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Sanders, Avihay, Mark Hilsenroth, and J. Christopher Fowler. "Object representation quality, therapeutic alliance, and psychotherapy process." Bulletin of the Menninger Clinic 78, no. 3 (September 2014): 197–227. http://dx.doi.org/10.1521/bumc.2014.78.3.197.
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Kasimatis, Nikolaos, Dimitrios Moschonas, and Thalis Papadakis. "The effects of session frequency on group analytic psychotherapy process." Group Analysis 53, no. 3 (May 14, 2020): 327–42. http://dx.doi.org/10.1177/0533316420916715.
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The study examined the effects of session frequency (fortnightly versus weekly) on specific group processes, i.e. group cohesiveness, group climate, and therapeutic alliance in a naturalistic setting. Results indicated that fortnightly frequency sessions were associated with significantly higher levels of engagement, conflict, as well as therapeutic alliance-task within long term group analytic groups, whereas levels of cohesiveness, therapeutic alliance-goal and therapeutic alliance-bond did not differ significantly. The findings suggest that fortnightly frequency sessions versus weekly, do not seem to endanger therapeutic processes, indicating the need for greater experimentation and research to be carried out with regards to the actual effects of session frequency on treatment process as well as outcome.
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Marcolino, José Alvaro Marques, and Eduardo Iacoponi. "The early impact of therapeutic alliance in brief psychodynamic psychotherapy." Revista Brasileira de Psiquiatria 25, no. 2 (June 2003): 78–86. http://dx.doi.org/10.1590/s1516-44462003000200006.
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INTRODCTION: Therapeutic alliance is a key component of the psychotherapeutic process. This study estimated the impact of the therapeutic alliance as measured by CALPAS-P in an individual brief psychodynamic psychotherapy program. METHODS: To study the impact of the therapeutic alliance patients in psychotherapy answered to the CALPAS-P at the first and third session and to the Self-report Questionnaire (SRQ-20), to the Beck Depression Inventory (BDI) and to the Hamilton Anxiety Scale at the beginning and at the end of psychotherapy. RESULTS: The study of the impact of the therapeutic alliance in brief psychodynamic psychotherapy showed that higher TUI scores in the first session were significantly associated to the improvement on the BDI. Patients with best scores in the working alliance, measured at the third PWC session had also significant symptomatic changes. DISCUSSION: The study of the impact of the therapeutic alliance in brief psychotherapy indicated that patients who perceived that their therapists had the best capability to understand and to be involved in their issues had best results in reducing depressive symptoms and patients with higher capability to form the working alliance reached the best psychotherapy outcomes.
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Samardzic, Ljiljana, and Gordana Nikolic. "Transference patterns and working alliance during the early phase of psychodynamic psychotherapy." Vojnosanitetski pregled 71, no. 2 (2014): 175–82. http://dx.doi.org/10.2298/vsp1402175s.
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Background/Aim. Working alliance, as a collaborative part of the therapeutic relationship has been proven to be one of the most powerful therapeutic factors in psychotherapy in general, regardless many technical differences between numerous psychotherapeutic modalities. On the other hand, transference is the basic concept of psychodynamic psychotherapy, and, according to the psychoanalytic theory and practice, it forms a major part of the therapeutic relationship. The aim of our paper was to determine the differences between the groups of patients with low, middle, and high working alliance scores and the dropout group in transference patterns, sociodemographic and clinical parameters, during the early phase of psychodynamic psychotherapy. Methods. Our sample consisted of 61 non-psychotic patients, randomly selected by the method of consecutive admissions and treated with psychoanalytic psychotherapy in the outpatient clinical setting. The patients were prospectively followed during 5 initial sessions of the therapeutic process. The working alliance inventory and Core conflictual relationship theme method were used for the estimation of working alliance and transference patterns, respectively. According to the Working Alliance Inventory scores, four groups of patients were formed and than compared. Results. Our results show a significant difference between the groups of patients with low, middle, and high working alliance inventory scores and the dropout group on the variable - transference patterns in the therapeutic relationship. Conclusion. Disharmonious transference patterns are more frequent in patients who form poor quality working alliance in the early phase of psychotherapy, or early dropout psychotherapy. It is of great importance to recognize transference patterns of a patient at the beginning of the psychotherapeutic process, because of their potentially harmful influence on the quality of working alliance.
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Langhoff, Christin, Thomas Baer, Doris Zubraegel, and Michael Linden. "Therapist–Patient Alliance, Patient–Therapist Alliance, Mutual Therapeutic Alliance, Therapist–Patient Concordance, and Outcome of CBT in GAD." Journal of Cognitive Psychotherapy 22, no. 1 (March 2008): 68–79. http://dx.doi.org/10.1891/0889.8391.22.1.68.
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The therapeutic alliance is seen as an important dimension in any type of psychotherapy. But patient, therapist, or observers can have different views on the therapeutic alliance. The question is which perspective best represents the therapeutic alliance, and what are the differences between these alternative views. In the present study, the therapist–patient alliance (TPA, the view of the therapist), patient–therapist alliance (PTA, the view of the patient), and mutual therapeutic alliance (MTA, the view of an observer) were measured simultaneously in cognitive behavior therapy of patients suffering from generalized anxiety disorder. Additionally, the concordance between patient and therapist ratings (TPC) was calculated. Cognitive behavior therapists attained high positive scores in all perspectives for all dimensions of the therapeutic alliance, such as empathy, cooperation, transparency, focusing, and assurance of progress. Correlations were consistently higher for ratings between therapist and patient than between observer and patient. A relation with outcome (Hamilton Anxiety Scale) was only found for observer ratings. It was concluded that cognitive behavior therapists can achieve good alliances with their patients. Different perspectives on the therapeutic alliance should be distinguished and taken into account separately in studies on the therapeutic process and outcome.
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Da Costa, Camila Piva, Carolina Stopinski Padoan, Simone Hauck, Stefania Pigatto Teche, and Cláudio Laks Eizirik. "What is the appropriate time to measure outcome and process factors in psychodynamic psychotherapy?" Trends in Psychiatry and Psychotherapy 41, no. 2 (June 2019): 112–20. http://dx.doi.org/10.1590/2237-6089-2017-0151.
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Abstract Introduction Different instruments and methods for measuring factors related to the progress and effectiveness of psychodynamic psychotherapy (PDT) have been widely discussed in the literature. However, there are no established guidelines on the most appropriate time to perform these measurements. Objectives The aim of this study is to problematize what is the appropriate time to measure the initial outcomes (symptoms, interpersonal relationships, quality, and social role) and process factors (alliance) in the early stages of PDT. Methods A naturalistic cohort study was conducted, following 304 patients during the first six months of psychotherapy. The therapeutic alliance was evaluated after four sessions; symptoms, interpersonal relationships, and social role were evaluated at intake and after 12 and 24 sessions. Results Our results indicate that four sessions were sufficient to measure the bond dimension of the therapeutic alliance, while more time is probably needed to adequately measure other aspects of the therapeutic alliance, such as tasks and goals. However, 12 sessions of treatment proved sufficient to detect improvements in all dimensions of the outcome instruments with moderate effect sizes, and those gains were stable at the 24th session. Conclusion According to our findings, 12 sessions seem to be sufficient to assess initial gains in PDT, although more studies are needed to evaluate the appropriate time to assess all aspects of the therapeutic alliance. Further studies are also required to evaluate the appropriate time to assess intermediate and long-term progress with regard to symptoms, interpersonal relations, social role and personality reorganization.
