Charles A. Kiesler shows that models of mental health policy based on health care policy have resulted in more expensive and less effective mental health services. Why Is There No Study of Cultural Equivalence inStandardized Cognitive Ability Testing?Janet E. Helms writes on the limits of the nature-versus-nurture debate about Black-White score differences on tests of cognitive ability.

Hundreds of psychotherapy outcome studies have demonstrated that people successfully change with the help of professional treatment (Lambert, Shapiro, & Bergin, 1986;Smith, Glass, & Miller, 1980). These outcome studies have taught us relatively little, however, about how people change with psychotherapy (Rice & Greenberg, 1984). Numerous studies also have demonstrated that many people can modify problem behaviors without the benefit of formal psychotherapy (Marlatt, Baer, Donovan, &

The transtheoretical model, in general, and the stages of change, in particular, have proven useful in adapting or tailoring treatment to the individual. We define the stages and processes of change and then review previous meta-analyses on their interrelationship. We report an original meta-analysis of 39 studies, encompassing 8,238 psychotherapy patients, to assess the ability of stages of change and related readiness measures to predict psychotherapy outcomes. Clinically significant effect sizes were found for the association between stage of change and psychotherapy outcomes (d = .46); the amount of progress clients make during treatment tends to be a function of their pretreatment stage of change. We examine potential moderators in effect size by study outcome, patient characteristics, treatment features, and diagnosis. We also review the large volume of behavioral health research, but scant psychotherapy research, that demonstrates the efficacy of matching treatment to the patient's stage of change. Limitations of the extant research are noted, and practice recommendations are advanced.

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This article introduces the journal issue devoted to the most recent iteration of evidence-based psychotherapy relationships and frames it within the work of the Third Interdivisional American Psychological Association Task Force on Evidence-Based Relationships and Responsiveness. The authors summarize the overarching purposes and processes of the Task Force and trace the devaluation of the therapy relationship in contemporary treatment guidelines and evidence-based practices. The article outlines the meta-analytic results of the subsequent 16 articles in the issue, each devoted to the link between a particular relationship element and treatment outcome. The expert consensus deemed 9 of the relationship elements as demonstrably effective, 7 as probably effective, and 1 as promising but with insufficient research to judge. What works-and what does not-in the therapy relationship is emphasized throughout. The limitations of the task force work are also addressed. The article closes with the Task Force's formal conclusions and 28 recommendations. The authors conclude that decades of research evidence and clinical experience converge: The psychotherapy relationship makes substantial and consistent contributions to outcome independent of the type of treatment. Clinical Impact StatementQuestion: What, specifically, is effective in the powerful psychotherapy relationship? Findings: Clinicians can use these meta-analytic conclusions and the practice recommendations of the Task Force on Evidence-Based Relationships and Responsiveness to provide what works in the relationship and simultaneously to avoid what does not work. Meaning: Based on original meta-analyses, experts deemed nine of the relationship elements as demonstrably effective, seven as probably effective, and one as promising. Next Steps: Future directions are to disseminate these findings to practice communities, to implement them in training programs, and to examine the interrelations of the effective elements of the relationship.

Psychotherapist empathy has had a long and sometimes stormy history in psychotherapy. Proposed and codified by Rogers and his followers in the 1940's and 1950's, it was put forward as the foundation of helping skills training popularized in the 1960's and early 1970's. Claims concerning its universal effectiveness were treated with skepticism and came under intense scrutiny by psychotherapy researchers in the late 1970's and early 1980's. After that, research on empathy went into relative eclipse, resulting in a dearth of research between 1975 and 1995 (Watson, 2001; Duan & Hill, 1996). Since the mid-1990's, however, empathy has once again become a topic of scientific interest in developmental and social psychology (e.g., Bohart & Greenberg, 1997; Ickes 1997), particularly because empathy came to be seen as a major part of "emotional intelligence" (Goleman, 1985). We believe the time is ripe for the reexamination and rehabilitation of therapist empathy as a key change process in psychotherapy (Bohart & Greenberg, 1997). Indeed, the meta-analytic results we will present clearly support such a conclusion. The most important development in the past 10 years, however, is the emergence of active scientific research on the biological basis of empathy, as part of the new field of social neuroscience (Decety & Ickes, 2009), which we will address briefly in the next section. Definitions and Measures Defining Empathy The first problem with researching empathy in psychotherapy is that there is no consensual definition (Bohart & Greenberg, 1997; Duan & Hill, 1996; Batson, 2009). Recent neuroscience research on empathy begins to clarify some of the conceptual confusion, as a result of the concerted efforts of researchers using a variety of methods ranging from performance tasks, self-report, and neuropsychological assessment to fMRI and transcranial stimulation. Research examining the brain correlates of different component subprocesses of empathy (Decety & Ickes, 2009) has extended the initial discovery of "mirror neurons" in the motor

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In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced.