Portland Psychotherapy 2018 Year in Review

Hello friends and colleagues. As we usher in a new year, we pause to take a look back at 2018, an exciting year of growth and new beginnings for us here at Portland Psychotherapy.

Expansion of clinical staff means more specialized services and an increased ability to serve our community

We just celebrated the one-year anniversary of the three newest members of our full-time clinical team: our Director of Clinical Operations, Kyong Yi, LCSW, and licensed psychologists Angela Izmirian, Ph.D. and Bryce Doehne, PsyD. Although they have only been with us for a year, Kyong, Angela, and Bryce have already made huge contributions to our organization. In addition to seeing clients, they have been meeting with members of our broader community to explore ways Portland Psychotherapy can better support underserved and disenfranchised populations, including immigrant communities and gender minorities. We are excited for how these partnerships will allow us to have a broader positive impact on our community in the years to come.

We are also fortunate to have Debesh Mallik, M.S. join us as an advanced practicum student this year. Debesh earned his master’s degree in psychology from the University of Louisiana at Lafayette, where he studied under Emily Sandoz, Ph.D., one of the foremost experts in ACT and RFT and who also happens to be coming to do a two-day training for us in Portland in April (see below). Debesh is pursuing a Ph.D. at Pacific University with a focus on substance use, mood, and anxiety disorders under the mentorship of Dr. Sarah Bowen. We are excited to have such a skilled and well-trained clinician as Debesh offer low fee therapy services at Portland Psychotherapy.

Books and other creative endeavors coming out of Portland Psychotherapy

With our wonderful and expanded team of clinicians onboard, Portland Psychotherapy founders, Jenna LeJeune and Jason Luoma were able to take a step back from the day-to-day operations of the clinic to spend the first half of 2018 abroad on sabbatical. This sabbatical allowed them more focused time to work on various research and writing projects including a forthcoming book entitled Values in Practice: A Clinician’s Guide to Helping Clients Develop Psychological Flexibility and Live a More Meaningful Life (Jenna and Jason, due out later this year by New Harbinger Press) and an RO DBT skills workbook (Jason with Tom Lynch, Ph.D. and Nicole Little, Ph.D.). Jason also worked on his soon-to-be released podcast, Research Matters in which he interviews established psychology researchers from around the world. Through the podcast, listeners, especially students and aspiring researchers, will be able to learn from the wisdom of these amazing researchers as they deconstruct the strategies that have worked for them for conducting meaningful social science research.

Research at Portland Psychotherapy

Portland Psychotherapy is the only research institution of its kind. Rather than relying on grants that make us dependent on the whims and priorities of external government funding sources, we use a social enterprise model in which profits from the income-generating activities of our organization are used to fund independent social science research. We also collaborate with other researchers around the world to help fulfill our mission of contributing to the wider community through scientific research. Over the past year, the publications that have come out of those research endeavors include: (see tinyurl.com/ppcscience for a complete list, with some available to download):

Guinther, P. (2017). Contextual influence over deriving others’ true beliefs using a relational triangulation perspective-taking protocol. Journal of the Experimental Analysis of Behavior, 108(3), 433-456.

Luoma, J. B., Codd, T. R., & Lynch, T. R. (2018). Radically Open Dialectical Behavior Therapy (RO DBT): Shared Features and Differences with ACT, DBT, and CFT. The Behavior Therapist.

Luoma, J.B., Guinther, P., Lawless DesJardins, N. M., & Vilardaga, R. (2018). Is Shame a Proximal Trigger for Drinking? A Daily Process Study with a Community Sample. Journal of Experimental and Clinical Psychopharmacology, 26(3), 290-301.

Luoma, J.B. & LeJeune, J.T. (in press). Incorporating Affective Science into ACT to Treat Highly Self-Critical and Shame Prone Clients. In M. E. Levin, M. P. Twohig & J. Krafft (Eds.), Innovations in ACT. Oakland, CA: New Harbinger.

Osborne, T., & Luoma, J.B. (2018). Overcoming a Primary Barrier to Practice-Based Research: Access to Independent Ethics Review. Psychotherapy, 55 (3), 255–262.

Appreciating where we have been and looking towards the future

During their sabbatical, Jason and Jenna were also able to pause to reflect on next steps for Portland Psychotherapy. It’s been more than 10 years since they launched this dream of developing a social enterprise in which the profits from providing exceptional, specialized therapy services could be used to increase the social good by funding important social science research and sliding scale services. There have been bumps along the road and at a lot of learning along the way, but we are proud of what our team has been able to accomplish thus far. If you’re interested in learning more about Portland Psychotherapy’s model of using social enterprise to make a positive difference you can read more at: tinyurl.com/ppcsocial.

