Driessen, E.; Van, H.L.; Peen, J.; Don, F.J.; Kool, S.; Westra, D.; Hendriksen, M.; Cuijpers, P.; Twisk, J.W.R.; Dekker, J.J.M.
Background The efficacy of psychodynamic therapy (PDT) for depression is debated due to a paucity of high-quality studies. We compared short psychodynamic supportive psychotherapy (SPSP) to cognitive behavioral therapy (CBT) in a randomized clinical trial. We used therapist-rated outcomes to examine
Banon, Elisabeth; Perry, John Christopher; Semeniuk, Trent; Bond, Michael; de Roten, Yves; Hersoug, Anne Grete; Despland, Jean-Nicolas
One requirement for psychotherapy research is an accurate assessment of therapeutic interventions across studies. This study compared frequency and depth of therapist interventions from a dynamic perspective across four studies, conducted in four countries, including three treatment arms of psychodynamic psychotherapy, and one each of psychoanalysis and CBT. All studies used the Psychodynamic Intervention Rating Scales (PIRS) to identify 10 interventions from transcribed whole sessions early and later in treatment. The PIRS adequately categorized all interventions, except in CBT (only 91-93% categorized). As hypothesized, interpretations were present in all dynamic therapies and relatively absent in CBT. Proportions of interpretations increased over time. Defense interpretations were more common than transference interpretations, which were most prevalent in psychoanalysis. Depth of interpretations also increased over time. These data can serve as norms for measuring where on the supportive-interpretive continuum a dynamic treatment lies, as well as identify potentially mutative interventions for further process and outcome study.
Ulberg, Randi; Amlo, Svein; Hersoug, Anne Grete; Dahl, Hanne-Sofie Johnsen; Høglend, Per
The primary aim of this article was to explore the effects of the therapist's disengaged feelings (i.e., bored, tired of, sleepy, indifferent, aloof) in psychodynamic therapy. The Transference Work Scale was used in combination with the Defense Mechanism Rating Scales and Structural Analyses of Social Behavior to explore the in-session process in 2 therapies with female patients with interpersonal problems. Analyses showed differences in in-session processes (i.e., defense mechanisms; transference work; degree of affiliation and interdependence in the dialogue) and treatment outcome between therapies characterized by a low versus a higher degree of disengaged feelings. Compared to the case with the engaged therapist, the disengaged therapist showed poorer interaction and less response to transference and defense interpretation. When aware of their disengaged feelings, therapists are advised to encourage their patients to discuss the patient-therapist interaction. © 2014 Wiley Periodicals, Inc.
Wiser, S; Goldfried, M R
Eighteen sessions of cognitive-behavioral (CB) and 13 sessions of psychodynamic-interpersonal therapy obtained from experienced clinicians in a naturalistic setting were investigated to determine the various therapeutic interventions associated with high and low emotional experiencing (EXP). Clients receiving reflections and acknowledgments, affiliative and noncontrolling interventions, or interventions highlighting nonspecific client content were associated with maintained high EXP. Lengthier interventions and interventions rated as affiliative but moderately controlling were associated with shifts to low EXP. For clients of CB therapists, questions, interventions rated affiliative but controlling, and highlighting minimal emotional content were also associated with shifts to low EXP. Male therapists were associated with clients who maintained high EXP and female therapists were associated with clients who shifted to low EXP.
Boterhoven De Haan, Katrina L; Lee, Christopher W
Debates continue over shared factors in therapy processes between different theoretical orientations. By seeking the opinions of practicing clinicians, this study aimed to elucidate the similarities and differences between cognitive-behavioural (CBT), psychodynamic (PDT), and schema therapy (ST) approaches. Forty-eight practitioners aligning with one of the three approaches were asked to identify crucial processes in their therapy using a modified online version of the Psychotherapy Process Q-set. Distinct differences between each theoretical orientation with few shared common factors were found. A comparison with ratings from previous studies indicated that CBT therapists have not changed over the last 20 years, whereas PDT therapists have changed and the differences appeared consistent with modern PDT theory. The differences between the therapy approaches were consistent with theories underlying each model. PDT therapists valued a neutral relationship, CBT therapists emphasized a didactic interaction, and therapists form a ST orientation placed a greater emphasis on emotional involvement.
Hill, Clara E; Knox, Sarah; Crook-Lyon, Rachel E; Hess, Shirley A; Miles, Joe; Spangler, Patricia T; Pudasaini, Sakar
Our objectives were to describe the frequency of therapists' dreams about their clients and clients' dreams about their therapists, to determine how therapists and clients who had such dreams differed from those who did not have such dreams, whether therapy process and outcome differed for those who had and did not have such dreams, and to describe the content and consequences of these dreams. Thirteen doctoral student therapists conducted psychodynamic psychotherapy with 63 clients in a community clinic. Therapists who had dreams about clients had higher estimated and actual dream recall than did therapists who did not dream about clients. Qualitative analyses indicated that therapists' dreams yielded insights about the therapist, clients, and therapy; therapists used insights in their work with the clients. Among the clients, only two (who were particularly high in attachment anxiety and who feared abandonment from their therapists) reported dreams that were manifestly about their therapists. Therapists-in-training dreamed more about their clients than their clients dreamed about them. Dreams about clients can be used by therapists to understand themselves, clients, and the dynamics of the therapy relationship.
Lingiardi, Vittorio; Muzi, Laura; Tanzilli, Annalisa; Carone, Nicola
Despite growing attention to the general therapist effects in a wide range of clinical settings, little is known about the individual, cross-situational, and therapy-nonspecific variables that impact on the differential effectiveness of clinicians. The current study is a systematic review of the evidence relating to the influence of therapist's subjective characteristics on outcomes of psychodynamic psychotherapies. A multistage and systematic search of articles published between 1987 and 2017 identified 30 relevant studies, which were organized into 6 areas according to the specific therapist's variable considered. Therapists' interpersonal functioning and skills showed the strongest evidence of a direct effect on treatment outcomes. Furthermore, there were preliminary evidence that therapists' attachment styles, their interpersonal history with caregivers, and their self-concept might affect outcomes through interaction effects with other constructs, such as technical interventions, patient's pathology, and therapeutic alliance. The high variability between studies on therapists' overall reflective or introspective abilities and personality characteristics suggested the need for more systematic research in these areas, whereas therapists' values and attitudes showed small effects on therapeutic outcome. The present review clarifies how a deep examination of the contribution of therapists' subjective characteristics can help elucidate the complex association between relational and technical factors related to the outcome of psychodynamic treatments. Copyright © 2017 John Wiley & Sons, Ltd.
