This exploratory study focused on the role of risk and protective factors in 179 adolescents from a middle and lower income northeastern school district. The protective factors examined were family cohesion, locus of control, mother/father communication, and relationship with a nonparent adult. The study found that the protective factors were powerful predictors of adaptation in their own right independent of risk. Protective factors were found to be highly context specific and there was no evidence of broadly applicable protective factors. Gender was found to be an important aspect of context, and there were significant sex differences. Most strikingly, the study did not find any significant interactions between protective factors and risk for girls or boys. Thus, these results support the growing view that researchers must identify specific rather than global protective factors that provide protection in the space of specific risks for youth in specific life contexts.

The present study examines relationships between patient attachment and therapist countertransference in a large, naturalistic, longitudinal study of psychodynamic psychotherapy in a safety-net hospital. This study explored patterns in the relationship between therapist countertransference and patient attachment in two ways: (a) by studying cross sectional associations between patient-reported attachment and therapist-reported countertransference at 3 months into treatment, and (b) by studying if changes in patient-reported attachment over the course of psychotherapy are associated with changes in therapistreported countertransference. In a sample of 101 therapy dyads, patients completed self-report attachment domains and therapists completed self-report countertransference measures 3 months following initiation of psychotherapy. Results showed initial significant positive associations between patient-rated attachment anxiety and therapist-rated "parental/protective," "special/overinvolved," and "overwhelmed/ disorganized" countertransference. A sample of 119 therapy dyads (these included dyads in which therapists and patients completed measures at any point in time) was analyzed using multilevel modeling. Results showed that initial patient-rated attachment anxiety was associated with decreases in therapistrated parental/protective and special/overinvolved countertransference over time. Decreases in patientrated attachment anxiety were associated with subsequent increases in therapist reports of feeling overwhelmed/disorganized. These findings provide a greater understanding of how attending to patient attachment and therapist countertransference together may cofacilitate treatment and improve patient outcomes.

Mental health care providers have been charged with the task of generating more evidence to support the quality and efficiency of their treatment practices. Health care policies are beginning to enforce the implementation of prescriptive treatment protocols with demonstrated efficacy for specific conditions. Psychotherapy treatment models designed for and evaluated in rigorously controlled experimental settings are frequently considered the hallmark of evidence-based practice. Experimental trials of psychotherapy brands have identified efficacious treatments for a number of specific conditions. However, the current experimental procedures for evaluating a specific treatment model may not be enough to account for the range of patients and challenges found in community practice settings. Clinicians express reservations that many research investigations do not address their most important concerns. Thus, clinical researchers are charged with the task of implementing research protocols of greater clinical utility. Public health practice settings offer numerous opportunities for joining clinical research and practice. However, implementing programmatic psychotherapy research in clinical practice settings presents a number of obstacles. In this article, a case example of implementing a research protocol in a public health safety-net hospital is the lens through which these obstacles are identified and possible solutions investigated. Experience gaps, financial constraints, design flaws, organizational culture, and clinician resistance are barriers to the implementation of practice-based psychotherapy research. With motivated efforts and creative problem solving, these barriers can be removed, opening an avenue for the advancement of practice-informed research and researchinformed practice.

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This article reports on our experiences conducting naturalistic research as clinician-researchers in a training setting within a public safety-net hospital. The naturalistic, practice-based context has presented various challenges to the research process, including the following: supporting research with limited finances, establishing continuity of research personnel, designating time for research within an intensive clinical training program, responding to difficulties obtaining data, seeking consultation for advanced data analysis, organizing the writing process, and determining order of authorship. In addition, in mixed-methods research of psychodynamic psychotherapy, each of these challenges has interacted with the inherent challenges of qualitative research. We describe the systemic and project-specific challenges of conducting such research, as well as practical strategies that we have used to overcome them, with the aim of helping other clinician-researchers facilitate naturalistic research. The challenges reflect the problem of being “stuck” in the gap that this special section of Psychotherapy is examining, although the strategies serve as optimistic reminders that this type of work is indeed possible.