Open research questions in Psychotherapy Techniques and Applications

What the literature leaves open

• findings therapeutic the ISSN 2710-1460 WAPP THE GLOBAL PSYCHOTHERAPIST. Volume 6. Number 2. July 2026 227 phases of psychotherapy rather than at a single stage. This suggests that, beyond its clinical application, the five-stage model may also serve as a useful framework for organizing and interpreting case material.

  Transformation of self-image through verbal self-expression in Positive Psychotherapy: Case study · 2026 · DOI

• Chapter 1 – History and Contemporary Developments Kaklauskas and Elizabeth A. Olson The authors present how combining theory with research from historical analyses is paramount. However, their adumbrating of a pre-therapy group influence is awry, specifically the first meetings Sigmund Freud conducted with his colleagues. They state, “Some cite…Freud’s Thursday night discussion group of psychoanalysts as the first group psychotherapy or group supervision meeting” (p. 3). First, who would “some” in, I gather, the Recommended Resources be? Second, note Clark (1980) says this group, started November 1902, was known as the Wednesday Society— meeting on Wednesdays (morphing into the Vienna Psychoanalytical Society in 1906).

  Core Principles of Group Psychotherapy: An Integrated Theory, Research, and Practice Training Manual · 2026 · DOI

• metric Technique Facilitating Group Psychotherapy 81 sexuality to get connected with people, but then you find that the intimacy of an enduring relationship is lacking in your relationships.

  Modified Sociometric Technique Facilitating Group Psychotherapy: · 2026 · DOI

• Further, little is known about the SP’s perspective on alliance formation which is an important gap given the correlation between patient perception of alliance and therapeutic success.

  “Meeting a human, not a medical condition”: a qualitative study of simulated patients’ perceptions of forming a therapeutic alliance with psychiatrists · 2026 · DOI

• The study demonstrates that therapeutic presence is not con- fined to physical co-presence. In I-EAET, therapist contact can provide containment and validation, and absence may evoke experiences of distance and longing. Working with- out a therapist may foster autonomy and reflective function- ing but also increase vulnerability to emotional overload. Future research should compare guided, partially guided, and self-guided internet-based psychodynamic treatments and examine individual difference factors that moderate patients’ capacity to benefit from varying levels of thera- pist presence. Integrating qualitative and process-oriented measures may further elucidate how emotional processing unfolds in written therapeutic formats.

  Between Presence and Distance: Patients’ Experiences of Therapist Connection in Internet Administrated Psychodynamic Therapy for Somatic Symptom Disorder · 2026 · DOI

• for uncovering core beliefs are through the administration of inventories, particularly when the patient is observed to have difficulty with noticing core beliefs. By using inventories, both positive and negative core beliefs can be identified that may have been previously dormant or difficult to detect. Other scholars have recommended identifying core beliefs through attending to language used such as use of verbs including “should” and through noticing moments of strong affect. J Psychiatry Brain Sci. 2026;11(3):e260008. https://doi.org/10.20900/jpbs.20260008 Journal of Psychiatry and Brain Science 10 of 17 Clinical Recommendation 6: Focus on both adaptive and maladaptive core beliefs, as well as on a limited number of beliefs related to the presenting problem. When working on core beliefs, Persons et al. (2001) recommend selecting one to two core beliefs that appear most closely related to the patient’s presenting problems. Moreover, it is recommended that the therapist also tend to the adaptive aspects of the patient’s underlying cognitive structures, and not just the maladaptive core beliefs. Shifting attention to more adaptive core beliefs can be a more effective way of producing core belief change. Dobson (2008) suggested that the focus on adaptive or developing of a more adaptive core belief should be a belief that is important and attainable to the patient. DISCUSSION This review focused on identifying cognitive techniques that target core beliefs, and aimed to identify clinical recommendations pertaining to their use. Therapist techniques applied in the treatment of major depression were reviewed from the retrieved literature. These interventions were grouped into two clusters: (1) techniques that identify core beliefs and (2) techniques that modify core beliefs. Common identifying techniques applied to core beliefs included considering the historical context, the downward arrow and use of inventories and worksheets. On the other hand, techniques directed at the modification of core belief included examining the evidence, examining the advantages and disadvantages, conducting historical tests, the continuum method, and an alternative beliefs and positive data log. In addition, the review identified a number of clinical recommendations for interventions. These recommendations included applying techniques after there has been a reduction in depressive symptomology, towards the end of treatment, and in the context of a strong therapeutic relationship. Recommendations also included normalizing the gradual shift of core beliefs and applying a variety of techniques to identify beliefs.

