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Aafjes-van Doorn K, Spina DS, Müller-Frommeyer L, Gorman BS, Stukenberg K, Waldron S. Implicit relational aspects of the therapeutic relationship in psychoanalytic treatments: an examination of linguistic style entrainment over time. Psychother Res 2024:1-14. [PMID: 38657280 DOI: 10.1080/10503307.2024.2341780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE In an attempt to operationalize an implicit aspect of the therapeutic relationship, this study assesses reciprocal linguistic style entrainment (rLSM) between the patient and therapist. rLSM is defined as the dynamic adjustment of function word usage to synchronize or to be in rhythm with another person as they change over time. METHOD In this exploratory study, levels of rLSM per talk turn were analyzed for 540 sessions of 27 long-term psychoanalytic treatments in relation to treatment outcomes. RESULTS Within sessions, rLSM appeared to decrease by the end of sessions and followed a negative linear trajectory, βlinear = -0.0002, SE < .001, t = -13.04, p < .001. Between sessions, rLSM showed significant variability such that neither a linear, nor a quadratic, nor a cubic trend line fit the session-by-session change over treatment. On average, therapist talk turns had significantly lower rLSM than patient talk turns, while accounting for the nested nature of the data using multilevel models βSpeakerT = -0.033, SE = 0.009, t = -3.65, p < .001. Levels of rLSM did not relate to treatment outcome. CONCLUSION Most of the rLSM variance was at the within-patient and within-session level. rLSM was no indicator of psychoanalytic treatment outcomes.
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Affiliation(s)
| | - Daniel S Spina
- Psychology Department, Pennsylvania State University, PA, USA
| | | | - Bernard S Gorman
- Department of Psychology, Hofstra University, New York, USA
- Psychoanalytic Research Consortium, New York, USA
- Derner Institute, Adelphi University, New York, USA
| | - Karl Stukenberg
- Psychoanalytic Research Consortium, New York, USA
- School of Psychology, Xavier University, Cincinnati, USA
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Staton A, Dawson D, Merdian H, Tickle A, Walker T. Functional neurological disorder: A qualitative study exploring individuals' experiences of psychological services. Psychol Psychother 2024; 97:138-156. [PMID: 37800641 DOI: 10.1111/papt.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Individuals with a diagnosis of FND report experiencing stigma in medical settings, however, there is a paucity of research exploring their experiences in psychological services. The aim of this research was to explore experiences of accessing UK psychological services, from the perspective of those with FND. METHODS This study utilised a qualitative approach with data collected from semi-structured interviews (n = 15) and analysed using reflexive thematic analysis. RESULTS One superordinate theme, 'the stigmatised self within the therapeutic relationship', and five interrelated subthemes were identified: 'internalised stigma and self-doubt', 'selective disclosure to professionals', 'perceptions of psychological explanations', 'having to educate the professionals' and 'attunement and trust within the therapeutic relationship'. Positive therapeutic relationships were perceived to mitigate the impact of these perceived barriers. The conceptualisation of FND and the perception of how this was responded to by services and professionals was a central tenet throughout the related themes. CONCLUSIONS Intra-personal, interpersonal and organisational stigma impact access and engagement to psychological treatment. The findings of this study highlight the need for increased training provision for practitioners with a focus on actively challenging FND stigma within services at both an individual and systemic level.
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Affiliation(s)
- Amelia Staton
- University of Nottingham, Nottingham, UK
- University of Lincoln, Lincoln, UK
| | | | | | | | - Tammy Walker
- Defence Medical Rehabilitation Centre, Loughborough, UK
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Hauenstein EJ, Schimmels J. Providing Gender Sensitive and Responsive Trauma-Informed Psychiatric Nursing Care. How Hard Can It Be? Issues Ment Health Nurs 2024; 45:202-216. [PMID: 38412453 DOI: 10.1080/01612840.2024.2310663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
This paper addresses the challenge of providing gender sensitive and responsive trauma-informed care (TIC) in psychiatric nursing practice. Gender identity, gender subordination, and gender-related trauma history are examined as three key individual-level factors that affect nurses' capacity to engage therapeutically to provide gender sensitive and responsive TIC. Using Peplau's Interpersonal Theory and building on a shared trauma and resilience model, gender-sensitive and responsive TIC is situated within interpersonal science and the ability of the psychiatric nurse to attune to her own and her patient's gender ideologies. Strategies for transforming practice including self-reflection, self-compassion, and peer and supervisor support are reviewed. Noting the import of the practice environment, several observations of changes needed at the level of the unit, organization, and society to effect gender equitable policies that enable the implementation of gender-sensitive and responsive TIC are made.