Fragkiadaki, Evangelia; Strauss, Susan M
Literature on termination originates mainly from clinical and theoretical accounts as well as practitioners' autobiographical reports. There is, however, a paucity of psychological research on termination. The purpose of this study is to examine the process of termination of therapy based on therapists' narratives of experiences of endings with patients. Grounded Theory methodology has been applied in this study in order to conceptualize the process of termination from the therapist's perspective. Ten psychoanalytic and psychodynamic therapists were interviewed for this study. Grounded Theory analysis of the data revealed five central categories: therapist as a person, therapist's awareness of termination, development of therapeutic relationship, working through termination, and the aftermath (post-termination phase). The results offer a Grounded Theory model of the therapist's journey through termination of therapy with patients. Subcategories and their relationships will be explored. Implications for clinical practice, limitations and suggestions for further research will be discussed. © 2011 The British Psychological Society.
McCarthy, Kye L; Mergenthaler, Erhard; Schneider, Sven; Grenyer, Brin F S
Psychodynamic change is understood to occur in part through the unique therapeutic relationship developed between therapist and patient, and the subtle cycles of their conversation from relaxed connection to intense experiencing. The Therapeutic Cycles Model (TCM) (Mergenthaler, 1996 ) and Heidelberg Structural Change Scale (HSCS) (OPD Task Force, 2008 ) were used to investigate therapist-patient dynamic processes across 16 sessions of psychotherapy. The TCM identified interventions of the therapist instigating change in emotion-abstraction patterns. Structural personality change was higher in TCM cycles, and differed according to emotion-abstraction patterns. The interventions of the therapist promoted dynamic structural change in the patient. The findings demonstrate for the first time the interconnection between specific types of therapist and patient dialogue that promote deep changes.
Goldfried, M R; Raue, P J; Castonguay, L G
Using the Coding System of Therapeutic Focus, this exploratory study was a comparative process analysis of clinically significant sessions obtained from 22 master cognitive-behavior and 14 master psychodynamic-interpersonal therapists. Therapists were nominated by experts in each of these orientations, and clients were seen in a naturalistic setting for problems with anxiety, depression, or both. Relatively few between-groups differences emerged with this master therapist sample. However, regardless of theoretical orientation, several differences were found between those portions of the session labeled by therapists as being clinically significant and those viewed as less significant. As these findings are different from those obtained in a previous study of the therapeutic focus in interventions carried out within the context of a controlled clinical trial, some of the possible factors contributing to these differences are noted.
Heinonen, E; Knekt, P; Jääskeläinen, T; Lindfors, O
Whether long-term psychodynamic therapy (LPP) and psychoanalysis (PA) differ from each other and require different therapist qualities has been debated extensively, but rarely investigated empirically. In a quasi-experimental design, LPP was provided for 128 and PA for 41 outpatients, aged 20-46 years and suffering from mood or anxiety disorder, with a 5-year follow-up from start of treatment. Therapies were provided by 58 experienced therapists. Therapist characteristics, measured pre-treatment, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). General psychiatric symptoms were assessed as the main outcome measure at baseline and yearly after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI). Professionally less affirming and personally more forceful and less aloof therapists predicted less symptoms in PA than in LPP at the end of the follow-up. A faster symptom reduction in LPP was predicted by a more moderate relational style and work experiences of both skillfulness and difficulties, indicating differences between PA and LPP in the therapy process. Results challenge the benefit of a classically "neutral" psychoanalyst in PA. They also indicate closer examinations of therapy processes within and between the two treatments, which may benefit training and supervision of therapists. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Pedersen, Inge Nygaard
This chapter/article describes the historical development of the disciplin Psychodynamic Movement. The importance of this disciplin for self-experience and for training in developing a therapist identy for the music therapy students are emphasized. Prototypeexercises developed and simplified...
Jones, S H; Krasner, R F; Howard, K I
A questionnaire was developed to assess the skillfulness of therapists from the perspective of the supervisor. This supervisor report yielded two scores: one for psychotherapeutic techniques and one for the educational alliance. These scores had high internal consistency and were relatively independent of one another. Ratings of proficiency in psychotherapeutic techniques accounted for 54% of the variance in supervisors' rating? of global skillfulness; educational alliance contributed an additional 12%. Compared with other supervisors, those who espoused self psychology based more of their appraisal of skill fulness on the trainee's use of the supervisory relationship.
Smith, Scott W; Levy, Saryn R; Hilsenroth, Mark J; Fiori, Katherine; Bornstein, Robert F
In the present study, we assess the extent to which patient personality features and prototypes are associated with early treatment therapist-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic. Clinicians completed the Working Alliance Inventory (J Couns Psychol 36:223-233; Psychother Res 9:405-423) to assess their views of early alliance and the Shedler-Westen Assessment Procedure 200 (SWAP-200; Assessment 5:333-353, Am J Psychiatry 161:1350-1365, 1743-1754; Am J Psychiatry 156:258-272, 273-285) to assess patient personality. The SWAP-200 Narcissistic Clinical Prototype, Dysphoric Q-Factor, and Dysphoric/High-Functioning Neurotic Q-Subfactor significantly correlated with early therapist-rated alliance. Correlations that trended toward significance were also found. Also identified were specific SWAP-200 items that were found to relate to high early therapist-rated alliance scores. These results demonstrate some relationship, albeit small, between patient personality characteristics and therapists' views of the alliance that may serve to further a conceptual understanding of the alliance, specific personality syndromes, and the associated impact on the therapeutic interaction.
Dodini, Aaron Jarrett
This exploratory study examined the beliefs of 82 experienced Marriage and Family Therapists regarding the treatment of marital infidelity. Participants were asked to read an on-line vignette and respond to a subsequent web based questionnaire by rating levels of hope, threat, forgiveness, and justification for a couple in regard to various affair scenarios. This study employed an experimental design using six groups to discover possible differences in responses across the dependent variabl...
Ybrandt, H.; Sundin, E. C.; Capone, G.
The shape of alliance in psychotherapy and supervision using growth curve modeling was examined for clinically inexperienced trainee therapists, who were engaged in long-term cognitive behavioral--or psychodynamic individual psychotherapy at a Psychology Clinic in Sweden. Trainee therapists rated their view of the alliance with their clients and…
Mackay, Hannah C.; Barkham, Michael; Stiles, William B.; Goldfried, Marvin R.
Whereas cognitive-behavioral (CB) therapy sessions aim to be instructive and encouraging, psychodynamic-interpersonal (PI) sessions aim to be exploratory and may be emotionally painful. Raters rated degree of pleasure and arousal in each sentence of client speech in CB and PI sessions (N=18) that therapists had identified as particularly helpful.…
Cooper, Stewart E.
