To provide an effective crisis intervention, there is a need to better understand how these interventions work. The aim of this study was to develop an explanatory theory of therapeutic processes implied in the psychological process of crisis intervention.

Background: Although internet-delivered cognitive behaviour therapy (ICBT) yields large clinical outcomes when accompanied by therapeutic support, a portion of clients do not benefit from treatment. In ICBT, clients review treatment materials online typically on a weekly basis. A key component of therapist-assistance involves answering questions as clients review and work on assignments related to the treatment materials. Aims: The goal of this study was to enhance understanding of the nature of client questions posed during ICBT and examine potential associations between the number of questions asked and treatment outcomes in order to provide insight into how to improve ICBT for future users. Method: Content analysis was used to qualitatively analyse and identify questions that 80 clients asked their designated therapist over the course of an 8-week ICBT programme for anxiety and depression. Results: On average, clients sent six emails during the course of treatment, of which less than two questions were asked. Of the 137 questions posed by clients, 46.72% reflected questions designed to enhance understanding and apply the material and techniques reviewed in the programme. Additional questions were categorized as clarifying the therapeutic process (22.62%), addressing technical challenges (18.25%), and seeking assistance with problems outside the scope of ICBT (12.41%). Number of client questions asked was not significantly correlated with the number of lessons completed, symptom change, or perceptions of therapeutic alliance. Conclusions: Findings can inform future practitioners who deliver ICBT of what to expect with this treatment approach and also assist in the development of future ICBT programmes.

It has been suggested that achieving greater effectiveness in psychotherapeutic treatment requires analyzing what therapists actually do and say, how they do this and when it is done. Based on this approach, in this study we focused on the rules emitted by therapists, since providing rules is thought to be of fundamental importance in promoting effective and efficient clinical change. Specifically, we sought to determine whether the experience level of therapists and the brevity of therapy would be related to patterns of therapist rule emission as categorized by the Category System of Rules emitted by the Therapist (SISC-RULES-T) (Vargas-de la Cruz & Pardo-Cebrián, 2014). Greater therapist experience and shorter therapy duration were found to be reliably predictive of more rule emissions across most rule categories (Z values between: Z = –3.68 and Z = –2.05; p values: p < .05 and p < .001). These variables were also predictive of more emissions of rules that specified all three operant contingency elements (situation, behavior, and consequence) rather than fewer elements (Z = –2.59, p < .05; Z = –2.26, p < .05). In the expert therapists and therapist with shorter cases, there was a nonsignificant tendency for the emission of general and conceptual rules to increase over sessions whereas emissions of concrete and particular rules tended to decrease; the explicitness of the three contingency elements also tended to decrease as treatment progressed. These findings may help to identify verbal characteristics of therapists that could lead to improved therapeutic practice.

Background: A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. Aims: We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Method: Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Results: Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. Conclusions: The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.

This article presents a panel discussion on the integration of collaborative empiricism, specifically Socratic Questioning, into cognitive behaviour therapy. The panel comprised experts in research and practice who had been invited as keynote presenters for the 34th National Conference for the Australian Association of Cognitive and Behaviour Therapy, held in Sydney, Australia. Experts responded to questions regarding (a) the definition of Socratic dialogue, and (b) whether the purpose of Guided Discovery using Socratic Questioning is to impart information, correct, or dispute patient cognitions. The session was well attended by mental health professionals from around the globe and the panel enjoyed the opportunity to discuss questions and comments from those in attendance. This article presents this exchange so that the broader AACBT membership may benefit from the ideas and comments generated.

This article explores the process of family therapy with a Turkish-speaking single-parent family with four children in which suicidal behaviour and family violence have become the norm. The following example describes a pivotal experience early within my career as a family therapist. The universality of first, being a beginner family therapist, and second, receiving a referral of a daunting, difficult case has led me to share my experience here. Central to this article is the focus on therapeutic process as a means to navigate beyond impasse. It is my hope that those who read this article will consider taking the risk to prioritise the therapeutic relationship, even when anxiety about ‘doing something’ to fix the problems is high.

Background: The term “socialization to the model” is frequently used in the Cognitive Behavioural Therapy (CBT) literature, but it is unclear exactly what constitutes socialization to the model and there is a paucity of research in this area. Aims: This study aimed to develop a working definition of “socialization to the model”. Method: A three-round electronic Delphi technique was used to generate data and to achieve a consensus agreement amongst a panel of experts (N = 9) in response to two questions pertaining to what constitutes “socialization to the model”. Results: All elements generated in response to the primary question at the first round were retained throughout and scored an IQR of ≤1 at the final round, indicating a consensus that all elements were either essential or important to accurately defining socialization to the model. The panel also reached a consensus on five elements considered to be “indicators” of socialization to the model, the secondary question. Conclusions: A working definition of socialization to the model is presented and discussed. This definition has implications for both clinical practice and research.