttreatment. Therapists rank-ordered their own perceived differential effectiveness across the same 12 domains included on the TOP (e.g., depression, sleep, social conflict, anxiety, substance misuse, suicidality). Multilevel models revealed that relative to one’s own mean level of effectiveness (across domains), a given therapist had significantly lower rates of reliable improvement on their self-ranked top 3 domains relative to the remaining domains (p = .010). These results further highlight therapists’ inaccuracy in perceiving their own problem-specific effectiveness. Such inaccuracy underscores the importance of using measurement-based systems to classify therapists’ strengths and weaknesses to optimize matching patients to empirically well-suited therapists (Constantino et al., 2021).

Ruptures in the therapeutic alliance (i.e., breakdowns in the emotional bond and/or disagreements on therapeutic tasks or goals) are associated with poorer psychotherapy outcomes. However, when effectively repaired, ruptures may catalyze improvement, including to levels beyond patients who never experience a rupture. A key step toward rupture repair is that both dyad members recognize it. Yet, most research has included static, single-rater rupture assessments, thereby neglecting the dynamic and dyadic nature of the rupture and repair process. Addressing these gaps, this study examines the effect of within-dyad similarity or discrepancy in patient and therapist rupture perceptions on next-session symptom change. Data derive from a trial in which 106 patients with generalized anxiety disorder received 14 sessions of cognitive-behavioral therapy (CBT), either alone or integrated with motivational interviewing. Patients and therapists provided alliance rupture ratings after each session, and patients reported worry at baseline and after each session. Dyadic multilevel modeling revealed no average pattern of discrepancy between participants’ ratings (γ000 = 0.10, p = .10). When either the patient (γ100 = 7.37, p < .001) or therapist (γ200 = 4.25, p < .001) independently perceived a rupture, it was associated with poorer next-session outcomes. In contrast, agreement on the presence of a rupture mitigated its negative impact (γ300 = -7.64, p < .001). Findings underscore the importance of routine rupture monitoring and suggest that mutual recognition of ruptures may be key to minimizing their negative effects, whereas a hypervigilant therapist stance may be as detrimental as an unrecognized patient-perceived rupture.

Aim: Interpersonal skills and the ability to respond effectively in complex therapeutic situations are strongly associated with treatment success. Strengthening these skills is therefore a crucial goal in psychotherapy training. However, further research is needed to identify which training methods best enhance interpersonal competence. Previous findings suggest that Deliberate Practice and Structured Feedback are particularly promising approaches. Methods: This ongoing randomized controlled trial includes three intervention groups (Deliberate Practice, Structured Feedback, and a combined condition*) and one active control group to evaluate the effectiveness of workshops designed to strengthen interpersonal skills in challenging therapeutic situations (Rupture–Repair). All workshops are based on Alliance-Focused Training. Deliberate Practice is implemented through simulated-patient interactions, while Structured Feedback is provided using the Facilitative Interpersonal Skills Rating Method and the Rupture-Resolution Rating System. Interpersonal skills are assessed using a German version of the Facilitative Interpersonal Skills Performance Task. Results: Pre–post comparisons of training effects will be presented, focusing on the development of interpersonal skills, differences between intervention groups, and associations between skill improvement and therapy outcomes. Discussion: This study aims to advance the evidence base on effective methods for fostering interpersonal competence in psychotherapy training. Initial findings will be discussed with respect to their implications for clinical education and training design.

Aim: Which preexisting properties lead to training success? Some knowledge related to personal properties of successful psychotherapists exists, but we know little what properties therapists need already before training. Methods: This study assessed many variables with a broad range of methods. Data from 145 future therapists have been put on ice for an average of 5 years, until they had terminated training included a number of training therapies. Their properties before training have been compared with effect sizes of therapies conducted by them as well as supervisor evaluations. Reflecting the scarce knowledge in this domain the study is exploratory rather than hypothesis testing. We modeled predictors of training success using mixed-effects machine-learning. Non-hierarchical baselines were compared using therapist-clustered nested cross-validation. Model explainability was assessed via SHAP variable importance. Results: No variable had a dominating effect on training success, but the findings point to a number of variables with some impact: Warmth/kindness, assertiveness, social understanding, search for meaning, intellectual interest/curiosity, absence of incongruence related to intimate relationship/attachment, absence of a cold/distances interpersonal stance, and positive emotion/cheerfulness/vivacity. Discussion: As certainly many factors have an impact on the training outcome, and a very goal of training is to target and neutralize deficits/problems of individual candidates, it would be rather surprising if one or a few factors had a dominating effect. The variables which determine some variance will be discussed along with limitations of the used methods.

Aim. This study evaluated a brief deliberate practice–based training program (“Facilitative Interpersonal and Relational Skills Training”) aimed at enhancing therapists’ facilitative interpersonal skills (FIS) in a sample of experienced clinicians. Methods. Using a waitlist-controlled design, two groups of therapists (N = 68) sequentially received a three-day workshop delivered across a period of two months. They completed performance-based observer-rated FIS assessments at three time points, along with self-reported FIS and therapist self-efficacy. Piecewise mixed-effects models tested pre-post change in each group and effects across the eight specific interpersonal skills. Results. No significant group × time interaction emerged. One group showed significant within-group improvement in FIS following training (g = .42, 95% CI [.15, .70], p = <.01), wheras the other showed a small, non-significant improvement (g = .21, 95% CI [-.20, .62], p = .31). Skill-specific analyses indicated the largest gains in alliance-related skills, namely alliance bond capacity and rupture-repair responsiveness. No significant effects were found for self-reported FIS or therapist self-efficacy.

Aim: Informed consent is a fundamental prerequisite of psychotherapy and requires transparent communication of aims, procedures, and potential risks. This contribution outlines what psychotherapy trainees must learn about negative effects to support safe and effective practice. Method: A systematic review on negative effects of psychotherapy (HARMS) and a naturalistic study (PSSO ±) in a multimodal psychosomatic day-clinic/inpatient program serve as initial reference points. The naturalistic study provides detailed assessments of adverse events from patient and therapist perspectives, including transient vs. persistent courses, perceived severity, and whether events were experienced solely as negative or as negative experiences with positive aspects. Results: The review and study highlight the current evidence base while simultaneously illustrating its limitations: existing research does not yet allow for fine-grained individual risk prediction. Still, the findings indicate that at least one in ten patients experiences adverse events and at least one in twenty-one experiences severe adverse events. These rates underline the need to address negative effects explicitly in psychotherapy training. Discussion: Training must not only convey knowledge but also cultivate a patient-centered attitude that prioritizes safety. Key elements include dialogic, individualized informed consent; harm-informed indication and treatment planning; process monitoring; and awareness of individual “effectiveness profiles.” As many adverse events arise within the therapeutic relationship, relational competence—e.g., through alliance-focused training—is essential. Embedding these competencies within a broader safety culture and ongoing quality assurance remains a central task for contemporary psychotherapy training.

Aim: Resilience is commonly defined as a dynamic process of adapting to adversity and stressors, whereas the complex-systems perspective conceptualizes it as a system’s capacity to maintain a stable, healthy state when perturbed. Risk and protective factors, such as adverse childhood experiences (ACEs) and social support, shape these adaptive capacities and contribute to individual differences in vulnerability. In daily life, dynamic responses to stressors, such as affective reactivity and recovery, can be viewed as micro-level indicators of resilient functioning or emerging system (in-)stability. Such stability-related markers may offer valuable insights into treatment readiness and personalized clinical decision making. The current EMA-based assessment is piloted in a non-clinical cohort to derive initial (in-)stability markers and inform a subsequent clinical study with individuals awaiting psychotherapy. Methods: In the pilot study, participants completed six EMA prompts per day for 14 days, assessing, among other variables, momentary affect and daily events. Each evening, they reported daily psychiatric symptoms. Baseline measures included ACEs and perceived social support. Analyses involved affective variability indices, modelling of affective recovery, network modelling, and exploratory dynamic landscape approaches. Results: Preliminary analyses show that indicators of (in-)stability can be derived from momentary affective dynamics and network structures. These dynamics provide initial insights into individual patterns of emotional adaptation and momentary (in-)stability, as well as their associations with risk and protective factors. Discussion: Findings from this study are expected to support the identification of stability-related markers relevant for treatment planning and personalized intervention approaches. The results contribute to a more nuanced understanding of daily resilience processes and may inform broader efforts in psychological risk prediction.

Suicide and self-harm remain among the most frequent and serious adverse events in psychiatric inpatient settings, yet clinicians currently lack reliable tools to identify which patients are at imminent risk. Existing approaches rely heavily on standardised assessments that are brief, infrequently administered, and unable to capture the dynamic fluctuations in risk that occur during hospitalisation. This study utilises 15 years of routinely collected clinical data from psychiatric inpatient services (N = 17,725, 312,240 daily assessments) to develop machine-learning models capable of predicting self-harm and suicide attempts over the next 7-days. By leveraging information already embedded in routine care, such as daily clinical observations and self-reported symptoms, the models generate dynamic risk estimates that update in step with patients’ clinical trajectories. Findings show that these algorithms detect the majority of self-harm events while meaningfully reducing false positives compared with baseline screening methods. Importantly, prediction performance declined sharply when risk assessments were simulated as infrequent, underscoring the necessity of continuous, data-driven monitoring rather than point-in-time evaluations. This work demonstrates that routinely collected patient data can support real-time identification of those at elevated risk, offering a scalable foundation for proactive clinical decision-making and enhanced inpatient safety.