Therapists in the field of college mental health counseling commonly voice an ambivalent orientation towards the utilization of formal psychological diagnostic systems yet often use diagnostic terms. Knowledge of the current and emerging diagnostic systems may contribute to greater syntheses of these differing approaches. This article will first…
Kazantzis, Nikolaos; Dattilio, Frank M
A random sample of 827 psychologists were surveyed to assess their definitions of homework, use of homework tasks, and perceived importance of homework. Theoretical orientation distinguished practitioners' responses. Cognitive-behavioral therapists defined homework as being closer to empirically supported therapy, whereas psychodynamic therapists rated homework as less characteristic of a process that embraces client responsibility and adaptive skills. Cognitive-behavior therapists did not limit their choices to activity-based tasks, and psychodynamic therapists reported using behavioral tasks "sometimes." Monitoring dreams and conscious thought were also used among the entire sample surveyed. Psychodynamic therapists rated homework as "somewhat" or "moderately" important, whereas cognitive-behavior therapists more often rated homework as "very important." Data suggest some homework may be common to different psychotherapeutic approaches. Findings are discussed in the context of recent theoretical work on homework in psychotherapy and recommendations for future research.
Imel, Zac E.; Hubbard, Rebecca A.; Rutter, Carolyn M.; Simon, Gregory
Objective: The ability to form a strong therapeutic alliance is considered a foundational skill across psychotherapies. Patient-rated measures of the alliance are now being used to make judgments about a therapist's tendency to build alliances with their patients. However, whether a patient-rated alliance measure provides a useful index of a…
Wiser, S; Goldfried, M R
Despite increased interest in the role of emotion in the process of psychotherapy, we currently lack a valid gauge of its importance in the change process. Significant sessions obtained from 13 experienced psychodynamic-interpersonal and 17 experienced cognitive-behavior therapists were examined to determine the extent of affective exploration and therapists' views of these client states. Results indicate that affective experiencing is present in equivalent amounts in the change sessions of these two orientations. However, therapists' clinical views were dissimilar. Psychodynamic-interpersonal therapists viewed portions containing higher affective experiencing as more critical to the change process, whereas cognitive-behavior therapists viewed lower levels of experiencing as being therapeutically more significant. These findings suggest that, with regard to emotional experiencing, psychodynamic-interpersonal therapists may share common ground with experiential therapists, whereas cognitive-behavior therapists appear to have a unique perspective.
BLAAUW, E; EMMELKAMP, PMG
This article reports on some psychometric features of the Therapist Client Rating Scale (TCRS), an instrument that claims to measure the therapeutic relationship in behaviour therapy sessions. A study is described in which the TCRS was completed after each therapy session by 28 obsessive-compulsive
Raue, P J; Goldfried, M R; Barkham, M
The quality of the therapeutic alliance was compared in sessions of psychodynamic-interpersonal and cognitive-behavioral therapy, and the alliance's relationship to various session impacts was investigated. As part of the Sheffield Psychotherapy Project 2 (D. A. Shapiro, M. Barkham, A. Rees, G. E. Hardy, S. Reynolds, & M. Startup, 1994), 57 clients diagnosed with major depression received 16 sessions of either psychodynamic-interpersonal or cognitive-behavioral therapy. Coders used the Working Alliance Inventory to rate 1 high-impact and 1 low-impact session from each client. Results indicated significantly greater alliance scores for cognitive-behavioral therapy sessions on the whole. Also, for the samples as a whole, high-impact sessions were characterized by higher alliance scores than those for low-impact sessions, and alliance was positively related to therapists' ratings of session depth and smoothness and to clients' ratings of mood.
Kivlighan, Dennis M; Hill, Clara E; Gelso, Charles J; Baumann, Ellen
We used the Actor Partner Interdependence Model (APIM; Kashy & Kenny, 2000) to examine the dyadic associations of 74 clients and 23 therapists in their evaluations of working alliance, real relationship, session quality, and client improvement over time in ongoing psychodynamic or interpersonal psychotherapy. There were significant actor effects for both therapists and clients, with the participant's own ratings of working alliance and real relationship independently predicting their own evaluations of session quality. There were significant client partner effects, with clients' working alliance and real relationship independently predicting their therapists' evaluations of session quality. The client partner real relationship effect was stronger in later sessions than in earlier sessions. Therapists' real relationship ratings (partner effect) were a stronger predictor of clients' session quality ratings in later sessions than in earlier sessions. Therapists' working alliance ratings (partner effect) were a stronger predictor of clients' session quality ratings when clients made greater improvement than when clients made lesser improvement. For clients' session outcome ratings, there were complex three-way interactions, such that both Client real relationship and working alliance interacted with client improvement and time in treatment to predict clients' session quality. These findings strongly suggest both individual and partner effects when clients and therapists evaluate psychotherapy process and outcome. Implications for research and practice are discussed. (c) 2016 APA, all rights reserved).
Hill, Clara E; Baumann, Ellen; Shafran, Naama; Gupta, Shudarshana; Morrison, Ashley; Rojas, Andrés E Pérez; Spangler, Patricia T; Griffin, Shauna; Pappa, Laura; Gelso, Charles J
We investigated changes over 12 to 42 months in 23 predoctoral trainees during their externship training in a psychodynamic/interpersonal psychotherapy clinic. Over time, trainees increased in client-rated working alliance and real relationship, therapist-rated working alliance, client-rated interpersonal functioning, ability to use helping skills (e.g., challenges, immediacy), higher-order functioning (e.g., conceptualization ability, countertransference management), feelings about themselves as therapists (e.g., more authentic, more self-aware), and understanding about being a therapist (e.g., theoretical orientation, curiosity about client dynamics). In contrast, trainees did not change in engaging clients (return after intake or for at least 8 sessions), judge-rated psychodynamic techniques in third and ninth sessions across clients (although trainees used more cognitive-behavioral techniques over time in third but not ninth sessions), or changes in client-rated symptomatology. Trainees primarily attributed changes to graduate training, individual and group supervision, research participation, and working with clients. Implications for training and research are discussed. (c) 2015 APA, all rights reserved).
Mullin, Anthony S J; Hilsenroth, Mark J; Gold, Jerold; Farber, Barry A
This study explores the effectiveness of psychodynamic psychotherapy in improving facets of object relations (OR) functioning over the course of treatment. The sample consisted of 75 outpatients engaged in short-term dynamic psychotherapy at a university-based psychological services clinic. Facets of OR functioning were assessed at pre- and posttreatment by independent raters using the Social Cognition and Object Relations Scale-Global rating method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011 ; Westen, 1995 ) from in-session patient relational narratives. The Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman, Bonge, & Blais, 2005 ) was used to assess therapist activity and psychotherapy techniques early in treatment. Independent clinical ratings of OR functioning and psychotherapy technique were conducted and all were found to be in the good to excellent range of reliability. Specific facets of OR functioning improved with medium to large effect changes posttreatment. These adaptive changes were significantly related to the incidence of psychodynamic-interpersonal (PI) techniques. Also, this study identified the role specific psychodynamic techniques had in facilitating change in a number of underlying dimensions of OR. Patient self-reported reliable change in symptomatology and reliable change in facets of OR were significantly related as well. This study highlights the utility of incorporating psychological assessment into psychotherapy practice to assess change at the explicit (symptoms) and implicit (OR) level. Limitations of this study, future research directions, and implications for clinical practice are discussed.
