Louis Castonguay | Penn State University (original) (raw)

Papers by Louis Castonguay

Research paper thumbnail of Summarizing Novel Efforts to Integrate Practice and Research from a Practice Oriented Research Perspective

REVISTA ARGENTINA DE CLINICA PSICOLOGICA, 2018

Los avances significativos en el campo de la psicoterapia están bien documentados, particularment... more Los avances significativos en el campo de la psicoterapia están bien documentados, particularmente los beneficios que pueden obtenerse en el tratamiento de numerosas condiciones clínicas, especialmente en el terreno de los trastornos mentales comunes (Lambert, 2013; Wampold y Imel, 2015). Asociado con estos avances, la estructura teórica y conceptual de la disciplina se ha sofisticado y las intervenciones se han diversificado en gran medida.

Research paper thumbnail of Personal pathways in psychotherapy integration

Journal of Psychotherapy Integration, 2006

This article traces the pathways that led the author to his current integrative perspective on ps... more This article traces the pathways that led the author to his current integrative perspective on psychotherapy. Such perspective is described as an attempt to cope with repeated confrontations with the complexity of human functioning, as revealed by the seductiveness of major intellectual traditions, the untamable nature of clinical reality, and the challenge of unexpected empirical findings. The article also outlines the author's current and future integrative efforts, both in terms of training and research. Recommendations for the future of the integration movement, as well as the Society for the Exploration of Psychotherapy Integrations, are also suggested. Important career choices are rarely accidental. It is frequently acknowledged that we study who we are, or what we try to run away from. As such, writing this paper on how I became an integrationist (or, more accurately, a "cognitive-behaviorist thinking integratively") has forced me to take a close look at some of my occupational (and, of course, personal) wishes and fears. Although my work in integration has been a rich source of intellectual and professional growth, I must candidly admit that part of my interest in this domain reflects a perfectionist trait: The need to know everything (or as much as possible) and to pay respect to every major contribution in the field. My difficulty to tolerate a sense of lack of control also has a lot to do with the path that I have been traveling for the last two decades (can you say obsessive-compulsive personality?!). In fact, I originally delve into the field of integration as a mean to escape a deep sense of confusion. Responding to Lampropoulos's (this issue) kind invitation, this paper The author is grateful for the helpful feedback of Michelle Newman on a previous version of this article.

Research paper thumbnail of Development of research designs for investigating concepts of Analytical Psychology and the efficacy / effectiveness of Jungian psychotherapy

relationship is not justified. A very good example for this is the extensive research program, ma... more relationship is not justified. A very good example for this is the extensive research program, mainly conducted by Chinese and Korean researchers, which has demonstrated the efficacy and effectiveness of Sandplay Therapy in a number of naturalistic studies and RCTs as well as process studies (see Roesler 2019). So from my point of view, there is a need to conduct more research in the field of analytical psychology, namely regarding the effectiveness and efficacy of Jungian psychotherapy, in the future. Why research? Apart from the pressure coming from outside of analytical psychology, from my point of view there is a number of reasons why it is important to investigate a psychotherapeutic approach such as Jungian psychotherapy. Psychotherapy can do harm: studies covering all schools of psychotherapy have demonstrated that 33-65% of the clients do not improve and do not respond to the therapy or even deteriorate; 3-15% of all therapies lead to an increase of symptoms and severely negative effects on partners of clients; 22% of all psychotherapy patients break off early (Swift et al. 2017). This means that, even if there is the intention in the therapist to help the client, the treatment can have severely negative effects and the client would be better off if no psychotherapy had been applied. Research on ineffective therapists: ineffective therapists systematically produce negative effect sizes-0.91 to-1.49, vs. systematically positive effects in good therapists 1.0-1.52 (Linden & Strauß 2018); it is estimated that over all schools of psychotherapy 10 to 15% of psychotherapists are ineffective with almost each of their clients (Barlow 2010). This means that the subjective judgment of the therapist that he or she is helpful may be wrong, and case reports or presentations are not enough to control for the quality of psychotherapy. As examples for this kind of research findings, see the following publications:

Research paper thumbnail of Keeping psychologists in the driver’s seat: Four perspectives on quality improvement and clinical data registries

Psychotherapy, 2019

Performance accountability-also frequently referred to as quality improvement in the fields of me... more Performance accountability-also frequently referred to as quality improvement in the fields of medicine and public policy-is under growing scrutiny in mental and behavioral health care. As one high-profile example, psychologists and other mental health providers will be deemed "eligible clinicians" under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act starting in 2019. This will incentivize psychologists to track their Medicare patients' clinical outcomes and report them in data registries, and those who do not will suffer a reimbursement penalty. However, many psychologists are not aware of these developments or prepared for this change. The goal of this article is to provide information to psychologists about quality improvement and clinical data registries from four distinct, though overlapping, vantage points: professional governance, quantitative research, qualitative research, and clinical practice. We review recent regulations and research in this area, with an emphasis on exploring both the potential benefits and challenges of quality improvement. We conclude by providing recommendations for the field of psychology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Research paper thumbnail of Therapist Effects on Dropout From a College Counseling Center Practice Research Network

Journal of counseling psychology, Jan 20, 2017

Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counse... more Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counseling centers. The present study examined potential predictors of dropout using a large data set (N = 10,147 clients, 481 therapists) that was gathered through a college counseling center practice research network as a replication and extension of recent findings regarding therapist effects on dropout. The final model resulted in a dropout rate of 15.9% and a therapist effect of 9.51% on dropout variance. Therapist demographic variables were investigated, though none were found to be significant. Variables found to be predictive of increased likelihood of dropping out included higher levels of general presenting concerns, alcohol-related distress, and current financial stress. Ultimately, this study showed that therapists may play an important role in the likelihood of client dropout, and that additional research should be conducted to identify additional predictors, particularly at the t...

Research paper thumbnail of This is what I need a clinical feedback system to do for me: A qualitative inquiry into therapists’ and patients’ perspectives

Psychotherapy Research, 2016

Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of prov... more Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of providing naturalistic research data and enhancing mental health care. However, implementation in routine care is challenging, and we need more knowledge about clinicians' and patients' needs from such systems. We aimed to study perspectives of clinicians and patients to explore how ROM/CFS can be helpful and acceptable to them. We interviewed 55 participants in focus groups and individual interviews and analyzed the data through rigorous team-based qualitative analyses. We report 3 overarching domains: (a) Shared needs, (b) Specific patient needs, and (c) Specific therapist needs. Shared needs, in which perspectives of different stakeholders converge, was the dominant domain in the material. Under each domain, we report 3 specific themes: (a1) Degree of trust in therapy, (a2) Allowing for openness, (a3) Monitoring joint objectives; (b1) Life functioning, (b2) Canary in the coal mine, (b3) Holistic report; and (c1) Emotional presence and style, (c2) Monitoring risk and symptoms, and (c3) Agency and ownership of process. In what should increase our confidence toward core aspects of ROM, we suggest that an integration of relational feedback concepts and stringent clinical dimension tracking into the ROM/CFS can be beneficial.

Research paper thumbnail of Kolik je na světě psychoterapií?

Pocet samostatně existujicich a odbornou komunitou uznaných (recognised) psychoterapeutických mod... more Pocet samostatně existujicich a odbornou komunitou uznaných (recognised) psychoterapeutických modelů se pohybuje mezi 200 a 250. Přestože v řadě zdrojů jsou uvaděny pocty vyssi. Důkladným monitorovanim 1294 abstraktů a dalsi stovky clanků v přednich psychoterapeutických casopisech, několika zasadnich knih věnovaných soucasne psychoterapii i zohledněnim situace v řadě zemi (Velka Britanie) a v Evropske psychoterapeuticke asociaci předkladame soupis těch psychoterapeutických směrů, ktere jsou v textech, výzkumech, přehledech o psychoterapii i politických seznamech samostatných modalit uvaděny jako samostatna psychoterapie. Dospěli jsme k tomu, že je potřebne třidit zvlasť ucelene směry a zvlasť techniky (oboje casto nazývane jako terapie). Ani toto třiděni se vsak neukazuje jako dostatecne, jak rozebirame v diskusi.

Research paper thumbnail of Predicting Therapist Effectiveness From Their Own Practice-Based Evidence

Journal of consulting and clinical psychology, Jan 15, 2016

Differences between therapists (therapist effect) are often larger than differences between treat... more Differences between therapists (therapist effect) are often larger than differences between treatments (treatment effect) in explaining client outcomes, and thus should be considered relevant to providing optimal treatment to clients. However, research on therapist effectiveness has focused largely on global measures of distress as opposed to a multidimensional assessment, and has failed to risk-adjust for client characteristics. The purpose of this study was to examine the stability and predictive validity of therapist effectiveness across multiple outcome domains using risk-adjusted outcomes. Initial and follow-up outcome data on the Treatment Outcome Package (Kraus, Seligman, & Jordan, 2005) were collected on 3,540 clients who were treated in naturalistic settings by a sample of 59 therapists. After risk-adjusting outcomes based on case-mix variables using random forest models, outcome data from the first 30 clients of each therapist were used to classify each therapist's eff...

Research paper thumbnail of Reflecting on curreat challenges and future directions in psychotherapy : What can be learned from dialogues between clinicians, researchers, and policy makers?

Journal of Clinical Psychology, 1999

Research paper thumbnail of Treatment outcome package: Measuring and facilitating multidimensional change

Psychotherapy (Chicago, Ill.), 2015

The Treatment Outcome Package (TOP; D. R. Kraus, Seligman, & Jordan, 2005) is a multidimensional ... more The Treatment Outcome Package (TOP; D. R. Kraus, Seligman, & Jordan, 2005) is a multidimensional routine progress and outcome measure developed for use in diverse naturalistic practice settings. In this article, we (a) provide a brief review and summary of the extant psychometric and research support for the TOP, (b) provide examples of the TOP's use in clinical training and practice, and (c) discuss the implications of the TOP for future psychotherapy training, research, and practice. In particular, we focus on the implications of risk-adjusted progress monitoring for systems of care and mental health care decision making. (PsycINFO Database Record

Research paper thumbnail of The working alliance: A flagship for the “scientist-practitioner” model in psychotherapy

Research paper thumbnail of Future directions of psychotherapy integration. In J. C. Norcross, & M. R. Goldfried (Eds.), The Future of Psychotherapy Integration: A Roundtable

Journal of Psychotherapy Integration

Research paper thumbnail of The potential role of interpersonal emotional processing in the treatment of generalized anxiety disorder

Research paper thumbnail of The therapist and client experience in integrative treatment for generalized anxiety disorder

Research paper thumbnail of Integrating cognitive-behavioral, interpersonal, and humanistic interventions: Why should we and how can we?

Research paper thumbnail of New dimensions in the treatment of generalized anxiety disorder: Interpersonal focus and emotional deepening

Research paper thumbnail of Integrating cognitive-behavioral and interpersonal/emotional processing treatments for generalized anxiety disorder: Preliminary outcome findings

Research paper thumbnail of Integrative psychotherapy

Research paper thumbnail of GrosseHoltforth2005MotAttun

Research paper thumbnail of EEG gamma band activity: Role in negative affect, worry and generalized anxiety disorder

GAD and worry are associated with increased left posterior cortex Gamma activation (commonly acti... more GAD and worry are associated with increased left posterior cortex Gamma activation (commonly activated for negative affect in general).

Research paper thumbnail of Summarizing Novel Efforts to Integrate Practice and Research from a Practice Oriented Research Perspective

REVISTA ARGENTINA DE CLINICA PSICOLOGICA, 2018

Los avances significativos en el campo de la psicoterapia están bien documentados, particularment... more Los avances significativos en el campo de la psicoterapia están bien documentados, particularmente los beneficios que pueden obtenerse en el tratamiento de numerosas condiciones clínicas, especialmente en el terreno de los trastornos mentales comunes (Lambert, 2013; Wampold y Imel, 2015). Asociado con estos avances, la estructura teórica y conceptual de la disciplina se ha sofisticado y las intervenciones se han diversificado en gran medida.

Research paper thumbnail of Personal pathways in psychotherapy integration

Journal of Psychotherapy Integration, 2006

This article traces the pathways that led the author to his current integrative perspective on ps... more This article traces the pathways that led the author to his current integrative perspective on psychotherapy. Such perspective is described as an attempt to cope with repeated confrontations with the complexity of human functioning, as revealed by the seductiveness of major intellectual traditions, the untamable nature of clinical reality, and the challenge of unexpected empirical findings. The article also outlines the author's current and future integrative efforts, both in terms of training and research. Recommendations for the future of the integration movement, as well as the Society for the Exploration of Psychotherapy Integrations, are also suggested. Important career choices are rarely accidental. It is frequently acknowledged that we study who we are, or what we try to run away from. As such, writing this paper on how I became an integrationist (or, more accurately, a "cognitive-behaviorist thinking integratively") has forced me to take a close look at some of my occupational (and, of course, personal) wishes and fears. Although my work in integration has been a rich source of intellectual and professional growth, I must candidly admit that part of my interest in this domain reflects a perfectionist trait: The need to know everything (or as much as possible) and to pay respect to every major contribution in the field. My difficulty to tolerate a sense of lack of control also has a lot to do with the path that I have been traveling for the last two decades (can you say obsessive-compulsive personality?!). In fact, I originally delve into the field of integration as a mean to escape a deep sense of confusion. Responding to Lampropoulos's (this issue) kind invitation, this paper The author is grateful for the helpful feedback of Michelle Newman on a previous version of this article.

Research paper thumbnail of Development of research designs for investigating concepts of Analytical Psychology and the efficacy / effectiveness of Jungian psychotherapy

relationship is not justified. A very good example for this is the extensive research program, ma... more relationship is not justified. A very good example for this is the extensive research program, mainly conducted by Chinese and Korean researchers, which has demonstrated the efficacy and effectiveness of Sandplay Therapy in a number of naturalistic studies and RCTs as well as process studies (see Roesler 2019). So from my point of view, there is a need to conduct more research in the field of analytical psychology, namely regarding the effectiveness and efficacy of Jungian psychotherapy, in the future. Why research? Apart from the pressure coming from outside of analytical psychology, from my point of view there is a number of reasons why it is important to investigate a psychotherapeutic approach such as Jungian psychotherapy. Psychotherapy can do harm: studies covering all schools of psychotherapy have demonstrated that 33-65% of the clients do not improve and do not respond to the therapy or even deteriorate; 3-15% of all therapies lead to an increase of symptoms and severely negative effects on partners of clients; 22% of all psychotherapy patients break off early (Swift et al. 2017). This means that, even if there is the intention in the therapist to help the client, the treatment can have severely negative effects and the client would be better off if no psychotherapy had been applied. Research on ineffective therapists: ineffective therapists systematically produce negative effect sizes-0.91 to-1.49, vs. systematically positive effects in good therapists 1.0-1.52 (Linden & Strauß 2018); it is estimated that over all schools of psychotherapy 10 to 15% of psychotherapists are ineffective with almost each of their clients (Barlow 2010). This means that the subjective judgment of the therapist that he or she is helpful may be wrong, and case reports or presentations are not enough to control for the quality of psychotherapy. As examples for this kind of research findings, see the following publications:

Research paper thumbnail of Keeping psychologists in the driver’s seat: Four perspectives on quality improvement and clinical data registries

Psychotherapy, 2019

Performance accountability-also frequently referred to as quality improvement in the fields of me... more Performance accountability-also frequently referred to as quality improvement in the fields of medicine and public policy-is under growing scrutiny in mental and behavioral health care. As one high-profile example, psychologists and other mental health providers will be deemed "eligible clinicians" under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act starting in 2019. This will incentivize psychologists to track their Medicare patients' clinical outcomes and report them in data registries, and those who do not will suffer a reimbursement penalty. However, many psychologists are not aware of these developments or prepared for this change. The goal of this article is to provide information to psychologists about quality improvement and clinical data registries from four distinct, though overlapping, vantage points: professional governance, quantitative research, qualitative research, and clinical practice. We review recent regulations and research in this area, with an emphasis on exploring both the potential benefits and challenges of quality improvement. We conclude by providing recommendations for the field of psychology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Research paper thumbnail of Therapist Effects on Dropout From a College Counseling Center Practice Research Network

Journal of counseling psychology, Jan 20, 2017

Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counse... more Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counseling centers. The present study examined potential predictors of dropout using a large data set (N = 10,147 clients, 481 therapists) that was gathered through a college counseling center practice research network as a replication and extension of recent findings regarding therapist effects on dropout. The final model resulted in a dropout rate of 15.9% and a therapist effect of 9.51% on dropout variance. Therapist demographic variables were investigated, though none were found to be significant. Variables found to be predictive of increased likelihood of dropping out included higher levels of general presenting concerns, alcohol-related distress, and current financial stress. Ultimately, this study showed that therapists may play an important role in the likelihood of client dropout, and that additional research should be conducted to identify additional predictors, particularly at the t...

Research paper thumbnail of This is what I need a clinical feedback system to do for me: A qualitative inquiry into therapists’ and patients’ perspectives

Psychotherapy Research, 2016

Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of prov... more Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of providing naturalistic research data and enhancing mental health care. However, implementation in routine care is challenging, and we need more knowledge about clinicians' and patients' needs from such systems. We aimed to study perspectives of clinicians and patients to explore how ROM/CFS can be helpful and acceptable to them. We interviewed 55 participants in focus groups and individual interviews and analyzed the data through rigorous team-based qualitative analyses. We report 3 overarching domains: (a) Shared needs, (b) Specific patient needs, and (c) Specific therapist needs. Shared needs, in which perspectives of different stakeholders converge, was the dominant domain in the material. Under each domain, we report 3 specific themes: (a1) Degree of trust in therapy, (a2) Allowing for openness, (a3) Monitoring joint objectives; (b1) Life functioning, (b2) Canary in the coal mine, (b3) Holistic report; and (c1) Emotional presence and style, (c2) Monitoring risk and symptoms, and (c3) Agency and ownership of process. In what should increase our confidence toward core aspects of ROM, we suggest that an integration of relational feedback concepts and stringent clinical dimension tracking into the ROM/CFS can be beneficial.

Research paper thumbnail of Kolik je na světě psychoterapií?

Pocet samostatně existujicich a odbornou komunitou uznaných (recognised) psychoterapeutických mod... more Pocet samostatně existujicich a odbornou komunitou uznaných (recognised) psychoterapeutických modelů se pohybuje mezi 200 a 250. Přestože v řadě zdrojů jsou uvaděny pocty vyssi. Důkladným monitorovanim 1294 abstraktů a dalsi stovky clanků v přednich psychoterapeutických casopisech, několika zasadnich knih věnovaných soucasne psychoterapii i zohledněnim situace v řadě zemi (Velka Britanie) a v Evropske psychoterapeuticke asociaci předkladame soupis těch psychoterapeutických směrů, ktere jsou v textech, výzkumech, přehledech o psychoterapii i politických seznamech samostatných modalit uvaděny jako samostatna psychoterapie. Dospěli jsme k tomu, že je potřebne třidit zvlasť ucelene směry a zvlasť techniky (oboje casto nazývane jako terapie). Ani toto třiděni se vsak neukazuje jako dostatecne, jak rozebirame v diskusi.

Research paper thumbnail of Predicting Therapist Effectiveness From Their Own Practice-Based Evidence

Journal of consulting and clinical psychology, Jan 15, 2016

Differences between therapists (therapist effect) are often larger than differences between treat... more Differences between therapists (therapist effect) are often larger than differences between treatments (treatment effect) in explaining client outcomes, and thus should be considered relevant to providing optimal treatment to clients. However, research on therapist effectiveness has focused largely on global measures of distress as opposed to a multidimensional assessment, and has failed to risk-adjust for client characteristics. The purpose of this study was to examine the stability and predictive validity of therapist effectiveness across multiple outcome domains using risk-adjusted outcomes. Initial and follow-up outcome data on the Treatment Outcome Package (Kraus, Seligman, & Jordan, 2005) were collected on 3,540 clients who were treated in naturalistic settings by a sample of 59 therapists. After risk-adjusting outcomes based on case-mix variables using random forest models, outcome data from the first 30 clients of each therapist were used to classify each therapist's eff...

Research paper thumbnail of Reflecting on curreat challenges and future directions in psychotherapy : What can be learned from dialogues between clinicians, researchers, and policy makers?

Journal of Clinical Psychology, 1999

Research paper thumbnail of Treatment outcome package: Measuring and facilitating multidimensional change

Psychotherapy (Chicago, Ill.), 2015

The Treatment Outcome Package (TOP; D. R. Kraus, Seligman, & Jordan, 2005) is a multidimensional ... more The Treatment Outcome Package (TOP; D. R. Kraus, Seligman, & Jordan, 2005) is a multidimensional routine progress and outcome measure developed for use in diverse naturalistic practice settings. In this article, we (a) provide a brief review and summary of the extant psychometric and research support for the TOP, (b) provide examples of the TOP's use in clinical training and practice, and (c) discuss the implications of the TOP for future psychotherapy training, research, and practice. In particular, we focus on the implications of risk-adjusted progress monitoring for systems of care and mental health care decision making. (PsycINFO Database Record

Research paper thumbnail of The working alliance: A flagship for the “scientist-practitioner” model in psychotherapy

Research paper thumbnail of Future directions of psychotherapy integration. In J. C. Norcross, & M. R. Goldfried (Eds.), The Future of Psychotherapy Integration: A Roundtable

Journal of Psychotherapy Integration

Research paper thumbnail of The potential role of interpersonal emotional processing in the treatment of generalized anxiety disorder

Research paper thumbnail of The therapist and client experience in integrative treatment for generalized anxiety disorder

Research paper thumbnail of Integrating cognitive-behavioral, interpersonal, and humanistic interventions: Why should we and how can we?

Research paper thumbnail of New dimensions in the treatment of generalized anxiety disorder: Interpersonal focus and emotional deepening

Research paper thumbnail of Integrating cognitive-behavioral and interpersonal/emotional processing treatments for generalized anxiety disorder: Preliminary outcome findings

Research paper thumbnail of Integrative psychotherapy

Research paper thumbnail of GrosseHoltforth2005MotAttun

Research paper thumbnail of EEG gamma band activity: Role in negative affect, worry and generalized anxiety disorder

GAD and worry are associated with increased left posterior cortex Gamma activation (commonly acti... more GAD and worry are associated with increased left posterior cortex Gamma activation (commonly activated for negative affect in general).