There is an urgent need for scalable tools to predict and prevent suicidality in older adults. Suicidality peaks in late life, yet existing models often fail to capture its fluctuating nature and are primarily developed for younger populations. Psychotherapy is effective but limited by challenges in identifying heightened risk and adapting treatment dynamically. Ecological Momentary Assessment (EMA) and passive sensing can address this gap by providing granular, real-time indicators of suicide risk. Our project integrates EMA and wearable passive sensing data to enhance early detection of suicidality in psychotherapy. Thirty adults aged 50–80 with major depression and suicidality completed periodic assessments and twice-daily EMA surveys. We used wearable rings to measure continuous physiological and behavioral changes (heart rate, heart rate variability, sleep, and activity patterns). Using these multimodal data, we developed a dynamic machine learning model that continuously updates predictions of suicidality across nine therapy sessions. The model aims to identify heightened suicidality risk and detect predictors of deterioration. We will compare the dynamic model to conventional prediction approaches based on periodic assessments, evaluating performance via time-specific and average R² and baseline linear regression models. Identifying early warning signals across self-report and wearable data yields clinically relevant information that can improve the timing and precision of interventions. Our findings aim to inform the development of an accessible, scalable tool for real-time suicide risk detection in late-life depression. This tool could support community therapists in providing precise and personalized interventions, improving safety and care for vulnerable older adults.

Background: Suicide is a major public health concern, with more than 700,000 deaths worldwide each year (WHO, 2024). Early detection of suicidality is crucial, as suicidal intentions are often communicated prior to attempts, yet may remain unrecognized (Pompili et al., 2016; WHO, 2014). Although language-based machine-learning models have shown promise, their performance is inconsistent and often lacks generalizability across domains (Franklin et al., 2017; Homan et al., 2022). It remains unclear whether weekly suicidal ideation can be predicted from German-language psychotherapy transcripts and linked to session-level self-reports. Methods: We analyzed more than 5,000 outpatient psychotherapy sessions with a session-level questionnaire item assessing suicidal ideation. A large language model was fine-tuned to classify text segments as suicidal or non-suicidal using manually annotated forum posts and psychotherapy segments. Segment-level probabilities were summarized using descriptive statistics (e.g., median, standard deviation, maximum) and used as predictors in machine-learning models to estimate session-level suicidal ideation. Preliminary Results: Most sessions (90.1%) indicated no suicidal ideation, while the remaining sessions predominantly reflected mild ideation. Interrater reliability for segment annotation was high (κ = 0.73), and explicit suicidality occurred in fewer than 1% of psychotherapy segments. Models trained only on forum data showed high performance on forum posts (F1 = 0.97) but reduced specificity in psychotherapy transcripts, whereas incorporating psychotherapy-specific training data improved segment-level performance. Analyses of session-level prediction are ongoing. Conclusion: The findings highlight substantial domain shift between social media and psychotherapy language and underscore the importance of psychotherapy-specific training data for clinically meaningful suicidality detection.

Background: The comorbidity of Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD) is linked to greater symptom severity, impairment, and poorer treatment outcomes. A key challenge in improving care for this population lies in the heterogeneity of PTSD, which complicates its understanding and the development of effective interventions. Objective: This study aimed to better characterize PTSD heterogeneity by identifying digital profiles using automatically captured digital features. Clusters were constructed separately for patients with MDD without PTSD (MDD-PTSD) and those with comorbid MDD+PTSD, based on affective and interpersonal behaviours from the first therapy session. Clusters were further characterized using clinical and self-report data and evaluated for clinical utility. Method: Eighty-five patients from a randomized controlled trial of psychodynamic psychotherapy were included. Eleven digital features-including facial expressions and nonverbal synchrony-were extracted and used to construct profiles separately for the two diagnostic groups. profiles were characterized using measures of interpersonal functioning, emotion regulation, and depression severity, and were evaluated based on depressive symptom trajectories across 16 sessions. Results: Two profiles emerged in each group. In MDD-PTSD, one cluster showed high arousal and engagement; the other showed emotional avoidance. In MDD+PTSD, profiles reflected a resilient-regulated versus an emotionally dysregulated profile. The resilient-regulated cluster showed better treatment outcomes. Conclusion: Findings support the use of digital phenotyping to identify clinically relevant profiles in comorbid MDD+PTSD. Multimodal digital profiling may inform personalized treatment strategies in complex clinical populations.

Background Posttraumatic stress disorder (PTSD) is associated with heightened reactivity to traumatic memories and increased limbic activation during trauma-related recall. Although Prolonged Exposure (PE) is an established treatment, clinical response varies widely, and the neural mechanisms underlying therapeutic improvement remain unclear. One proposed marker of recovery is a shift in how traumatic memories are represented in the brain, such that their neural patterns become more similar to those of other autobiographical memories. Methods Fifty individuals with PTSD underwent fMRI scanning while recalling traumatic, sad, and neutral autobiographical memories before and after randomized treatment with PE combined with either intravenous ketamine or placebo. Using the Shen 268-parcel atlas, Representational Similarity Analysis (RSA) was used to quantify the neural similarity among the three memory types. For each participant and for the group, we evaluated whether the similarity between traumatic, sad, and neutral memory representations increased following treatment. Results Across participants, the neural patterns associated with traumatic, sad, and neutral memories became more similar to each other after treatment. Significant pre–post increases in representational similarity were found in multiple Shen parcels (FDR-corrected p &lt; .01). These effects were most prominent in regions linked to limbic processing, salience–default mode network interactions, and frontoparietal control functions. . Conclusions These findings indicate that treatment was associated with greater neural similarity across traumatic, sad, and neutral autobiographical memories. The increased convergence of memory representations across several large-scale networks may reflect a change in how emotional memories are processed following therapy.

Background: Posttraumatic stress disorder (PTSD) is a heterogeneous condition with diverse symptom presentations and emotional experiences. While fear is traditionally viewed as central, growing evidence highlights the role of non-fear-based emotions - such as sadness, guilt, and shame - collectively termed Emotional Pain. This study aimed to identify Emotional Pain and Fear-based PTSD symptom profiles and their neural correlates across two independent samples. Methods: In Study 1 (n=838), trauma-exposed individuals with probable PTSD completed the PTSD Checklist for DSM-5 (PCL-5) and subjective ratings of Fear and Emotional Pain. Item-level network analysis was conducted to identify central symptoms and relationships. In Study (n=162), recent trauma survivors with high PTSD symptoms underwent resting-state and task-based functional MRI (fMRI) scans 1-month post-trauma, and completed follow-up clinical assessment at 14-months post-trauma. Connectome-based predictive modeling (CPM) was used to predict chronic symptom severity for Fear and Emotional Pain-based profiles, identified in Study 1. Results: Emotional Pain was rated as more impairing than Fear by most participants (69%). Symptom networks showed distinct patterns: Fear was associated with flashbacks, nightmares, distressing memories, exaggerated startle, and external avoidance; Emotional Pain was linked to anhedonia, negative beliefs, negative emotions, sleep disturbance and emotional reactivity. CPM predicted chronic Fear-based symptom severity (rho=0.228, p&lt;0.001), but not Emotional Pain (rho=0.167, p=0.055). Predictive features included connections across anterior default- mode, central executive, salience, motor-sensory and subcortical networks. Conclusions: Emotional Pain and Fear may represent distinct PTSD dimensions. Disentangling their neural signatures may improve diagnostic precision and guide personalized, mechanism- based interventions for trauma-related psychopathology.

Background: Mass trauma events often include exposure to immediate threat of both parents and children. However, not much is known about the impact of parental trauma exposure on children&#39;s mental and physical health, and how parental help-seeking behavior moderates this association. This study aimed to evaluate the impact of parental help-seeking behavior on the sequela of parents and children’s exposure to mass trauma. Methods: Israeli parents (N =187) of children aged 6-18 completed measures of traumatic exposure, psychological distress, psychological and somatic distress and parental and child help-seeking behavior during the Iron Sword war in Israel. Results: Parental help-seeking behavior significantly moderated the association between parental traumatic exposure and children’s somatic distress (b=-.38, SE= 0.10, p&lt;.01), such that parental exposure was significantly associated with children’s somatic distress among parents reporting no or an unmet need (b= .66, SE= 0.12, p&lt; .01, b=.30, SE= 0.07, p&lt; .01, respectively), but not among parents receiving treatment. Same significant pattern emerged for the association between children’s exposure and their parents’ distress (b= -.50, SE=0.22, p=0.02), indicating that this association was significant only among parents reporting no need for treatment (b=.75, SE=0.23, p&lt;.01), but not among parents that sought treatment for themselves and the child (b=-.26, SE=0.27, p=.34). Conclusion: Parental help-seeking behavior has a crucial role in shaping children and parent’s recovery from traumatic events. Early identification and intervention for parents may reduce the negative impact of trauma on children physical health. These results underscore the need for family-centered policies aimed to address parental mental health as a core component of post-trauma care. Key words: Mass trauma, help-seeking behavior, parents, treatment-seeking, somatic distress.

The high prevalence of internalizing disorders such as anxiety, depression, and trauma-related symptoms demands a better understanding of their shared and distinct features. Prior work has emphasized different pathogenic constructs and pathways across these conditions, yet psychological aspects of human freezing remain underexplored and poorly integrated. To date, a comprehensive network account of internalizing constructs, their symptoms, and interactions is lacking. This study integrates a novel, quantitative measure of anxious freezing to characterize internalizing symptomatology using network modeling. We constructed cross-sectional item-level and construct-level networks for a broad set of anxiety and depressive symptoms in an Asian sample (N = 406). Dysphoria, anxious apprehension, and cognitive freezing emerged as highly central, highlighting their significance across internalizing states. Community detection revealed three clusters: (1) anxious freezing and anxious arousal, (2) anxious apprehension and rumination, and (3) dysphoria and anhedonia. Our findings integrate established internalizing constructs with a newly quantifiable dimension, anxious freezing, offering a multi-angle perspective for understanding and treating clustered internalizing symptoms.

