Mental health care equity and access: A group therapy solution.

Mental health services are experiencing unprecedented levels of demand from clients during COVID resulting in longer wait lists and therapist burnout. As Nemoyer et al. (2019) point out, minorities experience a higher burden of mental illness while having less access and lower quality treatments.

New horizons in group psychotherapy research and practice from third wave positive psychology: a practice-friendly review.

Group psychotherapy has been shown to be equivalent to individual therapy for many disorders, including anxiety, depression, grief, eating disorders, and schizophrenia (Burlingame & Strauss, 2021). In addition to effectiveness in reducing symptoms, group offers members a sense of belonging, purpose, hope, altruism, and meaning throughout treatment (Yalom & Leszcz, 2020). These additional outcomes are especially important considering the COVID-19 pandemic and national/international conflicts, given the trauma, disruptions, and losses people have experienced.

Ruptures and Repairs in Group Psychotherapy: From Theory to Practice.

The group climate, cohesion, and alliance with the leaders are critical elements of effective group psychotherapy. Although there has been significant attention to these curative mechanisms, there has been less attention to ruptures in the group relationships or the repair of them. The current special issue is devoted to theory, research, training, and practice regarding ruptures and repairs in group treatment.

Repeated terminations: Transferring therapists in psychotherapy.

Therapists engage in transfers-a specific type of termination-with clients who will be continuing treatment with new therapists after they depart. Consequently, new therapists begin treatments in the shadow of the loss of outgoing therapist. These transfer experiences frequently occur in yearlong training settings, where therapists-in-training encounter some of their first therapy experiences and subsequently move on to other training settings or graduation.

Carrying Jeremy Safran into sessions: relying on internal representations of researchers to facilitate emotion regulation, clinical intervention, and self-efficacy.

Relying on positive internal representations facilitates our ability to feel safe and secure when taking risks and provides a road map to guide us during interpersonal exchanges. Although most graduate programs encourage students to engage in research, we rarely link participating in research as directly influencing positive internal representations that can influence treatment. We used a qualitative method to examine how watching videos of Jeremy Safran, coding therapy sessions using his model, and reading his articles on ruptures and repairs influenced students' ability to self-soothe, take risks, and engage when patients confront them or withdraw.

Introduction to special issue: Feedback in group psychotherapy.

The current issue highlights the necessity of feedback in group psychotherapy-both monitoring group member feedback during treatment and providing feedback to group members before and during group therapy. Regardless of the orientation or type of group, collecting members' perceptions and experiences influences how the group leader identifies members who are struggling in the group or are at risk of dropping out. Providing group members with feedback during the pregroup preparation and throughout the therapy process is also helpful to group members as they work to obtain their goals in the group.

Attachment in Group Psychotherapy: Bridging Theories, Research, and Clinical Techniques.

Attachment theory is influencing the research and practice of group psychotherapy. The current issue highlights some of the bridges attachment theory has made both to contemporary group theories that include interpersonal theory and polyvagal theory and to approaches to group work that include mentalization-based group treatment. In addition, attachment theory is facilitating a richer understanding of group leadership, group cohesion, and the process of change that occurs during group interactions.

Therapists-in-training experiences of working with transfer clients: One relationship terminates and another begins.

Data from interviews with 12 graduate-level trainees about their experiences of working with clients who had been transferred to them from another therapist were analyzed using consensual qualitative research. Trainees reported a range of helpful and hindering aspects about the transfer experience related to the client (e.g.

Fostering engagement during termination: Applying attachment theory and research.

Therapists often struggle to determine the most important things to focus on during termination. Reviewing the treatment, identifying plans for the future, summarizing positive gains, and saying goodbye receive the most attention. Despite our best intentions, termination can end up becoming intellectualized.

Can we collaborate? Mistakes made when group and individual therapists ignore multiple realities.

Often, group therapists collaborate with individual therapists in conjoint treatment. Many of these patients start in individual therapy and are referred to the group to help facilitate the treatment and address interpersonal and relational issues that either cannot or will not be addressed in the individual work. Although this has the potential to foster incredible growth for patients, it may also cause problems in treatment when collaboration between therapists falls apart.

Counselors' attachment anxiety and avoidance and the congruence in clients' and therapists' working alliance ratings.

Objective: To determine how counselors' attachment anxiety and avoidance related to congruence between counselors' and clients' Working alliance (WA) ratings. Congruence strength was defined as the regression coefficient for clients' WA ratings predicting counselors' WA ratings. Directional bias was defined as the difference in level between counselors' and clients' WA ratings.

Emphasizing the complexity of the relationship: the next decade of attachment-based psychotherapy research.

This article focuses on the future of attachment-based psychotherapy research and begins with a brief summary of the research that has been done and then explores 8 predictions for the future. The main emphasis of these predictions is the growing complexity in our research needed to capture the mechanisms that facilitate or hinder the therapy process for patients with different attachment styles. Future researchers will focus more on the interactions between the patient and therapist within the sessions, will apply more complex statistical analyses to study the dyad, and will integrate different research methods.

Neurosciences and adult health behaviors: recent findings and implications for counseling psychology.

