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Fiorini G, Bai Y, Fonagy P, Consortium TI, Midgley N. Short-term psychoanalytic psychotherapy with depressed adolescents: Comparing in-session interactions in good and poor outcome cases. Psychother Res 2023:1-14. [PMID: 37946369 DOI: 10.1080/10503307.2023.2270140] [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: 01/10/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. METHOD Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. RESULTS The EFA revealed three factors: (1) "Open, engaged young person working collaboratively with a therapist to make sense of their experiences", (2) "Directive therapist with a young person fluctuating in emotional state and unwilling to explore", (3) "Young person expressing anger and irritation and challenging the therapist". Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. CONCLUSION Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process.
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Affiliation(s)
- Guilherme Fiorini
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Yushi Bai
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
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2
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Levendosky AA, Turchan JE, Luo X, Good E. A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum. J Clin Psychol 2023; 79:2439-2451. [PMID: 37310149 DOI: 10.1002/jclp.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.
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Affiliation(s)
- Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Joshua E Turchan
- Counseling and Psychiatric Services, Michigan State University, East Lansing, Michigan, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, USA
| | - Evan Good
- Austen Riggs Center, Stockbridge, Massachusetts, USA
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Di Salvo G, Bianco M, Teobaldi E, Maina G, Rosso G. A Psychoanalytic-Derived Brief Psychotherapeutic Approach in the Treatment of Major Depression: Monotherapy Studies. Medicina (B Aires) 2022; 58:medicina58101335. [PMID: 36295496 PMCID: PMC9609679 DOI: 10.3390/medicina58101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Over the years, short term psychodynamic therapy (STPP) has been broadly researched in order to evaluate its efficacy in the treatment of major psychiatric disorders. In particular, a consistent number of studies focused on assessing clinical outcomes of the principal psychodynamic techniques in treating depressive disorders. We conducted a narrative review in which we aimed to evaluate the efficacy of STPP in monotherapy in major depressive disorder and to assess possible features that may correlate with its clinical use. Databases searched were PubMed, Ovid, Scopus, PsycINFO and Cochrane Libraries from inception to July 2022. Our research underlined that STPP in monotherapy is particularly effective in moderately severe depression and in preventing depressive relapses. Moreover, a case-by-case evaluation of its efficacy should be performed when considering STPP for the treatment of major depression with other comorbid psychiatric conditions. Although such key points emerged from scientific evidence, STPP should be better studied in the long-term perspective; further research is needed to define the clinical scenarios in which STPP can be considered a first-line approach as monotherapy in major depressive disorder compared to medications or other types of psychotherapy.
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Affiliation(s)
- Gabriele Di Salvo
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Matteo Bianco
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
| | - Elena Teobaldi
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Gianluca Rosso
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
- Correspondence: ; Tel.: +39-011-902-6504
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Çitak S, Avci SH, Kahraman BB. The effectiveness of short-term psychodynamic psychotherapy in depression and anxiety disorders. PSYCHODYNAMIC PRACTICE 2021. [DOI: 10.1080/14753634.2021.1951825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Serhat Çitak
- İstanbul Medeniyet University, Department of Psychiatry, Istanbul, Turkey
| | - Selma Hilal Avci
- İstanbul Medeniyet University, Department of Psychiatry, Istanbul, Turkey
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Bernaras E, Jaureguizar J, Garaigordobil M. Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Front Psychol 2019; 10:543. [PMID: 30949092 PMCID: PMC6435492 DOI: 10.3389/fpsyg.2019.00543] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 02/25/2019] [Indexed: 02/05/2023] Open
Abstract
Depression is the principal cause of illness and disability in the world. Studies charting the prevalence of depression among children and adolescents report high percentages of youngsters in both groups with depressive symptoms. This review analyzes the construct and explanatory theories of depression and offers a succinct overview of the main evaluation instruments used to measure this disorder in children and adolescents, as well as the prevention programs developed for the school environment and the different types of clinical treatment provided. The analysis reveals that in mental classifications, the child depression construct is no different from the adult one, and that multiple explanatory theories must be taken into account in order to arrive at a full understanding of depression. Consequently, both treatment and prevention should also be multifactorial in nature. Although universal programs may be more appropriate due to their broad scope of application, the results are inconclusive and fail to demonstrate any solid long-term efficacy. In conclusion, we can state that: (1) There are biological factors (such as tryptophan-a building block for serotonin-depletion, for example) which strongly influence the appearance of depressive disorders; (2) Currently, negative interpersonal relations and relations with one's environment, coupled with social-cultural changes, may explain the increase observed in the prevalence of depression; (3) Many instruments can be used to evaluate depression, but it is necessary to continue to adapt tests for diagnosing the condition at an early age; (4) Prevention programs should be developed for and implemented at an early age; and (5) The majority of treatments are becoming increasingly rigorous and effective. Given that initial manifestations of depression may occur from a very early age, further and more in-depth research is required into the biological, psychological and social factors that, in an interrelated manner, may explain the appearance, development, and treatment of depression.
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Affiliation(s)
- Elena Bernaras
- Developmental and Educational Department, University of the Basque Country, Donostia/San Sebastián, Spain
| | - Joana Jaureguizar
- Developmental and Educational Psychology Department, University of the Basque Country, Lejona, Spain
| | - Maite Garaigordobil
- Personality, Evaluation and Psychological Treatments Department, University of the Basque Country, Donostia/San Sebastián, Spain
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Leuzinger-Bohleber M, Hautzinger M, Fiedler G, Keller W, Bahrke U, Kallenbach L, Kaufhold J, Ernst M, Negele A, Schoett M, Küchenhoff H, Günther F, Rüger B, Beutel M. Outcome of Psychoanalytic and Cognitive-Behavioural Long-Term Therapy with Chronically Depressed Patients: A Controlled Trial with Preferential and Randomized Allocation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:47-58. [PMID: 30384775 PMCID: PMC6364135 DOI: 10.1177/0706743718780340] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE For chronic depression, the effectiveness of brief psychotherapy has been limited. This study is the first comparing the effectiveness of long-term cognitive-behavioural therapy (CBT) and long-term psychoanalytic therapy (PAT) of chronically depressed patients and the effects of preferential or randomized allocation. METHODS A total of 252 adults met the inclusion criteria (aged 21-60 years, major depression, dysthymia, double depression for at least 24 months, Quick Inventory of Depressive Symptoms [QIDS] >9, Beck Depression Inventory II [BDI] >17, informed consent, not meeting exclusion criteria). Main outcome measures were depression self-rating (BDI) and rating (clinician-rated QIDS [QIDS-C]) by independent, treatment-blinded clinicians. Full remission rates (BDI ≤12, QIDS-C ≤5) were calculated. An independent center for data management and biostatistics analyzed the treatment effects and differences using linear mixed models (multilevel models and hierarchical models). RESULTS The average BDI declined from 32.1 points by 12.1 points over the first year and 17.2 points over 3 years. BDI overall mean effect sizes increased from d = 1.17 after 1 year to d = 1.83 after 3 years. BDI remission rates increased from 34% after 1 year to 45% after 3 years. QIDS-C overall effect sizes increased from d = 1.56 to d = 2.08, and remission rates rose from 39% after 1 year to 61% after 3 years. We found no significant differences between PAT and CBT or between preferential and randomized allocation. CONCLUSIONS Psychoanalytic as well as cognitive-behavioural long-term treatments lead to significant and sustained improvements of depressive symptoms of chronically depressed patients exceeding effect sizes of other international outcome studies.
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Affiliation(s)
- Marianne Leuzinger-Bohleber
- 1 Sigmund-Freud-Institut, IDeA Center, Center for Adaptive and Individual Development and Adaptive Education for Children-at-Risk, Frankfurt, Germany, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Sigmund-Freud-Institut, Myliustr, Frankfurt, Germany.,2 University Medical Center, Mainz, Germany
| | - Martin Hautzinger
- 3 Department of Clinical Psychology, University of Tuebingen, Tübingen, Germany
| | - Georg Fiedler
- 4 Center for Suicidal Research, University Hospital Eppendorf, Hamburg, Germany
| | - Wolfram Keller
- 5 Medical Hospital in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Ulrich Bahrke
- 6 Department of Psychoanalysis, University of Kassel, Kassel, Germany.,7 Sigmund-Freud-Institut, Frankfurt a.M, Germany
| | - Lisa Kallenbach
- 6 Department of Psychoanalysis, University of Kassel, Kassel, Germany
| | - Johannes Kaufhold
- 6 Department of Psychoanalysis, University of Kassel, Kassel, Germany
| | | | | | | | - Helmut Küchenhoff
- 8 Statistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, München, Germany
| | - Felix Günther
- 8 Statistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, München, Germany
| | - Bernhard Rüger
- 8 Statistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, München, Germany
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Midgley N, Reynolds S, Kelvin R, Loades M, Calderon A, Martin P, O'Keeffe S. Therapists' techniques in the treatment of adolescent depression. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2018; 28:413-428. [PMID: 30518990 DOI: 10.1037/int0000119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
When comparing the relative effectiveness of different psychological treatment approaches using clinical trials, it is essential to establish fidelity to each manualized therapy, and differentiation between the treatment arms. Yet few psychological therapy trials include details about the assessment of treatment integrity and little is known about the specific techniques used by therapists, or to what degree these techniques are shared or distinct across different therapeutic approaches. The aims of this study were: to establish the fidelity of two established psychological therapies - cognitive-behaviour therapy (CBT) and short-term psychoanalytic psychotherapy (STPP) - in the treatment of adolescent depression; and to examine whether they were delivered with adherence to their respective treatment modalities, and if they could be differentiated from each other and from a reference treatment (a brief psychosocial intervention; BPI). The study also aimed to identify shared and distinct techniques used within and across the three treatments. Audio-tapes (N=230) of therapy sessions, collected as part of a trial, were blind double-rated using the Comparative Psychotherapy Process Scale (CPPS), which includes subscales for cognitive-behavioural and psychodynamic-interpersonal techniques. The treatments were delivered with reasonable fidelity and there was clear differentiation in the use of cognitive-behavioural and psychodynamic-interpersonal techniques between CBT and STPP, and between these two established psychological therapies and BPI. An item-level analysis identified techniques used across all three treatments, techniques that were shared between BPI and CBT, and techniques that were unique to CBT and STPP.
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Affiliation(s)
- Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Raphael Kelvin
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Maria Loades
- Department of Psychology, University of Bath, Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Ana Calderon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Martin
- Department of Applied Health Research, University College London, London, UK
| | - Sally O'Keeffe
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
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Weitkamp K, Daniels JK, Baumeister-Duru A, Wulf A, Romer G, Wiegand-Grefe S. Effectiveness Trial of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Symptoms in a Naturalistic Treatment Setting. BRITISH JOURNAL OF PSYCHOTHERAPY 2018. [DOI: 10.1111/bjp.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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9
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Zilcha-Mano S. Major developments in methods addressing for whom psychotherapy may work and why. Psychother Res 2018; 29:693-708. [DOI: 10.1080/10503307.2018.1429691] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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10
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Katz M, Hilsenroth MJ. Psychodynamic technique early in treatment related to outcome for depressed patients. Clin Psychol Psychother 2017; 25:348-358. [PMID: 29277973 DOI: 10.1002/cpp.2167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 01/18/2023]
Abstract
We examined the relationship between psychodynamic techniques early in treatment with reliable change in depressive symptomatology. Forty-six patients admitted for individual psychodynamic psychotherapy who received a diagnosis representative of a depressive spectrum disorder were assessed pretreatment and posttreatment through self-report of depressive symptoms. Videotapes from two early treatment sessions (3rd and 9th) were independently rated on the Comparative Psychotherapy Process Scale for use of psychodynamic-interpersonal and cognitive-behavioural techniques, with excellent interrater reliability (intraclass correlation coefficient > .75). We found a significant relationship between overall use of psychodynamic technique across early treatment (r = .31, p = .036), as well as specific psychodynamic techniques delivered across early treatment, with change in patient-reported depressive symptoms. Our findings suggest that focusing on affective experiencing and expression, as well as providing interpretations are particularly helpful early in psychodynamic treatment for depression. Clinical implications and future directions are discussed.
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Affiliation(s)
- Michael Katz
- Derner School of Psychology, Adelphi University, Garden City, NY, USA
| | - Mark J Hilsenroth
- Derner School of Psychology, Adelphi University, Garden City, NY, USA
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Bressi C, Fronza S, Minacapelli E, Nocito EP, Dipasquale E, Magri L, Lionetti F, Barone L. Short-Term Psychodynamic Psychotherapy with Mentalization-Based Techniques in Major Depressive Disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables - A Pilot study. Psychol Psychother 2017; 90:299-313. [PMID: 27801544 DOI: 10.1111/papt.12110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 08/16/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In depressed patients, recent advances have highlighted impairment in mentalizing: identifying and interpreting one's own or other's mental states. Short-Term Psychodynamic Psychotherapy (STPP) has proven to be effective in reducing symptoms and improving relational/functional abilities in these subjects. Therefore, the first aim of our study was to evaluate effectiveness of STPP with Mentalization-Based Techniques (STMBP) on their clinical outcomes and the second, to investigate Reflective Functioning and alexithymia concerning treatment outcomes in depressed subjects. DESIGN A baseline evaluation of reflective functioning, alexithymia and depression was conducted before an STMBP treatment. Patients were re-tested successively after 40 weeks (T1) and in a follow-up after 1 year at the end of the treatment (T2). METHODS A total of 24 patients principally diagnosed with Major Depressive Disorder (MDD) underwent a STMBP conducted by two expert therapists. Global Assessment Functioning (GAF), Toronto Alexithymia Scale-20 (TAS-20) and Hamilton Depression Rating Scale (HAM-D) data were collected at the baseline (T0) by two clinical therapists, along with RF scores rated by two trained raters. HAM-D, TAS-20 and GAF follow-ups were conducted at the end of the treatment after 40 weeks (T1) and after 1-year follow-up (T2). RESULTS Results highlighted an improvement of both HAM-D and TAS-20 scores in our sample. Moreover, a negative correlation between RF and TAS-20 was found. Both HAM-D and RF at T0 influenced depressive outcomes at the end of the treatment. CONCLUSIONS Results confirmed the effectiveness of STMBP in MDD, suggesting also an inverse association between RF and alexithymia. PRACTITIONER POINTS Our study demonstrates how STMBP could be effective in MDD even after 40 sessions, maintaining its effect in a 1-year follow-up. STMBP improves subjective capability of reflecting on the mental states of oneself and others. Our intervention allows patients to orientate thoughts from inside to outside, reducing negative beliefs also in absence of a pharmacological therapy (during the follow-up).
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Affiliation(s)
- Cinzia Bressi
- Unit of Psychiatry, Homogenous Area of Mental Health, Psychotherapy Service, Department of Pathophysiology and Transplantation (DePT), Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, State University of Milan, Italy
| | - Silvia Fronza
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Minacapelli
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Paola Nocito
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Dipasquale
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Magri
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Lionetti
- Psychology Section, Department of Brain and Behavioral Sciences, University of Pavia, Milan, Italy
| | - Lavinia Barone
- Psychology Section, Department of Brain and Behavioral Sciences, University of Pavia, Milan, Italy
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Oasi O, Buonarrivo L, Codazzi A, Passalacqua M, Ricci GMR, Straccamore F, Bezzi R. Assessing Personality Change with Blatt's Anaclitic and Introjective Configurations and Shedler-Westen Assessment Procedure Profiles: Two Case Studies in Psychodynamic Treatment. RESEARCH IN PSYCHOTHERAPY (MILANO) 2017; 20:231. [PMID: 32913731 PMCID: PMC7451303 DOI: 10.4081/ripppo.2017.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/10/2017] [Indexed: 12/02/2022]
Abstract
A growing body of empirical and clinical research attests to the influence of personality features on the development, course and outcome of psychotherapy. Over the last four decades, Blatt adopted a psychoanalytic and cognitive developmental approach in developing a theoretically and empirically grounded two-configurations model of personality. The main aim of this study was to evaluate possible changes in anaclitic and introjective configurations - as measured by the Depressive Experience Questionnaire (DEQ) (Blatt, D'Afflitti, & Quinlan, 1976) - set against simultaneous changes in personality profile measured by Shedler-Westen Assessment Procedure (SWAP-200). Two young patients, a man and a woman, characterized by different personality profiles - introjective and anaclitic, respectively - were assessed for one year in the context of a psychodynamic psychotherapy. A battery of instruments - Beck Depression Inventory II (BDI-II), Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders I and II, Defense Mechanism Rating Scale, DEQ and SWAP-200 - were administered at the beginning, during the assessment process, and after one year. Both patients displayed lower BDI-II scores, along with evident clinical progress. Defence profiles and Core Conflict Relationship Themes showed interesting developments, in keeping with the evolution of the psychotherapy process. Lastly, while DEQ profiles outlined substantial stability after one year, some important changes in SWAP-200 profiles - in particular with regard to Q factors - were observed. Although these findings should be considered as preliminary, these results appear to be consistent with the description of Self-criticism and Dependency as relatively stable personality dimensions. The potential influence of profile diversity - introjective vs anaclitic - on other key variables of the psychotherapy process is also discussed.