PTSD research often infers individual mechanisms from group-level data, limiting clinical utility, while idiographic approaches capture person-specific dynamics but frequently lack theory-driven structure. We present an integrated framework for quantifying PTSD case formulations by embedding cognitive theory, patient insight, and flexible measurement within individualized network models. Ehlers and Clark’s cognitive model of PTSD was operationalized using intensive longitudinal data from trauma-exposed individuals with PTSD or clinical-level symptoms (N = 41). Participants generated personalized items mapping negative appraisals, trauma memory, triggers, sense of current threat, and maladaptive strategies, and completed ecological momentary assessments over several weeks (2,594 observations). Dynamic network models tested theory-driven hypotheses and characterized individual mechanisms. We further introduce Momentary Structured Networks, a method guiding individuals to report perceived directional relations among components, demonstrated in an eight-month clinical case. Sense of current threat consistently emerged as a central hub linking key components, with clustering revealing reproducible formulation profiles. Comparisons between EMA-derived and patient-elicited networks highlighted challenges in formulation quantification. Overall, the framework offers a scalable, theory-grounded approach to personalized PTSD formulation with direct implications for clinical assessment and treatment planning.

Children and young people with experiences of complex trauma (repeated abuse, exposure to domestic violence) represent some of the most challenging clinical cases facing Clinical Psychology services. This paper reports our work elucidating the prevalence – in a large cohort of looked-after children, and appropriate diagnostic conceptualisation of, traumatic stress following complex trauma in youth. We then present the results of a randomised controlled trial (the DECRYPT trial) comparing trauma-focused cognitive therapy against usual care in the UK NHS for this population. Implications for the future clinical management of these clinical presentations are discussed.

Exposure to potentially traumatic events is common in childhood, yet PTSD in very young children (3–8 years) is increasingly recognised as both prevalent and impairing. Furthermore, current clinical guidelines provide little developmentally specific direction for the treatment of PTSD for this age group. Grounded in cognitive models of PTSD, CBT-3M targets the organisation and detail of trauma memories, the meanings children and caregivers attribute to the event and its aftermath, and the behaviour, avoidance patterns, and dysfunctional coping strategies that maintain symptoms. Findings from the earlier proof-of-concept PYCES-I trial indicated clinically meaningful effects relative to treatment as usual, providing preliminary support for the CBT-3M approach and informing the design of the current randomised controlled trial. This talk will outline the theoretical rationale for CBT-3M, describe its clinical implementation for very young children and their caregivers, and present key insights from PYCES-I that informed the design of the current NIHR-funded multi-site randomised controlled trial. Taken together, these findings highlight the potential of CBT-3M to strengthen evidence-based clinical pathways for very young children with PTSD.

The prevalence of large language models (LLMs) such as ChatGPT allows users to consult them about mental health topics. However, it is still unclear whether these applications are safe and effective in delivering evidence-based care. There is a lack of systematization of existing approaches, limiting comparability of study designs, methods and findings. Thus, systematic multidimensional and multifactorial assessment efforts of LLM effectiveness and safety in mental health is hindered. This study therefore examines how different evaluation concepts can be organized within a comprehensive framework model. We conducted a systematic review of peer-reviewed articles and, to effectively capture rapid developments in the field, an additional rapid review of the most relevant preprints. Identified methods were then mapped onto established frameworks for assessing human clinical skills proposed by Miller (1990) and Muse & McManus (2013). The proposed theoretical framework for assessing effectiveness and safety comprises four levels: 1) demonstration of theoretical knowledge, 2) ability to draw correct logical inferences, 3) application of skills in a standardized context, and 4) the implementation in the intended real-world setting. Each level requires distinct methods to enable a comprehensive evaluation of LLM effectiveness and safety. The framework highlights the complexity of LLM evaluation. It can support researchers in developing and comparing research questions, methods, and designs. For practitioners and users, the conceptualization may aid in selecting safe and effective chatbots based on individual needs. The model also enables the formulation of conditions and benchmarks consistent with quality assurance and regulatory requirements.

Aim: Psychotherapy research has grown substantially over recent decades, yet it is often described as fragmented across therapeutic orientations, methods, and research topics. At the same time, major clinical developments (e.g., evidence-based practice, digital interventions) and broader societal challenges (e.g., pandemic, conflicts) have placed new demands on mental health research. Against this background, the present contribution aims to provide a systematic trend analysis of psychotherapy research based on keywords from published articles. The analysis seeks to characterize how the topical focus of psychotherapy research has evolved over time and to explore whether shifts in research attention appear to precede, accompany, or follow broader developments in the field and society. Methods: Bibliographic metadata were extracted on January 1, 2026, from the Web of Science. Specifically, author-provided keywords were retrieved from all articles published in ten journals focusing on general, non-specific psychotherapy-related research. Analytically, keywords will be treated as indicators of topical focus and categorized using natural language processing (NLP). Temporal analyses are planned to examine changes in the prominence and relational structure of keywords. Results: Overall, a total of 50,495 keywords were extracted from 10,483 articles (M = 4.82, SD = 1.17, min = 1, max = 15) across 10 psychotherapy-related journals spanning the period from 2000 to 2025. Based on preliminary descriptive frequency analyses, excluding the keyword psychotherapy itself, the most commonly occurring keywords were depression, (therapeutic) alliance, anxiety, meta-analysis, and process research. Further results will be presented Discussion: Observed trends, and their implications for psychotherapy research will be discussed.

Though concerns about the dominance of RCTs is becoming more common in wider medical research (e.g. the EBM+ movement), they have received less attention in the field of mental health where one of the interventions, psychopharmaceuticals, is amenable to testing via RCTs while the other, therapy, is I suggest, less so. Though RCTs have many merits and are suitable for interventions such as pharmaceuticals, I suggest there is an ontological mismatch between the 'shape' of interventions presupposed by RCTs and therapy. RCTs presuppose interventions that are standardised, specific, time-limited and measurable, characteristics which are less straightforward in the case of therapy. In response, I propose a pluralistic evidence base for therapy that does not privilege RCTs and where other types of research and study designs work in concert to not only to evaluate the efficacy of therapy but to also optimise the study designs. Though other types of research into therapy are occasionally published, RCTs continue to dominate and are the basis for policy decisions, influencing healthcare provisioning, patient choice and workforce shortages. The proposed presentation will make a philosophical argument but also draws on existing empirical research on the routine practice of therapy and features two vignettes to make the piece accessible to a wide audience, particularly practitioners.

The prevalence of overweight (including obesity) among children and adolescents aged 5–19 has risen dramatically from 8% in 1990 to 20% in 2022 (WHO). The treatment and prevention of this phenomenon is therefore of international interest. There is still very little knowledge about the psychological origins and risk factors of obesity. The study shows the outcome of a multimodal program for overweight and obese minors between the ages of 10 and 14 has been launched in 2012. We used the Rorschach test and the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-KJ II), as well as the content analysis of the protocols of group psychotherapy. The results show insights into the psychodynamic origins, risk factors and resources of young patients. On the other hand, the effectiveness of the program is illustrated by comparing the initial and final tests. The OPD-KJ II tests show that the participants benefited from psychotherapy by a slightly improvement of the psychological structure on four different levels: control, identity, interpersonal relatedness and attachment. On the conflict axis there was a shift from early childhood conflicts to conflicts of later developmental stages. High scores were achieved also for the axis of life events. Further data and results will be presented and discussed in the full paper presentation.

Aim: This study examined whether parent–child clay art-making improves parents’ psychological well-being and whether incorporating a gratitude theme enhances its effects on positive and negative affect. Methods: A within-subject design was employed with 192 parents aged 28–35 years. Participants attended a 2.5-hour parent–child clay art-making session and completed the Positive and Negative Affect Schedule (PANAS) before and after the intervention. Twelve workshops were conducted over six days, with morning and afternoon sessions equally distributed. Gratitude-themed and non-themed workshops were evenly arranged across time periods to control for time-related confounding effects. Parents collaboratively created clay figures with their children using standardized materials and guided instructions. Pre–post changes in positive and negative affect were analyzed separately for gratitude-themed and non-themed conditions using paired-sample t-tests. Results: Non-themed sessions significantly increased parents’ positive affect but did not reduce negative affect. Gratitude-themed sessions significantly increased positive affect and reduced negative affect. Discussion: Parent–child clay art-making effectively enhances parents’ positive mood. Incorporating a gratitude theme strengthens its impact by facilitating emotional processing and cognitive reframing, contributing to reductions in negative affect. These findings suggest that gratitude-themed clay art-making may serve as a practical, relationally focused intervention to promote parents’ psychological well-being.

Aim Cultural humility emphasises ongoing self-reflection, attention to power, and institutional accountability and is increasingly being explored within professional training. However less is known about how qualified healthcare professionals engage with cultural humility within everyday clinical practice. This study aims to explore how cultural humility is engaged with and developed within reflective practice groups, and how these processes shape clinicians’ approaches to healthcare. Methods The study adopts a qualitative design using Charmaz’s constructivist grounded theory methodology. Interviews with psychology-based healthcare professionals will explore experiences of reflection in groups, power, difference, and organisational context. Data collection and analysis will commence shortly after submission. The process will be iterative, using line-by-line coding, constant comparison, memo-writing, and theoretical sampling to support the development of a theoretical framework. Anticipated Contributions The study is expected to generate an empirical conceptual account of how reflective practice groups function as relational spaces in which cultural humility is explored, negotiated, and sustained over time. Attention will be given to group processes, facilitation, and organisational conditions that enable or constrain engagement. By the time of the conference, the presentation will draw on interview data and early-stage analysis to illustrate emerging theoretical insights. Discussion This research will contribute to psychotherapy research by extending understandings of how culturally responsive practice is supported beyond formal training. The study has implications for psychotherapy training, supervision, and service structures seeking to move beyond competency-based approaches and towards sustained cultural humility in practice.