Colli, Antonello; Speranza, Anna Maria; Lingiardi, Vittorio; Gentile, Daniela; Nassisi, Valentina; Hilsenroth, Mark J
The aims of this study were to identify (a) patterns of clinicians' emotional responses to patients with eating disorders (ED); (b) patient, clinician, and treatment variables associated with therapist emotional responses; and (c) the influence of patient personality on therapist emotional responses. A random national sample of psychodynamic and cognitive-behavioral psychotherapists (N = 149) was asked to examine one patient (>18 years old) with an ED. Clinicians completed the SWAP-200, the Therapist Response Questionnaire, and the Clinical Questionnaire-Eating Disorder Form to provide general information about themselves, patients, and therapies. Results suggested a therapist pattern of emotional response in relation to different ED diagnosis and indicated meaningful influence of therapist experience and patient variables (such as sexual abuse, dissociative symptoms, and self-harm) on therapist emotional reactions. Finally, regression analysis suggested that therapist responses are more related to patient personality than ED symptoms. This study confirms the importance of patient personality in evoking specific therapists' reactions.
Wiseman, Hadas; Tishby, Orya
We describe client-therapist relational narratives collected in relationship anecdotes paradigm (RAP) interviews during psychotherapy and the application of the core conflictual relationship theme (CCRT) method. Changes in clients' and therapists' CCRT in relation to each other are examined and associations between their CCRTs and self-reported ruptures and repairs are explored. Sixty-seven clients and 27 therapists underwent RAP interviews and completed self-report rupture and repair items at early, middle, and late psychodynamic psychotherapy. Client-therapist relationship narratives were rated on the CCRT and the relational interplay within dyads was explored qualitatively. CCRT changes from early to late therapy showed that with time clients perceived the therapist (RO) and the self (RS) more positively, and the therapist perceived the self (RS) less negatively. Some associations were found between tension in the session and clients' and therapists' negative RO and RS. Therapists' reports of alliance repairs were associated with positive RO and RS. Relational narratives that clients and therapists tell in RAP interviews about meaningful interactions between them, enhance our understanding of clients' and therapists' inner experiences during interpersonal dances in the therapeutic relationship. Limitations and directions for future research are discussed, and implications for training are suggested.
Anderson, Timothy; Knobloch-Fedders, Lynne M; Stiles, William B; Ordoñez, Tatiana; Heckman, Bernadette D
This study compared participants' speech acts in low-hostile versus moderate-hostile interpersonal episodes in time-limited psychodynamic psychotherapy. Sixty-two cases from the Vanderbilt II psychotherapy project were categorized as low or moderate in interpersonal hostility based on ratings of interpersonal process using Structural Analysis of Social Behavior (Benjamin, 1996). Representative episodes were coded using a taxonomy of speech acts (Stiles, 1992), and speech acts were compared across low- and moderate-hostile episodes. Therapists in moderate-hostility episodes used more interpretations and edifications, and fewer questions and reflections. Patients in moderate-hostility episodes used more disclosures and fewer edifications. Content coding showed that therapist interpretations with a self/intrapsychic self focus were more characteristic of moderate-hostility than low-hostility episodes, whereas the two types of episodes contained similar levels of interpretations focused on the patient's interpersonal relationships and the therapeutic relationship.
Leuteritz, Katja; Weißflog, Gregor; Barthel, Yvette; Brähler, Elmar; Zwerenz, Rüdiger; Wiltink, Jörg; Beutel, Manfred E
A good therapeutic alliance is associated with better treatment outcomes in diverse types of psychotherapy and patient populations, but little is known about therapeutic alliance in psychotherapies with cancer patients. This study examines the association of therapeutic alliance and treatment outcome in short term psychodynamic psychotherapy (STPP) for breast cancer patients. Within a randomized controlled trial, 47 completers of STPP could be included in the analyses. The therapeutic alliance was assessed by patients and therapists at treatment termination with the Helping Alliance Questionnaire. Outcome was defined as no diagnosis of depression assessed with Structured Clinical Interview for DSM-IV (SCID-I) and a reduction of the HADS-depression score by at least two points at treatment termination. Patients' alliance ratings were significantly associated with outcome (r = 0.46, p = 0.015), while, in contrast to findings in non-cancer populations, therapists' ratings were unrelated. There was no association between patients' and therapists' ratings of therapeutic alliance. Especially success and working related aspects of patients' alliance scores were associated with outcome. Patients' and therapists' alliance scores were unrelated to any of their baseline characteristics, therapist characteristic or treatment variables. We conclude that therapists should regularly assess the quality of patients' perceived therapeutic alliance in the course of psychotherapy with breast cancer patients to improve psychotherapy outcome. The breast cancer patients' perspective should be actively inquired and considered throughout treatment by therapists. Possible discrepancies between both judgements can be addressed in treatment.
Nesci, Domenico Arturo
Mourning the death of a beloved person is one of life's most stressful events. This psychotherapy case study describes a form of psychodynamic psychotherapy that the author developed in working with a patient who suffered from complicated grief after the death of her father from lung cancer. During sessions, the therapist worked with the patient to collect pictures and organize a "strip of life" of her father's most meaningful moments. The patient then wrote a short text associated with each picture. Finally, she chose music to be added to this "slide show" or "psychodynamic montage" as its soundtrack. The resulting multimedia presentation was finally posted on the Internet on a website to which only the patient and her relatives and friends had access via a password. This therapeutic strategy was effective in helping this patient resolve her symptoms of complicated grief. The author suggests that this new approach to psychodynamic psychotherapy may be a cost-effective and well-received tool for use in institutions such as hospices and general hospitals.