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Affiliation(s)
- Osmano Oasi
- Department of Psychology, Catholic University of the Sacred Heart, Milan
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13
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Datz F, Parth K, Rohm C, Madanoglu S, Seidman C, Löffler-Stastka H. Dimensions of Activity in Countertransference and Therapist Reactions: Therapist Reactions During Sessions with Depressed Patients. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2016; 62:322-335. [PMID: 27924694 DOI: 10.13109/zptm.2016.62.4.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This paper presents the interaction structure between the therapist's countertransference and the patient's affect based on identified dimensions of how therapists feel and react during sessions with depressed patients. METHODS 639 sessions were audio-recorded and rated by trained raters. These recordings were obtained from the Munich Psychotherapy Study and analyzed with the PQS, the AREQ, and the TRQ/CTQ. RESULTS Seven components with good to excellent internal consistency (Cronbach α = .745-.902) were found and labeled Hostile Feelings, Positive, Disengaged, Overwhelmed and Encroaching Feelings concerning countertransference and therapists' emotional reaction, while the therapist's behavior was scored on separate dimensions. The middle and final sessions reveal significant correlations between a patient's positive affect experience and positive countertransference. CONCLUSIONS The confirmed pattern implies not only that a positive affect is related to a positive countertransference reaction, but also that a positive countertransference entails a positive affect. The fact that this pattern could be accounted for only during the middle and the last sessions indicate that the working alliance is not fully established at the beginning of the treatment.
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Affiliation(s)
- Felicitas Datz
- Dept. for Psychoanalysis and Psychotherapy and University Program for Psychotherapy Research Medical University Vienna Waehringer Guertel 18-20 A-1090 Vienna Austria https://www.meduniwien.ac.at/hp/psychoanalyse/
| | - Karoline Parth
- Dept. for Psychoanalysis and Psychotherapy and University Program for Psychotherapy Research Medical University Vienna Waehringer Guertel 18-20 A-1090 Vienna Austria https://www.meduniwien.ac.at/hp/psychoanalyse/
| | - Christine Rohm
- Dept. for Psychoanalysis and Psychotherapy and University Program for Psychotherapy Research Medical University Vienna Waehringer Guertel 18-20 A-1090 Vienna Austria https://www.meduniwien.ac.at/hp/psychoanalyse/
| | - Simon Madanoglu
- Dept. for Psychoanalysis and Psychotherapy and University Program for Psychotherapy Research Medical University Vienna Waehringer Guertel 18-20 A-1090 Vienna Austria https://www.meduniwien.ac.at/hp/psychoanalyse/
| | - Charles Seidman
- Emory University 201 Dowman Drive Atlanta, Ga. 30322 USA http://www.emory.edu/home/index.html
| | - Henriette Löffler-Stastka
- Dept. for Psychoanalysis and Psychotherapy and University Program for Psychotherapy Research Medical University Vienna Waehringer Guertel 18-20 A-1090 Vienna Austria https://www.meduniwien.ac.at/hp/psychoanalyse/
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Mullin ASJ, Hilsenroth MJ, Gold J, Farber BA. Changes in Object Relations over the Course of Psychodynamic Psychotherapy. Clin Psychol Psychother 2016; 24:501-511. [DOI: 10.1002/cpp.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/08/2016] [Accepted: 04/21/2016] [Indexed: 11/10/2022]
Affiliation(s)
- A. S. J. Mullin
- The Derner Institute; Adelphi University; Garden City NY USA
| | | | - J. Gold
- The Derner Institute; Adelphi University; Garden City NY USA
| | - B. A. Farber
- Teachers College; Columbia University; New York NY USA
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Zimmermann J, Löffler-Stastka H, Huber D, Klug G, Alhabbo S, Bock A, Benecke C. Is It All about the Higher Dose? Why Psychoanalytic Therapy Is an Effective Treatment for Major Depression. Clin Psychol Psychother 2015; 22:469-87. [PMID: 25196642 DOI: 10.1002/cpp.1917] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 07/08/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023]
Abstract
UNLABELLED Empirical evidence for the effectiveness of long-term psychodynamic psychotherapy (LTPP) in patients with mood disorders is growing. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/psychoanalytic techniques or to a higher number of sessions. We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) and cognitive-behavioural therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy and 24 receiving CBT. Depressive symptoms, interpersonal problems and introject affiliation were assessed prior to treatment, after treatment and at the 1-, 2- and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT. Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques on changes in introject affiliation during follow-up. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression. KEY PRACTITIONER MESSAGE Psychoanalytic therapy is an effective treatment for major depression, especially in the long run. The differential effectiveness of psychoanalytic therapy cannot be fully explained by its higher dose. Distinctive features of psychoanalytic technique (e.g., focusing on patients' dreams, fantasies, sexual experiences or childhood memories) may play an important role in establishing sustained therapeutic change.