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Békés, Vera, and Leon Hoffman. "The “Something More” Than Working Alliance: Authentic Relational Moments." Journal of the American Psychoanalytic Association 68, no. 6 (December 2020): 1051–64. http://dx.doi.org/10.1177/0003065120983602.
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The importance of relational processes during psychotherapy and psychoanalysis has long been emphasized. Theoretical and empirical investigations have focused mostly on episodes in which the therapeutic relationship is taken over by transference, leads to enactments, or suffers ruptures, and much less on understanding the role of positive relational episodes in the change process during psychotherapy. Episodes of the latter type, conceptualized as Authentic Relational Moments (ARMs), are core experiences in the patient’s implicit relational learning in psychotherapy. ARMs are episodes in which the connection between patient and therapist is especially strong, deep, and genuine; their three main aspects are authenticity, understanding, and witnessing.
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Daniels, Jo, and Alison J. Wearden. "Socialization to the Model: The Active Component in the Therapeutic Alliance? A Preliminary Study." Behavioural and Cognitive Psychotherapy 39, no. 2 (November 22, 2010): 221–27. http://dx.doi.org/10.1017/s1352465810000792.
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Background: Therapeutic alliance has been found to be a significant predictor of outcome in psychotherapy yet what constitutes therapeutic alliance remains unclear. Examining the common constructs of therapeutic alliance, it is possible that there may be a conceptual overlap between active components of therapeutic alliance and socialization to the treatment model. Aim: To investigate the relationship between socialization to the model and therapeutic alliance. Method: Participants (N = 43) were taken from the active treatment arm in a RCT for the treatment of chronic fatigue syndrome (CFS/ME). Therapeutic alliance was measured using a 5-item questionnaire (brief CALPAS) and socialization to the model was extracted from therapy tapes using a novel coding system. Results: Key findings were that when patients and therapists agreed about goals of treatment, there were higher levels of concordance, less evidence of applying principles incongruent to the model, and less resistance during the treatment sessions. Conclusions: The outcome of this preliminary study contributes to the potential understanding of active components in the therapeutic alliance, and supports further research to achieve a more detailed picture of “non-specific” factors in therapy, including the active process of socialization in therapeutic alliance.
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Hernandez, Silvia, James Overholser, and Kevin McCarthy. "Clinical Recommendations for Addressing Impasses in Long-Term Psychotherapy." Archives of Psychiatry and Psychotherapy 24, no. 3 (October 15, 2022): 53–62. http://dx.doi.org/10.12740/app/146027.
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Many clients benefit from psychotherapy sessions that extend across months or years. However, there is a risk for therapeutic impasse in long-term psychotherapy in which the work can become repetitive or with limited gains over time. The current paper provides five transtheoretical principles to increase the impetus in long-term therapy. The five principles include: planful spontaneity, habitual creativity, pushing the limits of the therapeutic alliance, guided discovery, and specific broad goals. The therapist is encouraged to share responsibility for creative flexibility with the client in each session, including within the therapeutic alliance and the real relationship. The therapist can use a series of questions to promote a process of guided discovery. A clear focus on principles of psychology and goals that reflect maintenance of gains, development of strengths, and promotion of enrichment can ensure that the therapy continues to produce change over the length of the relationship.
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Ogrodniczuk, John S., William E. Piper, Anthony S. Joyce, and Mary McCallum. "Different Perspectives of the Therapeutic Alliance and Therapist Technique in 2 Forms of Dynamically Oriented Psychotherapy." Canadian Journal of Psychiatry 45, no. 5 (June 2000): 452–58. http://dx.doi.org/10.1177/070674370004500505.
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Objective: This study addresses several issues concerning patients' and therapists' perceptions of key therapy process variables. This includes examining whether patients and therapists differ in their perceptions of the therapeutic alliance and therapist technique, what the relation is between perceptions of the alliance and technique, and whether these perceptions are predictive of treatment outcome. Method: Patient and therapist perceptions of the therapy process were provided in a comparative trial of 2 forms of short-term individual dynamic psychotherapy. Patients (n = 144) were randomly assigned to each condition. Treatment outcome was assessed using a large, comprehensive battery of reliable measures. Results: The findings revealed several differences in the patients' and therapists' ratings of the alliance and technique in the 2 forms of therapy. Patient ratings of the alliance and technique were predictive of treatment outcome. Conclusion: The findings contribute to understanding the extent to which therapy participants share views of therapy processes and highlight the importance of the therapist's attending to the patient's perception of therapy.
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Zilcha-Mano, Sigal. "Resolution of alliance ruptures: The special case of animal-assisted psychotherapy." Clinical Child Psychology and Psychiatry 22, no. 1 (October 17, 2016): 34–45. http://dx.doi.org/10.1177/1359104516671385.
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Many therapists regard alliance ruptures as one of the greatest challenges therapists face in the therapy room. Alliance ruptures has been previously defined as breakdowns in the process of negotiation of treatment tasks and goals and a deterioration in the affective bond between patient and therapist. Alliance ruptures have been found to predict premature termination of treatment and poor treatment outcomes. But ruptures can also present important opportunities for gaining insight and awareness and for facilitating therapeutic change. A process of rupture resolution may lead to beneficial outcomes and serve as a corrective emotional experience. The article describes unique processes of alliance rupture resolution inherent in animal-assisted psychotherapy (AAP). Building on Safran and Muran’s model and on clinical examples, the article describes strategies for identifying ruptures in AAP and techniques for repairing them to facilitate a corrective experience in treatment. Implications for clinical practice and future research are discussed.
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Frieswyk, Siebolt H., Jon G. Allen, Donald B. Colson, Lolafaye Coyne, Glen O. Gabbard, Leonard Horwitz, and Gavin Newsom. "Therapeutic alliance: Its place as a process and outcome variable in dynamic psychotherapy research." Journal of Consulting and Clinical Psychology 54, no. 1 (1986): 32–38. http://dx.doi.org/10.1037/0022-006x.54.1.32.
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Lochtenberg, Jessica, Ari Kirshenbaum, and Matthew Johnson. "Adjunct pharmacotherapy for psychotherapy." BJPsych Open 7, S1 (June 2021): S166—S167. http://dx.doi.org/10.1192/bjo.2021.460.
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AimsA variety of pharmacotherapies have been used to assist the psychotherapy process as “adjunctive therapies.” These drugs are used in an acute, targeted fashion, such that they are explicitly delivered in the context of psychotherapy for anxiety, mood and substance-dependence disorders (SUDs). Our narrative review highlights the potential of medically-assisted psychotherapy by outlining the current state of research on few of these medications and describing the basic science that supports their use.MethodFirstly, we researched an assortment of medications that have been used off-label to enhance psychotherapy, and selected a few that have received the most empirical attention in preclinical and clinical-trial settings. Our review of clinical trials focused on three of the most common psychiatric ailments. For all studies reviewed, we identify the strengths and weaknesses of the data supporting the use of the medications for the three aforementioned disorders.ResultD-cycloserine: accelerates the process of associative emotional learning, enhancing exposure therapy in the treatment of various anxiety disorders, including obsessive-compulsive disorder and posttraumatic stress disorder. Limited studies are available on efficacy in treating SUDs.Intranasal oxytocin: accelerates memory retrieval-extinction procedures used in posttraumatic stress disorder, and promotes prosocial cognition and behaviour, facilitating a therapeutic alliance. Sufficiently powered studies and safety studies are required before strong conclusions can be made.Propranolol: interrupts the reconsolidation of memories (leading to maladaptive learned responses) involved in posttraumatic stress disorder during memory-reactivation therapy sessions, but there is little evidence that this drug can be used for depression or SUDs.Psychedelics: may effect the brain's default mode network, engendering a transformative experience that is often followed by a reduction in psychiatric symptoms. 3,4-methylenedioxymethamphetamine may additionally modulate the amygdala response in a way that allows for reprocessing of traumatic memories, and improves the therapeutic alliance. Anxiety, mood, and SUDs appear to be positively influence by traditional and non-traditional (ketamine) psychedelics.ConclusionAlthough the efficacy of the medically-assisted psychotherapies reviewed is still under investigation, we propose that these novel treatment approaches may be preferred over traditional psychopharmacological treatments due to the presence of fewer chronic side effects, as well less toxicity and abuse potential. Furthermore, these adjunctive pharmacotherapies may help to reinforce the psychotherapeutic alliance and may ultimately yield better long-term treatment outcomes. If at least some of the adjunctive pharmacotherapies outlined in this review are found to be clinically efficacious and safe, patients will benefit from having more treatment options available to them in the future.
