Psychotherapy Theory, Research, Practice, Training - Vol 46, Iss 3

Mending the gap: Introduction to the invited commentaries on Dinger, Strack, Sachsse, and Schauenburg (2009).

2009

Introduces several commentaries on an article by U. Dinger et al (see record 200913603-002) entitled “Therapists’ attachment, patients’ interpersonal problems and alliance development over time in inpatient psychotherapy.” This article represents an ambitious effort on the part of the researchers to map a number of interrelated relational variables, over the course of treatment, in a relatively understudied patient population. “Attachment,” “interpersonal problems,” and “alliance” are variables that capture core components of the therapeutic relationship and psychotherapy process that have been reliably linked to patient improvement in many previous studies of mostly outpatient psychotherapy. Jeremy Holmes (see record 2009-13603-003) and George Silbershatz (see record 2009-13603-004) were invited to comment on this study while wearing their clinical hats. They were asked about how they made sense of the research results as practicing psychotherapists, the ways in which the findings were useful to them as clinicians, and where they considered the research to be of more limited value from a clinical point of view. Following the commentaries is a final word from the authors of the study (see record 2009-13603-005). It is hoped that this format of dialogue will have an impact on how clinical research is presented in the future. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Therapists’ attachment, patients’ interpersonal problems and alliance development over time in inpatient psychotherapy.

2009

The focus of this study is the investigation of the relation between patients’ interpersonal problems, therapists’ attachment representations, and the development of the therapeutic alliance over time. The authors investigated weekly alliance ratings of 281 psychotherapy inpatients, treated by 12 psychotherapists. Alliance quality was measured with the Inpatient Experience Scale. Multilevel regression models showed that patients’ interpersonal problems were associated with the level of alliance quality. Therapists’ attachment security was not related to alliance development, but higher attachment preoccupation of therapists was associated with lower levels of alliance quality. In addition, an interaction effect between therapists’ degree of attachment preoccupation and patients’ interpersonal problems explained variations of the alliance development curve over time. Limitations of the study are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Commentary on Dinger et al.: Therapist’s attachment, interpersonal problems and alliance development over time in inpatient psychotherapy.

2009

This short article is a commentary on a research study investigating therapist and client attachment styles and their relationship to alliance development in a 12-week psychodynamic psychotherapy program for nonpsychotic inpatients. The relationship is complex; unsurprisingly, securely attached therapists with less distressed clients formed the strongest alliances. A significant proportion of therapists were insecure, almost entirely in the preoccupied or hyperactivating mode. It is argued that collusive relationships between such therapists and similarly overaroused clients may be common. Therapists need both to accommodate to their client’s attachment style and to confound it if positive change is to result. Therapist self-scrutiny is likely to be a precondition for such positive outcomes. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

What have we learned about how the alliance develops over the course of therapy?

2009

This is a commentary on Dinger, Strack, Sachsse, and Schauenburg’s (2009) study of how therapist attachment styles and patient factors contribute to the development of the therapeutic alliance. I first address whether the research is useful for clinicians, arguing that it is not, and then discuss how the work could be presented to maximize both its scientific and its clinical impact. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Rejoinder: Therapists, patients, and alliance development.

2009

Responding to critical points raised by J. Holmes (2009) and G. Silberschatz (2009), the article “Therapists’ Attachment, Patients’ Interpersonal Problems, and Alliance Development Over Time in Inpatient Psychotherapy,” by U. Dinger, M. Strack, T. Sachsse, and H. Schauenburg (2009), is discussed. With regard to their particular study, the authors reflect upon the relevance of findings from the German-specific inpatient psychotherapy setting for treatment in other settings, as well as on the specific role of interpersonal problems in this sample. In addition, the authors discuss the clinical relevance of their findings, as well the clinical usefulness of the present state of research on alliance development. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

The developmental roots of narrative expression in therapy: Contributions from attachment theory and research.

2009

A central element in many forms of psychotherapy is the narrative articulation of client experience. From both theory, training, and practice, clinicians learn that structural aspects of client narratives may reveal important information about the client, but there is still limited research-based knowledge on this topic. This article explores and discusses the relevance of attachment theory and research to understanding structural and stylistic aspects of client narration in adult psychotherapy. Research into patterns of narrative expression identified by the Adult Attachment Interview (AAI) suggests that the emotional tone and structural organization of narratives are related to patterns of information processing and affect regulation originating in experiences in attachment relationships. Attachment research thus holds the potential of linking client in-session narration to findings in developmental psychology. Clinical implications of the AAI-related research are discussed in terms of the therapeutic significance of narrative coherence and the possible meaning of different kinds of narrative incoherence. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Perceived sources of change in trainees’ self-efficacy beliefs.

