RESUMEN
We examined discrepancies in 81 patient-therapist dyads' alliance ratings early in treatment (3rd or 4th session) in relation to Personality Assessment Inventory clinical scales, subscales and global psychopathology. Results indicated that PAI global psychopathology (mean clinical elevation) and the scales of Aggression [AGG], Somatization [SOM], and Anxiety-Related Disorders [ARD] were significantly, negatively associated with an absolute difference of patient and therapist alliance ratings at Session 3. Higher initial scores on these clinical scales at treatment onset are associated with less difference (i.e., more convergence) in patient/ therapist ratings of alliance at Session 3. Correlations between PAI clinical subscales and absolute differences of patient and therapist alliance ratings at Session 3 also demonstrated statistically significant inverse relationships for several PAI subscales of Aggression- Attitude [AGG-A], Aggression-Physical [AGG-P], Somatic- Health Concerns [SOM-H], Anxiety-Related Disorders-Traumatic Stress [ARD-T], Anxiety-Related Disorders- Obsessive Compulsive [ARD-O], Borderline Features-Affective Instability [BOR-A], Borderline- Self-Harm [BOR-S], Anxiety-Physiological [ANX-P], Depression-Physiological [DEP-P] and Antisocial-Stimulus Seeking [ANT-S]. Again, higher scores on these subscales at treatment onset are associated with less difference (i.e., more convergence) in patient/therapist ratings. We also examined group differences between patients rating alliance higher (Group 1) and therapists rating alliance higher (Group 2) and found that Group 1 had significantly lower scores on Mania-Activity Level [MAN-A]. Clinical implications of results are discussed.
Asunto(s)
Alianza Terapéutica , Humanos , Depresión , Personalidad , Trastornos de Ansiedad/terapia , Determinación de la Personalidad , Relaciones Profesional-PacienteRESUMEN
Based on the results of prior research, we examined relationships between Personality Assessment Inventory (PAI) items on clinical scales of antisocial features (ANT) and anxiety-related disorders (ARD) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also explored the relationship between the PAI treatment rejection scale (RXR) and early session therapist-rated alliance, despite null findings in previous work. We used PAI protocols from a clinical outpatient sample (N = 80). Data were analysed using backwards linear regressions. Results indicated that a group of ANT items from different ANT subscales predicted patient-rated therapeutic alliance, F(8,59) = 5.182, p = .000, R2 of .413, f2 = 0.70. Additionally, a group of ARD items from different ARD subscales significantly predicted therapist-rated alliance, F(6,62) = 3.007, p = .012, R2 of .225, f2 = 0.29. No significant relationships were found for RXR items and therapist-rated alliance, consistent with prior findings. Clinical implications are discussed.
Asunto(s)
Relaciones Profesional-Paciente , Psicoterapia , Humanos , Psicoterapia/métodos , Determinación de la Personalidad , Trastornos de Ansiedad , Pacientes Ambulatorios , Resultado del TratamientoRESUMEN
We examined relationships between the Personality Assessment Inventory (PAI) clinical scales (e.g., Somatic Complaints [SOM]) and subscales (e.g., Conversion [SOM-C]) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also replicated and extended findings from a previous study examining PAI treatment scales (Treatment Rejection, Treatment Process Index) and early session therapist-rated alliance. We used PAI protocols from a clinical outpatient sample (N = 84). Data were analyzed using stepwise linear regressions. Results suggest that patients who report lower early session alliance also report more antisocial features (ß = -.219, p = .050, f2 = 0.05) specifically more antisocial behaviors (ß = -.315, p = .004, f2 = 0.11). Additionally, therapists report higher early session alliance with patients who report more anxiety-related disorders (ß = .274, p = .012, f2 = 0.08), specifically traumatic stress (ß = .325, p = .003, f2 = 0.12). No significant relationships were found between patient- or therapist-rated alliance and Treatment Rejection and Treatment Process Index, consistent with prior findings. Clinical implications are discussed.
Asunto(s)
Relaciones Profesional-Paciente , Psicoterapia , Humanos , Personalidad , Determinación de la Personalidad , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/terapia , Psicoterapia/métodosRESUMEN
This study examined the relationship between adherence flexibility early in treatment and outcome within psychodynamic psychotherapy of depression. For this purpose, we used multilevel modeling (MLM) to examine the relationship between adherence to global psychodynamic-interpersonal (PI) technique early in treatment with outcome, the impact of flexibly incorporating some limited cognitive-behavioral (CB) interventions, as well the role of therapist effects. Our sample included 46 outpatients who were consecutively enrolled in individual psychodynamic psychotherapy, received a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) Axis I diagnosis of a depressive spectrum disorder, and were assessed pre- and posttreatment through self-report of depressive symptoms. Psychotherapy sessions were videotaped and 3rd and 9th sessions were independently rated on the Comparative Psychotherapy Process Scale (CPPS) for use of PI and CB techniques, with excellent interrater reliability (intraclass correlation coefficient [ICC] > .75). Mean technique ratings across the two early treatment sessions (3rd and 9th) were calculated. Our findings suggest that flexibly incorporating a limited amount of CB strategies early in psychodynamic therapy for depression can add some benefit to the unique positive relationship between PI adherence and outcome. Implications for clinical work and future research directions are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Psicoterapia Psicodinámica/métodos , Cumplimiento y Adherencia al Tratamiento/psicología , Adulto , Terapia Cognitivo-Conductual/métodos , Femenino , Humanos , Masculino , Pacientes Ambulatorios/psicología , Terapia Psicoanalítica/métodos , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
This study examines patient ratings of modality-specific technical interventions and their relation to therapeutic treatment change. The sample consisted of 55 individuals engaged in short-term psychodynamic psychotherapy at a university-based community outpatient treatment center. Results demonstrate that not only were patients capable of recognizing specific technical processes occurring within their psychotherapy, but also that those ratings were significantly related to measures of therapeutic outcome. Furthermore, patient ratings of session activities were found to be stable from early session rating to late in treatment. Findings support the conclusion that, as rated from the patient perspective, some degree of flexibility in and integration of modality-specific techniques is beneficial for outcome. Implications for future research and clinical practice are discussed.