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Avdi, Evrinomy, Evangelos Paraskevopoulos, Christina Lagogianni, Panagiotis Kartsidis, and Fotis Plaskasovitis. "Studying Physiological Synchrony in Couple Therapy through Partial Directed Coherence: Associations with the Therapeutic Alliance and Meaning Construction." Entropy 24, no. 4 (April 6, 2022): 517. http://dx.doi.org/10.3390/e24040517.
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In line with the growing recognition of the role of embodiment, affect and implicit processes in psychotherapy, several recent studies examine the role of physiological synchrony in the process and outcome of psychotherapy. This study aims to introduce Partial Directed Coherence (PDC) as a novel approach to calculating psychophysiological synchrony and examine its potential to contribute to our understanding of the therapy process. The study adopts a single-case, mixed-method design and examines physiological synchrony in one-couple therapy in relation to the therapeutic alliance and a narrative analysis of meaning construction in the sessions. Interpersonal Physiological Synchrony (IPS) was calculated, via a windowed approach, through PDC of a Heart Rate Variability-derived physiological index, which was measured in the third and penultimate sessions. Our mixed-method analysis shows that PDC quantified significant moments of IPS within and across the sessions, modeling the characteristics of interpersonal interaction as well as the effects of therapy on the interactional dynamics. The findings of this study point to the complex interplay between explicit and implicit levels of interaction and the potential contribution of including physiological synchrony in the study of interactional processes in psychotherapy.
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Bellia, Andrea. "Assessment Skills in Psychotherapy and Counselling: A Hypothetical Case of Procrastination and Resistance." Education and Society 40, no. 2 (November 1, 2022): 79–98. http://dx.doi.org/10.7459/es/40.2.06.
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In this article I wish to demonstrate the value of a quality relationship and good communication in the therapeutic process of counselling and psychotherapy. From the very first session, it is important to establish a trusting interaction between the client and the therapist in order to achieve a correct assessment and to establish a meaningful therapeutic alliance. The article focuses on the skills of the therapist which are needed in psychotherapy and counselling, and critiques the restricted dogmatic positions in the literature that classify cases and methods according to pre-conceived criteria. I advocate for skilled therapists, who are able to use wisdom, discernment and intuition, and who are free from any binding external sources, so that they may assess every case according to its own complexities and uniqueness.
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Maluenda-Gatica, Roberto, Matthias Schwannauer, and Angus MacBeth. "The Use of Synchronous Videoconference in Bipolar Patients." Social Science Protocols 5, no. 1 (February 6, 2022): 1–16. http://dx.doi.org/10.7565/ssp.v5.6714.
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Background: A considerable literature has developed around demonstrating the clinical relevance of mentalizing as a construct. However, much of the emphasis has been on patients’ deficits rather than therapist’s abilities. Although it may be the case that therapist’s mentalization capacity can facilitate better outcomes in psychotherapy, there is a dearth of empirical evidence concerning the impact mentalization has on therapist competencies in psychotherapy and the implications of this in clinical practice dyads.
Methods/Design: A pilot study will use an integrated design. A longitudinal case series alongside a qualitative grounded theory approach will be utilized to develop a context-specific, grounded micro theory model of therapeutic alliance rupture and resolution during online psychotherapy with patients with bipolar disorder. 10 dyads of therapists and patients will be assessed by pre-and post-session outcome ratings, as well as baseline and post-therapy performance ratings during the four-month intervention period. In addition, semi-structured grounded theory interviews will be conducted with participants to gain a deeper understanding of their experiences during the therapeutic process.
Discussion: New research findings on videoconferencing-enabled clinical interventions have been needed since the COVID-19 pandemic began. According to an assessment of the available evidence, little is known about psychotherapy, and significant gaps remain. This paper describes a protocol of a pilot aimed to capture the explicit and implicit knowledge that emerge from therapists and patients during the therapeutic process in order to investigate the complex process of therapeutic interaction beyond “outcome effects”.
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Maluenda-Gatica, Roberto, Matthias Schwannauer, and Angus MacBeth. "The Use of Synchronous Videoconference in Bipolar Patients." Social Science Protocols 5, no. 1 (February 6, 2022): 1–16. http://dx.doi.org/10.7565/ssp.v5.6714.
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Background: A considerable literature has developed around demonstrating the clinical relevance of mentalizing as a construct. However, much of the emphasis has been on patients’ deficits rather than therapist’s abilities. Although it may be the case that therapist’s mentalization capacity can facilitate better outcomes in psychotherapy, there is a dearth of empirical evidence concerning the impact mentalization has on therapist competencies in psychotherapy and the implications of this in clinical practice dyads.
Methods/Design: A pilot study will use an integrated design. A longitudinal case series alongside a qualitative grounded theory approach will be utilized to develop a context-specific, grounded micro theory model of therapeutic alliance rupture and resolution during online psychotherapy with patients with bipolar disorder. 10 dyads of therapists and patients will be assessed by pre-and post-session outcome ratings, as well as baseline and post-therapy performance ratings during the four-month intervention period. In addition, semi-structured grounded theory interviews will be conducted with participants to gain a deeper understanding of their experiences during the therapeutic process.
Discussion: New research findings on videoconferencing-enabled clinical interventions have been needed since the COVID-19 pandemic began. According to an assessment of the available evidence, little is known about psychotherapy, and significant gaps remain. This paper describes a protocol of a pilot aimed to capture the explicit and implicit knowledge that emerge from therapists and patients during the therapeutic process in order to investigate the complex process of therapeutic interaction beyond “outcome effects”.
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Maluenda-Gatica, Roberto, Matthias Schwannauer, and Angus MacBeth. "The Use of Synchronous Videoconference in Bipolar Patients." Social Science Protocols 5, no. 1 (February 6, 2022): 1–16. http://dx.doi.org/10.7565/ssp.v5.6714.
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Background: A considerable literature has developed around demonstrating the clinical relevance of mentalizing as a construct. However, much of the emphasis has been on patients’ deficits rather than therapist’s abilities. Although it may be the case that therapist’s mentalization capacity can facilitate better outcomes in psychotherapy, there is a dearth of empirical evidence concerning the impact mentalization has on therapist competencies in psychotherapy and the implications of this in clinical practice dyads.
Methods/Design: A pilot study will use an integrated design. A longitudinal case series alongside a qualitative grounded theory approach will be utilized to develop a context-specific, grounded micro theory model of therapeutic alliance rupture and resolution during online psychotherapy with patients with bipolar disorder. 10 dyads of therapists and patients will be assessed by pre-and post-session outcome ratings, as well as baseline and post-therapy performance ratings during the four-month intervention period. In addition, semi-structured grounded theory interviews will be conducted with participants to gain a deeper understanding of their experiences during the therapeutic process.