2009

Thought-listing procedures were used to examine the perceived incidence, size, direction, and bases of change in the session-level self-efficacy of therapists in training. Ninety-eight Master’s-level trainees completed a cognitive assessment task immediately after each session with a client in their first practicum. Participants typically reported modest-sized, positive changes in their therapeutic self-efficacy at each session. Seven perceived sources of change in self-efficacy were identified. Some of these sources (e.g., trainees’ performance evaluations, affective reactions) were consistent with general self-efficacy theory; others reflected the interpersonal performance context of therapy (e.g., perceptions of the therapeutic relationship and client behavior). Implications of the findings for training and future research on therapist development are considered. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Using clinically significant change to identify premature termination.

2009

Research examining treatment dropout is hindered by the inconsistencies in the methods used to operationalize the construct. In this article an operationalization based on the criteria of attaining clinically significant change prior to treatment discontinuation is reintroduced and compared with other existing dropout classification systems. A dropout rate of 77% was found in a university-based training clinic sample by using the clinically significant change (CSC) definition. This classification showed little agreement to classifications made by other popularly used definitions of dropout (median split, intake only, missed appointment, and therapist judgment). Further analysis indicated that the other popularly used definitions frequently classified clients as treatment dropouts when recovery had occurred or as treatment completers when recovery had not occurred. Uses and limitations of the CSC method and other popular definitions of treatment dropout are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Existentially informed HIV-related psychotherapy.

2009

This article describes an existentially informed approach to conducting psychotherapy with individuals living with the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). Uses of existential concepts to guide a holistic conceptualization of the individual and illuminate core existential concerns and dilemmas in confronting HIV-related challenges are delineated. Applications of existential ideas regarding psychotherapy process and technique in HIV-related psychotherapy also are illustrated. It is concluded that existential psychotherapy offers a conceptual framework that is especially well suited to the work of psychotherapy with individuals living with HIV disease, although the approach has received only limited attention in the HIV-related psychotherapy literature. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Clients’ experiences giving gifts to therapists.

2009

Nine therapy clients were interviewed regarding their experiences of giving gifts to therapists. Data were analyzed using consensual qualitative research. In describing a specific event when they gave a gift that was accepted, participants described having a good relationship with the therapist and usually identified their therapy concerns as relationship or family struggles or both. Most bought a relatively inexpensive gift they thought their therapist would like and gave it during a nontermination session to express appreciation or mark an important life event. Most participants acknowledged mixed emotions when giving the gift and noted that any discussion of the gift was brief and did not explore its deeper meaning. Nevertheless, most participants perceived that gift events positively affected them and their therapists. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Do personality problems improve during psychodynamic supportive–expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders.

2009

Studies involving patients with personality disorders (PDs) have not focused on improvement of core aspects of the PD. The authors examined changes in quality of object relations, interpersonal problems, psychological mindedness, and personality traits in a sample of 156 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PD diagnoses being randomized to either manualized or nonmanualized dynamic psychotherapy. Effect sizes adjusted for symptomatic change and reliable change indices were calculated. The authors found that both treatments were equally effective at reducing personality pathology. Only in neuroticism did the nonmanualized group do better during the follow-up period. The largest improvement was found in quality of object relations. For the remaining variables, only small and clinically insignificant magnitudes of change were found. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

When the shoe is on the other foot: A qualitative study of intern-level trainees’ perceived learning from clients.

2009

Twelve trainees (3 men and 9 women) who had recently completed predoctoral internships at a university counseling center were interviewed about what they had learned from clients. Data were analyzed using a consensual qualitative research method. Participants reported learning things about doing therapy, themselves, client dynamics, human nature, the therapy relationship, and the usefulness of supervision. In addition, participants highlighted the importance of consultation and self-reflection to help them recognize what they learned. Implications for practice and research are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Patient and therapist perspectives on session depth in relation to technique during psychodynamic psychotherapy.

