Context-responsive psychotherapy integration applied to cognitive behavioral therapy.

Constantino, Michael J.; Goodwin, Brien J.; Muir, Heather J.; Coyne, Alice E.; Boswell, James F.

doi:10.1037/0000240-008

Cited by 15 publications

(16 citation statements)

References 29 publications

(35 reference statements)

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“…As should be clear, future research is needed to more precisely understand how ROM systems work, and to establish how best to achieve such positive effects in the most efficient manner. Thus, at present, perhaps the best method for maximizing treatment efficacy with individual cases is to implement all ROM components, and to heed their special salience for driving context-responsiveness when predictive analytics point to a given patient being off track for a positive psychotherapy outcome (Constantino, Goodwin, Muir, Coyne, & Boswell, 2019).…”

Section: Using Rom To Improve Patient-level Care: Empirical Supportmentioning

confidence: 99%

“…To the extent that the marker is accepted and discussed openly, it may come to light that it is a proxy for things like a patient no longer believing in the credibility of the treatment, having become resistant to a particular direction that the clinician has taken, or having experienced a general alliance rupture or even a specific cultural microaggression. In any of these situations, the literature has identified, at least to some meaningful degree, specific types of evidence-backed, marker-specific “departures” from the initial treatment plan (for empirical reviews of these if-then sequences, see Constantino, Coyne, et al, 2019; Constantino, Goodwin, et al, 2019). Thus, one could argue that to the extent that using evidence is tied to ethical psychotherapy practice, ROM serves “double duty,” so to speak.…”

Section: Ethical Implications Of Rom At the Patient Levelmentioning

confidence: 99%

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Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems.

Muir¹,

Coyne²,

Morrison³

et al. 2019

Psychotherapy

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Although psychotherapy is generally efficacious, a substantial number of patients fail to improve meaningfully, whereas still others deteriorate. Moreover, psychotherapists have difficulty forecasting which patients are at risk for nonresponse or deterioration, especially when relying predominantly on their judgment. These limitations have implications for the ethical practice of psychotherapy, and they call for remediation strategies. One such strategy involves the use of routine outcomes monitoring (ROM), or the regular collection of core patient progress information that can be fed back to the clinician and patient in real time. ROM-informed analytics outperform clinical judgment in predicting patients who are on or off track for treatment success, which can help psychotherapists plan and responsively adjust their interventions. Additionally, research demonstrates that ROM-generated feedback improves treatment outcomes for the average case who receives versus does not receive it. ROM data can also uncover between-therapist differences in general efficacy, as well as scientifically highlight clinicians' own relative strengths and weaknesses in treating different mental health problems. In light of such evidence, we submit that the research on ROM has matured to the point that it should occupy a central role in discussions of, and guidelines about, the ethical practice of psychotherapy. In this vein, we discuss ROM at patient, psychotherapist, and mental health care systems levels; namely, for each of these stakeholders, we review the extant empirical support before turning to possible ethical implications. Finally, we offer concluding thoughts on the expanding relevance of ROM for helping psychologists fulfill their ethical practice obligations. Clinical Impact StatementQuestion: After surveying relevant research, we discuss the growing role of routine outcomes monitoring (ROM) for helping psychotherapists and mental health care systems fulfill their ethical practice obligations, including maximizing patient benefit and minimizing harm. Findings: There is expanding evidence that ROM-generated information has the potential to improve treatment outcomes at the patient level (e.g., by identifying patients at risk of nonresponse or harm and informing clinician responsiveness to this signal), psychotherapist level (e.g., by helping to establish clinicians' objective strengths and weaknesses that could inform their selective practice and personalized training foci), and mental health care systems level (e.g., by referring patients to empirically good-fitting clinicians within a care network). Meaning: Research on ROM suggests that it should be considered in any discussion about the ethical practice of evidence-based psychotherapy. Next Steps: It will be important for clinical and research efforts to concentrate on increasing ROM implementation to fulfill ethical demands at the patient, psychotherapist, and systems levels.

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Section: Using Rom To Improve Patient-level Care: Empirical Supportmentioning

confidence: 99%

Section: Ethical Implications Of Rom At the Patient Levelmentioning

confidence: 99%

Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems.

