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Psychotherapy Treatment Processes and Outcomes Among Urban, Historically Marginalized Populations

Urban marginalized communities face high distress and major barriers to care, yet are underrepresented in psychotherapy research. We study how therapy works in real community settings through three long-term studies designed to integrate clinical process, developmental theory, and cultural context:

  • The PEACE Program, launched in 2015, is an ongoing comprehensive program evaluation of clinical services offered to adults from urban marginalized populations. We look at baseline distress as well as therapist levels of cultural humility, mindfulness, and working alliance in facilitating effective psychotherapy outcomes.

    How It Works

    • Patients and therapists complete questionnaires at intake and every four months

    • Data are collected throughout treatment at The Psychological Center

    • Tracking each person over time shows how and why symptoms change

    What We’ve Found

    • Patients who started with more emotion regulation difficulties became more dysregulated during the first 8 months. Some patients may benefit from learning explicit regulation skills early on

    • Attachment, emotion regulation, and emotional intelligence work together to shape personality pathology and how well patients respond to treatment.

    • Emotional intelligence helps patients use the therapeutic relationship. Patients with greater emotional awareness may gain more from a strong working alliance.

  • TAAP, launched in 2019, is a short-term psychotherapy research program focusing on revealing how specific therapeutic techniques and the working alliance lead to change, in community clinics.

    How It Works

    • Therapists and patients complete questionnaires after every session

    • Every session is video recorded

    • Combining numbers with video lets us study both what can be measured and what can be observed

    • Dr. Rudenstine supervises all therapy, and 4 to 6 new patients join each semester.

    What We’ve Found

    • When therapists feel inadequate, patients rate the alliance as weaker, which limits symptom improvement.

    • Therapist hostility lowered patients’ alliance ratings, while positive feelings had no effect.

    • Therapists use different techniques depending on their emotional reactions to patients.

    New Methods

    • Vocal rhythm coordination. We adapted Beatrice Beebe’s system from mother-infant research to measure how in sync therapists and patients are when they speak. Early results suggest it may signal alliance strength and emotional attunement.

    • New coding systems. We developed ways to measure play, shared laughter, nonverbal communication, and therapist self-disclosure, which have been hard to quantify.

  • The CHAP Program is a comprehensive evaluation of the services provided to all child patients seen at The Psychological Center at the City College of New York. As such, it is a critical component of the evaluation process at The Psychological Center and informs the assessment and psychotherapy provided to children seen at the clinic. A wide range of data are collected during intake and subsequently every six months for the duration that the child is in treatment, providing a comprehensive picture of the child’s home environment, her psychiatric symptoms, inner thoughts and feelings, and coping/defense mechanisms.

    The CHAP Program is jointly led by Drs. Rudenstine and Tuber. 

Together, CHAP, PEACE, and TAAP help explain how therapeutic change happens among urban, help-seeking populations. Studying a community clinics allows us to show how cultural, emotional, and structural factors shape therapy outcomes.

    • Bloom, H., Tuber, S., & Rudenstine, S. (2026). An analysis of caregiver–child responses on the Thematic Apperception Test (TAT). Journal of Infant, Child, and Adolescent Psychotherapy, 25(2), 193–213. https://doi.org/10.1080/15289168.2026.2634643

    • Rudenstine, S., Schulder, T., & Gvozdieva, K. (2023). The power (and limits) of the therapeutic relationship: Working alliance, psychiatric distress, and the role of trait emotional intelligence. Journal of Clinical Psychology, 79(9), 2071–2080. https://doi.org/10.1002/jclp.23527

    • Greenberg, D., Rudenstine, S., Alaluf, R., & Jurist, E (2021). Development and validation of the Brief-Mentalized Affectivity Scale: Evidence from cross-sectional online data and an urban community-based mental health clinic. Journal of Clinical Psychology, 77(11) 2638-2652. https://doi.org/10.1002/jclp.23203

    • Rudenstine, S., Espinosa, A., Cancelmo, L., & Puliyampet, P. (2019). Psychological correlates of change in emotion regulation over 8 months of psychotherapy. Journal of Contemporary Psychotherapy, 49(4), 245–254. https://doi.org/10.1007/s10879-019-09435-6

    • Rudenstine, S., Wright, L., Morales, A. M., & Tuber, S. (2018). The value of integration: Psychoanalytic psychotherapy meets ego psychology in a psychotherapy group for children. Journal of Infant, Child, and Adolescent Psychotherapy, 17(4), 346-363. https://doi.org/10.1080/15289168.2018.1519754


 
 
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