  Therapist Techniques in Cognitive Behavioural Therapy: A Scoping Review of Interventions Targeting Core Beliefs in Major Depression · 2026 · DOI

• The findings of this study highlight the central role of the clinician–patient therapeutic alliance in improving treatment outcomes among patients with depression in Benue State. Accordingly, clinicians should deliberately prioritise early and sustained alliance-building as part of routine care. This can be achieved by clearly discussing treatment goals, agreeing on tasks, and actively involving patients in decision-making from the first few sessions. Also, healthcare facilities should also introduce routine assessment of therapeutic alliance using brief standardised tools to identify and address weak alliances early. Given that stronger therapeutic alliances lead to better outcomes, there is a need to improve the quality of clinician–patient interactions within the healthcare system. Administrators should implement caseload management strategies to reduce clinician burnout and allow adequate time for meaningful engagement with patients. Mental health services should adopt collaborative care approaches (Onah, 2024), ensuring that patients are active participants in treatment decisions, which enhances adherence and satisfaction. Furthermore, supervision systems should incorporate relational competence, enabling senior clinicians to mentor others on effective alliance-building. The integration 16 medRxiv preprint doi: https://doi.org/10.64898/2026.05.19.26353601 ; this version posted May 22, 2026. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license . of patient feedback mechanisms can also help monitor and improve the quality of therapeutic relationships. The significant role of relational factors such as trust, empathy, and communication underscores the importance of structured and intentional interpersonal engagement in clinical practice. Thus, clinicians should adopt effective communication techniques, including open-ended questioning, reflective listening, and clear summarisation, to strengthen trust and understanding. Ensuring continuity of care, where patients consistently see the same clinician, is critical for maintaining relational stability. Additionally, integrating psychoeducation for patients and families can reduce stigma, improve understanding of depression, and enhance trust in treatment. Community-based awareness initiatives should also be encouraged to promote positive attitudes toward mental health care. Finally, culturally responsive and context-sensitive strategies are essential for sustaining therapeutic relationships in Benue State. Clinicians should be trained to engage respectfully with local beliefs and cultural interpretations of depression, using appropriate language and communication styles, including local dialects where necessary. Low-cost innovations such as follow-up phone calls or SMS reminders can help maintain contact between visits and reinforce adherence. At the policy level, therapeutic alliance should be recognised as a key indicator of quality care, while training institutions should embed relational competence as a core component of clinical education. Overall, strengthening the therapeutic relationship represents a practical, scalable, and cost-effective approach to improving depression outcomes in resource-limited settings. 17 medRxiv preprint doi: https://doi.org/10.64898/2026.05.19.26353601 ; this version posted May 22, 2026. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license .

  Therapeutic Alliance and Treatment Outcomes Among Patients with Depression in Benue State · 2026 · DOI

• Several limitations should be considered when interpreting the findings of this study. First, the cross- sectional design precludes causal inference and limits the ability to establish temporal relationships among therapeutic alliance, relational factors, and treatment outcomes. Second, all variables were assessed using patient self-report measures, raising the possibility of common method bias and inflated associations. Third, the sampling strategy, which involved purposive selection of facilities, may restrict the generalisability of the findings to other settings, particularly underserved populations with limited access to care. Fourth, the absence of clinician-rated alliance measures and objective indicators of treatment adherence limits the comprehensiveness of the assessment. Finally, unmeasured confounding variables, such as clinician experience, treatment modality differences, and severity of depression at baseline, may have influenced the observed relationships. In addition, clinician-related characteristics such as professional discipline, years of clinical experience, and formal psychotherapy training were not comprehensively examined as independent predictors within the structural model. These factors may influence alliance formation and treatment outcomes and should therefore be incorporated into future research. However, beyond its empirical contributions, this study highlights the importance of situating therapeutic processes within their socio-cultural context. In settings characterised by limited resources, high stigma, and variability in mental health literacy, the therapeutic alliance may function not only as a clinical construct but also as a culturally embedded relational process. Future research should therefore move beyond universal models of alliance to develop contextually grounded frameworks that reflect the lived realities of patients in sub-Saharan Africa.