Gumz, Antje; Geyer, Michael; Brähler, Elmar
Observations from therapeutic practice and a series of empirical findings, for example, those on discontinuous change in psychotherapeutic processes, suggest modelling the therapeutic process as a self-organizing system with stable and critical instable phases and abrupt transitions. Here, a concept of psychotherapeutic change is presented that applies self-organization theory to psychodynamic principles. The authors explain the observations and considerations that form the basis of the concept and present some connections with existing findings and concepts. On the basis of this model, they generated two hypotheses regarding the co-occurrence of instability and discontinuous change and the degree of synchrony between the therapist and patient. A study design to test these hypotheses was developed and applied to a single case (psychodynamic therapy). After each session, patient and therapist rated their interaction. A measure of instability was calculated across the resulting time series. Sequences of destabilization were observed. On the basis of points of extreme instability, the process was divided into phases. Local instability maxima were accompanied by significant discontinuous change. Destabilization was highly synchronous in therapist and patient ratings. The authors discussed the concept and the methodological procedure. The approach enables the operationalization of crises and to empirically assess the significance of critical phases and developments within the therapeutic relationship. We present a concept of change that applies self-organization theory to psychodynamic therapy. We empirically tested the hypotheses formulated in the concept based on an extract of 125 long-term psychodynamic therapy sessions. We continuously monitored the therapeutic interaction and calculated a measure of the instability of the assessments. We identified several sequences of stable and unstable episodes. Episodes of high instability were accompanied by discontinuous
Laws, Holly B; Constantino, Michael J; Sayer, Aline G; Klein, Daniel N; Kocsis, James H; Manber, Rachel; Markowitz, John C; Rothbaum, Barbara O; Steidtmann, Dana; Thase, Michael E; Arnow, Bruce A
This study tested whether discrepancy between patients' and therapists' ratings of the therapeutic alliance, as well as convergence in their alliance ratings over time, predicted outcome in chronic depression treatment. Data derived from a controlled trial of partial or non-responders to open-label pharmacotherapy subsequently randomized to 12 weeks of algorithm-driven pharmacotherapy alone or pharmacotherapy plus psychotherapy. The current study focused on the psychotherapy conditions (N = 357). Dyadic multilevel modeling was used to assess alliance discrepancy and alliance convergence over time as predictors of two depression measures: one pharmacotherapist-rated (Quick Inventory of Depressive Symptoms-Clinician; QIDS-C), the other blind interviewer-rated (Hamilton Rating Scale for Depression; HAMD). Patients' and therapists' alliance ratings became more similar, or convergent, over the course of psychotherapy. Higher alliance convergence was associated with greater reductions in QIDS-C depression across psychotherapy. Alliance convergence was not significantly associated with declines in HAMD depression; however, greater alliance convergence was related to lower HAMD scores at 3-month follow-up. The results partially support the hypothesis that increasing patient-therapist consensus on alliance quality during psychotherapy may improve treatment and longer term outcomes.
Rosenthal, Richard J
The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970) psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.
Shafranske, Edward P
Spiritually oriented psychodynamic psychotherapy pays particular attention to the roles that religious and spiritual beliefs, practices, and experiences play in the psychological life of the client. Contemporary psychoanalytic theorists offer multiple approaches to understand the functions of religious experience. Spirituality provides a means to address existential issues and provide a context to form personal meaning. Religious narratives present schemas of relationship and models of experiences salient to mental health, such as hope. God images or other symbolic representations of the transcendent have the power to evoke emotions, which in turn, influence motivation and behavior. While employing theories and techniques derived from psychodynamic psychotherapy, this therapeutic approach encourages the analysis of the functions religion and spirituality serve, while respecting the client's act of believing in faith. Psychotherapists address a client's spirituality by exploring the psychological meaning of such personal commitments and experiences and refrain from entering into discussion of faith claims. (c) 2009 Wiley Periodicals, Inc.
Owen, Jesse; Hilsenroth, Mark J; Rodolfa, Emil
The current study examined the interaction of clients' perceptions of the psychodynamic-interpersonal (PI) and cognitive-behavioural (CB) techniques that their therapist utilized in their most recent therapy session and working alliance in the prediction of post-session changes. Seventy-five clients were treated by 25 therapists at a counselling centre in the USA. We posited that alliance would interact with clients' perceptions of their therapists' use of PI and CB techniques in the prediction of post-session changes. The results revealed a three-way interaction between clients' perceptions of the alliance, PI techniques and CB techniques in the prediction of post-session changes. More PI and more CB techniques and more PI but fewer CB techniques were associated with better post-sessions changes in the context of higher alliances. More CB techniques but fewer PI techniques and fewer PI and fewer CB techniques were not significantly associated with post-session changes in the context of higher (or lower) alliances. Clients' perceptions of PI techniques in the context of stronger alliances were most beneficial for post-session outcomes. Thus, a high alliance will likely maximize the impact of PI techniques. Clients who rated their therapist as being relatively inactive reported fewer positive post-session outcomes, suggesting that an idle therapeutic approach is not advantageous. Therapist differences explained two to three times more variation in session outcomes than client ratings of alliance or techniques. Some therapists are better at facilitating positive session outcomes as compared with others, suggesting that a potential key barometer of therapists' effectiveness may be captured by session outcomes. Copyright © 2012 John Wiley & Sons, Ltd.
... State & Area Data Explore resources for employment and wages by state and area for recreational therapists. Similar Occupations Compare the job duties, education, job growth, and pay of recreational therapists with ...
Glucksman, Myron L; Kramer, Milton
The initial and last manifest dream reports (MDRs) of 30 patients who had either successfully terminated, or continued to make satisfactory progress at an advanced stage of psychodynamic psychotherapy and combined psychotherapy/pharmacotherapy, were rated according to the following variables: Affect and Affect Valence; Affect Valence of Associations and Direction of Association Themes; Dream Narrative; Psychodynamic Formulation; Transference; and Dream Theme. Similar to previous studies, the initial MDRs contained more negative than positive affect. Conversely, the last MDRs contained more positive than negative affect. Associations to initial MDRs contained more negative affect; on the other hand, associations to last MDRs contained more positive affect. Direction of association themes were more negative in initial MDRs and more positive in last MDRs. Dream narratives were more negative in initial MDRs and more positive in last MDRs. Psychodynamic formulations were more negative in initial MDRs and more positive in last MDRs. Transference was more negative in initial MDRs and more positive in last MDRs. Relational and injury dream themes occurred more frequently than others in both initial and last MDRs. Initial MDRs contained more injury dream themes than last MDRs. The findings of this study demonstrate that there is a correlation between MDR variables and clinical improvement during treatment. The patients in this study were selected by MG, the treating therapist, on the basis of satisfactory progress. The MDRs of patients who failed to progress or did poorly were not discussed in this report. The findings, therefore, must be taken as preliminary and indicate the need for further research on manifest dreams during psychotherapy and combined psychotherapy/pharmacotherapy.
Full Text Available Scaling up psychotherapy services such as for addiction counseling is a critical societal need. One challenge is ensuring quality of therapy, due to the heavy cost of manual observational assessment. This work proposes a speech technology-based system to automate the assessment of therapist empathy—a key therapy quality index—from audio recordings of the psychotherapy interactions. We designed a speech processing system that includes voice activity detection and diarization modules, and an automatic speech recognizer plus a speaker role matching module to extract the therapist’s language cues. We employed Maximum Entropy models, Maximum Likelihood language models, and a Lattice Rescoring method to characterize high vs. low empathic language. We estimated therapy-session level empathy codes using utterance level evidence obtained from these models. Our experiments showed that the fully automated system achieved a correlation of 0.643 between expert annotated empathy codes and machine-derived estimations, and an accuracy of 81% in classifying high vs. low empathy, in comparison to a 0.721 correlation and 86% accuracy in the oracle setting using manual transcripts. The results show that the system provides useful information that can contribute to automatic quality insurance and therapist training.
Psychodynamic-oriented psychological assessment predicts evolution to schizophrenia at 8-year follow-up in adolescents hospitalized for a manic/mixed episode: interest of an overall subjective rating.
Louët, Estelle; Consoli, Angèle; Lucanto, Raffaella; Duplant, Nicole; Bailly-Salin, Marie-José; Lemoigne, Annie; Martin, Michèle; Mayer, Charlotte; Thompson, Caroline; Gollier-Briant, Fanny; Laurent, Claudine; Brunelle, Julie; Bodeau, Nicolas; Cohen, David
Little is known concerning the prognostic significance of manic/mixed episodes in adolescents. In particular, whether the use of psychodynamic-oriented projective psychological testing predicts evolution to schizophrenia at follow-up has not been established. Eighty subjects, aged 12-20years old, consecutively hospitalized for a manic or mixed episode between 1994 and 2003 were recruited. All patients were contacted in 2005-2006 for a follow-up assessment. For the subgroup of adolescents (N=40) who had psychodynamic-oriented psychological testing (Rorschach and TAT), two scores regarding psychosocial risk and schizophrenia risk were computed using the clinical global impression (CGI) assessment based on an overall subjective rating given by a panel of expert psychologists who reviewed all protocols. At follow-up (average 8years), 25 (62.5%) patients, 16 females and nine males, were assessed: 14 still had a diagnosis of bipolar disorder; eight changed to schizo-affective disorder and three to schizophrenia. Inter-rater reliability of both CGI-risk scores (psychosocial risk and schizophrenia risk) showed good clinical consensus with intraclass correlation and Kappa scores ranging from 0.53 to 0.75. Univariate analysis showed that CGI-psychosocial risk score (p=0.017), type of index episode (p=0.049) and CGI-schizophrenia risk score (p=0.09) were associated with transition to schizophrenia spectrum disorder at follow-up. Age, sex, socioeconomic status, duration of stay and the presence of psychotic features at index episode were not associated with the transition. We conclude that the CGI assessment appears to be valid to score risk of poor outcome using psychodynamic-oriented psychological testing and that these scores may predict, in part, the transition to schizophrenia in adolescents with a history of manic/mixed episode. Copyright © 2010 Elsevier Ltd. All rights reserved.
Nissen, Poul; Hansen, Kim Gabriel
This article presents the first Danish prospective outcome study of psychodynamic environmental therapy of children in residential treatment with early, serious traumatisation and extential relational disturbances. The study delves beneath the surface and explores the extent to which the children...
... bachelorâs degree and specific coursework, including biology and physiology. Many programs also require applicants to have volunteered ... of many conditions and ailments commonly associated with aging, such as arthritis and stroke. Occupational therapists also ...
... treatment on the basis of that personâ€™s needs. Empathy. Massage therapists must give clients a positive experience, ... Areas at a Glance Industries at a Glance Economic Releases Databases & Tables Maps calculators Inflation Injury And ...
... saturated with workers, and other areas (more often, rural areas) will be in need of respiratory therapistsâ€™ ... workers in the occupation, including what tools and equipment they use and how closely they are supervised. ...
The Autism Psychodynamic Evaluation of Changes (APEC) scale: a reliability and validity study on a newly developed standardized psychodynamic assessment for youth with Pervasive Developmental Disorders.
Haag, Geneviève; Botbol, Michel; Graignic, Rozenn; Perez-Diaz, Fernando; Bronsard, Guillaume; Kermarrec, Solenn; Clement, Marie-Christine; Cukierman, Annick; Druon, Catherine; Duprat, Andrée; Jardin, Françoise; du Chatellier, Anik Maufras; Tricaud, Jacqueline; Urwand, Simone; Guilé, Jean-Marc; Cohen, David; Tordjman, Sylvie
The present study was designed to examine the reliability and validity of the Autism Psychodynamic Evaluation of Changes (APEC) scale, developed to assess the evolution in individuals with autism under treatment. The APEC scale focuses on the key role of impairment in body image construction, which requires cross-modal sensory integration through emotional communication with motor representations. Thus, the body image construction is associated simultaneously with spatial and temporal organization and allows the emergence of self- and others-representations. The use of the APEC scale, with its seven domains (expression of emotion in relationships, eye contact, body image, graphic productions, exploration of space and objects, time perception, and verbal language), underlines the importance in autistic disorder of anxieties related to body and spatial representations, and of impairment in the body ego construction which is closely linked to the emergence of individuation/separation processes. This study was conducted on 73 children and adolescents with autistic disorder. They were recruited in day care facilities where two caregivers independently gave their ratings based on their clinical observation on a daily basis during the same month. Analyses included assessing construct validity through correspondence analyses and inter-rater reliability using kappa coefficients. The APEC scale offers a reliable and validated psychodynamic assessment of interest for professionals (such as child psychiatrists, caregivers, therapists or teachers) and researchers working with children, adolescents and adults with autistic disorder, especially in the follow-up of their evolution. The APEC scale provides an approach at the interface of psychoanalysis and neuroscience, and is also of interest for clinical and developmental psychology. Using the APEC scale in a range of different practical and research settings will foster links between psychoanalytic perspectives and educational
Berger, Lauren K; Zane, Nolan; Hwang, Wei-Chin
This study examined the relationship between therapist characteristics, therapeutic orientations, person-level and agency-level practices with cultural competency among 221 Los Angeles County community mental health clinicians. Results from an online survey indicated that compared to White therapists, ethnic minority therapists were more personally involved in communities of color, more likely to use a cultural framework in clinical practice, and perceived their agencies to be more culturally sensitive. Ethnic minority therapists also reported greater multicultural (MC) awareness and better MC counseling relationships with their clients than White therapists. Personal involvement in communities of color accounted for ethnic differences in MC awareness and MC counseling relationships. Compared to therapists with a strictly non-behavioral (psychodynamic or humanistic) orientation, therapists with an eclectic (or integrative) therapy orientation reported having a higher level of community knowledge. Therapists with an eclectic orientation reported greater MC awareness than therapists with a non-behavioral orientation, while both eclectic and behavioral (cognitive behavioral or behavior modification) therapists recounted better MC counseling relationships with their clients than therapists with a non-behavioral orientation. Community knowledge mediated eclectic vs. non-behavioral therapeutic orientation differences in MC awareness. Agency resources/linkages and outreach both moderated the relationship between therapeutic orientation and MC skills. Results suggest that if therapists become more personally involved with diverse populations, they will feel more culturally aware and feel like they have a better relationship with ethnic minority clients.