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Affiliation(s)
| | | | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum München-Harlaching, Munich, Germany
| | - Günther Klug
- Department of Psychosomatic Medicine, Technical University Munich, Munich, Germany
| | - Sarah Alhabbo
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Astrid Bock
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Cord Benecke
- Department of Psychology, University of Kassel, Kassel, Germany
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Sanders A, Hilsenroth M, Fowler JC. Object representation quality, therapeutic alliance, and psychotherapy process. Bull Menninger Clin 2015; 78:197-227. [PMID: 25247741 DOI: 10.1521/bumc.2014.78.3.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This is the first study to demonstrate the existence of a relationship between patient pretreatment object relations functioning as measured by the Mutuality of Autonomy (MOA) Scale and patient-rated therapeutic alliance. Specifically, MOA scores were related to a patient-rated alliance Bond score (lower, more adaptive object-relations representations were associated with a stronger alliance). In addition, higher MOA scores indicating more malevolent object relations were related to a greater use of psychodynamic techniques. Specific psychodynamic techniques focused on the patient's relationships with the therapist as well as cyclical patterns in actions, feelings, and experiences. Implications for clinical practice and future research are discussed.
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Oasi O. Observing the determinants of the psychotherapeutic process in depressive disorders. A clinical case study within a psychodynamic approach. Front Psychol 2015; 6:477. [PMID: 25954231 PMCID: PMC4404715 DOI: 10.3389/fpsyg.2015.00477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 04/02/2015] [Indexed: 12/04/2022] Open
Abstract
This paper focuses on the relationship between depressive disorders, personality configurations, and mental functioning. A one-year treatment of a young man with the diagnosis of Depression is presented: the clinical and empirical points of view are described in depth through an assessment at the beginning and at one year after of an oriented psychodynamic psychotherapy. SCID I and II and HAMRS were administered to the patient in assessment phase. In the same phase he filled in BDI-II, and DEQ; the psychotherapist completed SWAP-200. These clinician instruments were used again after 1 year of the treatment. The PDM point of view is also presented. All sessions are audiotaped: 12 verbatim transcripts were coded with the Defense Mechanisms Rating Scale and CCRT. The results show a decrease in depressive symptoms, a change in some personality configurations, but a substantial invariance of the introjective profile, and a modification in mental functioning.
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Affiliation(s)
- Osmano Oasi
- Department of Psychology, Catholic University of Milan Milan, Italy
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Parth K, Loeffler-Stastka H. Psychoanalytic core competence. Front Psychol 2015; 6:356. [PMID: 25870580 PMCID: PMC4375909 DOI: 10.3389/fpsyg.2015.00356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/13/2015] [Indexed: 02/05/2023] Open
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McCarthy KS, Keefe JR, Barber JP. Goldilocks on the couch: Moderate levels of psychodynamic and process-experiential technique predict outcome in psychodynamic therapy. Psychother Res 2014; 26:307-17. [DOI: 10.1080/10503307.2014.973921] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
This is a single case study utilizing time-series analysis for a young adult man with major depressive disorder and dysthymic disorder (i.e., double depression [DD]) and intermittent explosive disorder (IED). Treatment consisted of long-term psychodynamic psychotherapy (LTPP) with an emphasis on facilitating emotional expression and fostering autonomy. During 13 months of therapy, the patient completed daily measures related to his presenting complaint, including overall distress and episodes of rage. These data were examined for clinically significant change across baseline and two phases of treatment using Simulation Modeling Analysis for time-series data. Results indicated improvement in overall distress and in rage episodes. In addition to daily measures, the patient completed a measure of general psychological functioning at monthly intervals throughout treatment, the results of which indicated no reliable change. Complicating factors and implications of treatment are discussed, including the efficacy of LTPP in the treatment of DD and IED.
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Capps KL, Fiori K, Mullin ASJ, Hilsenroth MJ. Patient Crying in Psychotherapy: Who Cries and Why? Clin Psychol Psychother 2013; 22:208-20. [PMID: 24339383 DOI: 10.1002/cpp.1879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/16/2013] [Accepted: 10/21/2013] [Indexed: 11/10/2022]
Abstract
AIM The aim of the present study is to further the understanding of who cries in therapy and the relation of technique with crying behaviour in therapy. METHOD Psychological assessment feedback sessions, prior to the initiation of formal therapy for 52 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics and the process of the session were collected at the time of the session. Therapist's interventions were recorded verbatim and independently rated. RESULTS The number of times a patient cried during their session correlated negatively with global assessment of functioning scores and positively with measures of borderline personality disorder pathology as well as a measure of severity of childhood sexual abuse. Patients' crying behaviour demonstrated significant negative correlations with the overall experience of the session (bad/good), smoothness and positivity. Group differences between criers and non-criers reflected these trends as well. No significant correlations or group differences were found with regard to patient-rated or therapist-rated alliance as it relates to crying behaviour. Analysis indicates that therapist intervention prior to patient crying most often encouraged the exploration and expression of difficult affect, new perspectives on key issues or the patient's fantasies and wishes. DISCUSSION Our study addresses a significant gap in the clinical literature on crying. Crying behaviour seems to be related to certain clinical variables and has a negative impact on patient experience of the session in which they cry, although the alliance remained unaffected. LIMITATIONS Small sample, outpatients with mild/moderate psychopathology and graduate trainees provided therapy. KEY PRACTITIONER MESSAGE Patients with greater problems in emotional dysregulation, borderline personality disorder symptoms and greater severity of childhood sexual abuse are more likely to display greater affective intensity during the beginning of treatment. Results suggest that the alliance may remain strong despite patients experiencing a session in which they cried as difficult. Therapeutic interventions that focus on affect, new understanding of old patterns and patient fantasies with outpatient clinical populations appeared to be associated with crying in session.