Discussion: New research findings on videoconferencing-enabled clinical interventions have been needed since the COVID-19 pandemic began. According to an assessment of the available evidence, little is known about psychotherapy, and significant gaps remain. This paper describes a protocol of a pilot aimed to capture the explicit and implicit knowledge that emerge from therapists and patients during the therapeutic process in order to investigate the complex process of therapeutic interaction beyond “outcome effects”.
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Goodman, Geoff, Hyewon Chung, Leah Fischel, and Laura Athey-Lloyd. "Simulation modeling analysis of sequential relations among therapeutic alliance, symptoms, and adherence to child-centered play therapy between a child with autism spectrum disorder and two therapists." Clinical Child Psychology and Psychiatry 22, no. 3 (February 13, 2017): 455–66. http://dx.doi.org/10.1177/1359104517691082.
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This study examined the sequential relations among three pertinent variables in child psychotherapy: therapeutic alliance (TA) (including ruptures and repairs), autism symptoms, and adherence to child-centered play therapy (CCPT) process. A 2-year CCPT of a 6-year-old Caucasian boy diagnosed with autism spectrum disorder was conducted weekly with two doctoral-student therapists, working consecutively for 1 year each, in a university-based community mental-health clinic. Sessions were video-recorded and coded using the Child Psychotherapy Process Q-Set (CPQ), a measure of the TA, and an autism symptom measure. Sequential relations among these variables were examined using simulation modeling analysis (SMA). In Therapist 1’s treatment, unexpectedly, autism symptoms decreased three sessions after a rupture occurred in the therapeutic dyad. In Therapist 2’s treatment, adherence to CCPT process increased 2 weeks after a repair occurred in the therapeutic dyad. The TA decreased 1 week after autism symptoms increased. Finally, adherence to CCPT process decreased 1 week after autism symptoms increased. The authors concluded that (1) sequential relations differ by therapist even though the child remains constant, (2) therapeutic ruptures can have an unexpected effect on autism symptoms, and (3) changes in autism symptoms can precede as well as follow changes in process variables.
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Ryu, Jihan, Stephen Heisig, Caroline McLaughlin, Rebeccah Bortz, Michael Katz, and Xiaosi Gu. "A natural language processing approach to modelling treatment alliance in psychotherapy transcripts." BJPsych Open 7, S1 (June 2021): S48. http://dx.doi.org/10.1192/bjo.2021.177.
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AimsPatient-therapist alliance is a critical factor in psychotherapy treatment outcomes. This pilot will identify language concepts in psychotherapy transcripts correlating with the valence of treatment alliance using natural language processing tools. Specifically, high-order linguistic features will be extracted through exploratory analysis of texts and interpreted for their power to discriminate alliance rated by patients.MethodAdult patients and therapists in outpatient clinic at various stages of relationship building and treatment goals consented to participate in the cross-sectional study approved by the Institutional Board Review. Psychotherapy sessions were recorded using wireless microphones and transcribed by two research assistants. After the recording, each patient completed Working Alliance Inventory– Short Form, to generate clinical scores of alliance. We used the Linguistic Inquiry Word Count (LIWC) tool to map words to psycholinguistic categories, and generated novel linguistic parameters describing the individual language for each speaker role. Canonical-correlational analysis and descriptive statistics were used to analyze the two datasets.ResultPatients (N = 12, 83% female, mean age = 40) were primarily diagnosed with personality disorders (67%) working on real-life interpersonal issues (median treatment duration 18.5 weeks, 50% psychodynamic, 32% cognitive-behavioral, 16% supportive modality). In this heterogenous sample, patients who used the “achieve” (e.g. trying, better, success, failure) and “swear” psycholinguistic categories of words rated the treatment alliance lower (r=−0.70, p = 0.01; r=−0.65, p = 0.02). Patients rated alliance lower with therapists, who used more “I” pronoun (r=−0.58, p < 0.05) and higher with therapists using more “risk” (difficult, safe, crisis) and “power” (important, strong, inferior, passive) categories (r = 0.66, p = 0.02, r = 0.58, p < 0.05), which commonly appeared in psychoeducation and conceptual framing of problems. Interestingly, there was no correlation with “affiliation” category (p = 0.9). Linear regression modeling from “achieve,” “swear” variables and “I,” “risk” variables with duration of treatment as covariate predicted the patient's rating of alliance (Adjusted R2 = 0.66, p = 0.03).ConclusionOur data collection and sub-sample analysis are ongoing. Preliminary results are showing speaker-specific language patterns in cognitive-emotional domain, e.g. self-expressivity, and in clinician's therapy style, covarying with the patient's perceived closeness in the heterogenous treatment dyads. Novel application of natural language processing to characterize alliance using the data-driven approach is an unbiased method that can provide feedback to clinicians and patients. This characterization can also potentially provide insights into the mechanisms underlying the therapeutic process and help develop psycholinguistic markers for this critical clinical phenomena.
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Pomini, Valeria. "Η Θεραπευτική σχέση στη συστημική ψυχοθεραπεία οικογένειας και ζεύγους: απόψεις σε εξέλιξη." Psychology: the Journal of the Hellenic Psychological Society 26, no. 2 (June 7, 2021): 110. http://dx.doi.org/10.12681/psy_hps.26864.
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The relationship between therapist and client plays a central role in the quality and effectiveness of psychotherapy, independently from the therapeutic approach adopted by the therapist. The therapeutic relationship in the frame of Systemic Family and Couple Psychotherapy (SFCP), presents several peculiarities, especially when displayed in the "classical" therapeutic context of systemic psychotherapy, where complex and multifaceted relationships develop between therapists and family members, in front and through the one-way mirror, forming a network of "multiple bonds". Modern views on therapeutic relationship in SFCP have been influenced by the development of the "second order cybernetic", since the late 1980s, and the subsequent "linguistic shift", according to which the therapist, as a part of the therapeutic system, dialogues with family members, contributing to co-constructs new realities, as a therapeutic change cannot result from a didactic / guiding relationship. In this context, the emotions and feelings of the members of the therapeutic system come to the fore, whilst the issue of clients’ resistance to the treatment process is completely redefined. The research regarding the therapeutic relationship in the systemic approach, using both quantitative and qualitative methods, focused on a variety of dimensions, e.g., the impact of the session context and the used techniques, the degree of empathy between therapists and clients, and the therapeutic alliance that develops between them. In more recent years, the provision of mental health services using digital practices raised new challenges and concerns regarding the development of the therapeutic relationship in the new conditions of cooperation between therapist(s) and client(s) in online settings.
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Yotsidi, Vasiliki, and Kalliopi Kounenou. "Η θεραπευτική σχέση στην ψυχοδυναμική συμβουλευτική και ψυχοθεραπεία: σύγχρονα κλινικά και εμπειρικά δεδομένα." Psychology: the Journal of the Hellenic Psychological Society 26, no. 2 (June 7, 2021): 32. http://dx.doi.org/10.12681/psy_hps.26886.
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In the psychodynamic approach, the therapeutic relationship stands at the core of the therapeutic process and constitutes a key factor of the effectiveness of treatment. As such, highlighting the psychodynamic components associated with the therapeutic relationship can help reinforce the role of counseling and clinical psychologists, by offering a broader understanding of the various dynamic interactions in clinical work. Specifically, the present paper delineates particular aspects of the therapeutic relationship (e.g. therapeutic alliance, transference, countertransference, real relationship) that should be taken into account in counseling and psychotherapy as essential components of the therapeutic relationship. Current empirical data are presented to demonstrate the importance of these parameters for the therapeutic process and outcome. Emphasis is also placed on the conditions that need to be fulfilled in order to ensure a relationship of therapeutic value, such as the importance of the therapeutic framework and the role of the psychologists / psychotherapists in dealing with enactments. Finally, the benefits of using the potential of the therapeutic relationship in clinical practice are highlighted, for improving both someone’s relationship with oneself and with others.
