No abstract

Examination of the early phase of therapy is of growing importance. Early improvement in client symptoms and functioning is associated with positive posttreatment outcomes and reduced premature termination, including in cognitive-behavioral-oriented treatments. This article focuses on 3 strategies salient in the early phase of cognitive-behavioral therapy, including the provision of a rationale and goal-oriented framework, cultivating an attitude of collaborative empiricism, and initiating objective client self-monitoring. A description and rationale, relevant supporting research, and case examples are presented for each component. Finally, practical recommendations are offered for therapists and trainees to implement these strategies in their own practice.

Psychotherapy research often compares specific treatments to control conditions to establish efficacy of the specified treatment. Research has typically evaluated common factor elements (e.g., credibility, expectancy) in treatments only after the first or second session, largely as a manipulation check and under the assumption that such factors are static. This study observed therapist common factor and model-specific interventions in three treatment approaches from a randomized control trial for generalized anxiety disorder across the entire early phase of treatment (i.e., first five sessions). The parent randomized control trial compared two treatment conditions, using an additive design where patients were randomized to receive either interpersonal/emotional processing interventions or supportive listening after receiving a session of cognitive-behavioral therapy. The first five video-recorded sessions of N ϭ 40 randomly sampled participants were observationally coded with a multidimensional intervention measure, with subscales reflecting diverse theoretical orientations and common factors. Multilevel modeling was used to examine intervention use and investigate differences between treatment conditions and segments. Among the results, common factor interventions were rated as significantly more typical in cognitive-behavioral therapy compared with supportive listening. The pattern of intervention use of other subscales was generally consistent with the orientation of the respective protocols. In the early phase of treatment, supportive listening conditions do not appear to function as common factor controls in the manner that many might assume. Common factors are potentially enhanced in bona fide treatments that include a more detailed, specific rationale and clear and cohesive techniques and goals. Clinical Impact StatementQuestion: In a randomized control trial for generalized anxiety disorder, what is the relative typicality of common factor and model-specific interventions in the early phase of treatment in more active and directive treatments compared with a supportive control condition? Findings: Common factor interventions were rated as significantly more typical in a more directive CBT treatment compared with a supportive listening control treatment. Meaning: Results provide evidence that supportive listening treatments may not function as common factor "controls" in the way that many might assume. Next Steps: Future research should continue to explore therapist intervention use in the early phase of treatment and across the entire course of therapy, with additional clinical populations, in naturalistic settings, and with a larger sample of therapists.

The Coronavirus (COVID-19) pandemic has posed many unprecedented challenges to psychotherapists, as many clinics swiftly moved to providing services remotely or needed to close temporarily. While some practica were able to offer trainees the option to provide telehealth, some made the difficult decision to terminate psychotherapy training programs for the remainder of the academic year, or longer. This decision has had numerous implications for and impacts on students, such as concern over development of clinical and counseling skills, intervention and assessment hours, and uncertain effects on clients. These concerns are discussed from the perspective of a trainee, and several therapyrelevant resources and ways of managing are also highlighted.