In this brief paper I focus on key questions linked to the conference theme of reimagining psychotherapy in university counselling and mental health settings. The research focuses on how therapists who identify as gender and sexuality diverse navigate and must be open and create innovative ways of working with their student – clients in the university setting. The research explores what are the experiences of gender and sexuality diverse (GSD) therapists in university counselling services? How does this link to psychosocial assumptions made around matching therapist to student- client? The current landscape of working in the sector and coming from a marginalised and minoritised group will be outlined. In this research I will explore and highlight some experiences of gender and sexuality diverse therapists who come from marginalised groups who may experience minority stress, within their own institutions. Understanding their experiences will help inform the research. I will consider why this is important. I aim to demonstrate matching student- clients and therapists around gender and sexuality diverse identity is complex and may be clinically beneficial. Conversely, this research may demonstrate where this has been contraindicative to the work. That to assume similarity when there is so much difference, might negatively impact both therapist and student- client. Making psychosocial assumptions about similarity and difference in the matching process of therapist to client may be detrimental. The setting and structure (of the university service setting ) will be carefully considered in relation to the therapeutic frame.

Interpersonal physiology refers to the process through which individuals’ autonomic nervous systems interact and mutually influence one another. Within this field, the concept of physiological synchrony (PS) has attracted increasing research attention, particularly in psychotherapeutic contexts. Researchers employ various methodological approaches to examine what PS reflects or correlates with, most commonly focusing on empathy, therapeutic alliance, and related relational constructs. They are typically assessed through self-report questionnaires administered before and/or after the session. However, such methods provide limited insight into participants’ lived experiences during the dynamic fluctuations in PS that occur throughout a session. We will report preliminary findings from an ongoing study conducted in the context of psychotherapy supervision, a setting that has not yet been explored within PS research. We employ a phenomenological approach to collect experiential data from participants during episodes of high positive, negative, and low PS. To enhance ecological validity, experiential descriptions are obtained in real time, using continuous monitoring of PS levels. Our primary objective is to determine whether this method can reveal if the supervisor and supervisee are phenomenologically “synchronized” during periods of high PS. During the sessions, participants receive a signal from the researcher when high positive, high negative, or no synchrony in electrodermal activity is detected; they are then instructed to immediately record their current experience. Following the session, a micro-phenomenological interview is conducted with both participants to further deepen the understanding of their experiences. Based on the data currently being collected, we will discuss the relevance of this bottom-up approach.

The increasing integration of artificial intelligence (AI) into psychotherapy training raises both didactic opportunities and methodological concerns. This brief paper presents the development and initial evaluation of an AI-based patient simulator designed for undergraduate psychotherapy students. The simulator aims to provide a realistic yet deliberately constrained training environment, allowing students to practice basic therapeutic interviewing, hypothesis formation, and reflective decision-making without replacing human supervision. The system generates patient responses based on predefined clinical variables and dynamically adapts to students’ interventions, while offering structured feedback and reset functions to support iterative learning. To assess feasibility and acceptance, an exploratory evaluation was conducted focusing on students’ perceived realism, educational usefulness, and attitudes toward AI-assisted learning. Results indicate high perceived usefulness for early training stages, alongside persistent critical awareness regarding ethical boundaries, diagnostic validity, and the limits of simulated psychopathology—particularly in relation to psychotic and demential disorders. The findings suggest that AI-based patient simulation may serve as a valuable supplementary tool in psychotherapy education when embedded within a clearly defined pedagogical framework. Implications for curriculum design, ethical safeguards, and future empirical validation are discussed.

Intergenerational narratives, family stories passed from one generation to the next, are a key mechanism of cultural transmission (Merill & Fivush, 2016). However, among Chinese immigrant families, such narratives are often limited, and the reasons for this pattern remain underexplored (Chou et al., 2022). This study aims to examine how first-generation Chinese immigrant parents understand and construct intergenerational narratives by identifying 1) which stories they view as important to share, 2) which stories they choose to withhold, and 3) the reasoning underlying these decisions. Using purposive sampling, a total of 6–8 first-generation Chinese immigrant parents will be recruited through personal networks and community organizations and interviewed using semi-structured protocols. Initial data collection is currently underway. The data will be analyzed using an inductive approach to thematic analysis (Braun and Clarke, 2022). Preliminary findings suggest that Chinese immigrant parents favour non-verbal means of cultural transmission over direct, verbal narratives. Further findings are expected to illuminate the sources of the widespread narrative silences observed in previous research (Cai & Lee, 2022). This work has the potential to inform culturally responsive storytelling interventions and narrative-based mental health approaches for immigrant families and communities. Consequently, this research may enable us to develop further culturally appropriate psychotherapy approaches and support healthy bicultural identity development among Chinese Canadian youth, one of Canada’s largest and fastest-growing, yet historically underrepresented communities (Statistics Canada, 2023). More broadly, the study will contribute foundational knowledge to support the revitalization of intergenerational storytelling among diasporic groups that have been affected by trauma.

Introduction Generative artificial intelligence (GenAI) has become integrated into daily life, including for mental health needs. Many users build "relationships" with GenAI through anthropomorphism—attributing human-like qualities to non-human entities. Understanding interpersonal and mind representations of GenAI in therapeutic contexts can elucidate human-AI relationships and identify pathways to mitigate risks while enhancing benefits. This study examines users' interpersonal and mind perceptions of GenAI and whether these mediate the relationship between anthropomorphism and ethical trust. Methods We screened over 4,000 individuals and recruited 270 participants who used ChatGPT at least three times for mental health or emotional needs. Participants completed the Interpersonal Circumplex Perception of GenAI (assessing warmth and dominance) and Mind Perception Survey (assessing experience and agency). Results Participants generally experienced ChatGPT as very warm and slightly submissive, with limited experience but moderate agency. After controlling for well-being, higher anthropomorphism strongly predicted ethical trust in GenAI for mental health (B=0.17, p=.002). Interpersonal perceptions overall (p=.001), and perceptions of warmth (p<.001) but not dominance (p=.09), as well as mind perception of agency (p=.001) and experience (p=.04), fully mediated this relationship. Individuals higher in anthropomorphism perceived ChatGPT as warmer, more interpersonal, more capable of doing and feeling, leading to greater trust and fewer ethical concerns. Conclusion Our findings reveal a specific pathway: anthropomorphism enhances ethical trust through perceptions of GenAI as warm and capable. Targeted interventions could address ethical risks by focusing on users' perceptions of AI interpersonal qualities in therapeutic contexts.

Background: Depression is highly prevalent, recurrent, and impairing in young adults, ranking among the leading causes of years lived with disability worldwide. Interpersonal Psychotherapy (IPT) is a first-line treatment for depression and has demonstrated benefits in improving depression symptoms (DS) and social support (SS). However, evidence for IPT-G delivered by non-specialists to young adults remains limited. Objective: To evaluate whether an 8-session IPT-G delivered by non-specialists improves DS and SS in community young adults. Methods: A randomized controlled trial enrolled 38 young adults (18–24 years) with DS, allocated to IPT-G (n=19) or waiting list (WL; n=19). IPT-G followed the 8-session WHO protocol and was delivered by a medical student and a medical doctor trained for the intervention. Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), and SS was assessed using the Medical Outcomes Study–Social Support Survey (MOS-SSS). Outcomes were analyzed using linear mixed-effects models comparing baseline to 8-week follow-up. Results: IPT-G showed greater clinical improvement compared to WL. Mean HADS Total at baseline was IPT-G: 20.95 (SD=5.07) and WL: 19.89 (SD=7.18). After 8 weeks, scores decreased to IPT-G: 15.88 (SD=8.98) and WL: 18.10 (SD=6.94) (p<0.05; η²ₚ = 0.144). For SS, IPT-G improved from 51.87 (SD=22.19) to 66.12 (SD=29.04), while WL remained stable (66.27 [SD=22.01] to 69.21 [SD=23.43]) (p<0.05;η²ₚ = .153). Conclusion: An 8-session IPT-G delivered by non-specialists significantly improved DS and SS in young adults. To our knowledge, this is the first evidence worldwide demonstrating effectiveness of IPT-G for young adults implemented by non-specialists.

Email: yunyizhang@mail.adelphi.edu yunyizhang@mail.adelphi.edu Yunyi Zhang, Serena Bai, J. Christopher Muran, & Catherine F. Eubanks A rupture in the therapeutic alliance is a strain or deterioration in the working relationship between therapists and patients. Withdrawal ruptures, in which patients and/or therapists move away from each other or the work of therapy, can be subtle and difficult for therapists to detect. Boritz (2018) found that when therapists recognized and responded to withdrawal, the withdrawal patterns in patients persisted, suggesting that even when therapists recognize withdrawal ruptures, they may have difficulty addressing them effectively. This mixed-methods study aims to understand how therapists respond to patient withdrawal and the relationship between patient withdrawal, therapist withdrawal, and ratings of the working alliance. It will be a two-part study. Part 1 involved Interpersonal Process Recall (IPR) interviews with therapists who participated in a psychotherapy research program. During interviews, therapists reviewed their previous session segments with salient patient withdrawal and then reflected on their internal experiences. Thematic analysis will be used to identify key factors shaping therapists’ responses and decision-making. Part 2 will employ quantitative methods to examine the relationships among patients and therapists' rating of working alliances, therapists’ resolution strategies, and both patient and therapist withdrawal behaviors across sessions. Together, the study seeks to explore how therapists perceive and attempt to repair withdrawal ruptures. This work has the potential to inform therapists’ training model in rupture resolution and contribute to more effective and responsive psychotherapy practices.