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Rocco, Diego, Alessandro Gennaro, Francesco De Bei, Diego Zanelli, and Valeria Condino. "Development and Characteristics of the Therapeutic Alliance in a Short-Term Dynamic Psychotherapy: A Descriptive Case Study." Research in Psychotherapy: Psychopathology, Process and Outcome 16, no. 1 (August 17, 2013): 33–41. http://dx.doi.org/10.4081/ripppo.2013.152.
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Despite the long tradition in psychotherapy research literature concerning the role of therapeutic alliance (TA), both in terms of process and outcome in clinical inter-vention, little is known about its specific characteristics in short term dynamic psy-chotherapy (STDP). Accordingly, the main aim of the present work is to focus on the formal features of TA in a good outcome STDP. We applied the Collaborative Interaction Scale (Colli & Lingiardi, 2009) to verbatim transcripts in order to track macro and micro evolution of TA while considering the interplay of both therapist and patient contributions. Data were analyzed in terms of TA general trend, TA climate onset and high impact session TA characteristics. Results sustain the STDP theory of technique (Davanloo, 1990) concerning the general process, the onset fea-tures and patient therapist interplay from a TA perspective.
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Ghosh, G. J., P. M. Mclaren, and J. P. Watson. "Evaluating the alliance in videolink teletherapy." Journal of Telemedicine and Telecare 3, no. 1_suppl (June 1997): 33–35. http://dx.doi.org/10.1258/1357633971930283.
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The use of videoconferencing in psychotherapy remains largely unexplored. Videoconferencing compromises the range and quality of interactional information and thus might be expected to affect the working alliance (WA) between client and therapist, and consequently the process and outcome of therapy. A single case study exploring the effect of videoconferencing on the development of the WA in the psychological treatment of a female–male transsexual is described. The self-rated Working Alliance Inventory (WAI) was used to measure client and therapist perceptions of the WA after each session over 10 sessions of eclectic therapy conducted over a videolink. The serial WAI measurements charting the development of the WA in 4 cases of 10-session, face-to-face therapy by Horvath and Marx1 were used as a quasi-control. Therapist and client impressions of teletherapy are described. WAI scores were essentially similar to the face-to-face control group except for lower client-rated bond subscale scores. It is suggested that client personality factors accounted for this difference and that videoconferencing did not impair the development of an adequate working alliance or successful therapeutic outcome.
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Schechter, Ronningstam, Herbstman, and Goldblatt. "Psychotherapy with Suicidal Patients: The Integrative Psychodynamic Approach of the Boston Suicide Study Group." Medicina 55, no. 6 (June 24, 2019): 303. http://dx.doi.org/10.3390/medicina55060303.
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Psychotherapy with suicidal patients is inherently challenging. Psychodynamic psychotherapy focuses attention on the patient's internal experience through the creation of a therapeutic space for an open-ended exploration of thoughts, fears, and fantasies as they emerge through interactive dialogue with an empathic therapist. The Boston Suicide Study Group (M.S., M.J.G., E.R., B.H.), has developed an integrative psychodynamic approach to psychotherapy with suicidal patients based on the authors’ extensive clinical work with suicidal patients (over 100 years combined). It is fundamentally psychodynamic in nature, with an emphasis on the therapeutic alliance, unconscious and implicit relational processes, and the power of the therapeutic relationship to facilitate change in a long-term exploratory treatment. It is also integrative, however, drawing extensively on ideas and techniques described in Dialectical Behavioral Therapy (DBT), Mentalization Based Treatment (MBT), Cognitive-Behavioral Therapy (CBT), as well on developmental and social psychology research. This is not meant to be a comprehensive review of psychodynamic treatment of suicidal patients, but rather a description of an integrative approach that synthesizes clinical experience and relevant theoretical contributions from the literature that support the authors’ reasoning. There are ten key aspects of this integrative psychodynamic treatment: 1. Approach to the patient in crisis; 2, instilling hope; 3. a focus on the patient's internal affective experience; 4. attention to conscious and unconscious beliefs and fantasies; 5. improving affect tolerance; 6. development of narrative identity and modification of "relational scripts"; 7. facilitation of the emergence of the patient's genuine capacities; 8. improving a sense of continuity and coherence; 9 attention to the therapeutic alliance; 10. attention to countertransference. The elements of treatment are overlapping and not meant to be sequential, but each is discussed separately as an essential aspect of the psychotherapeutic work. This integrative psychodynamic approach is a useful method for suicide prevention as it helps to instill hope, provides relational contact and engages the suicidal patient in a process that leads to positive internal change. The benefits of the psychotherapy go beyond crisis intervention, and include the potential for improved affect tolerance, more fulfilling relational experiences, emergence of previously warded off experience of genuine capacities, and a positive change in narrative identity.
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Ewais, Tatjana, Jake Begun, Maura Kenny, Alan Headey, Merilyn Tefay, and Steve Kisely. "Mindfulness-based cognitive therapy experiences in youth with inflammatory bowel disease and depression: findings from a mixed methods qualitative study." BMJ Open 10, no. 11 (November 2020): e041140. http://dx.doi.org/10.1136/bmjopen-2020-041140.
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ObjectivesMindfulness-based cognitive therapy (MBCT) is effective in treating psychosocial comorbidities in inflammatory bowel disease (IBD); however, there have been no qualitative studies of MBCT experiences among youth with IBD. We aimed to examine the experiences of youth with IBD and depression who completed an adapted MBCT group programme, and the impact of common psychotherapy and group factors.DesignThis mixed method qualitative study, nested within a randomised controlled trial (RCT) of MBCT for youth with IBD, employed thematic analysis of qualitative data from three focus groups and open-ended survey questions.SettingThe study was conducted in the outpatient department of a tertiary hospital for young adults in Brisbane, Australia.ParticipantsOut of sixty-four adolescents and young adults recruited to the RCT of MBCT for youth with IBD and depression, 29 completed the MBCT evaluation survey and 19 attended the focus groups.ResultsFour key themes emerged: ‘connectedness and shared understanding’, ‘growing in wisdom’, ‘therapeutic alliance’ and ‘barriers to mindfulness practice’. Participants described MBCT experiences as healing and transformative with the themes of connectedness, growing in wisdom and therapeutic alliance laying the foundation for therapeutic change. Main barriers included fatigue, depression, time and travel constraints.ConclusionsThe study identified key themes facilitating the process of therapeutic change within the MBCT programme for youth with IBD and elucidated common and group psychotherapy factors underlying the key themes. Participants perceived connecting with peers as essential for learning mindfulness skills which in turn strengthened the connection. Study findings will facilitate interpretation of the results of the RCT of MBCT in youth with IBD and inform the design of future studies of MBCT in this cohort.Trial registration numberACTRN12617000876392; Results.
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Adomaitiene, V., and A. Kulak. "the Psychodynamic Aspects of Combined Psychotherapeutic and Psychopharmacological Treatment." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71271-4.