The current review comprehensively examines recent advances in 2 innovative areas of neuroscience research on healthy adults regarding neuropsychosocial interactions on human cognition and behavior, as well as implications for counseling psychologists conducting research and in practice. Advances in how oxytocin influences prosocial behavior and the mitigation of social stress, and the influence of environmentally mediated gene expressions on the development of attachment disorders are surveyed and discussed in terms of how counseling psychologists might best integrate recent neuroscience research into a framework for therapeutic intervention.

Novice therapist attachment and perceived ruptures and repairs: a pilot study.

Although extensively discussed in theoretical articles, empirical studies of therapist attachment and perceptions of ruptures and repairs are lacking. The present study examined the relationship between therapist attachment anxiety and avoidance and their perceptions of rupture tension, effort, and repair. Twenty-two novice therapists completed a measure of adult romantic attachment and a measure to assess perceptions of ruptures and repairs following the eighth session with their first clients.

The insecure psychotherapy base: Using client and therapist attachment styles to understand the early alliance.

The purpose of this study was to test the notion that complementary attachments are best for achieving a secure base in psychotherapy. Specifically, we predicted third to fifth session alliance from client- and therapist-rated attachment style interactions. Using a combined sample of 46 therapy dyads from a community mental health clinic and university counseling center, the client- and therapist-perceived therapy alliance, attachment anxiety, and attachment avoidance were examined at the beginning of therapy.

Client and therapist therapeutic alliance, session evaluation, and client reliable change: a moderated actor-partner interdependence model.

Actor-partner interdependence modeling (APIM; Kashy & Kenny, 2000) was used to study the early therapeutic alliance in 74 clients being treated by 29 therapists to explore the relationship between the alliance and treatment progress, while prioritizing the dyadic nature of the alliance. The APIM examines collaboration/influence by modeling the impact of one dyad member's alliance ratings on the other member's session impact rating (partner effects). In terms of the alliance, the results revealed significant client-actor effects for client ratings of session depth and positivity as well as significant therapist-actor effects for therapist ratings of session smoothness and positivity.

Adult attachment anxiety: using group therapy to promote change.

Group therapy can facilitate changes for members with greater attachment anxiety who tend to struggle with negative self-perceptions, difficulties regulating emotions, poor reflective functioning, and compromised interpersonal relationships. A clinical example of a therapy group with members who had elevated attachment anxiety and who were diagnosed with binge eating disorder demonstrates how attachment theory can be applied to group treatment. The clinical material from the beginning, middle, and end of group is presented to highlight how attachment anxiety influences members' emotional reactions and behaviors in the group, how group factors facilitate change, and how the leader fosters the development of a secure base within the group.

Empirical research on attachment in group psychotherapy: moving the field forward.

Despite a large literature applying attachment to individual, family, and couple psychotherapy, it has taken much longer for clinicians to apply attachment theory to group psychotherapy. The lack of research attention in this area makes these three studies in this special section even more important to the field. They contribute significant findings that have the potential to help group leaders facilitate more cohesive and effective treatments for patients as well as move the field forward.

Fostering new relational experience: clinical process in couple psychotherapy.

One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight.

Adult attachment, attachment to the supervisor, and the supervisory alliance: how they relate to novice therapists' perceived counseling self-efficacy.

The supervisory relationship is one of the most important components in training therapists' professional development, and it is a frequent area of training-focused research. The current study explored how 57 training therapists' adult romantic attachments relate to the attachment to the supervisor and the supervisory working alliance. Additionally, we explored how both adult attachment and supervisory attachment relate to trainees' perceptions of their counseling self-efficacy (CSE).

Empirically supported perspectives on transference.

There is much debate about the definition of transference and the use of transference in psychotherapy treatment. The current section brings together three papers presented at the American Psychological Association's Annual conference that bridge diverse areas of psychology and the study of transference. Each of these papers contributes to our understanding of what transference is, where it exists, and how it can influence people.

Relationships among client and counselor agreement about the working alliance, session evaluations, and change in client symptoms using response surface analysis.

Two studies explored how counselor and client agreement on the therapy alliance, at the beginning of treatment, influenced early session evaluations and symptom change. Unlike prior studies that operationalized alliance convergence as either a profile similarity correlation or a difference score, the present study used polynomial regression and response surface analysis to examine agreement. Study 1 explored the impact of working alliance congruence on session depth and smoothness at the 3rd session of treatment with 36 client-counselor dyads.

The influence of individual attachment styles on group members' experience of therapist transitions.

Attachment theory has recently been applied to clinical practice in an effort to improve understanding and treatment of the maladaptive relational patterns clients bring to therapy. While most of this research has focused on individual therapy, interest in the application of attachment theory to group psychotherapy is growing. This paper will explore the impact of clients' attachment styles on their experiences of co-therapist transition in an ongoing psychodynamic therapy group.

Multiple attachments and group psychotherapy: implications for college counseling centers.

A large body of literature has supported the application of attachment theory to the understanding of college student development and the process of individual psychotherapy. Despite group treatment being one of the major methods of intervention in college counseling centers, there has been very little research guided by attachment theory that has been applied to the area of group psychotherapy. Many current assessment instruments used in college counseling centers can be supported with attachment theory, and many group therapy interventions are aimed at facilitating secure working models of self, other, and groups.

Therapists' group attachments and their expectations of patients' attitudes about group therapy.

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature.