In the past few decades there has been an increasing movement toward adopting integrative perspectives. Although the levels of psychotherapy integration shown by therapists in naturalistic and experimental settings have been investigated, not much is known about the levels of integration among psychotherapy experts. The current study examines the levels of psychotherapy integration in psychotherapy sessions of known experts from different orientations, at different time points in history. Ratings of prototypical demonstrations of 9 psychotherapy experts from different therapeutic orientations and from different generations were examined to determine the extent of integration. Psychotherapy integration was observed in all prototypical demonstrations. Experts tended to integrate techniques from other approaches within their own "family"-similarities in the use of techniques were found among experts who identified with an 'exploratory' orientation as well as among experts who identified with a 'directive' orientation. The current findings show that experts "stay in the family"they integrate techniques from approaches similar to their own. Furthermore, experts from different generations showed similar levels of psychotherapy integration.

ObjectiveHematopoietic stem cell transplant (HSCT) survivors may show evidence of objective cognitive impairment; however, perceived cognitive problems and their impact on quality of life are less well-understood. The purpose of this study was to explore HSCT survivors’ perceptions of cognitive impairment and its effect on daily life functioning.MethodSixty-nine autologous and allogeneic HSCT survivors nine months to three years posttransplant experiencing mild survivorship problems completed a brief structured interview regarding perceived cognitive impairment since transplant. Data were coded and content analyzed. The frequency of participants reporting cognitive problems by domain and associations between reports of cognitive problems and age, depressed mood, anxiety, and health-related quality of life were examined.ResultOverall, 49 of the 69 participants (71%) reported cognitive impairments after transplant: 38 in memory (55%), 29 in attention and concentration (42%), and smaller numbers in other domains. There were no significant differences in problems reported by transplant type. Of the 50 participants who worked before transplant, 19 (38%) did not return to work following transplant, with 12 citing cognitive and health problems as being the reason. There were significant associations between reports of cognitive impairment and younger age (p = 0.02), depressed mood (p = 0.02), anxiety (p = 0.002), and health-related quality of life (p = 0.008).Significance of resultsA large proportion of survivors reported cognitive impairment following HSCT that impaired daily life functioning. Perceived cognitive impairment was associated with younger age, greater distress and reduced health-related quality of life.

Previous studies have shown that individuals with personality disorder (PD) suffer from significant interpersonal distress. Some PDs, such as avoidant personality disorder (AvPD), have been characterized with a clear homogeneous interpersonal profile. Other PDs, such as obsessive-compulsive personality disorder (OCPD), have shown significant heterogeneity rather than a distinct profile. Our study aimed to compare these two PDs and determine their interpersonal profiles. Analyses included 43 patients with OCPD and 64 with AvPD recruited in 2 clinical trials. They completed the Inventory of Interpersonal Problems at baseline (Alden, Wiggins, & Pincus, 1990). Structural summary and circular statistic methods were used to examine group interpersonal profile. Cluster analysis was used to identify subtypes within the OCPD and AvPD samples. The AvPD sample demonstrated a homogeneous interpersonal profile placed in the socially avoidant octant of the circumplex. In contrast, the OCPD group exhibited a heterogeneous interpersonal profile, with two subtypes on opposite sides of the circumplex: (a) “aggressive” (i.e., vindictive-domineering) and (b) “pleasing” (i.e., submissive-exploitable). Both clusters demonstrated homogeneous, prototypical, and distinct interpersonal profiles. Our findings show that individuals with either OCPD or AvPD exhibit significant interpersonal distress. Although AvPD may be inherently an interpersonal PD, OCPD cannot classified into one homogenous profile, but rather two distinct interpersonal subgroups. The heterogeneity may be explained by the presence of interpersonal subtypes. Detection of subtypes can inform future research on treatment targets as well as personalized interventions, tailored to patients’ specific interpersonal difficulties.

Most measures of psychotherapy outcome focus on symptomatic change. However, clients often report other changes through therapy, such as increased self-acceptance. This study reports on the development and validation of the Complementary Measure of Psychotherapy Outcome (COMPO) that assesses different areas of psychological functioning deemed important by clients and therapists. Items were written based on a literature review of client-reported change and feedback from experienced therapists. Exploratory factor analysis was conducted on the initial 42-item COMPO administered to 264 psychotherapy clients. Iterative item reduction resulted in the final 12-item, four-factor solution, with factors named self-acceptance, selfknowledge, relationship quality, and consideration of others. This factor structure, along with a bifactor model that contains a general factor and the four domain-specific factors, was replicated on a sample of 571 adults in the community. The 12-item COMPO exhibits convergent validity with measures of self-esteem, insight, social support, and empathy; demonstrates 2-week test-retest reliability; and predicts life satisfaction. The 12-item COMPO was further administered to 28 clients in short-term psychodynamic therapy for depression. Except for consideration of others, COMPO subscales and total scale scores improved from pre-to posttherapy. Posttherapy COMPO scores were also higher among clients who experienced clinically significant change compared to those who did not. The COMPO was negatively associated with depressive symptoms and impairments in functioning across the three samples. The brevity of the COMPO makes it a convenient tool to supplement symptom-based measures for a more comprehensive assessment of outcome in psychotherapy. Public Significance StatementThe goal of psychotherapy does not only include the reduction of psychological symptoms, yet most outcome measures focus on symptom change. A new measure is developed to assess nonsymptomatic changes that patients and therapists care about in therapies across theoretical orientations.

In the literature, therapist effects have been discussed as characteristics of a therapist, as well as particular interventions that a therapist practices in his or her sessions (Baldwin & Imel, 2013;Lutz, Leon, Martinovich, Lyons, & Stiles, 2007;Saxon & Barkham, 2012). There also may be qualitative differences and nuances in how different therapists could apply the same techniques. These nuances and inclinations can be broadly defined as the therapist's "style"-something about the therapist that makes psychotherapy work, patients engage, and the therapeutic process flourish. It could also be that different therapists are better at handling different kinds of patients (Barber, 2009). In this chapter, we try to uncover the use of specific techniques and identify what makes one therapist better than another, using the data from a randomized clinical trial (RCT) for depression conducted at the University of Pennsylvania (Treatments for Depression [TDS]; Barber, Barrett, Gallop, Rynn, & Rickels, 2012). In this RCT, patients were assigned randomly to receive an active medication, a placebo pill, or supportiveexpressive therapy (SET).We focus on patients in the SET condition, a form of psychodynamic psychotherapy that attends to patients' unconscious motivations, intra-and interpersonal conflicts, and experiences with others that underlie maladaptive patterns of behaviors (Luborsky et al., 1995). All therapists were experienced clinicians and adhered to the SET treatment manual (Luborsky, 1984;Luborsky et al., 1995). Although the manual prescribed which techniques to use, participating therapists still had the freedom to choose which ones to use at a certain moment, how frequently and how intensively to use them; and they could bring in their own knowledge, expertise, and clinical intuition, and apply the interventions that they felt were pertinent for each particular case or phase of treatment. Given that we know which of the therapists in this study were more or less successful in terms of the final outcomes of their patients, we can identify through statistical analysis the interventions that contributed to the "magic ingredients" of their work.We hypothesize that successful therapists focused their interventions more on their patients' relationships and interpersonal functioning. This hypothesis stems from our understanding of psychopathology as largely an interpersonal phenomenon, the approach that has been gaining much attention since mid-