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Scientific studies revealed that combined psychotherapeutic and psychopharmacological treatment may be more effective than psychotherapy or psychopharmacology separately. in clinical practice there is lack of integrity in psychological and medico-biological view. the artificial division of psychiatrists into psychopharmacologists and psychotherapists may be interpreted as the expression of competitive infant emotions that were not experienced through and were deferred.During the course of psychotherapy the prescription of psychotropic drugs is based on the three main principals:1.combined therapy is more effective than psychotherapy alone;2.psychotherapists, who have no skills and knowledge in psychopharmacology, must be in contact with psychiatrists;3.psychotherapist must understand the subjective meaning of prescription of psychotropic drugs for his patient.From the psychodynamic viewpoint, therapy is regulated based on a complex feeling shared and experienced by the patient and psychiatrist during the therapeutic process as well as an in-depth comprehension of psychological phenomena:1.the psychiatrist, who prescribed the medications, can become the object for intensive transference feelings;2.on the other hand the prescription of psychotropic drugs may be determined by powerful and not realized completely emotions (i.e. anger, anxiety, hopelessness, traumatic narcistic injury) of psychiatrist;3.the patient's resistance to the treatment, refuse to collaborate, denial of disease is intensive phenomenon in psychotherapy as well as in psychopharmacology and disturbs creation of safe therapeutic alliance.
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di Riso, Daniela, Silvia Salcuni, Loredana Laghezza, Cristina Marogna, and Adriana Lis. "Assessing Changes in Psychoanalytic Psychodynamic Therapy with an Early Adolescent." Rorschachiana 30, no. 2 (July 2009): 150–79. http://dx.doi.org/10.1027/1192-5604.30.2.150.
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This paper describes changes in personality functioning according to Exner’s Rorschach Comprehensive System (CS) in an early adolescent boy, Gabriele, referred for anxiety and obsessive compulsive symptoms. The DSM-IV diagnosis was General Anxiety Disorder (GAD). The therapy lasted about 2 years, and sessions were all audio-taped to create a more objective database. A total of 50 sessions were analyzed. The therapist employed a broadly defined, object-relations-focused, psychodynamic framework, with particular emphasis placed on balancing supportive versus insight-oriented modes of therapy ( Skean, 2005 ). After a brief introduction of Gabriele’s clinical history and anamnesis, the paper illustrates (a) changes in the symptoms from the beginning to the end of the supportive psychodynamic psychotherapy, which also included some cognitive-behavioral therapy (CBT) interventions; (b) changes in the CS administered at the beginning and at the end of the psychotherapy; and (c) the relevance of therapeutic alliance measured by the Collaborative Interactive Scale (CIS; Colli & Lingiardi, 2007 ) as a fundamental intervening variable in the psychotherapy process.
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Gonzalez-Mota, A., C. Fombellida Velasco, A. Gonzalez Gil, P. Gómez Hernández, I. Vicente Torres, M. Covacho Gonzalez, C. Payo-Rodriguez, E. Beltran-Mercado, and C. Roncero. "“I’ve discovered the COVID-19 vaccine”. Approach of a bipolar disorder clinical case in the Mental Health Day Hospital of Salamanca during the pandemic." European Psychiatry 65, S1 (June 2022): S412. http://dx.doi.org/10.1192/j.eurpsy.2022.1046.
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Introduction A 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master’s degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives:illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities. Objectives The objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder. Methods 3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords “psychotherapy”, “psychotherapies” and “bipolar disorder “.77 studies were analyzed: 12 included, 65 excluded. Results Several randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist. Conclusions The insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment. Disclosure No significant relationships.
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Locati, Francesca, Germano Rossi, Margherita Lang, and Laura Parolin. "In‐session interactive dynamics of the psychotherapy process between therapeutic alliance, therapist expertise, therapist technical intervention, patient metacognition and functioning." Clinical Psychology & Psychotherapy 27, no. 6 (June 4, 2020): 902–14. http://dx.doi.org/10.1002/cpp.2478.
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Romero-Moreno, Antonio, Alberto Paramio, Serafín J. Cruces-Montes, Antonio Zayas, Diego Gómez-Carmona, and Ana Merchán-Clavellino. "Development and Validation of the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12) in a Spanish Population." International Journal of Environmental Research and Public Health 18, no. 19 (October 1, 2021): 10372. http://dx.doi.org/10.3390/ijerph181910372.
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In recent decades, the study of psychotherapy effectiveness has been one of the pillars of clinical research because of its implication for therapeutic cure. However, although many studies have focused their interest on the patient’s perception, there are no instruments oriented to the study of psychotherapists’ attributions of effectiveness: to what factors psychotherapists attribute responsibility for the cure of the therapies they provide. The present study aimed to develop and validate an instrument for assessing the attribution of the effectiveness of psychotherapy in a population of 69 psychotherapists of different theoretical orientations. After an initial process of inter-judge content validation, 12 items were selected for validation in the targeted population, adequately fulfilling the quality requirements in the validity–reliability tests, and grouped into four factors after principal component analysis. These factors were as follows: (1) therapeutic alliance enhancers; (2) psychotherapist emotional characteristics; (3) therapy-specific variables; and (4) facilitators of patient engagement with therapy. This four-factor structure also showed a good fit for the fit indices checked in confirmatory factor analysis. In summary, we can conclude that the Psychotherapeutic Effectiveness Attribution Questionnaire (PEAQ-12) developed in our research can be helpful if tested on a larger number of individuals. The results can be replicated in other populations of psychotherapists.
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Manchanda, M., and P. Mclaren. "Cognitive behaviour therapy via interactive video." Journal of Telemedicine and Telecare 4, no. 1_suppl (March 1998): 53–55. http://dx.doi.org/10.1258/1357633981931452.
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Interactive video has been identified as a potential delivery medium for psychotherapy. Interactive video may restrict the range of both verbal and non-verbal communication and consequently impede the development of a therapeutic relationship, thus influencing the process and outcome of therapy. A single case study explored the feasibility of the provision of cognitive behaviour therapy using interactive video with a client diagnosed a shaving mixed anxiety and depressive disorder. A range of outcome measures were included together with an independent psychiatric assessment prior to, and on completion of, therapy. Different levels of outcome were also examined: clinical, social, user views and administration. Outcome measures indicated a reduction in psychopathology and some modification of dysfunctional attitudes, with no apparent impairment of the working alliance.
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Rzondzinski, Daniel. "Psicoterapia del oprimido." Revista de Humanidades, no. 39 (May 29, 2020): 99. http://dx.doi.org/10.5944/rdh.39.2020.19776.
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Resumen: Este artículo trata de analizar cómo se puede enseñar y aprender el concepto de relación terapéutica siendo éste término, el contenido central de la asignatura Pre-Práctica, materia previa y obligatoria para los estudiantes que deben realizar su práctica de residencia como psicoterapeutas en la carrera de Maestría en Espiritualidad y Psicoterapia de la Universidad Wilfrid Laurier de la provincia de Ontario, Canadá. El concepto de relación terapéutica es abordado desde las perspectivas teóricas del pensamiento de Piaget, Freire y Morin, siendo dicha relación un elemento esencial que permite la implementación del proceso de psicoterapia y de los cambios que el paciente necesita realizar para mejorar su salud mental. A su vez, se analizan los conceptos de transferencia, contratransferencia y alianza terapéutica desde la perspectiva dinámica y cognitiva. Este artículo está sustentado teórica y conceptualmente en los principios de la transdiciplinariedad y del pensamiento complejo.Abstract: This article describes how to teach and how to learn about the nature of the therapeutic relationship. This concept is the main content of the Pre-Practicum course which is a cumpulsory prerequisite for students before they begin their practicum as psychotherapists in the Master in Spirtuality and Psychotherapy degree program of Wilfrid Laurier University in the province of Ontario, Canada. The concept of therapeutic relationship is analyzed from the perspective of Piaget, Freire and Morin. This article is focused on the importance and the needs of reaching a good therapeutic relationship in order to implement the psychotherapy process and the changes that the client needs to achieve to improve his mental health. This work analyzes the concepts of transference, countertransference and therapeutic alliance from dynamic and cognitive perspectives. This article is supported by the principles of transdisciplinarity and complex thinking.
