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)

RESUMEN

This study examines the relationship between patient personality characteristics and therapeutic integration. Within a sample of patients (N=93) receiving outpatient psychodynamically- oriented psychotherapy, we assessed patient Borderline and Emotionally Dysregulated personality features through the Shedler-Westen Assessment Procedure (SWAP-200), and therapeutic technique using the Comparative Psychotherapy Process Scale (CPPS) during an early treatment session. We examined personality dimensionally, psychotherapy interventions across different theoretical orientations, as well as psychotherapy integration. These analyses revealed an overlap between the Borderline Clinical Prototype and the Emotionally Dysregulated-Dysphoric Q-factor, with the former associated with higher use of integration and the latter associated with higher use of either psychodynamicinterpersonal or cognitive-behavioural interventions. Secondary analyses also indicated the greater presence of interventions oriented towards emotional exploration and to the didactic instruction of effective symptom coping techniques across both of these personality subtypes early in treatment. The key differences between these personality types, as well as the theoretical, empirical, and clinical implications of these findings are discussed.

RESUMEN

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)

RESUMEN

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)

RESUMEN

This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G; Westen, 1995; see also Stein & Mulford, 2018) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) in relation to patient- and therapist-rated psychotherapy process measures. Using a university-based outpatient sample (n = 81), we found limited convergence for SCORS-G ratings across narrative type. First, paired t tests showed that the means for six of the eight SCORS-G dimensions differed significantly between the EM and PT narratives with the majority having a large magnitude of effect. Moreover, despite 29 significant correlations between a SCORS-G dimension and either an alliance or session quality variable, only two of the eight SCORS-G dimensions significantly correlated with the same process variable across narrative type (e.g., patient-rated session depth with SCORS-G Self Esteem [SE] and Identity and Coherence of Self [ICS]). Importantly, the high degree of theoretical coherence in the associations that emerged between the SCORS-G dimensions and the process variables suggest that the lack of convergence was not due to limited validity of the SCORS-G. Instead, the results underscore the importance of multi-method assessment techniques by highlighting that the manner in which a narrative is elicited will impact the object relational content patients provide. Future research and clinical implications related to the SCORS-G, alliance and psychotherapy process are discussed.

Asunto(s)

RESUMEN

The aim of the present study is to further the understanding of who cries at the beginning of psychotherapy and patients' experience of crying in that process. Intake sessions for 53 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics were also collected at intake. Results indicate that crying during intake sessions was related to lower global functioning and higher severity of childhood sexual abuse. Furthermore, patients who cried at intake were over four times more likely to also cry at feedback, and those who cried at feedback were almost 12 times more likely to have cried at intake. Finally, crying in the intake session did not appear to be related to patient- or therapist-rated working alliance. Overall, the present study provides valuable information about characteristics of patients who cry at the outset of the therapy process and patients' experience of crying over time in therapy. Findings suggest the need for further research on patient characteristics and aspects of the therapy process that may predict patient crying over the course of treatment, as well as how these early crying experiences may be related to eventual patient outcomes.

Asunto(s)

RESUMEN

This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) using a university-based outpatient sample (n = 101). First, we examined intercorrelations between SCORS-G ratings of EM and PT. Intercorrelations between SCORS-G EM and PT revealed that three of the dimensions significantly correlated with themselves across narrative type (Emotional Investment in Relationships [EIR], Experience and Management of Aggressive Impulses [AGG], and Self-Esteem [SE]), but that only AGG had its strongest correlation with itself (i.e., EM AGG to PT AGG). In addition, EM AGG was significantly related to all but one of the PT SCORS-G dimensions. Likewise, EM SE correlated with all but two of the PT SCORS-G dimensions. Second, we examined how narrative source related to clinical findings. With the use of a multimethod approach, we assessed how SCORS-G ratings from both narrative types correlated with selected variables from the Personality Assessment Inventory (PAI) and Rorschach Inkblot Test. Findings indicated that there were only three instances in which both narrative types had significant relationships to the same variable/scale, and all three instances were with the Rorschach. Together, these findings suggest that even when using the same scale (SCORS-G), different narrative sources differentially activate aspects of object relations. In addition, the results highlight that difficulties with self-esteem and poor management of aggression in childhood interactions relates to patients' object relational functioning later in life. Clinical implications and future research are discussed.

Asunto(s)

RESUMEN

The clinician-rated Adaptive Interpersonal Vulnerability Scale (AIVS) was developed from items of the Shedler-Westen Assessment Procedure (SWAP; Westen & Shelder, 2007; Westen, Waller, Shedler, & Blagov, 2014). Convergent validity of the AIVS was examined with self-report attachment style measures: Relationship Questionnaire (RQ; Bartholomew & Horowitz, 1991) and Experiences in Close Relationships Questionnaire-Revised (ECR-R; Fraley, Waller, & Brennan, 2000). Fifty-nine patients completed the RQ and ECR-R before beginning psychotherapy. Clinicians rated patients on the SWAP after six sessions. The AIVS was negatively related to the RQ Fearful/Avoidance scale, the ECR-R attachment anxiety scale, and the ECR-R attachment avoidance scale and positively related to the RQ Secure Attachment scale, although not significant. Findings provide initial supposrt for the AIVS as a therapist-rated measure associated with lower client-reported levels of the fearful/avoidant attachment prototype, attachment anxiety, and attachment avoidance. Implications and suggestions for future research on the AIVS and clinical work are discussed.

Asunto(s)

RESUMEN

Objective: Background regarding a recent debate between Cuijpers et al. (2019a, b) and the authors (Munder et al. 2019) about the efficacy of psychotherapy for depression is given. Method: A main reason for the discrepancy in Cuijpers et al.'s and our conclusions is discussed. Results: In our view the discrepancy is due, among other things, to a blurred distinction between questions of relative and absolute efficacy of psychotherapy. Although the efficacy of psychotherapy vis-à-vis alternative treatments may be ambiguous, there can be little doubt about the benefits of psychotherapy relative to no treatment. Conclusion: We do not think that raising fundamental concerns about the value of psychotherapy is a service to the field. We argue that moving the field forward requires a focus on how psychotherapy works and how the access to psychotherapy can be increased.

Asunto(s)

RESUMEN

The current study seeks to explore the relationship between patient-reported interpersonal problems and therapist interventions in early psychodynamic psychotherapy for 71 outpatients. Pretreatment ratings on the Inventory of Interpersonal Problems Circumplex Scales (IIP-C) total and subscale scores were examined in relation to early treatment process. Independent clinicians reliably rated therapist use of psychodynamic-interpersonal (PI) and cognitive-behavioural (CB) interventions using the Comparative Psychotherapy Process Scale (CPPS) over two early treatment sessions (third and ninth). Intraclass correlation (ICC) values were in the excellent range for CPPS-PI and CPPS-CB scale scores (CPPS-PI = 0.86; CPPS-CB = 0.78). A significant positive correlation was found between interpersonal problems and global PI therapist technique. A significant positive correlation was also found between interpersonal problems and specific PI interventions, most significantly experience and expression of feelings in session. In specific interpersonal problem subscales, most significant was that Cold/Distant and Socially Inhibited octants positively related to global PI and to specific PI techniques, including exploration of uncomfortable feelings. Multiple regression analyses revealed most significantly that CPPS Intervention 7 (discussion of patient-therapist relationship; positive) and CPPS Intervention 11 (therapist explanation of rationale behind treatment; negative) explained 15.6% of variance in interpersonal problem score. These findings demonstrate that the use of psychodynamic techniques tend to occur alongside patient-reported interpersonal problems early in psychotherapy treatment. Clinical implications are discussed for this area of research, and future directions are explored.

Asunto(s)

RESUMEN

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)

RESUMEN

For psychotherapy of mental disorders, presently several approaches are available, such as interpersonal, humanistic, systemic, psychodynamic or cognitive behavior therapy (CBT). Pointing to the available evidence, proponents of CBT claim that CBT is the gold standard. Some authors even argue for an integrated CBT-based form of psychotherapy as the only form of psychotherapy. CBT undoubtedly has its strengths and CBT researchers have to be credited for developing and testing treatments for many mental disorders. A critical review, however, shows that the available evidence for the theoretical foundations of CBT, assumed mechanisms of change, quality of studies, and efficacy is not as robust as some researchers claim. Most important, there is no consistent evidence that CBT is more efficacious than other evidence-based approaches. These findings do not justify regarding CBT as the gold standard psychotherapy. They even provide less justification for the idea that the future of psychotherapy lies in one integrated CBT-based form of psychotherapy as the only type of psychotherapy. For the different psychotherapeutic approaches a growing body of evidence is available. These approaches have their strengths because of differences in their respective focus on interpersonal relationships, affects, cognitions, systemic perspectives, experiential, or unconscious processes. Different approaches may be suitable to different patients and therapists. As generally assumed, progress in research results from openness to new ideas and learning from diverse perspectives. Thus, different forms of evidence-based psychotherapy are required. Plurality is the future of psychotherapy, not a uniform "one fits all" approach.