Brief Dynamic Interpersonal Therapy (DIT) is a manualised, psychodynamically oriented procedure limited to 16 sessions for patients with depression and anxiety disorders. A key feature of DIT is the identification of an interpersonal affective focus as the underlying problem causing the patient's symptoms. This focus is intensively addressed in the middle phase of therapy using mentalisation techniques and in the therapeutic relationship, taking into account transference and countertransference processes. The final phase of treatment is accompanied by a farewell letter, which is written jointly by the therapist and the patient. In the pre-conference workshop, the basics of DIT will be taught using many practical examples, and an initial exercise in psychodynamic case formulation will be carried out.

There are over 400,000 homosexual individuals in Hong Kong, who often encounter significant societal stigma, which contributes to their mental health challenges and might transform into internalised self-stigma. Understanding the interplay between sexual stigma, internalised self-stigma, community connectedness, and their attitudes of psychological help seeking by both quantitative and qualitative insights can contribute to their mental health and well-being. This study aims to investigate how does community connectedness within the Homosexual community impact their attitudes toward seeking psychological help and explore the attitudes of homosexual individuals towards seeking psychological help. The quantitative component involved 134 Hong Kong individuals, measuring the variables using validated scales. The qualitative component consisted of in-depth interviews with 4 – 6 participants to explore the key predictors, the diversity, multi-level contextual influences, collect personal narratives and investigate process moderating variables. Preliminary findings indicate that community connectedness within homosexual community is a moderator between internalised self-stigma and psychological help seeking attitudes (b = .291, p < .001); sexual stigma and psychological help seeking attitudes (b = -0.875, p < .001). This result also aligns with the hierarchical regression findings F(10,123) = 5.869, p < .001, R2 = .323. Further, the education level also plays a significant role towards the attitudes of psychological help-seeking (p < .05). Study highlights the community connectedness within the homosexual community, as it have a multifaceted nature of stigmatization's impact on their attitudes of psychological help-seeking. The findings have implications for mental health professionals on consider which therapies suit this population

Aim: This study examined juxtaposition in corrective emotional experiences (CEEs), which is recollecting past emotionally painful memories, evoking their emotional pain, and contrasting them with the current more positive emotional and relational experience with the therapist. Our goal was to identify what components are juxtaposed between past and present to successfully reach the completion of CEE. Methods: One successful case was selected from the database of an Emotion-Focused Therapy outcome research project in Japan. Corrective Emotional Experience Scale was used to identify that a major CEE occurred in Session 6th. We analyzed the session transcripts leading to this session using grounded theory analysis. We referred to data from post-session questionnaires as well as the client’s post-session diary entries. Results: The analysis identified three juxtapositions of past and present: past negative treatment by others and present positive treatment by the therapist, past negative self-treatment and emerging positive self-treatment, and past maladaptive emotions and beliefs and emerging positive emotional experience. The therapist and the client actively contrasted these two domains of experience as the client experienced emotions related to both at the same time. A process model of juxtaposition in CEEs was presented. Discussion: This study confirms clinical hypotheses that CEEs emerge through a juxtaposition of past and present experiences. Juxtaposition incorporates temporal dimensions (past and present), affective dimensions (painful and positive/healing), and relational dimensions (past hurtful and present healing). Future research needs to examine this process over time and across cases and refine the model accordingly.

Aim: Mental illness is highly prevalent (Kessler 2005), yet numerous structural and attitudinal barriers limit treatment access (Mojtabai 2011). Digital mental health interventions (DMHIs) aim to address these barriers by leveraging technology that can lower costs, remove the need for professional trained providers, and allow therapeutic interventions to be used privately and from anywhere. However, the uptake of DMHIs is low (Lorenzo-Luaces 2024). This study aims to identify distinct patterns of co-occurring barriers to DMHI uptake using latent class analysis. Understanding these patterns may help identify groups that experience compounding barriers to accessing care. Methods: Prolific users (n=995) completed an online survey regarding their DMHI use in the last year. Participants who disclosed not using a DMHI in the last year (n=729) were asked to select the reasons they did not use DMHIs from a checklist containing 19 reasons (e.g., "I didn’t really have a problem”, “I didn’t think it could replace therapy”). Latent class analysis will be used to identify groups of barriers to DMHI uptake. Data are collected; analysis will be completed prior to the conference. Expected Results: We hypothesize that four latent classes will emerge: financial barriers, attitudinal barriers regarding treatment broadly (e.g. stigma), negative attitudes about DMHIs specifically (e.g. believing DMHIs cannot replace therapy), and low barriers overall (e.g. low perceived need for treatment). Discussion: Identifying latent classes in the context of DMHI uptake may inform effective development, dissemination, and implementation of these tools, potentially improving uptake and accessibility of evidence-based mental health care.

The intersection of pregnancy and substance use disorder (SUD) presents a global public health challenge requiring trauma-informed and culturally responsive care. Across healthcare contexts, systemic barriers, punitive legal practices, and inequitable access to services contribute to adverse maternal and neonatal outcomes (e.g., drug-induced pregnancy-associated mortality; neonatal abstinence syndrome). This qualitative study examines protective and risk factors within one state’s maternal healthcare system (Utah, United States) that shape the perinatal and postpartum experiences of women with SUD, with implications for international psychotherapy practice and policy. Narrative data were collected through story circles, a narrative medicine method that creates supportive spaces for shared meaning-making, and individual writing activities with women receiving care at residential treatment facilities. These narrative approaches elicited detailed reflections on healthcare encounters and birth experiences. Data were analyzed using template analysis. Findings reveal that systemic inequities, including mandatory reporting policies and fragmented care systems, perpetuate fear, disengagement, and adverse health outcomes. In contrast, trauma-informed and culturally responsive models, including integrated prenatal clinic and peer recovery networks, function as protective factors by fostering therapeutic alliance, continuity of care, and psychological safety. By centering the voices of women with lived experience, this study offers a transferable framework for examining how legal, social, and healthcare structures shape perinatal mental health outcomes. Implications include the need for non-stigmatizing, patient-centered approaches and offer actionable insights to inform policy and practice aimed at improving maternal and neonatal outcomes and well-being of marginalized birthing populations across diverse cultural and legal settings.

The aim of this study is to conceptualize the lullaby as an early affective regulation space mediated through sound and to examine how early auditory experiences are reflected in self-development and implicit relational processes within psychotherapy. The study proposes reimagining psychotherapy not solely as a verbal and meaning-based practice, but as a relational process shaped by voice, rhythm, prosody, and the experience of being heard. This paper presents a theoretical and conceptual analysis. Drawing on Allan Schore’s right-brain-based model of affect regulation, Daniel Stern’s concept of vitality affects, Winnicott’s notion of the holding environment, and Anzieu’s Skin-Ego theory, the lullaby is explored as an early relational auditory environment. In addition, the psychodynamic psychotherapy literature on the clinical roles of voice, tone, and silence is reviewed from an integrative perspective. The analysis suggests that the lullaby constitutes a relational space in which sound becomes the first regulatory object. These early auditory experiences shape patterns of self-regulation through implicit memory processes and may be reactivated in adulthood within the psychotherapeutic relationship through the therapist’s voice, rhythm, and use of silence. Clinical observations indicate that sensitivities related to not being heard and difficulties in affect regulation may be associated with these early sound–self experiences. This study highlights the central role of sound and silence in psychotherapy and conceptualizes the therapeutic relationship as an acoustic and relational regulation space beyond verbal meaning-making.

The purpose of this study was to explore the loss experiences of young and middle-aged adults with type 2 diabetes and to examine the resilience-related roles and impacts of social support systems. A qualitative narrative research design was adopted. In-depth interviews were conducted with one young-to-middle-aged adult diagnosed with type 2 diabetes, and data were analyzed using a holistic–content narrative approach. The findings indicate that the participant known’s loss experiences can be understood as a gradual psychological process embedded within the overall life narrative. The experience began with the discovery of the illness, triggered by sudden weight loss, followed by surprise at the diagnosis and active efforts to identify its causes in the absence of a family history or unhealthy dietary habits. As the disease progressed, multiple life domains were affected, including disruptions to daily routines and academic life, restrictions related to diet and exercise, and heightened emotional sensitivity. In interpersonal interactions, concern and involvement from family and friends functioned as both sources of support and pressure, requiring repeated explanations of the illness. The diagnosis also led to adjustments in physical condition, eating habits, and social activities, such as reduced physical stamina, dietary control, and limited travel. When considering future employment, the participant prioritized work that balanced health needs and life rhythm while minimizing physical and psychological burden. Regarding the resilience role of social support systems, multiple sources contributed to sustaining and strengthening resilience. Personal coping strategies (e.g., dietary management, exercise adjustment, emotional regulation, and information seeking), practical and emotional support from family and friends, guidance and reassurance from healthcare professionals, and shared experiences from online peer communities collectively facilitated adaptation, hope, and proactive life adjustment. Overall, social support systems enhanced resilience in diverse ways, enabling the individual to gradually regain a sense of control amid loss and ongoing challenges. This study aims to deepen public and professional understanding of this population and to promote more responsive medical and mental health support. Keywords: Type 2 Diabetes; Young and Middle-Aged Adults; Loss Experiences; Recovery

Aim: While the therapeutic alliance has already been identified as a predictor of treatment success in physiotherapeutic interventions for chronic back pain, there is no research available in the context of psychotherapeutic treatments. The present study aims to address this research gap by examining the influence of the therapeutic alliance in the psychotherapeutic treatment for chronic back pain. To account for the variety of available instruments designed to assess the therapeutic alliance, the study incorporates both self-report and observer-report measures. Given the original psychodynamic conceptualization of therapeutic alliance, the study additionally includes a measurement specifically developed on the basis of this theoretical framework. Methods: As part of a multicenter clinical intervention study, 392 patients diagnosed with chronic back pain were randomly assigned to receive ten sessions of either Cognitive Behavioral Therapy or in vivo exposure. In every third session, patients completed the WAI-SR. Video-recorded therapy sessions from 129 patients were randomly allocated to eight trained rates, each of whom rated three sessions using the WAI-O and the short form of the VTAS-R to assess the therapeutic alliance. Treatment outcomes were measured using the DSF and the PDI at baseline, post-treatment, and follow-up assessments. Results: Data is currently being collected. Discussion: To our knowledge, this is the first study to examine the role of the therapeutic alliance in the treatment of chronic back pain using a large sample. Moreover, the separate analysis of self-report and observer-based measures will provide insights into the predictive validity an comparability of the instruments used.

