A Phenomenological Exploration of the Dialectic of Success and Failure in Psychotherapy: Explaining Interactional Patterns and the Therapeutic Alliance from Clients’ Perspectives

ABSTRACT Introduction Anxiety is central to the psychotherapy process, yet psychotherapists routinely infer a client's anxiety intensity from observable behaviour rather than from formal measurement, with no widely accepted framework to organise which observable markers indicate which levels of anxiety. This exploratory study examined how therapists make such classifications. Method Ninety‐one mental health professionals were randomly assigned to classify 41 text‐described behavioural and physiological markers using either a 5‐level or a simplified 3‐level category system, both derived from an integrated model of state anxiety in psychotherapy. Results Response distributions departed significantly from uniformity for nearly all markers in both formats, and the rank ordering of markers by intensity was highly consistent across formats, suggesting that therapists may share broad intuitions about relative marker intensity. Which markers elicited agreement, however, was far less reproducible, depending substantially on the response format. Convergence also depended on where the agreement criterion was set, declining from 90.2% to 51.2% of markers in the 3‐level format and from 63.4% to 22.0% in the 5‐level format as the criterion rose from > 0.50 to > 0.70. The 3‐level format yielded more classifiable markers at every criterion, although this advantage was not consistent across indices, whereas the 5‐level format elicited fewer ‘Insufficient to Determine’ responses. Markers placed at the highest intensity levels were classified most consistently. Discussion These findings offer preliminary groundwork for research on marker operationalisation, contextualised rating tasks and the development of training materials for psychotherapy process research.

Experiences of bullying can have significant psychological consequences, including an increased risk of social anxiety. This study aimed to examine changes in social anxiety following Virtual Reality Social Exposure (VRSE) among bullying victims. A one-group pretest–posttest design without a control group was employed with 12 participants. The intervention consisted of three gradual exposure sessions in virtual environments representing social situations. Social anxiety was measured before and after the intervention, and the data were analyzed using the Wilcoxon Signed-Rank Test. The results indicated a statistically significant decrease in social anxiety scores following the intervention (p = 0.002), with a reported effect size of 0.974. These findings suggest that VRSE may be a promising approach for reducing social anxiety among bullying victims. However, the absence of a control group and the small sample size limit conclusions regarding its effectiveness and safety. Further studies with larger samples, control groups, and systematic safety assessments are needed.

Stress arising from academic, professional and financial demands is common among students and young professionals, and the coping methods within easiest reach, such as listening to music, do not always suffice. This paper presents a survey-driven design for a virtual reality (VR) gadget that combines selectable immersive natural environments, environment-matched sound therapy and heart-rate biofeedback for short relaxation sessions. An online questionnaire completed by 24 respondents, mostly college students, supplies the user requirements. Among those who answer the relevant items, 65.2% report daily stress, 73.9% name academic or job pressure as the main cause, and 47.8% state that a busy schedule prevents regular yoga or meditation. Music is the most common coping method (63.6%). Asked about a 10–15 minute VR relaxation session described as free of side effects, 83.3% answer “yes, definitely” and 8.3% answer “maybe” if the price is under Rs. 5000. The findings yield design requirements, a system architecture, a session workflow and a protocol for comparing the gadget with guided breathing, meditation and relaxing music. That comparison is planned, not yet carried out: the prototype has not been tested with users, and the paper makes no claim of clinical effectiveness.

Abstract Background Repetitive negative thinking (RNT) is a transdiagnostic process relevant to common mental health problems in primary care. RNT-ACT is a brief acceptance and commitment therapy-based protocol targeting RNT in two sessions. This pilot study assessed the feasibility of RNT-ACT compared with therapist-supported internet-based cognitive behavioural therapy (iCBT) in Swedish primary care. Methods Thirteen participants were randomised: 7 to RNT-ACT and 6 to iCBT. The primary feasibility outcomes were recruitment rate, intervention non-completion, and patient satisfaction measured with the Client Satisfaction Questionnaire (CSQ-8). Symptom and process measures were secondary outcomes. Secondary outcomes were assessed at baseline and at 1- and 3-month follow-ups. Analyses were descriptive and exploratory, based on available observations without imputation of missing data. Results Thirteen of 20 eligible individuals were enrolled (65%), corresponding to 35% of all 37 individuals screened. All participants in the RNT-ACT group completed the intervention, whereas 4 of 6 participants in the iCBT group did not complete the intervention. Mean CSQ-8 scores were 27.8 (SD 3.7; n = 5) in the RNT-ACT group and 23.0 (SD 0.0; n = 2) in the iCBT group. Conclusions The small sample size and high iCBT non-completion limit between-group comparisons. Further investigation of recruitment, treatment engagement, and patient and therapist experiences is needed before determining whether and how to proceed to a full-scale RCT. Trial registration ClinicalTrials.gov NCT05946382 registered July 14, 2023.

Mental health services are constantly evolving with the gradual introduction of functionalized care, which means medical intervention has become more focused on a particular clinical area or stage of the illness. This has progressed to having designated teams for inpatient psychiatry. Usually, psychiatrists manage their patients both in outpatient and inpatient settings while working in a particular geographical area or sector. Moving away from this model to a functionalized inpatient setting, where other psychiatrists take care of their patients, is seen as a breach in continuity of care. In this context, it was intended to review the current literature for the experience of clinicians and patients in these sectorized (medical continuity) or functionalized models of psychiatric inpatient care. A narrative review of the current literature from multiple databases was conducted. The results suggested that there are positive and negative observations in both models. It appeared that neither met the expectations of patients nor clinicians. Patients preferred to be seen by the same consultant in community and inpatient settings, but clinical outcomes were not significantly different in the two models. The functionalized care was mostly medical continuity rather than multidisciplinary. Any changes in the care models may be driven by local facilities and issues. There is a need to improve the quality of care through existing models before any changes. More studies are needed to improve the evidence on the effectiveness of these service models.