Refereed articles in scientific journals

Bilu, Y., Kalkstein, N., Gilboa-Schechtman, E., Akiva, P., Zalsman, G., Itzhaky, L., & Atzil-Slonim, D. (2023). Predicting future onset of depression among middle-aged adults with no psychiatric history. BJPsych Open, 9(3), e85.


Atzil-Slonim, D., Soma, C. S., Zhang, X., Paz, A., & Imel, Z. E. (2023). Facilitating dyadic synchrony in psychotherapy sessions: Systematic review and meta-analysis. Psychotherapy Research, 1-20.


Igra, L., Shilon, S., Kivity, Y., Atzil-Slonim, D., Lavi-Rotenberg, A., & Hasson-Ohayon, I. (2023). Examining the associations between difficulties in emotion regulation and symptomatic outcome measures among individuals with different mental disorders. Frontiers in Psychology, 14, 973.

Alfi-Yogev, T., Kivity, Y., Hasson-Ohayon, I., Ziv-Beiman, S., Yehezkel, I., & Atzil-Slonim, D. (2022). Client-therapist temporal congruence in perceiving immediate therapist self-disclosure and its association with treatment outcome. Psychotherapy Research, 1-15.


Warikoo, N., Mayer, T., Atzil-Slonim, D., Eliassaf, A., Haimovitz, S., &

Gurevych, I. (2022). NLP meets psychotherapy: Using predicted client emotions and self-reported client emotions to measure emotional coherence. arXiv preprint arXiv:2211.12512.


Atzil-Slonim, D., Stolowicz-Melman, D., Bar-Kalifa, E., GilboaSchechtman, E., Paz, A., Wolff, M., … & Feldman, R. (2022). Oxytocin reactivity to the therapeutic encounter as a biomarker of change in the treatment of depression. Journal of Counseling Psychology.


  Shapira, N., Atzil-Slonim, D., Tuval-Mashiach, R., & Shapira, O. (2022, July). Measuring Linguistic Synchrony in Psychotherapy. In Proceedings of the Eighth Workshop on Computational Linguistics and Clinical Psychology (pp. 158-176).‏


 ‏Zirikly, A., Atzil-Slonim, D., Liakata, M., Bedrick, S., Desmet, B., Ireland, M., … & Yates, A. (2022, July). Proceedings of the Eighth Workshop on Computational Linguistics and Clinical Psychology. In Proceedings of the Eighth Workshop on Computational Linguistics and Clinical Psychology.


‏Tsakalidis, A., Chim, J., Bilal, I. M., Zirikly, A., Atzil-Slonim, D., Nanni, F., … & Liakata, M. (2022). Overview of the CLPsych 2022 Shared Task: Capturing Moments of Change in Longitudinal User Posts.


‏Atzil-Slonim, D., Juravski, D., Bar-Kalifa, E., Gilboa-Schechtman, E.,Tuval-Mashiach, R., Shapira, N., & Goldberg, Y. (2021). Using topic models to identify clients’ functioning levels and alliance ruptures in psychotherapy. Psychotherapy.‏


Alfi-Yogev, T., Hasson-Ohayon, I., Lazarus, G., Ziv-Beiman, S., & Atzil-Slonim, D. (2021). When to disclose and to whom? examining within-and between-client moderators of therapist self disclosure-outcome associations in psychodynamic psychotherapy. Psychotherapy Research31(7), 921-931.


Shapira, N., Atzil-Slonim, D., Juravski, D., Baruch, M., Stolowicz-Melman, D., Paz, A., … & Goldberg, Y. (2021, June). Hebrew Psychological Lexicons. In Proceedings of the Seventh Workshop on Computational Linguistics and Clinical Psychology: Improving Access (pp. 55-69).


Tsakalidis, A., Atzil-Slonim, D., Polakovski, A., Shapira, N., Tuval-Mashiach, R., & Liakata, M. (2021, June). Automatic Identification of Ruptures in Transcribed Psychotherapy Sessions. In Proceedings of the Seventh Workshop on Computational Linguistics and Clinical Psychology: Improving Access (pp. 122-128).Ts


Bar, M., Saad, A., Slonim‐Atzil, D., Tuval‐Mashiach, R., Gour, T., Baron, N., & Mendlovic, S. (2021). Patient–therapist congruent exchanges engaged with the potential‐to‐experience is associated with better outcome of psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice94, 304-320.