Community mental health clients rarely present with isolated identity factors (Butler et al., 2025). Rather, they embody complex, intersecting demographics that may be linked to therapeutic process and engagement (e.g., Hays, 2024; Leaf et al., 1987). Existing research often analyzes variables like ethnicity, gender, and SES in isolation, potentially obscuring the cumulative impact of intersectional identities on treatment outcomes (e.g., Cougle & Grubaugh, 2022; Finegan et al., 2018; Ogden & Hagen, 2009). The present study utilizes cluster analysis to move beyond univariate predictions to create distinct, multivariate profiles to predict treatment trajectories. Using archival data from over 40,000 cases at a community mental health agency in Canada, we will stratify clients based on interacting factors such as age, gender, ethnicity, and SES indicators. We will analyze clusters based on three benchmarks: initial distress (as measured with the OQ-45), early termination, and change in OQ-45 scores over the course of treatment. Our goal is to identify which demographic combinations are most vulnerable to undesirable outcomes and which benefit the most from treatment. By identifying at-risk client personas, we can move beyond generic retention strategies and toward precision care. These findings will serve as the foundational feature engineering layer for the development of an automated client-therapist matching system, adding explainability and ensuring algorithmic assignments are sensitive to the nuanced realities of clients’ intersecting identities.

Mental health awareness and access to culturally responsive psychological services remain underdeveloped in the South Pacific (Allen et al., 2016), including in the Republic of the Marshall Islands (RMI). While spirituality and indigenous traditions often play central roles in emotional healing across Micronesian cultures, limited empirical research has examined how Marshallese individuals perceive mental health concerns, therapeutic practices, and culturally grounded healing strategies. The present qualitative study seeks to address this gap by exploring Marshallese adults’ understandings of mental health, preferred healing practices, and perceptions of counseling services. Interpretive Phenomenological Analysis (IPA) will be utilized as a qualitative approach to analyze 8 in-depth, semi-structured interviews with native Marshallese participants. Interviews were conducted in Marshallese in the Marshall Islands by a fluent Marshallese speaker. They were then transcribed and translated (as well as back-translated for accuracy) by a research team of Marshallese speakers into English for analysis. Preliminary analyses were gathered yielding various themes related to perceived causes of mental health challenges; experiences with spiritual, cultural, and indigenous healing practices; perceptions of counseling effectiveness; and expectations for psychological services. Only two participants reported prior therapy experiences, and most expressed greater confidence in spirituality—rather than therapy or indigenous practices—as a means for alleviating emotional distress. Additional findings are forthcoming and will be available by the time of the conference. The results of this study can possibly assist Marshallese clients in feel culturally and spiritually-connected to psychotherapy.

Background: Traditional masculine norms, particularly those emphasizing self-reliance and emotional control, often serve as significant barriers to men’s psychological help-seeking. While prior research has established these associations, the underlying psychological mechanisms remain underexplored in East Asian contexts. This study examined a parallel mediation model to investigate how masculine role norms influence help-seeking intentions through emotion regulation strategies—cognitive reappraisal and expressive suppression—within the context of intimate relationship conflict in Taiwan. Methods: A cross-sectional design was employed, recruiting 225 Taiwanese adult men through online sampling. Participants completed a context-adapted General Help-Seeking Questionnaire (GHSQ) framed within a high-conflict scenario (discovery of a partner’s infidelity). Additional measures included the Conformity to Masculine Norms Inventory (CMNI-30) and the Emotion Regulation Questionnaire (ERQ). Exploratory Factor Analysis (EFA) supported construct validity, indicating robust factor structures in the current sample. Data were analyzed using Hayes’ PROCESS Model 4 to test for parallel mediation, supplemented by stepwise regression to identify key predictive masculine norms. Age was controlled as a covariate in all analyses. Data were analyzed using Hayes’ PROCESS Model 4 to test parallel mediation, supplemented by stepwise regression to identify key predictive masculine norms. Age was controlled as a covariate in all analyses. Results: Preliminary analysis indicated that psychological aggression was the most prevalent form of relationship conflict (average 20.4% endorsement per item), followed by monitoring/controlling behaviors (18.4%) and physical aggression (10.0%). Correlation analyses showed that conformity to emotional control norms was significantly associated with lower help-seeking intentions (r = −.36, p < .001). Mediation analyses revealed that emotional control norms predicted lower cognitive reappraisal (β = −.21, p = .001) and higher expressive suppression (β = .18, p = .007). Critically, only the indirect effect via expressive suppression was significant (effect = −.05, 95% CI [−.10, −.01]), whereas the pathway through cognitive reappraisal was not (effect = −.01, 95% CI [−.05, .02]). The direct effect remained significant (β = −.29, p < .001), indicating partial mediation. Discussion Findings suggest that expressive suppression—rather than cognitive reappraisal—is the primary mechanism linking masculine emotional control norms to reduced help-seeking intentions among Taiwanese men. In the context of intimate conflict, the inhibition of emotional expression appears to serve as a more proximal barrier to seeking support than cognitive processing abilities. These results underscore the importance of addressing culturally reinforced norms around emotional expression. Interventions in East Asian contexts may benefit from reducing the perceived threat of vulnerability and fostering safer conditions for emotional disclosure, rather than focusing solely on cognitive reappraisal skills. Keywords: Intimate relationship conflict, masculine role norms, emotion regulation, help-seeking intention

Aim: Prior research suggested that the impostor phenomenon (IP) mediated the association between self-concealment and mental health among sexual minority adults. However, it remains unclear how the other coping strategies of LGB individuals (e.g. sexual identity disclosure) jointly operate in this process. This study tested the mediation role of IP separately among heterosexual individuals, LGB individuals with and without disclosure experience. Methods: A total of 269 Japanese participants (132 heterosexual and 137 LGB) completed a battery of self-report measures assessing IP, self-concealment, mental health (depression and anxiety), disclosure- and LGB identity-related items. Results: Analyses of variance showed that, compared with heterosexual individuals, LGB participants reported higher levels of depression and state anxiety. In addition, disclosure-inexperienced LGB participants exhibited higher levels of self-concealment. Disclosure-experienced LGB participants showed higher levels of IP, whereas no group difference was observed in its prevalence. Moreover, Muti-group mediation analyses indicated different mediation patterns across groups. Specifically, partial mediation was found for heterosexual participants, full mediation for disclosure-experienced LGB participants, and no significant mediation for disclosure-inexperienced LGB participants. Discussion: These findings may be useful for mental health professionals working with Japanese LGB individuals by treating IP as a key clinical indicator for understanding the situational meanings and functions of self-concealment across disclosure stages. Such an approach may help LGB individuals foster engage in context-sensitive and flexible disclosure decision-making, thereby reducing the impact of IP on mental health.

This study aims to identify the psychological effects of “environmental transition” (Wapner et al., 1973), which refers to the changing relationship between individuals and their environment that accompanies university enrollment. An online questionnaire survey was administered every two weeks from late March, prior to the start of school, until July, when the first semester ended, to 18- to 22-year-olds who were scheduled to enter university in April 2025. In total, 370 participants completed the survey. The main components of the questionnaire were as follows: (1) items assessing aspects of environmental transition (e.g., moving and living arrangements), (2) the Emotional Arousal Checklist (EACL; Oda et al., 2015), and (3) the Kessler Psychological Distress Scale (K10; Kessler, 2002). To indicate their initial reactions to the environmental transition, the participants were classified into three groups based on differences in their K10 scores between late March and early April: improved, worsened, and unchanged. We then analyzed the subsequent trajectories of K10 and EACL scores across these groups. The results suggested that the groups differed in the change patterns associated with their mental health and emotional experiences over time. These findings indicate that early fluctuations in psychological distress may be associated with later differences in emotional states and mental health trajectories during the transition to university life. This study provides insights that may be useful for understanding students’ psychological adjustments during this period. Keywords:environmental transition, university students, mental health

Chronic pain is a complex condition that is frequently associated with impairments in personality functioning. Current clinical guidelines therefore recommend multiprofessional and interdisciplinary treatment approaches. Drawing on the alternative model of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Eleventh Revision (ICD-11), an integrative treatment manual was developed for use within the interdisciplinary, multimodal day-clinic pain program at the Orthopedic Clinic of Heidelberg University Hospital. The day-clinic population comprises patients with medically unexplained chronic pain as well as patients with chronic pain related to osteoarthritis. The manual is designed to specifically address core domains of personality functioning, including emotion regulation, identity, empathy, and interpersonal relationships, through a combination of individual and group-based interventions grounded in a mentalization-based therapeutic framework. To explore the feasibility and implementation of the manual in clinical practice, a qualitative focus group study with members of the interdisciplinary treatment team was conducted. Results indicated good overall applicability of the manual and high satisfaction among team members. Importantly, the manual facilitated the development of a shared conceptual language across professional disciplines, which was perceived as beneficial for interdisciplinary collaboration and therapeutic interaction within the treatment setting.