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Calderon, Ana, Knut Arne Hooper Storeide, Cecilie Elvejord, Helene Amundsen Nissen-Lie, Randi Ulberg, and Hanne-Sofie Johnsen Dahl. "Examining Psychotherapeutic Processes with Depressed Adolescents: A Comparative Study of Two Psychodynamic Therapies." International Journal of Environmental Research and Public Health 19, no. 24 (December 16, 2022): 16939. http://dx.doi.org/10.3390/ijerph192416939.
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To understand processes associated with better or poorer psychotherapy outcomes is vital. This study examined and contrasted interaction patterns between one therapist and two depressed 17-year-old girls, Johanna (good outcome) and Sonja (poor outcome), in short-term psychoanalytic therapies selected from an RCT. Outcome data were collected regarding level of inter- and intra-personal functioning and symptoms of depression. Process data were obtained using the Adolescent Psychotherapy Q-Set on all available sessions. Analyses yielded five relational patterns or “interaction structures” in the two therapy processes; Three explained most of the variance in sessions with Johanna (i.e., ‘positive working alliance’, ‘therapist’s active use of psychodynamic techniques’, and ‘a receptive patient’) and two explained more of the variance in sessions with Sonja (i.e., ‘therapist using a more problem-solving and symptom-oriented approach’ and ‘patient displaying limited capacity for mentalization’). The processes in the two cases presented differences related to mentalization, psychological mindedness, and attachment style of the patients. The therapist used different therapeutic approaches, favouring more psychodynamic interventions in the good outcome case and a more problem-solving and symptom-oriented approach with the poor outcome case. In the latter case, the relationship seemed to be more of a struggle.
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Kister, Klaudia, Jakub Laskowski, Ewelina Dybała, and Agata Makarewicz. "Are we ready for Telepsychiatry? Benefits and challenges of digital psychotherapy." Current Problems of Psychiatry 24 (February 27, 2023): 52–67. http://dx.doi.org/10.12923/2353-8627/2023-0005.
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Background: Telemedicine is one of the most modern and fastest-growing branches of medicine. The most common form is video consultation. We distinguish between synchronous and asynchronous telepsychiatry. This study aims to show the benefits of using telepsychiatry services, the challenges it poses to users, and to evaluate its use against traditional therapy. Materials and methods: A review of literature from 1956-2023 in EMBASE, OpenKnowledge and PubMed databases was conducted. Keywords used were: telepsychiatry, teletherapy, and digital psychiatry. Ninety-eight articles were included. Discussion: Telepsychiatry is an opportunity for regions affected by medical staff shortages. It bypasses cultural barriers, the problem of traveling and reduces the cost of medical point-of-service. Telepsychiatry is an opportunity for patients who do not use psychiatrists due to discrimination in a conservative society. Groups that may find it challenging include the elderly, the blind, and the deaf. Creating a healthy therapeutic alliance through a screen can be impossible, making it difficult to achieve successful therapy. A barrier to developing telepsychiatry is the need for more guidelines for dealing with medical errors. Conclusions: Telemedicine can help in accessing specialized care regardless of location. Telepsychiatry provides a safe and anonymous environment for patients reluctant to receive inpatient therapy. The effectiveness of online therapy is primarily debated. Telepsychiatry should be limited to follow-up consultations and well-known patients - it is a form of complementing the diagnosis and treatment process. The authors point to the need for developing specific guidelines for conducting teletherapy with particular attention to the problem of suicide. Keywords: telepsychiatry, teletherapy, digital psychiatry.
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Šefarová, I., and M. Šlepecký. "Self-efficacy of the psychotherapist in the context of supervision." European Psychiatry 41, S1 (April 2017): s506. http://dx.doi.org/10.1016/j.eurpsy.2017.01.645.
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IntroductionIn the context of the importance of psychotherapy in mental health care the aim of our study is to highlight the importance of supervision as an integral part thereof.AimWe analyze the relationship between the assessment of the quality of supervision and the perceived self-efficacy of the psychotherapist as one of the antecedents of decision-making in the psychotherapeutic process. This framework is applied to an empirical study that focuses on psychotherapist's perception of clinical supervision in relationship to professional self-efficacy in the therapeutic process.MethodsThe study was operationalized using the Manchester clinical supervision scale (MCSS), containing a demographic questionnaire, counselor self-efficacy scale–modified version. One hundred and twenty-five psychotherapists with supervisory experience participated in the research, including 67 trainees and 58 graduates of psychotherapy training.ResultsThe results show a positive relationship between effective supervision and self-efficacy (r = 0.363; sig = 0.000; n = 125). The participants who attributed higher ratings to supervision and supervision work alliance also assigned higher scores to perceived self-efficacy–although there is a significant relationship among the participants of psychotherapeutic training (r = 0.444; sig = 0.000; n = 67), this relation is not significant among the actual graduates. Based on modeling, rapport was discovered to be the most important predictor of supervision effectiveness assessment.ConclusionsThe results support the merits of supervision in the education of psychotherapists and the importance of investing resources in its regular implementation.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Haliday, H., M. Reynaud, and B. Lignier. "Effects of a brief psychodynamic intervention on depressive patients. The “unfreezing” of psychic activity." European Psychiatry 65, S1 (June 2022): S297—S298. http://dx.doi.org/10.1192/j.eurpsy.2022.759.
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Introduction While psychotherapy is an essential aspect of the treatment of depression, there are few studies focusing on the effectiveness of psychoanalytic and psychodynamic group therapies for depressed patients. Objectives In this presentation, we will study the effects of a brief, 4-session psychodynamic intervention (BPI) led by a group of therapists, as inspired by the Lausanne model. Methods The patients were recruited in a therapeutic setting. A free consent form was completed and the ethics of research explained to each participant. Our sample consisted of 32 patients (average age = 43.81 years, sex ratio: 1M/ 4F). The therapists gathered data by completing several assessment scales after each therapy session: MADRS, ESM, EFP, HAQ-IT, EDICODE, Counter-Transfer Scale. The SPPS software (V21) was used to analyze the data. Results The patients’ mean MADRS score dropped by more than 11 after the four sessions. This improvement matches a more positive and committed self-reported counter-transference of the therapists towards the patients. As their insight increases, patients show greater behavioral and psychic activity. We name this exit of the depressive inhibition the “unfreezing” process. It enables more satisfactory human interactions and a more focused and structured self-narrative. Conclusions BPI led by a group of therapists seem to be an effective therapeutic adjuvant in the “unfreezing” of the psychic processes in depressive patients. Our results point out the importance of jointly aiming at symptomatic improvement and therapeutic alliance. Disclosure No significant relationships.
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Michel, Konrad. "Suicide Models and Treatment Models Are Separate Entities. What Does It Mean for Clinical Suicide Prevention?" International Journal of Environmental Research and Public Health 18, no. 10 (May 17, 2021): 5301. http://dx.doi.org/10.3390/ijerph18105301.
