Process and technique factors associated with patient ratings of session safety during psychodynamic psychotherapy

How narrative source impacts convergence of ratings from the Social Cognition and Object Relations Scale-Global Rating Method with psychotherapy process measures

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

Deepening the Group Training Experience: Group Cohesion and Supervision Impact in Alliance-Focused Training

Objective

The aim of the current study is to explore experiences of trainees engaged in alliance-focused training (AFT), a group supervision modality with an explicit focus on awareness of ruptures and implementation of repair strategies. Using Cognitive Behavioral Therapy (CBT) group supervision as a point of comparison, the study examines supervisory alliance, ruptures, group cohesion and safety, and supervision impact.

Method

Eighty-three trainees (clinical psychology interns, advanced-level psychology externs and psychiatry residents) at a metropolitan medical center in New York City who received supervision in CBT (N = 38) or AFT (N = 45) reported on their group supervision experience. Participants had a mean age of 29.5 (SD = 4.9); 77% were women; 84% of participants identified as White, 7% as Multiethnic, 6% as Hispanic/Latinx, 1% as Black, and 1% as Asian. Participants reported on occurrence of ruptures with their supervisor, supervisory alliance (Working Alliance Inventory-Short), group safety, supervision depth and smoothness (Session Evaluation Questionnaire), and group cohesion (Group Climate Questionnaire). Mixed and general linear models, and correlation analyses were used for analysis.

Results

All trainees reported equally low incidence of ruptures with their supervisor alongside high ratings of supervisory alliance. Trainees in AFT reported experiencing less safety, smoothness, and greater intergroup conflict than trainees in CBT supervision; however, they also reported stronger group engagement and a deeper supervision experience.

Conclusions

Results suggest that AFT may provide a rich environment to foster a certain level of discomfort and risk-taking that may facilitate an engaging and meaningful learning experience.

An Italian validation of the Comparative Psychotherapy Process Scale: Reliability and validity

The Comparative Psychotherapy Process Scale (CPPS) is an instrument designed to measure therapist interventions in a psychotherapy session. The scale includes 20 items divided into two subscales: the PI (psychodynamic-interpersonal) scale, which describes psychodynamic-interpersonal techniques; and the CB (cognitive-behavioural) scale, which includes cognitive-behavioural interventions. The aim of the study was to examine the psychometric properties of the CPPS, comparing the PI and CB subscales with the psychodynamic, cognitive and STTP prototypes, as described by the Psychotherapy Process Q-set(PQS). The sample comprised 94 sessions (N = 94) of psychodynamic and cognitive-behavioural orientation. Two groups of independent raters with excellent interrater reliability (ICC = .78) evaluated the sessions. The results suggest that the CPPS is a valid and reliable instrument that provides a clinically sensitive and psychometrically robust evaluation of a therapist's techniques. The clinical and research implications of the results are discussed.

Student clinicians' and clients' perceptions of the therapeutic alliance and outcomes in stuttering treatment

PURPOSE

The purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.

METHODS

Student clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.

RESULTS

Results suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.

CONCLUSION

Clinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients' perspective regarding TA status.

TTPAL Promotes Colorectal Tumorigenesis by Stabilizing TRIP6 to Activate Wnt/β-Catenin Signaling

Copy number alterations are crucial for the development of colorectal cancer. Our whole-genome analysis identified tocopherol alpha transfer protein-like (TTPAL) as preferentially amplified in colorectal cancer. Here we demonstrate that frequent copy number gain of TTPAL leads to gene overexpression in colorectal cancer from a Chinese cohort (n = 102), which was further validated by a The Cancer Genome Atlas (TCGA) cohort (n = 376). High expression of TTPAL was significantly associated with shortened survival in patients with colorectal cancer. TTPAL promoted cell viability and clonogenicity, accelerated cell-cycle progression, inhibited cell apoptosis, increased cell migration/invasion ability in vitro, and promoted tumorigenicity and cancer metastasis in vivo. TTPAL significantly activated Wnt signaling and increased β-catenin activation and protein expression of cyclin D1 and c-Myc. Coimmunoprecipitation followed by mass spectrometry identified thyroid receptor-interacting protein 6 (TRIP6) as a direct downstream effector of TTPAL. Depletion of TRIP6 significantly abolished the effects of TTPAL on cell proliferation and Wnt activation. Direct binding of TTPAL with TRIP6 in the cytoplasm inhibited ubiquitin-mediated degradation of TRIP6 and, subsequently, increased levels of TRIP6 displaced β-catenin from the tumor suppressor MAGI1 via competitive binding. This sequence of events allows β-catenin to enter the nucleus and promotes oncogenic Wnt/β-catenin signaling. In conclusion, TTPAL is commonly overexpressed in colorectal cancer due to copy number gain, which promotes colorectal tumorigenesis by activating Wnt/β-catenin signaling via stabilization of TRIP6. TTPAL overexpression may serve as an independent new biomarker for the prognosis of patients with colorectal cancer. SIGNIFICANCE: TTPAL, a gene preferentially amplified in colorectal cancer, promotes colon tumorigenesis via activation of the Wnt/β-catenin pathway.