Background: Although psychotherapy has shown to be effective for most patients, about one-third of patients do not benefit or deteriorate during treatment. Technical progress has allowed the integration of routine outcome monitoring (ROM) into treatment, helping therapists detect patients at risk for a nonresponse or poor outcome early on. Psychological therapy can be enhanced by providing therapists with individual treatment recommendations for these atrisk patients. One example of such a comprehensive feedback system is the Trier Treatment Navigator (TTN). Objective/Method: This clinical case study aims to illustrate the implementation of the TTN in a cognitive behavioral therapy (CBT) outpatient clinic in the treatment of a 30-year-old patient called Ms. Daun, who has a recurrent depressive disorder. Based on this case, the benefits of applying information from ROM in psychotherapy, important context factors, and possible implementation issues are discussed. Results/Conclusion: We conclude by encouraging practitioners to integrate ROM into their clinical thinking and daily practice.

Objective: The therapist effect has been demonstrated in various studies. However, studies on putative therapist characteristics show heterogeneous results. Although the majority of studies have solely examined effects between therapists, a growing interest in effects within therapists has emerged. However, it remains unclear whether therapist characteristics are rather a state-like than a trait-like phenomenon. The main aim of the present study is to test whether clinical microskills as well as correct application of techniques and strategies (both between and within therapists) predict across-session change of symptom severity in a large naturalistic data set. Method: The results are based on 398 patients and 48 therapists who treated 5–17 patients each. Clinical microskills and correct application of techniques/strategies were rated using the Inventory of Therapeutic Interventions and Skills, and symptom severity was assessed with the Hopkins Symptom Checklist-11. Results: Results demonstrated significant within- and between-therapist variability in clinical microskills and correct application of techniques/strategies, and no change over the course of treatment in both variables. Moreover, correct application of techniques/strategies was significantly associated with symptom improvement within, but not between therapists. In addition, higher treatment difficulty as well as an interaction between treatment difficulty and correct application of techniques/strategies were significantly associated with symptom improvement. Clinical microskills were neither predictive of symptom improvement within nor between therapists. Conclusions: These results provide initial evidence that not the therapist’s average correct application of techniques/strategies is important, but rather how correctly they use a technique with a specific patient.

The current article presents a way of practising case formulation using technology augmentation in the context of data-informed psychotherapy. First, we explain how case formulation guides the decision-making processes in psychotherapy and how decisions made under an intuitive clinical judgement can be biased. The use of actuarial methods is pointed out as a way of addressing these biases, mainly through clinical decision support systems based on statistical tools and machine learning algorithms. We present the Trier Treatment Navigator (TTN), a clinical decision support system developed in a University research-based clinical training programme. We show how the TTN can contribute to an initial case formulation and its dynamic adaptations during treatment with a clinical case. Finally, we discuss how case formulation and data-informed psychotherapy are aimed at the same goal: treatment personalisation. We argue that case formulation and data-informed psychotherapy enrich and feedback on each other.

Zusammenfassung. Theoretischer Hintergrund: In der Ausbildung von Psychotherapeutinnen konnte bereits ein subjektiver Kompetenzgewinn durch die Arbeit mit Simulationspatientinnen (SP) belegt werden. Fragestellung: Neben der Replikation dieser Befunde, welche auf Selbstberichten basieren, untersuchte vorliegende Studie die objektive Behandlungsintegrität von Studierenden anhand von Beobachterratings. Methode: Die Stichprobe setzte sich aus 39 Studierenden aus 4 Fallseminaren zusammen. Zur Validierung der objektiven Behandlungsintegrität wurde eine Vergleichsstichprobe von Psychologischen Psychotherapeutinnen in Ausbildung (PPiA) herangezogen (Videos N = 763). Zusätzlich wurden Charakteristika der Studierenden hinsichtlich ihrer prädiktiven Fähigkeiten untersucht. Ergebnisse: Die Ergebnisse belegten neben einem selbstberichteten Kompetenzzuwachs auch eine zufriedenstellende objektive Behandlungsintegrität, die signifikant niedriger ausfiel als die der PPiA. Zusätzlich konnten Prädiktoren für die Behandlungsintegrität identifiziert werden. Schlussfolgerungen: Die Ergebnisse zeigen, dass Studierende Therapiesituationen, die ihrem Novizen-Status entsprechen, in zufriedenstellendem Maße ausgestalten können.

Background and aimsFor the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to estimate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists' level of expertise regarding PUD, and to identify predictors for psychotherapy demand.MethodsFour studies were conducted: 1. Online study in the general population (n = 2070; m = 48.9%, f = 50.8%, d = 0.2%), 2. Survey among practicing psychotherapists (n = 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n = 185), 4. Interviews with psychotherapeutic inpatient clinics (n = 28).ResultsThe estimated prevalence of lPUD in the online study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indicated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%–2.9% of lPUD cases among their patients. 43.2%–61.5% of psychotherapists stated to be poorly informed about PUD. Only 7% of psychotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative consequences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not.Discussion and conclusionsAlthough PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treatments are urgently needed.