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Affiliation(s)
- Emily J Hauenstein
- School of Nursing, University of Virginia, Charlottesville, Virginia, USA
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Albano G, Salerno L, Cardi V, Brockmeyer T, Ambwani S, Treasure J, Lo Coco G. Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:135-146. [PMID: 35983983 PMCID: PMC10087304 DOI: 10.1002/erv.2948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/29/2022] [Accepted: 08/07/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. METHOD 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention. RESULTS Both early (1st session) and late (6th session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads. CONCLUSIONS These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome.
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Affiliation(s)
- Gaia Albano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Valentina Cardi
- Department of Psychological Medicine, King's College London, London, UK.,Department of General Psychology, University of Padova, Padova, Italy
| | - Timo Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Miner AS, Fleming SL, Haque A, Fries JA, Althoff T, Wilfley DE, Agras WS, Milstein A, Hancock J, Asch SM, Stirman SW, Arnow BA, Shah NH. A computational approach to measure the linguistic characteristics of psychotherapy timing, responsiveness, and consistency. NPJ MENTAL HEALTH RESEARCH 2022; 1:19. [PMID: 38609510 PMCID: PMC10956022 DOI: 10.1038/s44184-022-00020-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/18/2022] [Indexed: 04/14/2024]
Abstract
Although individual psychotherapy is generally effective for a range of mental health conditions, little is known about the moment-to-moment language use of effective therapists. Increased access to computational power, coupled with a rise in computer-mediated communication (telehealth), makes feasible the large-scale analyses of language use during psychotherapy. Transparent methodological approaches are lacking, however. Here we present novel methods to increase the efficiency of efforts to examine language use in psychotherapy. We evaluate three important aspects of therapist language use - timing, responsiveness, and consistency - across five clinically relevant language domains: pronouns, time orientation, emotional polarity, therapist tactics, and paralinguistic style. We find therapist language is dynamic within sessions, responds to patient language, and relates to patient symptom diagnosis but not symptom severity. Our results demonstrate that analyzing therapist language at scale is feasible and may help answer longstanding questions about specific behaviors of effective therapists.
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Affiliation(s)
- Adam S Miner
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA.
| | - Scott L Fleming
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Albert Haque
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Jason A Fries
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | - Tim Althoff
- Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Denise E Wilfley
- Departments of Psychiatry, Medicine, Pediatrics, and Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
| | - Jeff Hancock
- Department of Communication, Stanford University, Stanford, CA, USA
| | - Steven M Asch
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Shannon Wiltsey Stirman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- National Center for Posttraumatic Stress Disorders, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
- Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
- Technology and Digital Solutions, Stanford Healthcare, Stanford, CA, USA
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Altmann U, Strauss B, Tschacher W. Cross-Correlation- and Entropy-Based Measures of Movement Synchrony: Non-Convergence of Measures Leads to Different Associations with Depressive Symptoms. ENTROPY (BASEL, SWITZERLAND) 2022; 24:e24091307. [PMID: 36141194 PMCID: PMC9497848 DOI: 10.3390/e24091307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several algorithms have been proposed to quantify synchronization. However, little is known about their convergent and predictive validity. METHODS The sample included 30 persons who completed a manualized interview focusing on psychosomatic symptoms. The intensity of body motions was measured using motion-energy analysis. We computed several measures of movement synchrony based on the time series of the interviewer and participant: mutual information, windowed cross-recurrence analysis, cross-correlation, rMEA, SUSY, SUCO, WCLC-PP and WCLR-PP. Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ9). RESULTS According to the explorative factor analyses, all the variants of cross-correlation and all the measures of SUSY, SUCO and rMEA-WCC led to similar synchrony measures and could be assigned to the same factor. All the mutual-information measures, rMEA-WCLC, WCLC-PP-F, WCLC-PP-R2, WCLR-PP-F, and WinCRQA-DET loaded on the second factor. Depressive symptoms correlated negatively with WCLC-PP-F and WCLR-PP-F and positively with rMEA-WCC, SUCO-ES-CO, and MI-Z. CONCLUSION More standardization efforts are needed because different synchrony measures have little convergent validity, which can lead to contradictory conclusions concerning associations between depressive symptoms and movement synchrony using the same dataset.