Muir¹,

Coyne²,

Morrison³

et al. 2019

Psychotherapy

Self Cite

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“…Namely, there is growing evidence that strict fidelity, without careful consideration of contextual information, may have limited value at best and may be harmful at worst. Instead, research supports the importance of therapists' theoretical flexibility and contextual responsivity to the patient, relationship, moment, and/or their own practice-generated evidence (Constantino et al, 2020;Constantino, Goodwin, et al, 2021;Stiles & Horvath, 2017).…”

Section: Evidence Supporting a Contextually Driven Model Of Psychothe...mentioning

confidence: 99%

“…Although therapist responsivity comes in diverse forms, we focus here on the CRPI framework that our team has advanced (Boswell et al, 2020;Constantino et al, 2020;Constantino, Goodwin, et al, 2021;Gaines & Goldfried, 2021). CRPI is perhaps best described as a "metaorientation" that can guide therapists of any theoretical orientation in their use of evidence-based and context-responsive clinical decision making.…”

Section: The Crpi Frameworkmentioning

confidence: 99%

Training on context-responsive psychotherapy integration: An evidence-informed framework.

Constantino¹,

Coyne²,

Boswell³

et al. 2023

Becoming Better Psychotherapists: Advancing Training and Supervision.

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D espite their dubious impact (see Chapters 3 and 4, this volume), the primary training models in psychotherapy have remained mostly unchanged. Specifically, the focus has largely been on training therapists to academically determined competency thresholds and then encouraging fidelity in applying such competencies across patients, contexts, and time. As one prominent version of this approach, therapists are trained to administer somewhat theory-narrow empirically supported treatments (ESTs) for specific disorders, with the replicable use of the theory-prescribed ingredients ostensibly signifying a clinician's competence. Although EST-centered training can be useful, as we know that many therapists become generally effective, we have little evidence that it is the training method itself that causes providers to become effective. Additionally, this approach is limiting in that it privileges treating the average patient rather than the individual, thereby neglecting those who may be less likely to respond to an EST when delivered in its standard form. Further, this EST-centric approach also implies that change will generally be linear-with few, if any, major bumps in the road that require therapists to shift their theoretical orientation during treatment.

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“…At a minimum, clinically, this suggests that therapists should appreciate that the course of therapy is more often dynamic than fixed and allow for regular metacommunicative check-ins with their clients to see if a given session focus or structure needs revision-in a way that genuinely supports the client's agency (Levitt et al, 2016). At a maximum, therapists can consume and apply the burgeoning literature on evidence-based responsivity to specific clinical markers that can help guide important clinical "departures" (from whatever foundational treatment they are administering) in salient moments that call for them-what has been referred to as context-responsive psychotherapy integration (Constantino, Goodwin, et al, 2021;Constantino et al, 2020). As just one example, therapists can become more client centered and autonomy granting in the face of client resistance to the therapist's direction (Westra et al, 2016).…”

Section: Corrective Experiences: What Do Clients Say Is Corrective?mentioning

confidence: 99%

Clients’ own perspectives on psychotherapy outcomes and their mechanisms.

Constantino¹,

Gaines²,

Coyne³

2022

The Other Side of Psychotherapy: Understanding Clients’ Experiences and Contributions in Treatment.

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H aving read, lauded, and concurred with Fuertes and Williams's (2017) call for more client-focused psychotherapy research, we eagerly agreed to contribute this chapter on clients' own views of psychosocial treatment outcomes and their mechanisms. That said, we also appreciated the inherent challenge in identifying this chapter's unique and complementary scope within the overall volume. In its broadest sense, client-focused psychotherapy research could conceivably cover any outcome construct or variable that pertains to the client (whether defined by researchers, therapists, or clients), with data collected in any number of ways. After having recently contributed a comprehensive review of the research on the client, therapist, and relational factors to Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (seventh ed.; Constantino, Boswell, & Coyne, 2021), we were acutely aware of how vast and unwieldy a review of "all things client related" could get! However, to us, truly client-focused outcome research requires more than an examination of any inherently client-related factors that change or predict change. Rather, such research needs to explicitly draw out and privilege the client's voice or narrative to understand these primary outcome-related elements. To draw on McLeod et al.'s (2009) rubric of stakeholder positions, such focus reflects user-constructed outcomes and their mechanisms, as opposed to researcher-or therapist-constructed outcomes and mechanisms. Accordingly, we discuss herein research that has, in both content and method, directly asked adult clients (this age criterion is consistent with the volume's overall

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Context-responsive psychotherapy integration applied to cognitive behavioral therapy.

Abstract: Context-Responsive Psychotherapy Integration Applied to CBT • 153THERAPIST: (after a pause) When you put it like that, I can really sense that hopelessness. That's indeed a heavy burden to carry, and I can hear in your voice how hard this is for you.

Cited by 15 publications

References 29 publications

Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems.

Ethical implications of routine outcomes monitoring for patients, psychotherapists, and mental health care systems.

Training on context-responsive psychotherapy integration: An evidence-informed framework.

Clients’ own perspectives on psychotherapy outcomes and their mechanisms.

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