Atzil-Slonim, Dana; Tishby, Orya; Shefler, Gaby
This study examined changes in adolescents' internal representations of their relationship with their therapist and the extent to which these changes were related to changes in their representations of their relationship with their parents and to treatment outcomes. Thirty adolescents (aged 15-18 years, 70% women) undergoing psychodynamic psychotherapy participated in relationship anecdote paradigms interviews based on the core conflictual relationship theme method and completed outcome measures at the beginning of treatment and a year later. Adolescents' positive representations of their therapists increased throughout the year of treatment, whereas their negative representations did not change. There was an association between the development of the therapeutic relationship and improvement in the perception of the relationship with parents over the course of therapy. Increases in the level of positive representations and decreases in the level of negative representations of the therapist were associated with greater satisfaction with treatment but not with the other outcome measures. These results support the centrality of the therapeutic relationship in the process of change during adolescents' psychodynamic psychotherapy. The finding that positive representations of the therapist increased throughout treatment but that negative representations remained steady suggests that therapists who treat adolescents should expect and be able to hear adolescent clients' positive and negative internal representations of themselves. Therapists need to realize that although adolescents often experience negative emotions and perceptions in therapy as in other significant relationships, this does not necessarily block the development of positive emotions. The finding that changes in the representations of the therapist are associated with changes in the representations of parents is in line with psychodynamic theory, which posits that psychotherapy facilitates new
Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin
In the present study of 203 patients in psychodynamic group psychotherapy, we explore associations between patient and therapist global retrospective outcome evaluations (ROE), and pre-post-treatment changes on the Symptom Check List 90 Revised (SCL-90-R) and non-symptomatic focus of therapy. The......, and associated with personality factors or domains not captured by standard questionnaires....
Ollila, Pekka; Knekt, Paul; Heinonen, Erkki; Lindfors, Olavi
Information on how the patient's interpersonal problems predict alliance development during long-term therapy is lacking. The aim of this study was to explore how the patient's pre-treatment interpersonal problems predict the development of alliance in long-term psychotherapy. Altogether 128 adult outpatients experiencing mood or anxiety disorder were assigned to long-term psychodynamic psychotherapy in the Helsinki Psychotherapy Study. The Inventory of Interpersonal Problems (IIP) total score and the eight octant scores, assessed at baseline, were used as predictors. The trajectories of change in patient- and therapist-rated Working Alliance Inventory (WAI) were used as outcome measures at 7, 12, and 36 months of follow-up after baseline. Study of the changes by time showed that the patient-rated alliance was significantly improved by the 36-month follow-up, i.e. the most usual end-point of therapy, in persons with higher pre-treatment level of the IIP total score. Low total IIP score and low to moderate level of hostile type problems showed no slope of improvement of patient-rated alliance during follow-up. The therapist-rated alliance showed a similar course as the patient-rated alliance with the exception of a faster improvement for higher IIP scores. In conclusion, a higher level of patients' interpersonal problems predicted favorable alliance development. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Chevan, Julia; Haskvitz, Esther M
Physical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity. The purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals. A cross-sectional survey design was used. There were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed. Physical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS. Limitations The study may be limited by sampling and response bias. This study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy
Malberg, Norka T; Mayes, Linda C
Authors address the transformations taking place in the last 25 years in the theory and practice of developmental psychoanalysis. They emphasize the role of attachment theory in this process and its clinical applications to the work with children and families and the social systems supporting them. The article also describes and explores a move toward an integrative and systemic developmental psychodynamic approach and its relevance to today's practitioner. Copyright © 2013 Elsevier Inc. All rights reserved.
Rosenbaum, B; Garfield, D
The concept of the container has a place within cognitive science as well as within psychodynamic theories. Cognitive semantics has shown that many metaphors giving meaning to daily life-events use the container as a basic reference point. Psychoanalytic theory, most notably, Freud's psychosexual developmental model, illustrates how the container of the body results in meaning. Object relations theory in psychoanalysis has shown how patients with borderline personality disorder behave according to the dynamics of container and containment. Both the cognitive and the psychodynamic conceptions of containers are clinically relevant. The fundamental notion of the container leads to an exploration of 'container dynamics' both in cognitive semantics and in psychodynamic work. A model of the cusp may be of help in the description of the dynamics at the border of the container. Furthermore, the descriptions of the patient's communication of emotion and thoughts may involve three interacting dimensions: an effective-perceptual dimension, a phantasy dimension and a socio-interactive dimension. The interaction between these dimensions has implications for dealing with container dynamics and the process of containment.
Tasca, Giorgio A; Balfour, Louise
A contemporary psychodynamic framework can add much to our understanding of eating disorders. Eating disorders are associated with complex comorbidities, high levels of mortality, and therapist countertransferences that can complicate psychological treatments. Mainstream models currently focus on cognitive, biological, or cultural factors to the near exclusion of attachment functioning, and the individual's dynamics. As such, standard models appear to exclude person-centred and developmental considerations when providing treatments. In this article, we describe a contemporary psychodynamic model that understands eating disorder symptoms as a consequence of vulnerability to social pressures to be thin and biological predispositions to body weight. Individual vulnerabilities are rooted in unmet attachment needs causing negative affect, and subsequent maladaptive defenses and eating disorder symptoms as a means of coping. We describe how this model can inform transdiagnostic eating disorder treatment that focuses on symptoms as well as specific attachment functions including: interpersonal style, affect regulation, reflective functioning, and coherence of mind. Two clinical examples are presented to illustrate case formulations and psychological treatments informed by these conceptualizations.
Willemsen, Jochem; Della Rosa, Elena; Kegerreis, Sue
This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases. PMID:28210235
Burnand, Yvonne; Andreoli, Antonio; Kolatte, Evelyne; Venturini, Aurora; Rosset, Nicole
The authors compared a combination of clomipramine and psychodynamic psychotherapy with clomipramine alone in a randomized controlled trial among patients with major depression. Seventy-four patients between the ages of 20 and 65 years who were assigned to ten weeks of acute outpatient treatment for major depression were studied. Bipolar disorder, psychotic symptoms, severe substance dependence, organic disorder, past intolerance to clomipramine, and mental retardation were exclusion criteria. Marked improvement was noted in both treatment groups. Combined treatment was associated with less treatment failure and better work adjustment at ten weeks and with better global functioning and lower hospitalization rates at discharge. A cost savings of 2,311 dollars per patient in the combined treatment group, associated with lower rates of hospitalization and fewer lost work days, exceeded the expenditures related to providing psychotherapy. Provision of supplemental psychodynamic psychotherapy to patients with major depression who are receiving antidepressant medication is cost-effective.