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Affiliation(s)
- Uwe Altmann
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, Jena University Hospital, D-07743 Jena, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, Jena University Hospital, D-07743 Jena, Germany
| | - Wolfgang Tschacher
- Department of Experimental Psychology, University Hospital of Psychiatry and Psychotherapy, CH-3060 Bern, Switzerland
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Qiu H, Tay D. A Mixed-Method Comparison of Therapist and Client Language across Four Therapeutic Approaches. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2022. [DOI: 10.1080/10720537.2021.2021570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Han Qiu
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Dennis Tay
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Scheidt CE, Pfänder S, Ballati A, Schmidt S, Lahmann C. Language and Movement Synchronization in Dyadic Psychotherapeutic Interaction - A Qualitative Review and a Proposal for a Classification. Front Psychol 2021; 12:696448. [PMID: 34744862 PMCID: PMC8569105 DOI: 10.3389/fpsyg.2021.696448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
In individual psychotherapy verbal communication and movement synchronization are closely interrelated. The microanalysis of timing, rhythm and gestalt of movement has established dynamic movement coordination as a systemic property of the dyadic interaction. Movement synchronization supports and enhances the unfolding of linguistic meaning. In order to substantiate the importance of the concept of synchrony for adult psychotherapy we review evidence from developmental psychology and discuss approaches to measure synchrony with particular reference to the naturalistic setting of dyadic psychotherapy. As the concept of synchrony is still ambiguous, and the respective interactional phenomena are ephemeral and fluid, in the current paper we suggest a set of five criteria for the description of synchronization in general terms and eight additional criteria which specifically enable the description of phenomena of movement synchronization. The five general dimensions are: (1) context, (2) modality, (3) resources, (4) entrainment, and (5) time-lag. The eight categories for the description of movement synchrony are: (1) spatial direction, (2) amplitude, (3) sinuosity, (4) duration, (5) event structure, (6) phase, (7) frequency, and (8) content. To understand the process of participatory sense-making and the emergence of meaning in psychotherapy, synchrony research has to cope with the multimodality of the embodied interaction. This requires an integrated perspective of movement and language. A system for the classification of synchrony phenomena may contribute to the linking of variations and patterns of movement with language and linguistic utterances.
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Affiliation(s)
- Carl Eduard Scheidt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany.,Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stefan Pfänder
- Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-University Freiburg, Freiburg, Germany.,Romanisches Seminar, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Arianna Ballati
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany.,Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-University Freiburg, Freiburg, Germany
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Aafjes‐van Doorn K, Müller‐Frommeyer L. Reciprocal language style matching in psychotherapy research. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Wiltshire TJ, Philipsen JS, Trasmundi SB, Jensen TW, Steffensen SV. Interpersonal Coordination Dynamics in Psychotherapy: A Systematic Review. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10106-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Background
The aim of this study was to gain a better understanding of interpersonal coordination (i.e., covariation over time) in different modalities (e.g., physiology, language) during psychotherapy and their importance for understanding the dynamics of psychotherapeutic interaction and efficacy.
Methods
We conducted a systematic review of all studies examining some form of interpersonal coordination in a psychotherapeutic context.
Results
We first summarize details of the included studies such as gender composition, therapy types, and methods used. The collation of these studies provided evidence that, during psychotherapeutic contexts, interpersonal coordination occurs in physiology, movements, interpersonal displays, and language/vocalizations. Further, it also showed that movement coordination was most frequently associated with psychotherapy outcomes, physiological coordination was most frequently associated with empathy, and coordination in a variety of modalities including language/vocalizations were most frequently associated with therapeutic alliance.
Conclusions
We discuss these results, shortcomings with the current literature, and highlight three crucial questions for future research. Research on interpersonal coordination in psychotherapy has potential to advance the both the research and practice of psychotherapy.
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Zalman H, Doorn KAV, Eubanks CF. Alliance challenges in the treatment of a narcissistic patient: the case of Alex. ACTA ACUST UNITED AC 2019; 22:351. [PMID: 32913794 PMCID: PMC7451310 DOI: 10.4081/ripppo.2019.351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/01/2019] [Indexed: 11/23/2022]
Abstract
People with pathological narcisism, with their conflicted sense of grandiosity and vulnerability, often pose a variety of therapeutic challenges, which may impede these patients’ ability to benefit from psychotherapy. To offer a case illustration and provide insight into the intrinsic difficulties of working with this patient group, we examined the treatment of a fictional character, Alex, from the TV series In Treatment. Based on the Shedler-Westen Assessment Procedure-200 we diagnosed Alex with pathological narcissism, and evaluated the treatment process (seven sessions) by reporting on measurements of session-by-session change in explicit working alliance, implicit language alliance, and ruptures and repairs. Over the course of treatment, the working alliance (Working Alliance Inventory-Observer scale) fluctuated with a particularly low bond at session five, identified as a rupture (Rupture Resolution Rating System). Language analysis (Linguistic Inquiry and Word Count) showed that the unconscious aspects of the alliance started to deteriorate just before the rupture occurred. The results illustrate how therapists might be pulled to collude with narcissistic patients’ grandiosity, with the risk of neglecting their vulnerability. This fictional portrayal of a treatment with a narcissistic patient may be widely shared with researchers, students and therapists alike, offering a common locus of scholarly attention, and an innovative tool for teaching. Given the lack of empirical treatments for pathological narcissism and the great therapeutic challenges narcissistic patients present, further research and development of clinical guidelines are warranted.
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Affiliation(s)
- Hemrie Zalman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
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