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Affiliation(s)
- Kristen L Capps
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA
| | - Katherine Fiori
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA
| | - Anthony S J Mullin
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA
| | - Mark J Hilsenroth
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA
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Gibbons MBC, Thompson SM, Scott K, Schauble LA, Mooney T, Thompson D, Green P, MacArthur MJ, Crits-Christoph P. Supportive-expressive dynamic psychotherapy in the community mental health system: a pilot effectiveness trial for the treatment of depression. ACTA ACUST UNITED AC 2013; 49:303-16. [PMID: 22962971 DOI: 10.1037/a0027694] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of the current article is to present the results of a randomized pilot investigation of a brief dynamic psychotherapy compared with treatment-as-usual (TAU) in the treatment of moderate-to-severe depression in the community mental health system. Forty patients seeking services for moderate-to-severe depression in the community mental health system were randomized to 12 weeks of psychotherapy, with either a community therapist trained in brief dynamic psychotherapy or a TAU therapist. Results indicated that blind judges could discriminate the dynamic sessions from the TAU sessions on adherence to dynamic interventions. The results indicate moderate-to-large effect sizes in favor of the dynamic psychotherapy over the TAU therapy in the treatment of depression. The Behavior and Symptom Identification Scale-24 showed that 50% of patients treated with dynamic therapy moved into a normative range compared with only 29% of patients treated with TAU.
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Short-term psychodynamic psychotherapy in patients with "male depression" syndrome, hopelessness, and suicide risk: a pilot study. DEPRESSION RESEARCH AND TREATMENT 2013; 2013:408983. [PMID: 23401757 PMCID: PMC3557639 DOI: 10.1155/2013/408983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 12/23/2012] [Accepted: 12/23/2012] [Indexed: 11/17/2022]
Abstract
Objectives and Methods. This was an observational study of the efficacy of short-term psychodynamic psychotherapy (STPP) in a sample of 35 (30 women and 5 men) patients with moderate-to-severe "male depression" (Gotland Scale for Male Depression (GSMD) ≥ 13) comorbid with unipolar mood disorder (dysthymia and major depression) or anxiety disorder. Outcome measures were GSMD and BHS (Beck Hopelessness Scale) score changes from baseline. Results. Patients had a strong response to STPP on the GSMD (estimated mean score change (± SE) = -9.08 ± 2.74; P < 0.01; partial eta squared = 0.50), but not on the BHS (estimated mean score change (± SE) = -0.92 ± 1.55; P = 0.57; partial eta squared = 0.03). BHS score changes were significantly associated with GSMD score changes (Pearson's r = 0.56; P < 0.001), even when controlling for the severity of hopelessness at the baseline (partial r = 0.62; P < 0.001). Conclusions. STPP proved to be effective in patients suffering from "male depression" although hopelessness was only marginally reduced by this treatment which points to the need to better understand how STPP can be involved in the reduction of suicide risk.
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25
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Mullin ASJ, Hilsenroth MJ. Relationship Between Patient Pre-treatment Object Relations Functioning and Psychodynamic Techniques Early in Treatment. Clin Psychol Psychother 2012; 21:123-31. [DOI: 10.1002/cpp.1826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Anthony S. J. Mullin
- Derner Institute of Advanced Psychological Studies; Adelphi University; Garden City NY USA
| | - Mark J. Hilsenroth
- Derner Institute of Advanced Psychological Studies; Adelphi University; Garden City NY USA
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26
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Fowler JC, Hilsenroth MJ, Groat M, Biel S, Biedermann C, Ackerman S. Risk factors for medically serious suicide attempts: evidence for a psychodynamic formulation of suicidal crisis. J Am Psychoanal Assoc 2012; 60:555-76. [PMID: 22517915 DOI: 10.1177/0003065112442240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored a psychodynamic model for suicide risk by examining risk factors for medically serious suicide attempts, including assessments of affect flooding, negative self-schema / fragmentation, and impaired reality testing, closely approximating Maltsberger's psycho-dynamic formulation of suicide crisis. Baseline risk factors including age, gender, psychiatric symptoms, high-risk behaviors, and the Implicit Risk for Suicide Index (IRSI) were used to detect medically serious suicide attempts monitored for up to a year after the assessment. Twenty-five psychiatric inpatients who made life-threatening suicide attempts after assessment were compared to 25 inpatients and 25 psychotherapy outpatients who made no suicide attempts during follow-up. Statistical analysis revealed that a history of at least one suicide attempt and elevated IRSI scores accounted for 60 percent of the variance in detecting medically serious suicide attempts. Elevated IRSI accurately identified suicide attempt status above and beyond past suicide attempts and other empirically validated risk factors. Results are discussed in light of psychodynamic formulations of suicide risk.
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Affiliation(s)
- J Christopher Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 2800 Gessner Road, Houston, TX 77080, USA.
