BACKGROUND: Psychotherapy outcomes are typically measured in terms of symptom relief. However, this method might overlook important changes from clients' perspectives when they are asked to report on them. A more client-centred approach might bring a deeper understanding of psychotherapy outcomes. We aimed to evaluate the outcomes identified by clients within qualitative psychotherapy research. METHODS: The PsycArticles, PsycInfo, and MEDLINE Complete databases were searched for English language studies published until Nov 11, 2023. Additional studies were identified through references in the primary studies and previous meta-analyses or systematic reviews. Search terms were related to psychotherapy and counselling, clients' or patients' experiences, psychotherapy outcomes and changes, post-treatment perspectives, and types of qualitative methods. Qualitative studies on client-identified outcomes of individual psychotherapy were included. Findings related to clients' perceptions of psychotherapy outcomes were extracted (by ML and checked by TR and LT) and analysed (by all authors) using the descriptive-interpretative meta-analytic approach. All authors have personally experienced psychotherapy as clients. This study was pre-registered with PROSPERO (CRD42021277330). FINDINGS: We included 177 studies in the qualitative meta-analysis, from 24 countries, including descriptions from 2908 clients. Most of the studies were of good quality; they covered a wide range of therapeutic approaches and diagnoses. The descriptions of psychotherapy outcomes were classified into 60 meta-categories and grouped into ten clusters. These clusters related to clients' relational and social functioning; their emotional functioning; self-awareness, self-understanding, and more adaptive cognitive processing; behavioural functioning; developing their own resources; clients' attitudes towards themselves; generally embracing life; symptom and problem change; and more general wellbeing. The tenth cluster was outcomes that could not be clearly attributed to psychotherapy, which was considered outside the scope of this study. INTERPRETATION: The meta-analysis showed that clients value outcome dimensions beyond symptom reduction, such as deeper self-understanding, enhanced self-agency, and greater social engagement. By examining psychotherapy outcomes across various diagnoses and therapeutic approaches, we highlight limitations in traditional outcome measures, showing the need for more comprehensive, client-centred assessment tools and the value of incorporating qualitative methods into understanding dimensions of change. FUNDING: European Union.

• MeSH
• Mental Disorders therapy   psychology   MeSH
• Qualitative Research MeSH
• Humans MeSH
• Psychotherapy * methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: The Cooper-Norcross Inventory of Preferences (C-NIP) is a brief, multidimensional measure of clients' therapy preferences. This study aimed to examine the factor structure and measurement invariance of the C-NIP. METHOD: Fifteen datasets (N = 10,088 observations) representing the C-NIP in nine language versions were obtained from authors of psychometric studies. Confirmatory factor analysis and exploratory structural equation modeling were used to analyze the data. RESULTS: None of the proposed models adequately fit the data. Therefore, a new model was developed that sufficiently fit most of the C-NIP version 1.1 datasets. The new model was invariant up to the strict and means levels across genders, ages, and psychotherapy experience but only up to the metric level across translations. CONCLUSIONS: The C-NIP can be used to compare men and women, people of diverse ages, and people with some vs. no experience with psychotherapy. Lower reliabilities of the C-NIP scales are a limitation.

• MeSH
• Adult MeSH
• Factor Analysis, Statistical MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Patient Preference MeSH
• Psychometrics * instrumentation   standards   MeSH
• Psychotherapy * standards   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: Dynamic systems theory and complexity theory (DST/CT) is a framework explaining how complex systems change and adapt over time. In psychotherapy, DST/CT can be used to understand how a person's mental and emotional state changes during therapy incorporating higher levels of complexity. This study aimed to systematically review the variability of DST/CT methods applied in psychotherapy research. METHODS: A primary studies search was conducted in the EBSCO and Web of Knowledge databases, extracting information about the analyzed DST/CT phenomena, employed mathematical methods to investigate these phenomena, descriptions of specified dynamic models, psychotherapy phenomena, and other information regarding studies with empirical data (e.g., measurement granularity). RESULTS: After screening 38,216 abstracts and 4,194 full texts, N = 41 studies published from 1990 to 2021 were identified. The employed methods typically included measures of dynamic complexity or chaoticity. Computational and simulation studies most often employed first-order ordinary differential equations and typically focused on describing the time evolution of client-therapist dyadic influences. Eligible studies with empirical data were usually based on case studies and focused on data with high time intensity of within-session dynamics. CONCLUSION: This review provides a descriptive synthesis of the current state of the proliferation of DST/CT methods in the psychotherapy research field.