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Theoretical models of suicide are based on risk factors associated with suicide, such as psychiatric pathology, genetics, epigenetics, functional brain disorders, and impaired decision making. In current clinical practice, the predominant risk model is the medical model, which posits that treating suicide risk is primarily a matter of treating psychiatric disorders. However, even comprehensive risk factor models cannot overcome the basic problem that, by their nature, they cannot accommodate the suicidal person’s psychological experience of suicidality. Risk factor models do not translate into effective treatment models. Suicide risk is highly personal and fluid, and is related to individual vulnerabilities and to person-specific events triggering suicidal thoughts and actions. Clinicians need treatment models that are meaningful to suicidal patients. Understanding the single person’s suicidality requires a patient-centered approach. Therapeutic interventions that effectively reduce the risk of suicidal behavior have been developed from general principles of psychotherapy. Therapy process factors associated with effective therapies are working alliance, validation of the individual patient’s thoughts and feelings, active treatment engagement. Psychological therapies need patients who are active participants in a collaborative working relationship between therapist and patient. The goal must be to jointly develop a meaningful understanding of the suicidal crisis. In view of the limited personal resources in health care systems it is important that effective therapies are brief and effective. Future research must aim to improve our understanding of the factors involved in effective therapies in order to optimize treatments for individuals at risk. This may also include the integration of biological risk factors in psychological treatment models.
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Mathieson, Fiona, Jennifer Jordan, and Maria Stubbe. "Recent applications of metaphor research in cognitive behaviour therapy." Metaphor in Mental Healthcare 10, no. 2 (November 13, 2020): 199–213. http://dx.doi.org/10.1075/msw.00003.mat.
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Abstract Metaphors are common in psychotherapy. The last decade has seen increasing interest in the use of metaphor in cognitive behaviour therapy (CBT), with attention to client metaphors being asserted as a way of enhancing CBT. However, prior to this current research there was very little research on the use of metaphor in CBT sessions, and no studies have examined how to train therapists in this skill. This article discusses four studies that provide a preliminary empirical basis for the exploration of metaphors in CBT. The first study evaluated the reliability and utility of an approach to metaphor identification. The second study explored how clients and therapists co-construct metaphors, contributing to development of a shared language in early therapy sessions and identified a range of responses to each other’s metaphors. The third study explored the effect of training CBT therapists to intentionally bring client metaphors into case conceptualisations in terms of building therapeutic alliance and collaboration, along with an exploration of preference for metaphoric language. The fourth study explored the impact of the metaphor training on therapist confidence, awareness and use of metaphors, based on therapist self-report ratings and reflections on their ongoing application of learning over a three month period. These findings suggest that it is possibly to conduct empirical research on metaphor in CBT, with metaphor having potential as an important therapy process1 variable.
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Parker Hall, Sue. "Being Mindful About Mindfulness: Exploring the Dark Side." International Journal of Coercion, Abuse, and Manipulation 1, no. 1 (2020): 17–28. http://dx.doi.org/10.54208/ooo1/1001.
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In this paper, I acknowledge the rising popularity of mindfulness and analyze research into its positive, and less-researched negative, outcomes. I examine concerns about the training, quality, and supervision of mindfulness teachers. I address the roots of mindfulness in Buddhism and the consequences of its secularization, reduction, and commercialization. I argue that the mindfulness intervention works well as a standalone modality, predominantly as a means to manage symptoms and with relatively well clients, but that it is contraindicated with those who have experienced significant life or developmental trauma. I discuss the potential for the abuse of mindfulness in terms of its use in military conflict, recruitment of people into cults, and the purpose of influencing people to accept and tolerate oppressive environments. I make a case for combining psychotherapy and psychoeducation with mindfulness to create a safer and more effective therapeutic process that can support clients, including former members, with more complex trauma issues. Being Mindful About Mindfulness: Exploring the Dark Side There is currently great enthusiasm in the United Kingdom for mindfulness, a psychological intervention garnered from Buddhism, and numerous applications are being rolled out by the state and private enterprises. The National Institute for Health and Care Excellence recommends mindfulness, and it is the focus of a Mindfulness All-Party Parliamentary Group (MAPPG) and the subject of a major parliamentary report, The Mindfulness Initiative (2015). This alliance reported having been “impressed by the quality and range of evidence for the benefits of mindfulness and believe it has the potential to help many people to better health and flourishing” (MAPPG, 2015, p. 4) and is advocating mindfulness as a cost-effective route to tackling the country’s mental health crisis (MAPPG, 2015).
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Parker Hall, Sue. "Being Mindful About Mindfulness: Exploring the Dark Side." International Journal of Coercion, Abuse, and Manipulation 1, no. 1 (2020): 17–28. http://dx.doi.org/10.54208/ooo1/1001.
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In this paper, I acknowledge the rising popularity of mindfulness and analyze research into its positive, and less-researched negative, outcomes. I examine concerns about the training, quality, and supervision of mindfulness teachers. I address the roots of mindfulness in Buddhism and the consequences of its secularization, reduction, and commercialization. I argue that the mindfulness intervention works well as a standalone modality, predominantly as a means to manage symptoms and with relatively well clients, but that it is contraindicated with those who have experienced significant life or developmental trauma. I discuss the potential for the abuse of mindfulness in terms of its use in military conflict, recruitment of people into cults, and the purpose of influencing people to accept and tolerate oppressive environments. I make a case for combining psychotherapy and psychoeducation with mindfulness to create a safer and more effective therapeutic process that can support clients, including former members, with more complex trauma issues. Being Mindful About Mindfulness: Exploring the Dark Side There is currently great enthusiasm in the United Kingdom for mindfulness, a psychological intervention garnered from Buddhism, and numerous applications are being rolled out by the state and private enterprises. The National Institute for Health and Care Excellence recommends mindfulness, and it is the focus of a Mindfulness All-Party Parliamentary Group (MAPPG) and the subject of a major parliamentary report, The Mindfulness Initiative (2015). This alliance reported having been “impressed by the quality and range of evidence for the benefits of mindfulness and believe it has the potential to help many people to better health and flourishing” (MAPPG, 2015, p. 4) and is advocating mindfulness as a cost-effective route to tackling the country’s mental health crisis (MAPPG, 2015).
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van Dooren, Marierose M. M., Valentijn Visch, Renske Spijkerman, Richard H. M. Goossens, and Vincent M. Hendriks. "Mental Health Therapy Protocols and eHealth Design: Focus Group Study." JMIR Formative Research 4, no. 5 (May 6, 2020): e15568. http://dx.doi.org/10.2196/15568.
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Background Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results Therapists used the protocol as a “toolbox” comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process.
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Safran, Jeremy D., J. Christopher Muran, and Michael A. Tompkins. "The Therapeutic Alliance in Brief Psychotherapy." Journal of Cognitive Psychotherapy 15, no. 1 (January 2001): 67–68. http://dx.doi.org/10.1891/0889-8391.15.1.67.
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Simpson, Susan G., and Corinne L. Reid. "Therapeutic alliance in videoconferencing psychotherapy: A review." Australian Journal of Rural Health 22, no. 6 (December 2014): 280–99. http://dx.doi.org/10.1111/ajr.12149.
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Summers, R. F. "Therapeutic Alliance as a Measurable Psychotherapy Skill." Academic Psychiatry 27, no. 3 (September 1, 2003): 160–65. http://dx.doi.org/10.1176/appi.ap.27.3.160.
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Lingiardi, Vittorio, Ludovica Filippucci, and Roberto Baiocco. "Therapeutic alliance evaluation in personality disorders psychotherapy." Psychotherapy Research 15, no. 1-2 (January 2005): 45–53. http://dx.doi.org/10.1080/10503300512331327047.
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Stubbe, Dorothy E. "The Therapeutic Alliance: The Fundamental Element of Psychotherapy." FOCUS 16, no. 4 (October 2018): 402–3. http://dx.doi.org/10.1176/appi.focus.20180022.
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