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27
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28
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Patient motivation for participating in clinical trials for depression: validation of the motivation for clinical trials inventory-depression. Int Clin Psychopharmacol 2010; 25:7-16. [PMID: 19901843 DOI: 10.1097/yic.0b013e328332055c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The motivation for clinical trials inventory-depression (MCTI-D) was developed and evaluated for assessing motivations to participate in clinical trials on depression. Sixty-four participants completed the MCTI-D: 40 individuals expressing interest in participating in a randomized clinical trial (RCT); and 24 clinic patients receiving traditional care for depression. Content validity was supported by feedback derived from a panel of experts in depression research and respondents completing the measure. The motivation most frequently endorsed for participating in an RCT was the desire to help others and/or to further science. The potential stigma associated with seeing a psychiatrist was reported to have the least influence. Patients expressed a greater likelihood to participate in RCTs that involved psychotherapy than in experimental medication or placebo-controlled trials. Data from the MCTI-D may provide useful information for depression researchers to consider as possible influences on patients' decisions about whether or not they will participate.
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29
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Bucci W, Maskit B. Beneath the surface of the therapeutic interaction: the psychoanalytic method in modern dress. J Am Psychoanal Assoc 2007; 55:1355-97. [PMID: 18246765 DOI: 10.1177/000306510705500412] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study represents a new generation of psychotherapy process research, using multiple perspectives on the data of the analytic situation, including impressions of the treating analyst, ratings of complete sessions by clinical judges, and objective linguistic measures. Computerized measures of language style developed in the framework of multiple code theory were applied to verbatim session recordings from a psychoanalytic case; the measures are illustrated in microanalyses of the process in two sessions. The results show agreement between the linguistic measures and clinical ratings based on a psychoanalytic perspective. The linguistic measures look beneath the surface of the therapeutic interaction by relying largely on lexical items of which clinicians are not likely to be explicitly aware, and enable a new perspective on the therapeutic discourse as seen in the graphic images of the microprocess. While the results of this study were limited to a single case, the automatized measures can be readily applied to large samples and in repeated single case designs. Two goals of process research, using measures such as those developed in this study, are discussed: to develop measures of mediating variables that can be used to identify specific treatment effects in comparative outcome studies; and, beyond this pragmatic aim, to assess development of capacities for self-exploration and self-regulation as psychoanalytic treatment goals.
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Affiliation(s)
- Wilma Bucci
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
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30
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Abbass AA, Hancock JT, Henderson J, Kisely S. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev 2006:CD004687. [PMID: 17054212 DOI: 10.1002/14651858.cd004687.pub3] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Over the past 40 years, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Four published meta-analyses of STPP, using different methods and samples, have found conflicting results. OBJECTIVES This review evaluated the efficacy of STPP relative to minimal treatment and non-treatment controls for adults with common mental disorders. SEARCH STRATEGY We searched CCDANCTR-Studies and CCDANCTR-References on 25/4/2005, CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, DARE and Biological Abstracts were also searched. We contacted triallists and checked references from papers retrieved. SELECTION CRITERIA All randomised controlled trials (RCT) of adults with common mental disorders, in which a brief psychodynamic therapy lasting less than 40 hours in total, and provided in individual format, were included. DATA COLLECTION AND ANALYSIS Three reviewers working in pairs evaluated studies. Studies were selected only if pairs of reviewers agreed they met inclusion criteria. A third reviewer was consulted if two reviewers could not reach consensus. Data were collected and entered into Review Manager. Study quality was assessed and scored by pairs of raters. Publication bias was assessed using a funnel plot. Sensitivity analyses were also conducted. MAIN RESULTS 23 studies of 1431 randomised patients with common mental disorders were included. These studies evaluated STPP for general, somatic, anxiety, and depressive symptom reduction, as well as social adjustment. Outcomes for most categories of disorder suggested significantly greater improvement in the treatment versus the control groups, which were generally maintained in medium and long term follow-up. However, only a small number of studies contributed data for each category of disorder, there was significant heterogeneity between studies, and results were not always maintained in sensitivity analyses. AUTHORS' CONCLUSIONS STPP shows promise, with modest to moderate, often sustained gains for a variety of patients. However, given the limited data and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.
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Affiliation(s)
- A A Abbass
- Dalhousie University, Psychiatry, Suite 9215, 5909 Veterans Memorial Lane, Halifax, NS, Canada.
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31
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Siefert CJ, Hilsenroth MJ, Weinberger J, Blagys MD, Ackerman SJ. The relationship of patient defensive functioning and alliance with therapist technique during short-term psychodynamic psychotherapy. Clin Psychol Psychother 2006. [DOI: 10.1002/cpp.469] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Resnick B, Bellg AJ, Borrelli B, Defrancesco C, Breger R, Hecht J, Sharp DL, Levesque C, Orwig D, Ernst D, Ogedegbe G, Czajkowski S. Examples of implementation and evaluation of treatment fidelity in the BCC studies: where we are and where we need to go. Ann Behav Med 2005; 29 Suppl:46-54. [PMID: 15921489 DOI: 10.1207/s15324796abm2902s_8] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Treatment fidelity plays an important role in the research team's ability to ensure that a treatment has been implemented as intended and that the treatment has been accurately tested. Developing, implementing, and evaluating a treatment fidelity plan can be challenging. The treatment fidelity workgroup within the Behavior Change Consortium (BCC) developed guidelines to comprehensively evaluate treatment fidelity in behavior change research. The guidelines include evaluation of treatment fidelity with regard to study design, training of interventionists, delivery and receipt of the intervention, and enactment of the intervention in real-life settings. This article describes these guidelines and provides examples from four BCC studies as to how these recommended guidelines for fidelity were considered. Future work needs to focus not only on implementing treatment fidelity plans but also on quantifying the evaluations performed, developing specific criteria for interpretation of the findings, and establishing best practices of treatment fidelity.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD 21201, USA.