  Therapeutic Alliance and Treatment Outcomes Among Patients with Depression in Benue State · 2026 · DOI

• Given the limited literature on this subject, we aim to contribute by examining (i) the specificity of the cancer experience, particularly its five main existential dimensions and dialectics, (ii) the psychological challenges patients with cancer encounter from a psychodynamic perspective and (iii) the relationship between these psychological dimensions and the existential dialectics experienced by patients, which we consider central to psychodynamic psychotherapy.

  Reflections on psychodynamic psychotherapy for patients with cancer facing existential threat · 2025 · DOI

• Despite its clinical significance, comprehensive empirical support is still lacking regarding whether ET is an inherent characteristic of the patient or acts as a catalyst for therapeutic change.

  More than Meets the “I”: A Panoramic View of Epistemic Trust in Psychotherapy · 2024 · DOI

• Although in recent decades, there has been growing recognition of her life and work, the importance of her theoretical contributions (Spielrein, 2019a [1911], 2019b [1912], 2015 [1922], 2019c [1923], 2019d [1923]), her influence on later psychoanalytic thought and the role she played in the history of psychoanalysis have not yet been fully elucidated.

  Death Instinct and Mental Conflict in Sabina Spielrein’s Early Work (1911–1912) · 2024 · DOI

• A literature review identified gaps in research including: how practitioners use language when asking for feedback, in particular about sensations and pleasure, and how they help clients deal with specific distractions and blockages arising from SF exercises.

  Therapists’ use of feedback from clients about Sensate Focus exercises: an interpretive description of therapists’ perspectives · 2023 · DOI

• Given the evidence that increasing social cognition, attachment security, and engagement with the imagination may all be associated with decreasing negative symptoms of psychosis, it is surprising that SPT, an expressive play therapy with Jungian origins, has not been tested for treatment of psychosis, even for negative symptoms, in any randomised clinical trials.

  Sandplay therapy for people coping with negative symptoms of psychosis: a theoretically promising option · 2023 · DOI

• The role and nature of conflict in the development and manifestation of dissociative identity disorder (DID) remains underexplored beyond theoretical deduction.

  How do Patients Diagnosed with Dissociative Identity Disorder Experience Conflict? A Qualitative Study · 2022 · DOI

• Despite this lack of evidence, there seems to be enough anecdotal evidence to support that VCP is certainly better than no therapy at all, and in some cases, quite effective in maintaining the parameters of a highly charged and emotionally rich patient/therapist dyad.

  Technology, Transference, and <scp>COVID</scp>‐19 — With Reference to Davanloo's Intensive Short‐term Dynamic Psychotherapy · 2021 · DOI

• I conclude by noting limitations of this study based as it was on the immediate reaction of myself and my colleagues to the transition from providing clinic‐based to online psychotherapy, not on interviews with patients about their experience of this transition nor on any measure of the relative effectiveness of online compared with clinic‐based psychotherapy.

  Online Psychotherapy: Transference and Countertransference Issues · 2021 · DOI

• However, much remains to be said about the implications of methodological developments and debate in psycho-social studies for social work research, particularly in terms of the impetus it provides for reflecting on the transformations brought about in resituating psychoanalytic concepts and practices away from their traditional clinical context in social research and theory.

  The psychoanalytically-informed interview in social work research · 2020 · DOI

• By borrowing phraseology from explorer/colonialist John Stanley's description of Africa as the "dark continent," Freud links all that is "dark," mysterious, and not understood about the human psyche to Africa and its inhabitants, while tying psychoanalysis itself to colonialism, exploring and bringing understanding, or "light," to an entire continent and people stereotypically and offensively defined by ignorance and incomprehensibility.

  The Mixed-Race Child Within: Psychoanalyzing Race, Trauma, Vermin, and Spider-Man · 2020 · DOI

• , 4,5,35) that therapists should refrain from using psychological jargon and overly technical language when making interpretations, this question had not yet been investigated empirically.

  Is there a relationship between therapist language use, patient defensive functioning and therapeutic alliance? A pilot study of in-session processes · 2019 · DOI

• I discuss the research that suggests that potentially harmful processes can be avoided by a dynamic‐agentive systems model, which views psychotherapy as a conversation, in which turn‐taking, rupture and repair, and perspective‐taking are the intersubjective tools that help to build the therapeutic alliance and that can be the focus for further study into the mechanisms by which psychotherapy is helpful or harmful.