Atzil-Slonim, D., Juravski, D., Bar-Kalifa, E., Gilboa-Schechtman, E., Tuval-Mashiach, R., Shapira, N., & Goldberg, Y. (2021). Using topic models to identify clients’ functioning levels and alliance ruptures in psychotherapy. Psychotherapy.


Paz, A., Rafaeli, E., Bar-Kalifa, E., Gilboa-Schectman, E., Gannot, S., Laufer-Goldshtein, B., … & Atzil-Slonim, D. (2021). Intrapersonal and interpersonal vocal affect dynamics during psychotherapy. Journal of Consulting and Clinical Psychology89(3), 227.‏


Shapira, N., Lazarus, G., Goldberg, Y., Gilboa-Schechtman, E., Tuval-Mashiach, R., Juravski, D., & Atzil-Slonim, D. (2021). Using computerized text analysis to examine associations between linguistic features and clients’ distress during psychotherapy. Journal of counseling psychology68(1), 77.


Chui, H., Chong, E. S., Atzil-Slonim, D., Sahin, Z., Solomonov, N., Minges, M. V., … & Barber, J. P. (2020). Beyond symptom reduction: Development and validation of the Complementary Measure of Psychotherapy Outcome (COMPO). Journal of counseling psychology.


Fluckiger, Lutz, W., ….Atzil-slonim, D., & Barber, J., (2020). The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis. Journal of Consulting and Clinical Psychology. 88(9). 829.


Paz, A.,  Rafaeli, E., Keshet, Y., Gannot, S., Bar-Kalifa, E., & Gilboa-Schechtman, E., Atzil-Slonim, D., (in press). Intrapersonal and interpersonal vocal affect dynamics during psychotherapy. Journal of Consulting and Clinical Psychology


Igra, L., Lavidor, M., Atzil-Slonim, D., Arnon-Ribenfefeld, N., de-Jong, S., Hasson-Ohayon, I. (In press) A meta-analysis of client-therapist perspectives on the therapeutic alliance: Examining the moderating role of type of measurement and diagnosis. European Psychiatry


Alfi, T., Hasson-Ohayon, I., Lazarus, G., Beiman, S., & Atzil-Slonim, D., (2021). When to disclose and to whom? examining within- and between-client moderators of therapist self disclosure-outcome associations in psychodynamic psychotherapy. Psychotherapy Research


 Lutz, W., Prinz, J., Schwartz,  B., Paulick, J., Schoenherr, D., Deisenhofer, A.K., Terhürne, P.,  Boyle, K., Altmann, U., Strauß, B., Rafaeli, E., Atzil-Slonim, D., Bar-Kalifa, E., Rubel, J. (2020). Patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multidimensional outcome. Journal of Counseling Psychology


Chen, R., Rafaeli, E., Ziv-Beiman, S., Bar-Kalifa, e., Solomonov, N., Barber, J.P., Peri, T., & Atzil-Slonim, D. (2020). Therapeutic technique diversity is linked to quality of working alliance and client functioning following alliance ruptures. Journal of Consulting and Clinical Psychology


Bar-Kalifa, E., & Atzil-Slonim, D. (2020). Intrapersonal and interpersonal emotional networks and their associations with treatment outcome. Journal of Counseling Psychology


 Bar, M., Saad, A., Atzil-Slonim, D., Tuval-Mashiach, R., Gour, T., Baron, N., Mendlovic, S., (2020).  Patient-therapist congruent exchanges engaged with the potential-to-experience is associated with better outcome of Psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice


  Shapira, N., Lazarus, G., Goldberg, Y., Gilboa-Schechtman, E., Tuval-Mashiach, R., & Atzil-Slonim, D.  (2020).  Using Computerized Text-Analysis to Examine Associations Between Linguistic Features and Clients’ Distress during Psychotherapy. Journal of Counseling Psychology