2009

This study investigates the relationship between therapist techniques with patient and therapist ratings of session Depth (powerful, valuable, deep, full, and special). Eighty-three patients were admitted to a university-based community outpatient psychological clinic, and videotapes of an early treatment session were reliably rated by trained coders to identify techniques used by therapists. Overall amount of psychodynamic–interpersonal technique was found to have a significant positive correlation with patient-rated session Depth, and a trend toward significance was observed with therapist-rated session Depth. In addition, clinically relevant covariates (e.g., patient and clinician ratings of psychiatric severity, degree of Axis II pathology, and therapeutic alliance) of this session Depth and technique relationship were examined and found to have a nonsignificant impact. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Review of Margaret Mahler: A biography of the psychoanalyst.

2009

Reviews the book, Margaret Mahler: A biography of the psychoanalyst by Alma Halbert Bond (see record 2008-07778-000). This psychobiography tells an evocative tale of the late Margaret Mahler’s embattled, difficult, yet highly productive life. Mahler was a developmental researcher and a psychoanalyst. Her delineation of the separation–individuation process dramatically shifted psychoanalytic developmental theory, altering psychoanalytic understanding of pathogenesis and treatment. Her understanding of the mother–child matrix, as well as her approach to studying it, directly affected psychoanalytic child therapy as well, focusing clinical attention on the moment-by-moment vicissitudes of early development and also upon the possibility of altering its course through therapeutic intervention in the mother–child relationship. The book suffers from a number of problems: the narrative is sloppy, marred by numerous jarring, obvious, even surprising flaws. There is tremendous repetitiveness—sentences and whole passages are repeated verbatim within several pages. There are multiple errors, inconsistencies, and contradictions, including in the chapter notes and bibliography. Along with this shoddiness, there is reliance upon antiquated, sometimes simply inaccurate, conceptualizations and definitions of psychoanalytic and psychological ideas. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Review of The case formulation approach to cognitive-behavior therapy.

2009

Reviews the book, The case formulation approach to cognitive-behavior therapy by Jacqueline B. Persons (see record 2008-13011-000). This book places case formulation as its core organizing principle for cognitive–behavior therapy (CBT). Explicitly framing case formulation in a hypothesis-testing context, Persons helps bridge the gap between those advocating strict adherence to manual-driven, empirically supported therapies (ESTs) and those who find such constraints impractical and less than optimal. Her guiding principle is to use ESTs to the extent that one can but to adapt them idiographically as one must to address the array of problems presented by the specific individual being treated. Persons’ case formulation model is deceptively simple. It involves four basic components: (a) symptoms, disorders, and problems; (b) mechanisms; (c) precipitants; and (d) the origins of the mechanisms. Persons provides a fresh outlook on all these familiar components. In addition to providing step-by-step instruction for developing the formulation, Persons includes discussions of goal setting, which is organized in categories focused on mechanism change or learning compensatory strategies; treatment plan development; monitoring progress; decision making in the session; and handling nonadherence and treatment failure. A major strength of the book is the focus on the patient–therapist relationship. Persons repeatedly returns to the importance of establishing a positive working alliance and also discusses the opportunities that arise in efforts to re-establish a positive alliance following a rupture. The book is well organized, clearly written, contains up-to-date research references, and is replete with clinical examples. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Review of Transforming narcissism: Reflections on empathy, humor, and expectations. Vol. 28: Psychoanalytic inquiry book series.

2009

Reviews the book, Transforming narcissism: Reflections on empathy, humor, and expectations. Vol. 28: Psychoanalytic inquiry book series by Frank M. Lachmann (see record 2008-01083-000). This book is a welcome addition to the conversation on working with self-pathology. Lachmann brings a personal, conversational voice to the dialogue; there is much here to benefit students and seasoned clinicians alike. It is not a treatment manual for narcissism, but rather Lachmann’s own transformational dialogue with Heinz Kohut. Using Kohut’s (1966) article “Forms and Transformations of Narcissism” as a starting point, Lachmann elaborates Kohut’s contention that archaic narcissism is transformed through psychotherapy into empathy, humor, creativity, wisdom, and acceptance of our transience. He focuses on the first three elements as a means as much as a product of transformation in therapy, and the latter two elements are discussed as hopeful outcomes of the transformational process therapy engenders. Although there are limitations in terms of this book’s utility as a treatment guide for interventions with patients with narcissistic disorders, as a series of reflections on transformational processes it is often quite compelling. Lachmann the therapist advocates using empathy, humor, and creativity, not to try to impress or demonstrate his cleverness, but rather as bridge to transformational intimacy with his patients. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Comments (0) - Read and Add your own Comments