  The Harmful Effects of Psychotherapy: When the Therapeutic Alliance Fails · 2019 · DOI

• BACKGROUND/AIMS: This paper offers a hermeneutic-phenomenological perspective on three dangers relevant to the psychotherapy of an underserved and often poorly understood population: persons with schizophrenia and other psychotic conditions.

  Three Dangers: Phenomenological Reflections on the Psychotherapy of Psychosis · 2019 · DOI

• Additionally, counseling psychologists' expertise in culture, attunement to therapeutic processes, and our focus on prioritizing patients' perspectives and quality of life can fill the gap in research on MUS and bringing increased attention to counseling psychologists' unique contributions to health service delivery.

  Medically Unexplained Physical Symptoms: Why Counseling Psychologists Should Care About Them · 2019 · DOI

• The main conclusions indicate that in addition to the main problem of an optimal/lack of adaptation of humans to the underwater environment, there is insufficient psychological knowledge (including Polish reports) in the area of personality differences between various types of divers, their social functioning, mental health and psychoeducation with regard to underwater exposures.

  Psychological Aspects of Diving in Selected Theoretical and Research Perspectives · 2018 · DOI

• Unfortunately, research regarding the specific contents of these CCRT components in complex trauma is scarce and adopts a static approach in studying interpersonal patterns.

  Core conflictual relationship patterns in complex trauma: A single-case study · 2018 · DOI

• But despite the use of linguistic and literary terms such as ‘metaphor’ and ‘narrative’, the relationship between the role played by language in the constitution of the subject and how it functions in the process of communication between therapist and patient, in general and as a key to change, remains to be elucidated.

  Wittgenstein's ‘Lighting up of an Aspect’ and the Possibility of Change in Psychoanalytic Therapy · 2017 · DOI

Most-cited papers in Psychotherapy Techniques and Applications

• Transdiagnostic approaches to mental health problems: Current status and future directions. · Journal of Consulting and Clinical Psychology · 2020 · 747 citations
• Overconfidence in case-study judgments. · Journal of Consulting Psychology · 1965 · 604 citations
• Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science · Behavioral and Brain Sciences · 2014 · 394 citations
• The Theory Crisis in Psychology: How to Move Forward · Perspectives on Psychological Science · 2021 · 312 citations
• Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis · Clinical Psychology Review · 2021 · 291 citations
• What works for whom: Tailoring psychotherapy to the person · Journal of Clinical Psychology · 2010 · 239 citations
• Is the alliance really therapeutic? Revisiting this question in light of recent methodological advances. · American Psychologist · 2017 · 232 citations
• Child, parent and therapist (dis)agreement on target problems in outpatient therapy: The therapist's dilemma and its implications. · Journal of Consulting and Clinical Psychology · 2003 · 219 citations
• Clinical Significance Methods: A Comparison of Statistical Techniques · Journal of Personality Assessment · 2004 · 198 citations
• Toward a more clinically valid approach to therapy research. · Journal of Consulting and Clinical Psychology · 1998 · 182 citations

Most recent work

• The Essence of Ericksonian Psychotherapy: Toward a Manualized Resource · International Journal of Clinical and Experimental Hypnosis · 2026
• Between actionality and meaning: Group therapy as a site of liberation madness · Group Analysis · 2026
• How to define psychological therapy and psychotherapy? – An interdisciplinary proposal · Clinical Psychology in Europe · 2026
• Hypnotically Informed Psychotherapy: Erickson and Beyond · International Journal of Clinical and Experimental Hypnosis · 2026
• From Maverick to Mainstream: Four Key Contributions of Milton H. Erickson to Hypnosis and Psychotherapy · International Journal of Clinical and Experimental Hypnosis · 2026
• Ericksonian Hypnotherapy and Psychotherapy: Special Issue · International Journal of Clinical and Experimental Hypnosis · 2026
• Between Presence and Distance: Patients’ Experiences of Therapist Connection in Internet Administrated Psychodynamic Therapy for Somatic Symptom Disorder · Journal of Contemporary Psychotherapy · 2026
• What Is Precision Psychotherapy? · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · 2026
• Drive <i>or</i> Trauma – Drive <i>and</i> Trauma (Ilse Grubrich-Simitis) Revisited: Even More Relevant Than Four Decades Ago · The Psychoanalytic Study of the Child · 2026
• Microprocesses predicting early emotional bond in videoconferencing and face-to-face psychotherapy. · Psychotherapy · 2026

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