Aim: Sleep difficulties and elevated stress are common among individuals recovering from substance use disorders (SUDs), often persisting long after initial detoxification. Music-based interventions offer a low-risk, nonpharmacological option that may support sleep and stress regulation. This study examined whether a Structured Music Listening Protocol (SMLP) could improve sleep quality and reduce perceived stress within a residential SUD treatment program. Methods: Fifty eligible patients were enrolled in the Intervention Group (SMLP – Structured Music Listening Protocol) and fifty in the Control Group (Standardized Therapy) from a residential treatment center for SUDs. Both groups received standard therapy from the center, the intervention group used SMLP nightly. Sleep quality and perceived stress were measured weekly across four timepoints using the Sleep Quality Scale and the Perceived Stress Scale. Linear mixed-effects models assessed changes over time and Group × Time interactions. Estimated marginal means and planned comparisons further examined group differences. Results: Significant main effects for Time emerged for both perceived stress and sleep quality. The Group × Time interaction was not statistically significant for either outcome; however, planned comparisons showed that the music group demonstrated significantly lower perceived stress than the control group at later timepoints. No significant group differences were found for sleep quality. Discussion: SMLP appears to be a safe and feasible adjunct to standard care but does not have an obvious additional effect. Future research could examine whether SMLP is effective as a standalone intervention or investigate its impact on other substance-use-related stressors, such as cravings.

The present study explored themes of self and relationships that emerged in dream sessions of Asian international students. Fourteen international students who had moved to the United States within one year participated in single-session dream work using the Hill (2004) dream model. Drawing from the Hill (2004) model, participants explored three to five salient dream images, collaboratively interpreted the meaning of their dreams, and generated concrete ideas for changes they could implement in their lives. The research team identified, by consensus, all dream session segments in which participants discussed self, relationships, and related coping strategies. These excerpts were analyzed using Consensual Qualitative Research (CQR; Hill et al., 2005) by a coding team and an auditor. Qualitative analyses revealed that participants typically discussed low self-esteem, lack of self-competence, feeling of helplessness, and negative self-image during dream sessions. In terms of themes related to relationships, participants typically discussed difficulties maintaining connections with family, partners, and friends in their home countries due to physical distance, feelings of criticism from family members, interpersonal conflicts with friends in the United States stemming from cultural differences, and loneliness from limited meaningful connections. Coping strategies to address self- and relationship-related issues included using positive self-talk to foster self-acceptance and confidence, increasing communication with family, friends, and partners in their home countries, and adopting proactive approaches to forming new relationships in the United States. Implications for counseling practice and future research will also be presented.

Background: Psychological problems can be conceptualized as complex, dynamic networks. Network Control Theory (NCT) provides methods to quantify intervention effects on dynamic systems and might provide approaches to identify optimal treatment targets and intervention strategies. Objective: This study formulates a proof-of-concept approach to applying NCT to ecological momentary assessment (EMA) data from patients with anxiety and depressive disorder. Method: EMA data from 20 patients ((13 women, M age = 39 years), with depression or anxiety disorders were modelled using a discrete-time, linear dynamic system model (LDS). Effects of 31 evidence-based interventions were estimated through nomothetic knowledge and via an expert-coded intervention-process-dimension matrix. Within the framework of NCT we select two controllability metrics that provide means to quantify the theoretical impacts of an input, e.g. therapeutic intervention. The metric of average controllability (AC) was calculated, which quantifies intervention efficiency for system-wide change. The metric of cumulative impulse response (CIR) was applied to assess quantity and direction of change per EMA variable following intervention. Results: interventions with elevated AC values could be identified, that seem appropriate in the broader context of research. Uncertainty exists work regards to clinical meeting as we found differences between interventions recommended by NCT metrics and what therapist actually did. Conclusion: It remains an open empirical question whether NCT metrics can reliably identify interventions that produce clinically meaningful outcomes. This proof-of concept approach demostrates the applycation of NCT through provisional input specifications and outlines future directions for refining and empirically validating these estimates

Contemplative practices, both secular and religious, have gained increasing scientific attention for their capacity to shape cognition, emotion, and well-being through measurable effects on the brain. Yet, despite parallel research traditions, the neural mechanisms that differentiate mindfulness meditation from religious forms of prayer remain insufficiently understood. This study provides a direct neuroscientific comparison between secular mindfulness and Christian religious meditation identifying their shared neural features as well as the mechanisms that distinguish them. Using a mixed ANOVA design (within factor time pre/post intervention; between factor mindfulness/religious group), twenty-four meditation-naïve adults participated in either a 5-day Mindfulness-Based Stress Reduction (MBSR) retreat or a 5-day retreat of Ignatian Spiritual Exercises. Structural and functional magnetic resonance imaging (MRI) data were collected one week before and after the interventions. Voxel-Based Morphometry (VBM) revealed significant increases in gray matter density across both groups in occipital, insular, and frontal regions, indicating that short, intensive contemplative practice—independent of spiritual content—promotes rapid structural neuroplasticity. In contrast, resting-state Independent Component Analysis (ICA) revealed a marked divergence in functional effects: within the Frontostriatal Control Network, the mindfulness group showed increased functional connectivity, whereas the Ignatian group showed a significant decrease. These opposing patterns suggest that mindfulness strengthens top-down regulatory processes, while Ignatian prayer may rely on a deliberate reduction of executive control to facilitate receptivity, surrender, and absorptive spiritual states. Together, these findings demonstrate that even though both practices support structural brain plasticity, they operate through fundamentally different functional pathways; supporting componential models in contemplative neuroscience and challenging modular interpretations of spiritual cognition.

Coming out, the process of disclosing one’s LGBTQIA2S+ identity, to parents is common among sexual minority youth (Rosario et al., 2009). Parental responses to a child’s coming out play a critical role in queer youths’ mental health: parental support functions as a key protective factor (Ryan et al., 2010), whereas parental rejection has been linked to poorer identity development and adverse health outcomes (Katz-Wise et al., 2016). Research further indicates that LGB youth with ethnic minority parents report higher parental rejection than those with ethnic majority parents (i.e., White, non-Hispanic; Richter et al., 2017). Despite parents’ central role in queer youths’ mental health and identity integration, parental perspectives on navigating a child’s coming out, particularly within racial and ethnic minority immigrant families, remain largely underexplored (Choubak, 2014). This presentation synthesizes existing literature on parental coming out experiences and cultural and immigrant minority parenting factors providing a conceptual foundation for a work-in-progress qualitative study. This study will draw on semi-structured interviews with racial and ethnic minority immigrant parents of lesbian or gay children in Canada to explore these parents’ experiences of their child’s coming out, the challenges they encounter, and the coping strategies they use in the process of acceptance. The focus on parents of lesbian and gay children reflects differences in coming out processes and lived experiences compared to other sexual identities. Findings may inform culturally responsive psychotherapy by enhancing clinicians’ understanding of immigrant parents’ experiences and supporting more effective therapeutic engagement with both parents and their queer children.

Background: Depression is highly prevalent, and its early detection is of great relevance for clinical practice. Smartphones, widely used in daily life, enable the passive collection of behavioral data. Digital phenotyping, as a form of passive ecological momentary assessment (EMA), captures real-time, in-context behavioral signals without requiring active self-report. This method continuously monitors patterns such as screen activity, mobility, and device movement, offering an objective, low-burden approach to mental health monitoring. However, studies using smartphone-based passive EMA to detect depression remain limited, particularly in low- and middle-income countries. Aim: This study aims to examine the association between passively collected behavioral markers from smartphones and depressive symptomatology in a university population. The project evaluates screen state patterns, geographical mobility, device acceleration, and touch interactions to identify behavioral indicators linked to depression. Methods: An observational pilot study will be conducted with 40 students over 14 days. Participants will use the AWARE app to collect sensor data (screen events, GPS, accelerometer, touch interactions) and complete validated self-report measures (PHQ-9, BDI-II, WHO-5, GAD-7, QIDS-SR16). Data will be encrypted and stored on a secure server. Associations between passive behavioral metrics and depressive symptoms will be analyzed. Results: It is expected that higher active screen time, reduced geographical mobility, lower device acceleration, and increased touch interactions will be associated with greater depressive symptomatology. Discussion: This study will provide local evidence on the feasibility of digital phenotyping in Argentina and its potential to complement clinical assessments for earlier mood detection.

Aims: This study investigates the role of attachment-related patterns in shaping the therapeutic alliance during the early stages of psychotherapy. Specifically, it examines how individual patterns of attachment (PA) of both patients and therapists in training affect the perception of the working alliance (WA). Method: The sample consists of therapists (n=35) in training and their patients (n=35) from the Psychotherapeutic Outpatient Clinic for Adults of Sigmund Freud University Vienna. Data collection employs standardized instruments that are administered at multiple points in the therapeutic process. Attachment patterns are assessed using the ECR-RD (anxiety, avoidance), completed by both patients and therapists prior to therapy initiation (T1). Additionally, both patients and therapists in training complete the Working Alliance Inventory (WAI) (bond, task, goal) after each of the first ten sessions. Correlations between PA (anxiety, avoidance) und (WA) (bond, task, goal) were conducted (1) for therapists and (2) patients. Results: For therapists anxiety is correlated with bond (session1 (r=.46,p=.026), session5 (r=.45,p=.055), session10 (r=.39,p=.140)); avoidance with bond (session1 (r=.44,p=.041), session5 (r=.27,p=.270 ), session10 (r=.29,p=.269)); correlations between PA and task or goal show no effects (r.< .10,p>.05). No relevant correlations were observed in patients (r.< .10,p>.05). Discussion: These preliminary findings indicate that attachment-related patterns significantly influence perceptions of the working alliance (bond), especially for therapists and not for patients. Possible explanations and implications for therapist education are discussed.

Aim Adolescents living through large-scale crises increasingly present in clinical settings with war-related worries, low mood and anxiety. Clinical theories of filial responsibility suggest that the objective burden of caregiving is less detrimental than perceived family unfairness—the feeling that one’s contributions are unequally shared or unacknowledged. We hypothesized that perceived unfairness acts as a barrier, intensifying distress and limiting the capacity to channel war-related concern into adaptive, prosocial engagement. Methods In a longitudinal three-wave study of Polish adolescents ($N = 281$; ages 16–18), data were collected between the second year of the COVID-19 pandemic (November 2021) and the first months of the Russia-Ukraine war (May 2022). Participants completed measures of depressive and anxiety symptoms (PHQ-9, GAD-7), war-related concerns, prosocial behaviors toward refugees, and the fairness subscale of the Filial Responsibility Scale–Youth. Moderation models tested whether perceived family unfairness altered the associations between war-related concerns and both emotional distress and prosocial actions. Results Moderation analyses revealed distinct pathways based on family dynamics. War-related concerns predicted higher depressive and anxiety symptoms only among adolescents reporting medium-to-high family unfairness; this association was non-significant under conditions of low unfairness. Conversely, war-related concerns predicted increased helping behavior toward refugees only when adolescents perceived their families as fair. Under conditions of high unfairness, high levels of concern failed to translate into prosocial action. Discussion Findings identify family unfairness as a barrier that blocks the channeling of empathy into resilience-building agency. For clinicians, this underscores the necessity of assessing the family "justice structure." Systemic interventions fostering reciprocity may be crucial innovations to reduce distress and unlock adolescents' capacity for prosocial engagement amidst political and cultural crises.

Theory Perfectionism is a multidimensional construct, comprising trait, state and behavioral components (Comprehensive Model of Perfectionistic Behavior, Hewitt et al., 2017). The state component, perfectionistic cognitions, reflects automatic thoughts that are activated when a discrepancy between real and ideal self is perceived. These thoughts typically focus on excessively high standards and anticipated failure. They are clinically relevant, acting as a vulnerability factor for depression and explaining additional variance in depressive symptoms beyond trait perfectionism. The Perfectionism Cognitions Inventory (PCI; Flett et al., 1998) measures perfectionistic cognitions and is a widely used unidimensional measure. However, no validated German version exists. This study aimed to translate a short form of the PCI into German and evaluate its psychometric properties. Method The PCI items were translated following the stepwise procedure by Wild et al. (2005), resulting in the Perfectionism Cognitions Inventory-10-German (PCI-10-G). Patients of the Psychosomatic Outpatient Clinic in Duesseldorf and healthy participants completed web-based questionnaires assessing perfectionistic cognitions, trait perfectionism, self-criticism, depressive and anxiety symptoms, and personality functioning. Psychometric properties (reliability, factor structure, construct and criterion validity) were examined. Results The PCI-10-G demonstrated good to excellent reliability. Scores correlated highly with trait perfectionism and self-criticism, and moderately with symptom burden and personality functioning. Discussion Results are discussed to examine whether the PCI-10-G can be considered a reliable and valid measure of state perfectionism within the broader multidimensional perfectionism framework.

Autistic college students often require many more counseling sessions to achieve outcomes comparable to non-autistic peers. Given the co-occurrence of ASD and anxiety, a plausible mechanism for this difference is heightened in-session stress. This pilot study examines whether physiological stress during counseling differs for autistic students and whether this relates to perceived stress, treatment dose (sessions attended), and clinical outcomes. Participants are college students receiving counseling at a university center. During sessions, students wore the Empatica E4 wristband, which continuously records autonomic signals associated with stress. These include heart rate, heart rate variability, and electrodermal activity. Baseline physiological measurements were obtained out of session and students completed questionnaires assessing perceived levels of stress during the sessions. A comparison group of matched students without ASD completed the same protocol, adjusting for age and gender. We will compare physiological responses across sessions and between groups, along with associations with perceived stress, number of sessions, and outcome change. Analyses are currently underway. We hypothesize that autistic students will show higher in-session physiological arousal than non-autistic peers, and that higher arousal will be associated with greater perceived stress and slower therapeutic progress. By integrating wearable psychophysiological monitoring with routine outcome tracking, we hope to illuminate barriers to psychotherapy progress and inform adaptations that may improve engagement and outcomes for autistic clients. This pilot also supports the feasibility of wearable physiological monitoring for psychotherapy process research.

Background: Experiencing chronic stress during childhood can undermine both psychophysical health and the ability to de- velop and nurture supportive social relationships. This study explored the impact of an enactive–playful intervention on stress regulation and social integration among school-aged children. Methods: Forty-one preadolescents (ages 10–11years) from a public school in Bariloche, Argentina, were assigned to either an intervention group (IG; n = 23) or a waitlist group (WG; n = 18). The IG participated in weekly 1-h sessions over 6 months, where interoceptive and mind–body awareness practices, collaborative games and reflective instances took place. Outcomes were assessed using hair cortisol concentration (HCC), sociometric measures of peer preference and semi-structured interviews. Results: Post-intervention results showed a significant decrease in HCC in the IG (p=0.01), with no significant change in the WG. Social preference improved significantly in the IG (p=0.02), while it declined in the WG (p=0.00). Thematic analysis of interviews with children revealed four key themes: enhanced well-being, emotional awareness and self-regulation, increased engagement and agency and improved social relationships. Many participants reported using the practices outside school and sharing them with family members. Teacher feedback further confirmed positive changes, including students' autonomous use of the practices and greater emotional support within the classroom. Conclusions: These findings highlight the potential of embodied, enactive interventions to reduce stress and strengthen peer relationships in school settings. As well as, fostering the potential of body-oriented innovations in child psychotherapy. To our knowledge, this is the first study to analyse this kind of intervention in this age group using a mixed-methods approach, which integrates physiological, behavioural and experiential data. keywords: : agency | chronic stress

Background: Clients’ expectations for therapy not only predict treatment outcomes but also play an important role in preventing premature termination (Dew & Bickman, 2005). This study examined how clients’ session experiences influence their positive expectations toward the next session. Methods: Data were drawn from an ongoing outcome and process study of emotion-focused therapy (EFT) in Japan, in which 31 clients received a 16-session individual treatment. Using the Japanese Client Feedback Inventory, pre-session outcomes (Expectation) were treated as dependent variables, and previous-session process variables (Therapeutic Gain, Hope, Discordance, Relationship) as independent variables. Exploratory factor analysis was conducted to reorganize subscales, and linear mixed-effects models were applied to account for sessions nested within clients. The hypothesis was that the therapeutic relationship would more strongly predict positive expectations than session-specific gains. Results: Therapeutic gain and the therapeutic relationship significantly predicted positive expectations for the next session, whereas hope did not show significant effects. Discordance demonstrated a significant interaction with session time, indicating that its influence changed as treatment progressed. Discussion: Future work will refine the model to deepen understanding of how expectations evolves longitudinally across therapy, contributing to the clarification of therapeutic processes.

Background: Previous research suggests that clients' expectations for therapy are shaped by how they experience preceding sessions. Given that psychotherapy is theorized to progress through distinct stages (Hill & Lambert, 2004), this study aimed to examine how the process factors influencing outcome expectations change over time. Specifically, we investigated how the impact of session experiences shifts across the early, middle, and late phases of treatment. Methods: Data were derived from an Emotion-Focused Therapy (EFT) study in Japan (16 sessions). The treatment was divided into three stages: Early (Sessions 1–5), Middle (6–11), and Late (12–16). Using the Japanese Client Feedback Inventory (Sugiyama et al., 2018), four process subscales (Therapeutic Gain, Hope/Expectation, Discordance, and Relationship) were treated as independent variables, while the pre-session Outcome scale (Effectiveness/Expectation) served as the dependent variable. We calculated estimated marginal means for each stage and employed Linear Mixed Models (LMM) to examine the interaction between session stage and process factors. We hypothesized that an early secure "Relationship" and "Discordance" in the early/middle stages would enhance "Effectiveness/Expectation." Results: Estimated means for "Gain," "Discordance," and "Relationship" increased significantly from the middle to the late stage. LMM analysis revealed a significant trend toward an interaction effect specifically for "Therapeutic Gain" across the therapy stages. Discussion: Findings suggest that clients’ perceptions of their session experiences become more multifaceted as therapy progresses. Furthermore, the varying impact of "Therapeutic Gain" depending on the stage suggests that how clients internalize progress is closely linked to their expectations for subsequent sessions.

The Experiential God Representation Scale (EGRS) is a 14-item measure designed to assess how an individual experiences God. It contains two subscales: demandingness and responsiveness, adapted from the work of Baumrind (1966) and Maccoby & Martin (1983) on parenting styles. Preliminary item analysis was conducted on pilot data (N = 29), examining reliability (Cronbach’s α = 0.822; 0.819) and internal discriminant validity using exploratory factor analysis. Limitations and considerations for further development and validation of the EGRS are discussed. The EGRS may provide a useful tool for examining how an individual's experience of God relates to various mental health factors. Keywords: God representation, Measurement