Big needle jumps in psychotherapy research

Coedited by Michael J. Constantino, Alice E. Coyne, and James F. Boswell, the September 2025 special section of Psychotherapy, “Big Needle Jumps in Psychotherapy Research,” highlights innovative research that embodies or sets up revolutionary advancements in studying, understanding, and practicing psychosocial treatments. These articles describe studies for which their substantial impact took one of three general forms: (1) the results they revealed, (2) the proof-of-concept methods or analyses they used, or (3) the proof-of-concept clinical practices they created. Borrowing from Kuhn’s (1996) parlance related to scientific revolutions, the call for papers for this section emphasized methods or results that trended toward disruptive versus normal science across the broad areas of psychotherapy processes, outcomes, training, and so forth. The overarching idea was more important than the sample size.

Despite having learned much about psychotherapy over more than seven decades of systematic research, the field remains relatively immature in its lack of core and consensual findings (Gaines & Goldfried, 2024). Thus, “big needle movements” are required to help meet the immense need for effective mental health care. These nine articles cover diverse topics and provide varied templates for understanding, through scientific inquiry, the inherently complex psychotherapy endeavor.

• Dynamic structural equation models can be used to identify a key empirical marker of therapists’ fluctuating perceptions of session quality, which can inform their effective responsiveness to unique dyadic climates and individual patient needs (An et al., 2025).
• Observers can successfully rate therapists’ optimal adherence to personalized case conceptualizations (Critchfield et al., 2025). Such work disrupts the typical notion of therapist adherence reflecting the standardized delivery of treatment techniques, without adjusting for individual case conceptualizations or different case-level needs for flexibility and personalization. As this novel measurement of treatment rationale–strategy alignment predicted better patient outcomes, it meaningfully outperforms the general lack of association between traditionally defined adherence and patient outcomes.
• Artificial intelligence (AI) and large language models (LLMs) can revolutionize the effective and scalable assessment of key therapy concepts, such as a therapist’s embodiment of a multicultural orientation (Goldberg et al., 2025) and facilitative interpersonal skills (Aafjes-van Doorn et al., 2025), as well as patient–therapist alliance quality in group therapy settings (Kivlighan et al., 2025). These novel methods can stimulate, and make doable, major research agendas for psychotherapy equity, inclusion, processes, outcomes, and training.
• Community-based participatory research frameworks can significantly advance the field (Gutierrez Chavez et al., 2025). As such methodology has lagged in psychotherapy research, relative to other human services contexts, successful templates can guide the future adoption of big needle jumps.
• Community mental health care can be improved by using multidisciplinary teams to leverage the typically passive waitlist period to engage in evidence-based practices (EBPs) prior to longer-term care for those who need it (Connolly Gibbons et al., 2025). Such work holds immense promise for solving stubborn problems related to waiting for and being effectively triaged to the appropriate care level.
• Outside-the-traditional-box innovations, such as psilocybin-assisted therapy (Palitsky et al., 2025) and peer-delivered brief interventions (Anderson et al., 2025), can be feasible and scalable additions to the EBP repertoire.

• Researchers have methods for establishing a scientific foundation for notions of therapist flexibility and responsivity that have heretofore been more conceptually versus empirically grounded.
• AI and LLMs are powerful tools to support both disruptive and normal science (Kuhn, 1996) in psychotherapy.
• Community-based participatory research is a powerful method for studying psychotherapy and advancing its implementation in cultural contexts.
• EBPs can be used during previously assumed stuck points (e.g., when a patient is on a waitlist for longer-term care), integrated with other therapies (e.g., psilocybin use), or effectively crowdsourced to peers for certain presenting concerns and in certain contexts, which can enhance the overall effectiveness of and access to help for those in need.

This article is in the Clinical Psychology topic area.

Aafjes-van Doorn, K., Cicconet, M., Bate, J., Cohn, J. F., & Aafjes, M. (2025). Development of an artificial intelligence-based measure of therapists’ skills: A multimodal proof of concept. Psychotherapy, 62(3), 301–314. https://doi.org/10.1037/pst0000551

An, M., Akter, S., & Kivlighan, D. M. (2025). Context matters: Leveraging therapists’ session evaluations to optimize technical adjustments and enhance client outcomes. Psychotherapy, 62(3), 267–279. https://doi.org/10.1037/pst0000551