    Arnon-Ribenfeld, N., Atzil-Slonim, D., Bar-Kalifa, E., Silber, Y., Fisher, H., Peri, T., … & Hasson-Ohayon, I. (2019). Tracing metacognition in psychotherapy: associations with symptoms of general distress an  depression. The Journal of nervous and mental disease, 207(11), 936-943


Koole, S., Atzil-Slonim, D., Butler, E., Dikker, S., Tschacher, W., & Wilderjans, T. (2020). In sync with your shrink: Grounding psychotherapy in interpersonal synchrony. In Applications of social psychology – Sydney Symposium in Social Psychology. Psychology Press.


Atzil-Slonim, D. (2019). Psychodynamic Psychotherapy for Adolescents. In J. S., Ogrodniczuk & D. Kealy (Eds.) Contemporary Psychodynamic Psychotherapy. Academic Press, Elsevier.


Lazarus, G.,* Atzil-Slonim, D., Bar-Kalifa, E.,  & Rafaeli, E. (2019) Emotional instability and therapists' inferential flexibility predict therapists' session-by-session empathic accuracy. Journal of Counselling Psychology. 66(1), 56.


Galili-Weinstock, L., *  Lazarus, G., *  Atzil-Slonim, D., Bar- Kalifa, E., Rafaeli, E., & Peri, T.  (2019). Self-compassion among psychotherapy clients is in the details of negative, not positive, emotions. The Journal of Positive Psychology.


Bar-Kalifa, E., Prinz, J., Atzil-Slonim, D., Rafaeli, E., & Lutz, W., (2019). Physiological Synchrony and Therapeutic Alliance in an Imagery-based Treatment. Journal of Counselling Psychology.


Fisher, H.,* Rafaeli, E., Bar Kalifa, E., Barber, J., Solomonov, N., Peri, T., & Atzil-Slonim, D. (2019). Therapists' Interventions as a Predictor of Improvement in Clients' Emotional Experience, Self-Understanding, and Treatment Outcomes. Journal of Counselling Psychology.


Galili, L., Chen, R., Atzil-Slonim, D., Rafaeli, E., & Peri, T., (2019). Enhancement of self compassion in psychotherapy- the effect of therapists' interventions. Psychotherapy Research.


Atzil-Slonim, D., & Tschacher, W. (2019). Dynamic Dyadic Processes in Psychotherapy: Introduction to a Special Section. Psychotherapy Research.


Atzil-Slonim, D., Bar-Kalifa, E., Fisher, H., Lazarus, G., Hasson-Ohayon, I., Lutz, W., … & Rafaeli, E. (2019). Therapists’ empathic accuracy toward their clients’ emotions. Journal of consulting and clinical psychology87(1), 33


Arnon-Ribenfeld, N., Bloom, R., Atzil-Slonim, D., Peri, T., de Jong, S., & Hasson-Ohayon, I. (2018). Metacognitive Reflection and Insight Therapy (MERIT) among people with schizophrenia: Lessons from two case studies. American journal of psychotherapy, appi-psychotherapy


Chen, R., Rafaeli, E., Bar-Kalifa, E., Gilboa-Schechtman, E., Lutz, W., & Atzil-Slonim, D. (2018). Moderators of congruent alliance between therapists and clients: A realistic accuracy model. Journal of Counseling Psychology, 65(6), 703-714. http://dx.doi.org/10.1037/cou0000285


Wiseman, H. & Atzil-Slonim, D. (2018). Closeness and distance dynamics in the therapeutic relationship. In O. Tishby & H. Wiseman (Eds.), Developing the Therapeutic Relationship: Integrating Case Studies, Research, and Practice. Washington, DC: APA Press.