RESUMEN

We examined the relationship between psychodynamic techniques early in treatment with reliable change in depressive symptomatology. Forty-six patients admitted for individual psychodynamic psychotherapy who received a diagnosis representative of a depressive spectrum disorder were assessed pretreatment and posttreatment through self-report of depressive symptoms. Videotapes from two early treatment sessions (3rd and 9th) were independently rated on the Comparative Psychotherapy Process Scale for use of psychodynamic-interpersonal and cognitive-behavioural techniques, with excellent interrater reliability (intraclass correlation coefficient > .75). We found a significant relationship between overall use of psychodynamic technique across early treatment (r = .31, p = .036), as well as specific psychodynamic techniques delivered across early treatment, with change in patient-reported depressive symptoms. Our findings suggest that focusing on affective experiencing and expression, as well as providing interpretations are particularly helpful early in psychodynamic treatment for depression. Clinical implications and future directions are discussed.

Asunto(s)

RESUMEN

This study explores the effectiveness of psychodynamic psychotherapy in improving facets of object relations (OR) functioning over the course of treatment. The sample consisted of 75 outpatients engaged in short-term dynamic psychotherapy at a university-based psychological services clinic. Facets of OR functioning were assessed at pre- and posttreatment by independent raters using the Social Cognition and Object Relations Scale-Global rating method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011 ; Westen, 1995 ) from in-session patient relational narratives. The Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman, Bonge, & Blais, 2005 ) was used to assess therapist activity and psychotherapy techniques early in treatment. Independent clinical ratings of OR functioning and psychotherapy technique were conducted and all were found to be in the good to excellent range of reliability. Specific facets of OR functioning improved with medium to large effect changes posttreatment. These adaptive changes were significantly related to the incidence of psychodynamic-interpersonal (PI) techniques. Also, this study identified the role specific psychodynamic techniques had in facilitating change in a number of underlying dimensions of OR. Patient self-reported reliable change in symptomatology and reliable change in facets of OR were significantly related as well. This study highlights the utility of incorporating psychological assessment into psychotherapy practice to assess change at the explicit (symptoms) and implicit (OR) level. Limitations of this study, future research directions, and implications for clinical practice are discussed.

Asunto(s)

RESUMEN

The Social Anxiety/Avoidance Scale was recently added to the Shedler Westen Assessment Procedure (SWAP), and requires independent validation. This study used data drawn from a larger ongoing project in order to retrospectively examine its convergent validity with two self-report attachment measures: Relationship Questionnaire (RQ) and Experiences in Close Relationships Questionnaire-Revised (ECR-R). Fifty-two patients completed the RQ and the ECR-R before beginning psychotherapy treatment. Clinicians rated the patients on the SWAP after six sessions. The SWAP Social Anxiety/Avoidance Scale (SWAP-SAAS) was negatively related to the RQ secure attachment prototype scale and positively related to the ECR-R attachment anxiety scale. Our findings provide initial support for the use of the SWAP-SAAS as a therapist-rated measure associated with lower patient-reported levels of fit with a secure attachment prototype and with higher patient-reported levels of attachment anxiety. Implications and suggestions for future research on the SWAP-SAAS, as well as for clinical work with socially anxious and avoidant patients, are discussed.