Looking to the future, Portland Psychotherapy will focus on 1. Having a broader positive impact through partnerships with other like-minded colleagues and organizations, 2. Expanding our research program by hiring more clinician researchers and strengthening our research collaborations with colleagues around the world, and 3. Continuing to expand our clinical services by bringing on new therapists who are experts in their area of specialty and are interested in our mission. To help meet these goals, Portland Psychotherapy hopes to hire at least one new full-time therapist, a full-time postdoctoral fellow, and a full-time research psychologist (see: http://portlandpsychotherapytraining.com/employment-opportunities-at-portland-psychotherapy/).

Groups and classes

We continue to offer a variety of groups and classes for members of the public. Our current offerings are (see portlandpsychotherapyclinic.com/classes_and_groups/ for a complete list):

  • ACT for Depression Group
  • ACT on Life for Women
  • Radically Open Dialectical Behavior Therapy Skills Classes

Upcoming training events

To support our training mission, we will continue to host workshops based on a variety of topics within Contextual Behavioral Science and related fields. Upcoming trainings include (see portlandpsychotherapytraining.com for a complete list):

  • Evoke, Reinforce, Repeat: Enhancing the Creativity and Sensitivity of your ACT work with a Plain Language Behavioral Perspective to Clinical Work – April 12-13, 2018 with Emily Sandoz, Ph.D.
  • Helping Patients Forgive: REACH Forgiveness as Evidence-Based Practice in Psychology – September 28, 2019 with Everett Worthington, Ph.D.

In looking back on this year, and the more than 10 years Portland Psychotherapy has been serving our Portland community, we are humbled by all the support we have received from friends and colleagues around the work. Your support, in all of its forms, is essential in the work that we do and our ability to fulfill our mission. Thank you and we look forward to what lies ahead.

New RCTs: Acceptance and Commitment Therapy is effective for treatment resistant clients

New RCTs: Acceptance and Commitment Therapy is effective for treatment resistant clients

Two recent randomized control trials seem to indicate that acceptance and commitment therapy (ACT) is a good option for people who have no benefitted from prior treatment. A lot of people don’t respond to their first round of treatment, so this is good news for a lot of people. This research adds to a growing list of studies showing that ACT is helpful across a large range of conditions and life difficulties.

ACT outperforms CBT for people who had not previously responded to therapy


In a study published in July of 2014 the investigators compared group-based ACT to group-based CBT (treatment as usual) for 61 participants.  These participants came to the study with a range of diagnoses and all had participated in previous psychotherapy for which they did not receive a significant beneficial response.  The results of the study showed that both groups showed initial benefit, however in the group that received ACT treatment the benefits were completely sustained at a 6 month follow up assessment.


ACT works for people with panic disorder that didn’t respond to previous treatment


Another RCT published in March of 2015 tested ACT as an intervention for “treatment-resistant patients” struggling with panic disorder and/or agoraphobia.  There were 43  participants in this study and they all had received evidenced-based, standard of care treatment (mean number of previous sessions = 42) with unsuccessful results.

The participants were grouped into the conditions of treatment, short-term wait-list and delayed treatment and each offered 8 sessions over 4 weeks of manualized ACT treatment.  The results show a medium-to-large effect sizes with sustained and improved results a 6 month follow up assessment.

The authors conclude that this data suggest that ACT is a viable treatment option for panic disorder and agoraphobia treatment-resistant patients.

Research into treatment recommendations and factors concerning non-responders to psychotherapy is a clear gap in the current literature.  However, these studies are building evidence that ACT is a robust treatment that appears to offer patients something useful that other treatments were not able to provide.

Newest Data on Shame and Drinking Published at Western Psychological Association Conference

Newest Data on Shame and Drinking Published at Western Psychological Association Conference

Last Friday, Portland Psychotherapy research assistants Monica Bahan, Megan Cheslock, and Jackie Potter presented a research poster at the annual Western Psychological Association convention, which took place in Portland. Their poster detailed findings from one of our ongoing studies exploring the relationship between shame, guilt, and drinking behavior. The findings were based on the first 88 participants in the study, all volunteers from the Portland area.

Congratulations to Monica, Megan, and Jackie on their first presentation!

Jason Luoma, Ph.D.

Author: Jason Luoma, Ph.D.

Jason is a psychologist who researches ways to help people with chronic shame and stigma and also works clinically with people struggling with those same problems.

A Meta-Analysis Comparing Psychotherapy and Medication for OCD

A Meta-Analysis Comparing Psychotherapy and Medication for OCD

This post was featured on our client-centered blog The Art and Science of Living Well, but I thought it would be of interest to therapists as well.

The post is about a finding from a meta-analysis by Cuipjers and colleagues that looked at studies comparing medication against psychotherapy in the treatment of anxiety disorders and depression. For obsessive-compulsive disorder, the researchers found a clear advantage of evidence-based psychotherapy for OCD above medication.

You can read the post by clicking here, and it includes links to the original article, which you can download for free.

