RESUMEN
OBJECTIVES: Working alliance (WA) has been shown to be an important process influencing the success of therapy. The association of clients' underlying attachment representations with WA and the subsequent success of therapy has increasingly been recognized. This study explores the association between adult attachment representations, specific attachment to the therapist and WA in patients receiving psychological therapy. METHOD: Fifty-eight participants due to receive therapy were recruited from primary care psychological services. Participants completed self-report measures of attachment, WA, and psychopathology. RESULTS: Patients with greater secure attachment to the therapist showed significantly greater WA. In a subset of participants completing therapy, change in outcome was also correlated with baseline attachment towards the therapist. CONCLUSIONS: The study suggests that attachment towards the therapist is an important predictor of WA. The results suggest that in terms of WA, attachment to the therapist may be more important than pre-existing attachment representations. PRACTITIONER POINTS: A more secure attachment to the therapist was associated with greater WA and improvement in therapy. Clinicians should be mindful of signs of an insecure attachment to themselves, reflecting a difficulty around trusting the therapist and viewing them as a secure base. Missed sessions and an ongoing reluctance to disclose personal information to the therapist may be signs of an insecure attachment. This may be the case even in cognitive-behavioural approaches to therapy where relational processes are not necessarily a focus of therapy. Incorporating attachment processes in the formulation, including attachment to the therapist, may provide one way of exploring these issues in therapy.
Asunto(s)
Terapia Cognitivo-Conductual/normas , Apego a Objetos , Evaluación de Procesos y Resultados en Atención de Salud , Relaciones Profesional-Paciente , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVES: This review systematically examines research that investigates changes in adult attachment representations during psychological therapy. METHOD: Studies from two adult attachment approaches are reviewed (interview and self-report) with the aim of concluding whether psychotherapy can improve attachment representations. To guide the interpretation of findings, the methodological quality of studies is assessed. RESULTS: The results suggest that attachment security increases following therapy, whereas attachment anxiety decreases following therapy. Findings are unclear with regard to attachment avoidance. Improvements are observed across different methodologies, patient groups, therapeutic approaches, and therapy settings. Findings also appear to be consistent across different levels of study quality. CONCLUSIONS: Overall, research supports the suggestion that attachment styles may alter during the course of psychotherapy, but further controlled trials are required to confirm this conclusion.
Asunto(s)
Ansiedad/psicología , Relaciones Interpersonales , Apego a Objetos , Psicoterapia/normas , Resultado del Tratamiento , HumanosRESUMEN
OBJECTIVE: To evaluate a multidisciplinary cognitive behavioural therapy pain management programme (PMP) based at a small community hospital. METHODS: Patients attending the PMP were assessed at three intervals (pre-training, and 18 and 44 weeks post-training) using a set of seven questionnaires. Information about their general practitioner (GP) and consultant visits was recorded at pre-training and final follow-up visits. Questionnaires were completed and additional personal information recorded before patients attended their appointments. RESULTS: Between 1997 and 2006, 163 patients completed at least six sessions out of the eight-week programme. Of these, 70 who had completed at least one questionnaire outcome measure at the three assessment intervals, and 83 who had provided information on their GP and consultant visits at pre-training and final follow-up, were included in the analyses. The results showed that patients reported being more confident in coping with their pain (pain self-efficacy questionnaire) at 18 weeks post-training and their improvement was sustained at the final follow-up. They were significantly less depressed (hospital and anxiety depression scale [HADS]) and reported a large improvement in their quality of life (modified patient generated index) at the final follow-up. They also reported a significant reduction in pain-related GP and consultant visits at their final follow-up. Although there were improvements in the Tampa scale of kinesiophobia, anxiety (HADS-Anx) and sickness impact profile scores, these were not statistically significant. CONCLUSION: The result of the evaluation indicated that this PMP, delivered in a community hospital setting, made some significant differences to patients with intractable chronic pain conditions.
Asunto(s)
Enfermedad Crónica , Terapia Cognitivo-Conductual/métodos , Hospitales Comunitarios , Pacientes Ambulatorios/psicología , Dolor , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Resultado del Tratamiento , Reino UnidoRESUMEN
While past research has suggested an association between the ability to taste PROP and liking for the taste of sucrose, many aspects of this relationship remain ambiguous. To clarify this further, 60 volunteers (40 women and 20 men) were classified as PROP super-medium or non-tasters and as sweet likers or dislikers depending on hedonic and intensity ratings for PROP and sucrose. 67% of PROP super-tasters were sweet dislikers, compared to 12% of PROP non-tasters. PROP super-tasters also rated the intensity of salty and sweet tastes as greater than did non- or medium PROP tasters, but these differences in sweet intensity could not explain the group differences in sweet liking. The groups did not differ in restraint or BMI. Taste bud density was higher in PROP super-tasters and sweet dislikers than in PROP medium or non-tasters or sweet likers. Overall these data confirm that PROP super-tasters are more likely to be sweet dislikers, and that this cannot be explained as secondary to cognitive attitudes to sweetness (restraint) or enhanced sweet intensity.