Asunto(s)

RESUMEN

The current study examined how techniques in a psychodynamic model of therapy (Blagys and Hilsenroth, Clin Psychol Sci Pract. 7, 167-188, 2000) were related to changes in anxiety symptoms across early treatment process among a transdiagnostic sample of patients with primary anxiety disorder, subclinical anxiety disorder, and no anxiety disorder. Secondary analyses examined the use of specific psychodynamic techniques in relation to symptom change. Results revealed that therapists' use of psychodynamic-interpersonal (PI) techniques were significantly and directly related to changes in anxiety symptoms, in line with previous findings (Pitman, Slavin-Mulford, and Hilsenroth, J Nerv Ment Dis. 202, 391-396, 2014). In addition, patients with co-occurring axis I and II disorders demonstrated positive changes in anxiety symptoms regardless of level of PI technique used, whereas patients without co-occurring disorders experienced greater improvement with more PI. Implications for transdiagnostic treatment protocols for anxiety, notably Leichsenring and Salzer's (Psychotherapy 51, 224, 2104) Unified Psychodynamic Protocol for Anxiety Disorders, are discussed in relation to the current findings.

Asunto(s)

RESUMEN

OBJECTIVE: This study was the first to examine psychotherapy termination from both therapists' and patients' perspectives by using standardized psychotherapy process measures. Our aim was to examine whether patient participation and therapist exploration during the termination phase of treatment are related to how good and productive the session was. METHOD: The sample consisted of 30 outpatient adults who had completed the Vanderbilt Psychotherapy Process Scale-Short form (VPPS-S; Smith, Hilsenroth, Baity, & Knowles, 2003) and the Session Evaluation Questionnaire (SEQ; Stiles, 1980) during a termination-phase session. These ratings were examined from mutually agreed upon terminations with largely successful outcomes. RESULTS: Higher ratings of patient participation, as rated by both the therapist and patient, were significantly related to patient ratings of how good and productive the session was. Mixed findings were shown for therapist exploration. CONCLUSIONS: We provide clinical examples and suggestions for future research to illuminate process elements of psychotherapy termination.

Asunto(s)

RESUMEN

This introduction to the special issue on psychotherapy termination begins by noting the almost complete lack of research and clinical discussion on this topic in the literature. It is with a desire to effect some sort of change to this current state of affairs that Psychotherapy invited manuscripts for this special issue. Specifically, the editors sought contributions on both the clinical practice and research aspects of the psychotherapy termination process from a variety of different theoretical orientations, perspectives, and methodologies. This special issue will include two sections, clinical practice and research, each serving to help better define the nature and extent of this important, but often ignored aspect of psychotherapy. (PsycINFO Database Record

RESUMEN

In this review, we synthesize findings regarding the relationship between perfectionism and therapeutic alliance, most of which come from analyses by Blatt and colleagues. Results suggest what follows. First, patients' initial level of perfectionism negatively affects patients' bond with therapists and perception of therapists' Rogerian attributes (empathy, congruence, and regard) early in treatment and engagement in therapy later in treatment. Second, therapists' contribution to alliance is not seemingly affected by patients' initial perfectionism level. Third, individual patients of therapists who are perceived on average by their patients to be higher on Rogerian attributes experience greater decreases in perfectionism and symptoms. Fourth, more positive perceptions of therapists' Rogerian attributes early in treatment lead to greater symptom decrease for patients with moderate perfectionism. Fifth, greater early patient engagement in therapy is related to greater decrease in perfectionism, but a strong relationship with the therapist may be necessary for an accompanied greater decrease in symptoms. The relationship between pre-treatment perfectionism and alliance is partially explained by higher levels of hostility and lower levels of positive affect. Sixth, the relationship between pre-treatment perfectionism and outcome is almost entirely explained by level of patient contribution to alliance and satisfaction with social network, highlighting the importance of focusing on social functioning for patients with high perfectionism (both in and outside of the session). Limitations include that most of the findings are from analyses of one large data set and a range of measurement issues. Future research should utilize different measures, perspectives, and populations and examine specific session process.

RESUMEN

OBJECTIVE: Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia). METHOD: The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT superiority: (a) effect size, power, and statistical significance, (b) focusing on disorder-specific symptom measures and ignoring other important indicators of psychological functioning, (c) problems inherent in classifying treatments provided in primary studies into classes of treatments, and (d) the inclusion of problematic trials, which biases the results, and the exclusion of trials that fail to find differences among treatments. RESULTS: When these issues are examined, the effects demonstrating the superiority of CBT are small, nonsignificant for the most part, limited to targeted symptoms, or are due to flawed primary studies. CONCLUSION: Meta-analytic evidence for the superiority of CBT in the three meta-analysis are nonexistent or weak.

Asunto(s)