Lazarus, G., Atzil-Slonim, D., Bar-Kalifa, E., Hasson-Ohayon, I., & Rafaeli, E. (2018, November 29).
Clients’ Emotional Instability and Therapists’ Inferential Flexibility Predict Therapists’ Session-by-
Session Empathic Accuracy. Journal of Counseling Psychology. Advance online publication.
http://dx.doi.org/10.1037/cou0000310


Shalom, J. G., Gilboa-Schechtman, E., Atzil-Slonim, D., Bar-Kalifa, E., Hasson-Ohayon, I., van Oppen, P., . . . Aderka, I. M. (2018). Intraindividual variability in symptoms consistently predicts sudden gains: An examination of three independent datasets. Journal of Consulting and Clinical Psychology, 86(11), 892-902. http://dx.doi.org/10.1037/ccp0000344


HaCohen, N., Atzil-Slonim, D., Shapira, K., Bar-Kalifa, E., & Tuval-Mashiach, R. (in press). Investigating the Mutual Changing of Patient's and Therapist's Self-States: An Integrative Clinical Research Study of a Single Case. Journal of Psychotherapy Integration


Shlomo Mendlovic, Amit Saad, Uri Roll, Ariel Ben Yehuda, Rivka Tuval-Mashiah & Dana Atzil-Slonim (2018): The association between patient–therapist MATRIX congruence and treatment outcome, Psychotherapy Research, DOI: 10.1080/10503307.2018.1448479


Rubel, J. A., Bar-Kalifa, E., Atzil-Slonim, D., Schmidt, S., & Lutz, W. (2018) Congruence of Therapeutic Bond Perceptions and Its Relation to Treatment Outcome: Within- and Between Dyad Effects. Journal of Consulting and Clinical Psychology


Atzil-Slonim, D., Bar-Kalifa, E., Fisher, H., Peri, T., Lutz, W., Rubel, J., & Rafaeli, E. (2018). Emotional congruence between clients and therapists and its effect on treatment outcome. Journal of Counseling Psychology, 65(1), 51-64


Galili‐Weinstock, L., Chen, R., Atzil‐Slonim, D., Bar‐Kalifa, E., Peri, T., & Rafaeli, E. (2017). The association between self‐compassion and treatment outcomes: Session‐level and treatment‐level effects. Journal of clinical psychology.‏


Hacohen, N., Atzil-Slonim, D., Tuval-Mashiach, R., Bar-Kalifa, E., & Fisher, H. (2017). Multiplicity and mutuality in the transition of patient and therapist’s self-states: Comparison of good vs. poor outcome groups. Psychotherapy Research, 1-14.


Fisher, H., Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., & Peri, T. (2017). Growth curves of clients’ emotional experience and their association with emotion regulation and symptoms. Psychotherapy Research, 1- 16.‏


Arnon-Ribenfeld, N., Hasson-Ohayon, I., Lavidor, M., Atzil-Slonim, D., & Lysaker, P. H. (2017). The association between metacognitive abilities and outcome measures among people with schizophrenia: A meta-analysis. European Psychiatry46, 33-41


 Mendlovic, S., Doron, A., Saad, A., Atzil-Slonim, D., Saed, M. I., Bloch, Y., & Yehuda, A. B. (2017). The MATRIX, a novel tool exploring dynamic psychotherapy: Preliminary psychometric properties. Psychiatry research258, 344-350.‏


Chen, R., Atzil-Slonim, D., Bar-Kalifa, E., Hasson-Ohayon, I., & Rafaeli, E. (2016).Therapist Recognition of Alliance Ruptures as a Moderator of Changes in


Alliance and Symptoms. Psychotherapy Research. 1-11

 Bar-Kalifa, E. , Atzil-Slonim, D., Rafaeli, E., Peri, T., Rubel, J., &. Lutz, W., (2016). Accuracy and bias in therapists' assessments of clients' functioning. Journal of Consulting and Clinical Psychology, 84(12


 Fisher, H., Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., & Peri, T. (2016). Emotional experience and alliance as common factors that synergistically contribute to therapeutic change. Psychotherapy, 53(1), 105-116


Atzil-Slonim, D., Reshef, M., Berman, E., Peri, T. & Shulman, S. (in press). Changes in romantic competence and career adaptability among young adults in psychotherapy. Emerging Adulthood


 Atzil-Slonim, D., Wiseman, H., & Tishby, O. (2015). Relationship representations and change in adolescents and emerging adults during psychodynamic psychotherapy. Psychotherapy Research. Published online March, 2015


Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., Lutz, W., Schiefele, A. K., Rubel, J., & Peri, T. (2015). Therapeutic bond judgments: congruence and incongruence. Journal of Consulting and Clinical Psychology, 83(4), 773-784


 Atzil-Slonim, D., Shefler, G., & Tishby, O. (2015). Internal representations of the therapeutic relationship among adolescents in psychodynamic psychotherapy. Clinical Psychology and Psychotherapy, 22, 502-515


Atzil-Slonim, D., Shefler, G., Slonim, N., & Tishby, O. (2013). Adolescents in psychodynamic psychotherapy: changes in internal representations of relationships with parents. Psychotherapy Research, 23(2), 201-217


Atzil-Slonim, D., Shefler, G., Dvir, S., & Tishby, O. (2011). Changes in rigidity and symptoms among adolescents in psychodynamic Psychotherapy. Psychotherapy Research, 21(6), 685-695


Atzil-Slonim, D. (2007) Treating Bulimia from the guts. Sihut, Israeli Journal for psychotherapy. March (2


PRESENTATIONS AT SCIENTIFIC CONFERENCES

Atzil-Slonim, D. (2019). The Sounds of Change: Using Vocal Measures to Study Intra-Personal and Inter-Personal Emotion Regulation in Psychotherapy. INSPIRE meeting, Braga, Portugal.

Atzil-Slonim, D. (2019). Using Vocal Measures to Study Intra-Personal and Inter-Personal Emotion Regulation in the Treatment of Depression. A paper to be presented at the annual meeting of the Society for Psychotherapy Research, Buenos-Aires.

Atzil-Slonim, D. (2019).The future of psychodynamic psychotherapy. Structured discussion at the annual meeting of the Society for Psychotherapy Research, Buenos-Aires.

Atzil-Slonim, D. (2019).Using novel technologies in psychotherapy research. Structured discussion at the annual meeting of the Society for Psychotherapy Research, Buenos-Aires.

Atzil-Slonim, D. (2019). The potential of using computational methods in psychotherapy research. Symposium on Computational Methods for Mental Health, Tel-Aviv, Israel.

Atzil-Slonim, D. (2019). Dynamic dyadic processes in psychotherapy. SPR-EU, Krakow, Poland.

Atzil-Slonim, D. (2018). Emotional synchrony in psychotherapy. Qualitative research in psychotherapy. Bar-Ilan University, Israel

Atzil-Slonim, D. (2018). Coregulation in psychotherapy. A paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Amsterdam

Paz, A., Rafaeli, E., Keshet, J., Gannot, S., Stolowicz-Melman, D., & Atzil-Slonim, D. (2018). Client-therapist vocal synchronicity and its association with the therapeutic alliance and treatment outcome. A paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Amsterdam

Stolowicz-Melman, D., Lazarus, G., Paz, A., Fisher, H., & Atzil-Slonim, D. (2018). Moderators of the Association between Client-Therapist Emotional Congruence and Treatment Outcome. A paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Amsterdam

Alfi-Yogev, T., Hasson-Ohayon, I., Lazarus, G., Ziv-Beiman, S., & Atzil-Slonim, D. (2018).  The effectiveness of therapist self disclosure- The role of the client’s emotion regulation. A Paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Amsterdam

Atzil-Slonim, D., Bar-Kalifa, Lazarus, G., & E., Rafaeli. (2017). The effects of therapists` empathic accuracy regarding the clients` emotions on clients` outcomes. Paper  presented at the annual meeting of the Society for Psychotherapy Research (SPR), Toronto, Canada

Bar-Kalifa, E., Prinz, J., Atzil-Slonim, D. Wolfgang, L., & Rafaeli, E. (2017). Dyadic Synchrony as an agent of coregulation in imagery and rescripting work. Paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Toronto, Canada

Stolowicz, D., Bar-Kalifa, E., Atzil-Slonim, D., Aderka, I., & Hasson-Ohayon, I. (2017). Testing within-session changes in perceived functioning as a predictor of next-session sudden-gains and sudden-losses. Paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Toronto, Canada

Lazarus, G., Bar-Kalifa, E., Rafaeli., E. & Atzil-Slonim, D. (2017) Patients’ session-to-session emotion dynamics – within person and dyadic associations. Paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Toronto, Canada

Fisher, H., Atzil-Slonim, D., Bar-Kalifa, E., & Peri, T. (2017). Clients and therapists perspective on the therapeutic processes: the association among therapists` intervention, clients` involvement in the therapeutic process and treatment outcome. Paper presented at the annual meeting of the Society for Psychotherapy Research (SPR), Toronto, Canada

Atzil-Slonim, D., Bar-Kalifa, E., Fisher, H., & Rafaeli, E., (2016). Client-Therapist Emotional Coregulation and its Association with Treatment Outcomes. A paper to be presented in the Society for Psychotherapy Research (SPR), June 2016, Jerusalem, Israel

Fisher, H., Atzil-Slonim, D., Bar-Kalifa, E., & Peri, T. (2016). Patterns of Change in Emotional Experience During Psychodynamic Therapy. A paper to be presented in the Society for Psychotherapy Research (SPR), June 2016, Jerusalem, Israel.

Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., Lutz, W., Schiefele, A. K., Rubel, J., & Peri, T. (2015). Therapeutic bond judgments: congruence and incongruence. A paper presented in the Society for Psychotherapy Research (SPR), Philadelphia, USA.

Fisher, H., Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., & Peri, T. (2015, June). The development of emotional-involvement session by session throughout treatment and its association with therapeutic alliance, emotional regulation and symptoms. A paper presented in the Society for Psychotherapy Research (SPR), Philadelphia, USA.

Fisher, H., Atzil-Slonim, D., & Peri, T. (2015). Emotional Experience and Alliance as Common Factors that synergistically contribute to Therapeutic Change. Paper presented at the conference of the Psychology Department, Bar-Ilan University, Ramat-Gan, Israel.

Atzil-Slonim, D., Wisman, H., & Tishby, O. (2014). Relationship Representations and Change in Adolescents and Emerging Adults during Psychodynamic Psychotherapy. A paper presented in the Society for Psychotherapy Research (SPR), Copenhagen, Denmark.

Fisher, H., Atzil-Slonim, D., & Peri, T. (2014). Client-therapist emotional synchronicity, client's emotional regulation and treatment outcome. A paper presented in the Society for Psychotherapy Research (SPR), Copenhagen, Denmark.

Atzil-Slonim, D. (2014). Accuracy and bias in therapeutic alliance judgments. Paper presented at the conference of the Psychology Department, Bar-Ilan University, Ramat-Gan, Israel.

Atzil-Slonim, D. (2014). Relational perspectives on adolescents. Paper presented in the Israeli branch of the International Association for Relational Psychoanalysis (IARPP), Tel-Aviv, Israel.

Atzil-Slonim, D. (2013). Adolescents in psychodynamic psychotherapy. Paper presented in the Israeli Society for Research on Adolescence (ISRA). Bar-Ilan, Israel.

Atzil- Slonim, D., Shefler, G., & Tishby, O. (2011). Changes in adolescent's interpersonal patterns with their parents throughout psychodynamic psychotherapy. Paper presented in the Society for Psychotherapy Research (SPR), Bern, Switzerland.

Atzil- Slonim, D., Tishby, O. & Shefler, G. (2010). Processes of change among adolescents in psychodynamic psychotherapy. Paper presented in the Society for Psychotherapy Research (SPR), Asilomar, California, USA.

Atzil- Slonim, D., Tishby, O. & Shefler, G. (2008). Stability and change among adolescents in psychodynamic therapy. Paper presented in the Society for Psychotherapy Research (SPR), Barcelona, Spain.

Atzil- Slonim, D., Tishby, O., Foltz, C. & Barber, J.P. (2006). Agreement, similarity, and projection in romantic couples and their association to depressive symptoms. Poster presented in the Society for Psychotherapy Research (SPR), Edinburgh, Scotland.

Tishby, O., Raichik, I., & Atzil-Slonim, D. (2005). The second individuation and the CCRT: Relationship schemas in adolescence. Paper presented in the Society for Psychotherapy Research (SPR), Montreal, Canada.