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Thompson-Brenner H, Westen D. A naturalistic study of psychotherapy for bulimia nervosa, part 2: therapeutic interventions in the community. J Nerv Ment Dis 2005; 193:585-95. [PMID: 16131941 DOI: 10.1097/01.nmd.0000178883.82580.18] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data from naturalistic samples provide an important complement to findings from randomized trials of psychotherapy. A random national sample of US clinicians provided data on 145 completed treatments of patients with bulimic symptoms. We attempted to characterize the nature of treatments in the community and to examine the relation between treatment variables and outcome. Clinicians of all theoretical orientations report using interventions with polysymptomatic cases designed to address clinically significant personality characteristics and interpersonal patterns. Whereas cognitive-behavioral therapy is associated with more rapid remission of eating symptoms, psychodynamic interventions and increased treatment length predict better global outcome across treatment modalities, suggesting the importance of integrative treatments for the broad range of pathology seen in patients with bulimic symptoms.
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Affiliation(s)
- Heather Thompson-Brenner
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, Boston, Massachusetts 02215, USA
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Thompson-Brenner H, Westen D. A naturalistic study of psychotherapy for bulimia nervosa, part 1: comorbidity and therapeutic outcome. J Nerv Ment Dis 2005; 193:573-84. [PMID: 16131940 DOI: 10.1097/01.nmd.0000178843.81100.eb] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Data from naturalistic samples provide an important complement to findings from randomized trials of psychotherapy. A random national sample of US clinicians provided data on 145 completed treatments of patients with bulimic symptoms. Treatment in the community was substantially longer than treatment prescribed in manuals, with a mean length of cognitive-behavioral therapy of 69 sessions and significantly longer for eclectic and psychodynamic therapies. Most patients treated in the community had substantial comorbidity, and this comorbidity was associated with longer treatments and poorer outcome. Using four common exclusion criteria from randomized controlled trials for bulimia nervosa, approximately 40% of the naturalistic sample would have been excluded from randomized controlled trials. These patients showed higher pretreatment severity and required longer treatments to achieve positive outcomes relative to patients who did not meet these exclusion criteria.
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Affiliation(s)
- Heather Thompson-Brenner
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, Boston, Massachusetts 02215, USA
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35
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Cogan R, Porcerelli JH. Clinician reports of personality pathology of patients beginning and patients ending psychoanalysis. Psychol Psychother 2005; 78:235-48. [PMID: 16004701 DOI: 10.1348/147608305x28727] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this work was to use a clinician Q-sort procedure to describe the personality pathology and adaptive functioning of patients beginning and ending psychoanalysis. DESIGN With a cross-sectional design, we compared a group of patients beginning and a group of patients ending psychoanalysis. METHODS Twenty-six psychoanalysts described a patient beginning psychoanalysis and 26 described a patient ending psychoanalysis using the Shedler-Westen Assessment Procedure 200 (SWAP-200). Each clinician also completed questions about themselves, the patient, and the treatment. The most characteristic SWAP-200 items describing patients beginning and patients ending psychoanalysis provide a meaningful picture of the two groups. RESULTS Among patients at the end of psychoanalysis, scores were significantly lower on the SWAP-200 Paranoid, Schizotypal, Borderline, Histrionic, and Dependent scales and scores were significantly higher on the SWAP-200 High functioning scale and the DSM-IV GAF scale. Common characteristics of patients beginning psychoanalysis were anxiety, guilt, and shame. Common characteristics of patients ending psychoanalysis were conscientiousness and responsibility, striving to live up to moral and ethical standards, and enjoyment of challenges. CONCLUSIONS The findings demonstrate the usefulness of a clinician report measure for the study of psychoanalytic psychotherapy and psychoanalysis.
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Affiliation(s)
- Rosemary Cogan
- Department of Psychology, Texas Tech University, Lubbock, 79409, USA.
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Thompson-Brenner H, Westen D. Personality subtypes in eating disorders: validation of a classification in a naturalistic sample. Br J Psychiatry 2005; 186:516-24. [PMID: 15928363 DOI: 10.1192/bjp.186.6.516] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research has identified three personality subtypes in patients with eating disorders: emotionally dysregulated, constricted and high-functioning/perfectionistic. AIMS To see whether the subtypes are distinguished in ways indicative of valid classification, notably in patterns of adaptive functioning, comorbidity, treatment response and therapeutic interventions. METHOD A random sample of experienced clinicians provided data on 145 patients with bulimic symptoms, including data on eating disorder symptoms, DSM-IV comorbidity, personality pathology, treatment response and treatment interventions. RESULTS Patients categorised as dysregulated had the poorest functioning, most comorbidity and worst outcome, followed by patients in the constricted and high-functioning groups. The three subtypes elicited different therapeutic interventions and accounted for substantial incremental variance in outcome, holding constant the severity of eating disorder symptoms and presence of other Axis I disorders. CONCLUSIONS The data provide accumulating evidence for the validity of three personality subtypes in patients with eating disorders.
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Affiliation(s)
- Heather Thompson-Brenner
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, USA.
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