• MeSH
• Humans MeSH
• Psychological Theory MeSH
• Psychotherapy * methods   MeSH
• Systems Theory * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Systematic Review MeSH

Objective: This study aimed to develop an updated brief self-report post-session measure, suitable for collecting systematic feedback on clients' session reactions in the context of measurement-based care (MBC). Method: The Session Reactions Scale-3 (SRS-3; 33 items) was developed by extending and adjusting the Revised Session Reactions Scale. In Study 1, the psychometric properties of the SRS-3 were tested on N = 242 clients. In Study 2, a brief version of the SRS-3 (SRS-3-B; 15 items) was developed using a combination of conceptual, empirical, and pragmatic criteria. In Study 3, the psychometric properties of the SRS-3-B were tested on a new sample of N = 265 clients. Results: Exploratory factor analysis supported the use of the SRS-3-B as a two-factor (helpful reactions, hindering reactions) or unidimensional (overall session evaluation) instrument. The SRS-3-B was meaningfully related to another process measure (Individual Therapy Process Questionnaire) both on the item and factor levels. Conclusions: The SRS-3-B is a reliable process measure to elicit rich and clinically meaningful feedback from clients within the MBC context and as a research instrument to assess the helpful and hindering aspects of therapy sessions.

• MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Psychometrics MeSH
• Psychotherapy * methods   MeSH
• Professional-Patient Relations * MeSH
• Self Report MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: A considerable number of clients report adverse or unwanted effects of psychological treatments. This study aimed to synthesize the findings of qualitative studies focused on what clients perceive as negative experiences in psychotherapy. METHOD: A database search was conducted to find primary studies, and a qualitative meta-analysis was used to aggregate the findings on the kinds of negative experiences psychotherapy clients reported. RESULTS: A total of 936 statements were extracted from 51 primary studies and categorized into 21 meta-categories, some of which were further divided into subcategories. These meta-categories covered clients' experiences, which fell into four broad clusters: therapists' misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment. CONCLUSION: Clients' negative experiences of psychotherapy are a vast and heterogeneous area, the breadth of which is not captured by any single study. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date.

• MeSH
• Qualitative Research MeSH
• Humans MeSH
• Psychotherapy * MeSH
• Professional-Patient Relations * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH

Mechanisms of change represent the cornerstone of the therapeutic process. This study aimed to investigate how network models could be used to test mechanisms of change at a group level. A secondary aim was to investigate which of the several hypothesized mechanisms (emotion regulation, interoceptive awareness, and acceptance) are related to changes in psychological well-being. The sample comprised adult patients suffering from psychological disorders (N=444; 70% women) from 7 clinical sites in the Czech Republic who were undergoing groupbased multicomponent treatment composed mainly of psychodynamic psychotherapy (lasting from 4 to 12 weeks depending on the clinical site). Data were collected weekly using the multidimensional assessment of interoceptive awareness, emotion regulation skills questionnaire, chronic pain acceptance questionnaire-symptoms and outcome rating scale. A lag-1 longitudinal network model was employed for exploratory analysis of the panel data. The pruned final model demonstrated a satisfactory fit. Three networks were computed, i.e., temporal, contemporaneous, and between-person networks. The most central node was the modification of negative emotions. Mechanisms that were positively associated with well-being included modification, readiness to confront negative emotions, activity engagement, and trust in bodily signals. Acceptance of negative emotions showed a negative association with well-being. Moreover, noticing bodily sensations, not worrying, and self-regulation contributed indirectly to changes in well-being. In conclusion, the use of network methodology to model panel data helped generate novel hypotheses for future research and practice; for instance, well-being could be actively contributing to other mechanisms, not just a passive outcome.

• Publication type
• Journal Article MeSH

Objective Negative effects (NEs) in group treatments remain an under-researched area. This study aimed to explore the prevalence of various types of NEs in a multicomponent group-based treatment and to determine their predictors. Method: A total of 330 patients participating in a multicomponent group-based treatment were recruited across seven clinical sites. At the end of treatment, the Negative Effects Questionnaire (NEQ) was used to measure NEs. Item-level descriptive analysis was conducted to explore the prevalence of various types of NEs, and structural equation modeling was used to determine predictors of these NEs. Results: The most frequently reported type of NEs was the worsening of symptoms, and the single most frequently reported item was the resurfacing of unpleasant memories. Predictors of NEs included the overall distress level, alexithymia, attachment avoidance, low working alliance, problem actuation, and worse outcomes; psychological mindedness was a protective factor. Conclusion: Patients who experience higher levels of distress at the beginning of treatment, who perceive the group working alliance as problematic, and who experience high in-session emotional arousal related to their problem seem to be especially prone to reporting NEs. Furthermore, the findings do not support the assumption that NEs are a prerequisite for therapeutic change.Trial registration: ISRCTN.org identifier: ISRCTN13532466.