Anderson, R. E., Gesser, N., Welk, V.-J., Tom, K., & Holmes, S. C. (2025). Promoting recovery and prevention simultaneously through peer providers to reduce the impact of childhood sexual abuse: Acceptability, feasibility, and fidelity of an integrated intervention model. Psychotherapy, 62(3), 363–375. https://doi.org/10.1037/pst0000551

Connolly Gibbons, M. B., Tyler, J., Crits-Christoph, P., Cristancho, M., Galbraith, J., Chiu, R. Y., Duong, L. A., & Oquendo, M. A. (2025). A multifaceted outpatient treatment model for mood and anxiety disorders designed to optimize both treatment outcomes and access to care. Psychotherapy, 62(3), 337–347. https://doi.org/10.1037/pst0000551

Constantino, M. J., Coyne, A. E., & Boswell, J. F. (2025). Big needle jumps in psychotherapy research. Psychotherapy, 62(3), 263–266. https://doi.org/10.1037/pst0000551

Critchfield, K. L., Gornish, A., Epstein, L., Mackaronis, J. E., & Benjamin, L. S. (2025). The “gift of love” as a candidate mechanism of psychopathology and change in interpersonal reconstructive therapy for patients with high-acuity clinical needs. Psychotherapy, 62(3), 280–291. https://doi.org/10.1037/pst0000551

Gaines, A. N., & Goldfried, M. R. (2024). Evidence-based psychotherapy: On what can we agree? In APA handbook of psychotherapy: Evidence-based practice, practice-based evidence, and contextual participant-driven practice., Vol. 2. (pp. 117–133). https://doi.org/10.1037/0000354-008

Goldberg, S. B., Tanana, M., Stewart, S. H., Williams, C. Y., Soma, C. S., Atkins, D. C., Imel, Z. E., & Owen, J. (2025). Automating the assessment of multicultural orientation through machine learning and natural language processing. Psychotherapy, 62(3), 292–300. https://doi.org/10.1037/pst0000519

Gutierrez Chavez, M., Baucom, K. J. W., Sanchez-Birkhead, A., Villalta, J., Carbajal-Salisbury, S., Zavala Gonzalez, N., Tatarevic, L., & Asnaani, A. (2025). Questioning the status quo: Latino community members as researchers in the study of health equity. Psychotherapy, 62(3), 326–336. https://doi.org/10.1037/pst0000545

Kivlighan, M., Stremmel, J., Wang, K., Brownstone, L., & Lin, B. (2025). Leveraging natural language processing to enhance feedback-informed group therapy: A proof of concept. Psychotherapy, 62(3), 315–325. https://doi.org/10.1037/pst0000570

Kuhn, T. S. (1996). The structure of scientific revolutions (3rd ed.). University of Chicago Press. https://doi.org/10.7208/chicago/9780226458106.001.0001opens in new window

Palitsky, R., Maples-Keller, J. L., Peacock, C., Dunlop, B. W., Mletzko, T., Grant, G. H., Raison, C. L., Chao, S., Shub, I., Mendelbaum-Kweller, M., Smolyar, L., Kaplan, D. M., Rothbaum, B. O., & Zarrabi, A. J. (2025). A critical evaluation of psilocybin-assisted therapy protocol components from clinical trial patients, facilitators, and caregivers. Psychotherapy, 62(3), 348–362. https://doi.org/10.1037/pst0000551

Michael J. Constantino, PhD, is a professor of clinical psychology in the Department of Psychological and Brain Sciences at the University of Massachusetts Amherst. He is an APA fellow, associate editor for Psychotherapy and the Journal of Consulting and Clinical Psychology, andpast-president of APA Division 29 (Society for the Advancement of Psychotherapy) and the North American Society for Psychotherapy Research. His research centers on diverse aspects of psychotherapy processes, outcomes, integration, and implementation, all to optimize evidence-based mental health care. Contact Michael J. Constantino.

Alice E. Coyne, PhD, is an assistant professor of clinical psychology in the Department of Psychology at American University. She is the scientific program chair for APA Division 29 (Society for the Advancement of Psychotherapy) and an associate editor for Psychotherapy Research. Her research program centers on diverse forms of psychotherapy process and outcomes research, focusing on investigating measurement-based methods for personalizing treatment selection, intervention delivery, and therapist selection to the unique needs of patients. 

James F. Boswell, PhD, is an associate professor of clinical psychology and the director of clinical training in the Department of Psychology at the University at Albany, State University of New York. He is an APA fellow and past-president of the North American Society for Psychotherapy Research. He conducts practice-oriented research on the processes and outcomes of psychological interventions in routine service settings, as well as the integration of science and practice, including measurement-based care implementation.