Enough already: Let’s move on from meta-analyses of psychoanalytic psychotherapy and do the hard work of quality studies

Enough already: Let’s move on from meta-analyses of psychoanalytic psychotherapy and do the hard work of quality studies

The past few years has seen an increasing push to demonstrate the legitimacy of long-term psychodynamic and psychoanalytic therapies (e.g., Leichsenring & Rabung, 2008). It seems proponents of psychodynamic therapy are trying to play catch up. There’s an enormous amount of research support for cognitive behavioral approaches; by contrast, controlled research for psychodynamic approaches is sparse.

Since long-term psychoanalytic psychotherapy is a mouthful, we’ll follow the cue of those before us and call it LTPP for short.

It’s unfortunate there’s not a lot of controlled research on LTPP, as I think controlled studies carefully examining the processes and outcomes of psychodynamic therapies could only enhance our understanding of treatment. As a way to bolster support, some psychodynamic researchers have taken what studies exist and published meta-analyses of the existing research. Some of the recent ones concluded that LTPP is an effective treatment for a variety of psychiatric conditions (De Maat, 2009; Leichsenring & Rabung, 2008, 2011). These findings were not without controversy, however.

You may have noticed, for example, that Leichsenring and Rabung are listed twice. There’s a reason for this: their 2008 meta-analysis was widely criticized for miscalculating effect sizes. According to critics, the researchers had simply looked at pre-post changes (within-group difference) rather than comparing LTPP against the control conditions (between-group differences). The researchers redid their analysis in the 2011 meta-analyses and found LTPP was effective, albeit to a lesser degree.

Although I think meta-analyses on psychodynamic therapy have been over-played of late, I was excited about a new one published in Clinical Psychology Review (Smit et al., 2012). This article is a collaboration of Dutch researchers and John Ioannidis. I perked up at the mention of Dr. Ioannidis’ involvement.

Who is John Ioannidis?

Not to give short shrift to the others involved, but I was really excited by Ioannidis’ presence on this article. Ioannidis, a medical researcher with several academic appointments, has become one of the foremost experts in the credibility of medical research. He published a hugely influential paper arguing that most medical findings are inaccurate, and he was even profiled in The Atlantic. With his name attached to this piece, I could be confident that the methodology of this meta-analysis had been scrupulously thought out and executed.

A little background on meta-analysis

Meta-analyses are a way of consolidating a number of studies on a particular area of focus that allows for comparison across studies. Researchers may then draw more general conclusions from a bunch of data. This is done by converting the results from each individual study into effect sizes.

Like any tool, meta-analyses are only as good as the way they are used. Researchers make decisions about what studies to include (and not to include), what outcomes to look at, and how to run the analyses. As they say, “garbage in, garbage out.” Moreover, meta-analyses are no substitute for rigorously controlled studies.

The bottom line: meta-analyses of low quality research lead to low quality conclusions

The reason why I’m hoping this article will be the final word on this topic for now is that it ultimately points to the need for more high quality data.

In contrast to previous meta-analyses, the researchers in this study had difficulty drawing firm conclusion about LTPP because the available research was generally of low quality. Their main criticism is that LTPP was often compared against substandard treatments. The authors call these “straw man” comparisons, as there is little reason to believe these control conditions are effective. In the few studies that compare LTPP against evidence-based treatments such as dialectical behavior therapy, LTPP does not fare so well, according the researchers.

What this means is that without well-controlled studies of LTPP against established treatments for specific psychiatric problems. It is difficult to gauge the effectiveness of LTPP. The few highly quality studies available suggest that when LTPP is compared against bona fide treatments, it doesn’t appear to be particularly effective. Hopefully, researchers will now take a break from meta-analysis and focus their efforts towards creating more high quality, controlled studies comparing LTPP to treatments with a strong track record.

Let’s move on and do the work…

I think we’ve seen enough meta-analyses on LTPP for the time being. If a strong argument for LTPP is to be made, it will require a focus on quality, controlled research that compares LTPP to bona fide treatments for specific conditions.

But don’t take my word for it: I highly recommend reading the study yourself. For a scientific article, it’s actually quite lucid and readable. I obtained it by following James Coyne’s suggestion in the blog post that alerted me to this article, and emailing the author, Arnoud Arntz, who quickly and thoughtfully sent me a copy:



April 17 and 18, 2020, 9:15 am – 5:00 pm · Portland, OR · Details

Do you ever “get stuck” as a therapist? Do some of your clients press your “hot buttons”? Do you ever find yourself struggling and thinking about “what do I do next” or feeling anxious, scared or stressed in therapy? In this workshop we will work on clarifying your therapist values and defining what is “difficult” about “difficult” clients. Through discussions, demonstrations and roleplays we will then work on these difficult clients and look at the processes from a compassionate ACT perspective. Read more