• MeSH
• Depression * psychology   MeSH
• Humans MeSH
• Prevalence MeSH
• Surveys and Questionnaires MeSH
• Stress, Psychological * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Cíl. Škála Chronic Pain Acceptance Questionnaire (20položková verze) měřící přijetí chronické bolesti byla adaptována k měření přijetí obecných chronických obtíží pacientů klinických zařízení: Chronic Pain Acceptance Questionnaire – Symptoms. Tato studie popisuje českou adaptaci plné a zkrácené (CPAQ-S) verze škály. Vzorek. Finální vzorek sestával z 368 pacientů (71 % žen) ze sedmi klinických zařízení v České republice. Hypotézy. Předpokládaná dvoufaktorová struktura (Zapojení do aktivit navzdory bolesti a Ochota snášet symptomy) byla testována společně s dalšími teoreticky relevantními modely. Statistické analýzy. Byla použita ordinální konfirmační a následná explorační faktorová analýza. Výsledky. Žádný z testovaných faktorových modelů CPAQ-S-20 nebyl podpořen daty. Využití explorační faktorové analýzy nepřineslo žádnou přidanou informační hodnotu. Empiricky odvozená osmipoložková verze škály (CPAQ-S-8) byla charakterizována poměrně dobrými psychometrickými vlastnostmi i po zachování očekávané dvoufaktorové struktury tj., Zapojení do aktivit navzdory bolesti a Ochota snášet symptomy. Limity. Zatímco heterogenitu vzorku je možné vnímat jako silnou stránku studie, heterogenita různých typů obtíží, jimiž pacienti ve vzorku trpěli, mohla způsobit neuspokojivé fungování škály.

Objective. The Chronic Pain Acceptance Questionnaire – Symptoms (CPAQ-S, 20 items) measures patients’ acceptance of their symptoms. The questionnaire was created by reframing the Chronic Pain Acceptance Questionnaire-20 (CPAQ-20). This study describes the Czech validation of the full and short CPAQ-S forms. Sample and settings. The final sample consisted of 368 patients (71% female) recruited at seven clinical sites in the Czech Republic. Hypotheses. A hypothesized two-dimensional factor structure (Activity Engagement and Symptom Willingness) was tested together with other theoretically relevant factor solutions. Statistical analyses. An ordinal confirmatory and exploratory factor analysis were employed. Results. None of the theory-driven factor structures were confirmed in the CPAQ-S-20, and exploratory factor analysis did not yield any satisfactory factor solution. However, an eight-item version (CPAQ-S-8) was derived based on the factor analysis that was characterized by good psychometric properties even when retaining important facets of the expected two-factor structure (i.e., Activity Engagement and Symptom Willingness). Limitations. While the sample heterogeneity was conceived as a strength of the study, an underlying noninvariance across different types of complaints could have caused unsatisfactory functioning of the scale.

OBJECTIVE: Understanding the client perspective is important for the provision of psychotherapy. The significant events paradigm, within which clients report on the most significant events of a therapy session immediately after the session, represents a useful means to explore clients' in-session experience. METHOD: The aim of this study was to investigate what types of client-identified impacts are reported in qualitative studies on helpful and hindering events in psychotherapy. Seventeen primary studies focusing on client-identified helpful and hindering events were identified through database searches and subsequent manual searches. The data were subjected to qualitative meta-analysis. RESULTS: The descriptions of event impacts were classified into 12 helpful (e.g., gaining a new perspective on the self; feeling heard, understood, and accepted; and feeling engaged in the therapeutic process) and eight hindering (e.g., lacking guidance from the therapist and feeling emotionally overwhelmed) impact meta-categories. CONCLUSION: The findings provide an update to a previous meta-analysis by identifying several new categories of helpful event impacts and by categorizing hindering event impacts.

• MeSH
• Emotions MeSH
• Qualitative Research MeSH
• Humans MeSH
• Psychotherapy * MeSH
• Professional-Patient Relations * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Research Support, Non-U.S. Gov't MeSH

The Emotion Regulation Skills Questionnaire (ERSQ, 27 items) is an instrument designed to measure nine emotion regulation skills. This study examined the psychometric properties and longitudinal network structure of the Czech translation of the ERSQ in the clinical sample (primarily mood or neurotic disorders). Czech patients N = 427 completed the ERSQ weekly during treatment. The data were analyzed using confirmatory factor analysis (CFA) and network modeling. The CFA supported an eight-dimensional factor solution (with merged Acceptance and Tolerance subscales). The subscales' internal consistency ranged from ωh = .669 (Bodily sensations) to ωh = .859 (Acceptance/Tolerance). The factor structure was invariant across genders, two age groups, and seven measurement waves (invariance tested as an assumption for network analysis). The longitudinal network model indicated the existence of perceptive and modulatory clusters of emotional regulation skills and revealed the central role of Modification, Bodily sensations, and Readiness for confrontation in emotional regulation. The Czech translation of the ERSQ is a psychometrically sound instrument comparable to the original version. Despite the high internal consistency of the total score (ωtot = .910), the ERSQ is not recommended for use as a unidimensional instrument. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

• MeSH
• Adult MeSH
• Emotional Regulation * MeSH
• Humans MeSH
• Surveys and Questionnaires MeSH
• Psychometrics MeSH
• Reproducibility of Results MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH