A brief overview is provided of the current state of the efforts to extend the relevance and application of Evidence-Based Treatments (EBT) beyond the Euro-American milieus in which EBTs originated. In the multicultural settings of North America, meta-analyses have demonstrated superior outcomes for culturally adapted psychotherapies as compared with the standard, unmodified versions of the same services. In particular, the key components of effective psychotherapeutic interventions such as empathy, therapist-client relationship, and therapeutic alliance appear to be promising objects for further investigation. Internationally, psychotherapy is widely applicable and effective, cognitive behavioral therapy (CBT) has been extensively studied in multicultural settings in the US, and its investigation in Japan and elsewhere in East Asia has been initiated. Future developments are envisaged in applying EBTs to locally developed and practiced therapies and in continuing to modify imported therapies to fit local needs and meet local expectations. The eventual goal is to answer the question, “What works with whom on a worldwide basis?” and thereby establish a specific empirical link between psychotherapy and culture.

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Empirically supported treatments have brought much enthusiasm for establishing a firm empirical basis for clinical practice. However controversies about what constitutes evidence in psychotherapy and what research methodologies qualify as sufficiently rigorous to produce such evidence also abound. Although most psychotherapy researchers are in agreement with the underlying rationale that psychotherapy should be based on rigorous scientific research, many are in disagreement as to what constitutes ideal scientific practice in evidence-based psychotherapy; alternative frameworks of evidence have been proposed. This paper first reviews different models of evidence, namely empirically supported treatments, empirically supported psychotherapy relationships, research informed principles of therapeutic change, and evidence-based practice in psychology, and discusses their relative strengths and limitations. Secondly, it illustrates three research topics and corresponding strategies that both supplement these evidence models and deepen an understanding of process and outcome in psychotherapy. These three areas are: mechanisms of change, systematic case studies, and researcher-practitioner collaboration.

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Within psychotherapy research traditions there are two cultures. One group of investigators, emphasizing the commonalities inherent in different schools of therapy and recognizing the extreme variability across clients and therapists, focuses on the interpersonal and emotional interactions between client and therapist as the agency of change in client well-being. The other, characterized by the cognitive-behavioral approach and supporting the empirically-supported treatment movement, focuses on the replicable procedures and techniques designed for and tailored to symptom change within specific syndromes. Both approaches are now drawing together by virtue of the growing recognition that all therapy can be represented as the arrangement of social and psychological experiences that facilitate change. We discuss some implications of this change model and describe some of the complexities of the changes that take place within the course of psychotherapy. Some broad principles of change are suggested and related concepts, such as means-ends relationships, response interrelationships, and practical and psychological barriers to change are briefly outlined. The value of monitoring change in clients, a long-standing tradition in behavior therapy, is argued, with one additional twist proposed, namely the monitoring of client experiences and actions that themselves facilitate change, regardless of the targeted problem area.

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Behavioral treatments for depression that originated in the early 1970s have emerged again in the early 21st century known as Behavioral Activation (BA). The current formulation of BA is based on the earlier work, and represents a refinement rather than a completely new approach. As the treatment has gained in popularity, several misconceptions and misunderstandings about the treatment have developed: that it is unique; that there are multiple, substantially different forms of BA; that the treatment requires specific strategies be used in all cases; and that the treatment is conducted in a lock-step fashion. In this article one of the primary authors of the main texts/protocols for BA argues that these are misconceptions and that BA needs to remain a treatment driven by a good functional analysis of the individual case, and that, at the most basic level, BA is just good behavior therapy for depression.

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Patients with thyroid disease have been reported to develop psychiatric symptoms. However, the specific psychological mechanism underlying their development remains unknown. This paper examined the psychological features of patients with thyroid disease using both the Japanese version of the NEO Five-Factor Inventory and the Tree Drawing Test. A total of 64 patients with Graves’ disease, 38 with Hashimoto disease, and 68 with Nodule Goiter were examined, and compared with 22 neurotic patients. The following results were obtained: (1) While patients with thyroid disease obtained standard scores on the Japanese version of NEO Five-Factor Inventory, they drew less structured trees regarding boundary compared with the neurotic patients; and (2) patients with Nodular Goiter exhibited more notable weakness of the boundary than patients with Graves’ disease. The implications of these results are discussed in comparisons with the levels of psychological adjustment according to objective and projective personality tests.

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This study examined whether counsellors’ memory of client-presented information varies qualitatively according to the number of years of counselling experience. This study developed a methodology to measure the amount of counsellors’ recall memory obtained from a free recall task after watching videotaped stimulus interviews. Four experienced counsellors, seven novice counsellors, and 12 non-counsellors watched videotaped stimulus interviews and then wrote freely everything they could recall about what the client had said in the interview. Participants’ performance was measured using interview transcripts. Independent coders judged the parts of the transcript to which the recalled items corresponded. The results indicated that the experienced counsellor group scored the highest in recalling client-presented information and that recalled contents differed among the participant groups. Implications of the results for the steps to gain counsellor expertise were discussed.

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