Probst, Thomas; Sattel, Heribert; Gündel, Harald; Henningsen, Peter; Kruse, Johannes; Schneider, Gudrun; Lahmann, Claas
This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT) for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y), self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS) of the SF-36 Health Survey. The potential moderator (M) alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20) at pre-treatment and the predictor (X) the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ) at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients' alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists' alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome (p alliance in the therapists' perspective was beneficial for the outcome only for patients scoring above 61 on the TAS-20. This moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9) as a covariate to the moderation model. The results underline the importance of a good therapists' view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.
Gonzalez, Jodi M; Prihoda, Thomas J
This study examines the effectiveness of long-term outpatient psychodynamic group psychotherapy for individuals with bipolar disorder who may have psychiatric comorbidity. The Integrative Outpatient Model (IOM) includes psychoeducation regarding illness, illness management, and exploration of dynamic and interpersonal issues. At one-year follow up, group members had significantly less depressive symptomatology and were less likely to be in a mood episode, compared to controls. There were no between-group differences in manic symptoms or global assessments of functioning. For group-treated patients, the number of days well per week improved significantly; there were no significant improvements in the control group. This pilot study indicates that psychodynamic group psychotherapy is feasible as a component of treatment for bipolar disorder diagnoses. The results suggest benefits on depressive, but not manic symptoms. The 73% retention rate suggests that further study of this treatment is warranted, especially in the cases of patients for whom pharmacotherapy alone is not sufficient.
Nissen-Lie, Helene A; Havik, Odd E; Høglend, Per A; Rønnestad, Michael Helge; Monsen, Jon T
Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore the development of the working alliance (using the Working Alliance Inventory), rated by both patients and therapists as a function of therapist in-session experiences. The therapist experiences were gathered by means of the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005). Data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (Havik et al., 1995) were used. Multilevel growth curve analyses of alliance scores from Sessions 3, 12, 20 and 40 showed that the therapist factors predicted working alliance levels or growths differently, depending on whether the alliance was rated by patients or by therapists. For example, it emerged that therapists' negative reactions to patients and their in-session anxiety affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of flow (Csikszentmihalyi, 1990) during sessions impacted only the therapist-rated alliance. The patterns observed in this study imply that therapists should be particularly aware that their negative experiences of therapy are noticed by, and seem to influence, their clients when they evaluate the working alliance through the course of treatment. The findings of this study suggest that the working alliance is influenced by therapists' self-reported practice experiences, which presumably are communicated through the therapists' in-session behaviours. The study found a notable divergence between practice experiences that influenced the therapists and those that influenced the patients when evaluating the working alliance. Specifically, practitioners' self-reported difficulties
Goldfried, M R; Castonguay, L G; Hayes, A M; Drozd, J F; Shapiro, D A
This study compared therapeutic foci in a sampling of 30 cognitive-behavioral and 27 psychodynamic-interpersonal manual-driven treatments for depression. High- and low-impact sessions were coded for each client, with the Coding System of Therapeutic Focus. Results indicated that psychodynamic-interpersonal sessions focused more on such variables as emotion, patterns, incongruities, the impact that others made on clients, clients' expected reaction of others, the tendency to avoid therapeutic progress, therapists themselves, clients' parents, and links between people and time periods in clients' lives. Cognitive-behavioral sessions placed greater emphasis on external circumstances and clients' ability to make decisions, gave more support and information and encouraged between-session experiences, and focused more on the future. Relatively few differences emerged as a function of session impact. Results are discussed in terms of the different and similar theoretical conceptions of the change process.
Clemens, Norman A
In a democracy, elections are the way in which the collective thought processes of the voters arrive at a decision to direct their government. The author explores how the individual voter assesses and resolves many conflicting internal and external forces to arrive at a vote. The midterm elections of 2010 illustrate the parallel between individual resolution of conflicting forces and the process of a campaign leading to the outcome of an election. The psychodynamic concepts of conflict and compromise, affects, aggression, unconscious forces, mechanisms of defense, superego, and the ego's integrative functions are evident in both the individual voter and the collective electoral process. The author expresses concern about the historical vulnerability of democracies and the unbalancing effect of allowing limitless infusion of anonymous corporate money to pour into campaigns.
Woods, Craig D
Managing the "difficult" patient is a challenge all dentists face. This paper describes a psychodynamic model that pictures the dentist-patient relationship as a two-way interaction that involves unconscious processes...
Sanchen Henning; Frans Cilliers
Orientation: The researchers constructed a Systems Psychodynamic Wellness Model (SPWM) by merging theory and concepts from systems psychodynamics and positive psychology. They then refined the model for application in organisations during a Listening Post (LP) that comprised experienced subject experts.Research purpose: The purpose of the research was to construct and refine the SPWM in order to understand psychological wellness at the individual, group and organisational levels.Motivation fo...
Glucksman, Myron L.
The dream is a unique psychodynamically informative instrument for evaluating the subjective correlates of brain activity during REM sleep. These include feelings, percepts, memories, wishes, fantasies, impulses, conflicts, and defenses, as well as images of self and others. Dream analysis can be used in a variety of clinical settings to assist in diagnostic assessment, psychodynamic formulation, evaluation of clinical change, and the management of medically ill patients. Dreams may serve as ...
Salzer, Simone; Cropp, Carola; Streeck-Fischer, Annette
Borderline personality disorder (BPD) should be understood as a disorder of development (Streeck-Fischer 2008, 2013) that has its first manifestation in late childhood and adolescence. There are only few treatment studies of adolescents meeting the diagnostic criteria of borderline personality disorder, although early interventions for these patients are urgently needed (see Chanen & McCutcheon 2013). We examined the effectiveness of an inpatient psychodynamic therapy (PDT). Twenty-eight adolescents fulfilling the DSM-IV diagnostic criteria of borderline personality disorder were treated with psychodynamic therapy. The mean duration of treatment was 29.87 weeks (SD = 15.88). Outcomes were remission rates, GAF, GSI, SDQ, IIP and BPI scores. Assessments were made at admission and after treatment. Pre-post comparisons and comparisons with normative data were conducted. At the end of treatment 39.29% of the patients were remitted. We found significant improvements for the GAF, GSI, SDQ, IIP (all p0.001) and the BPI (p = 0.006). These clinically relevant improvements demonstrate the effectiveness of psychodynamic therapy in adolescents with borderline personality disorder and stress the usefulness of an early intervention for these patients.
Schenkman, Margaret; McFann, Kimberly; Barón, Anna E
Individuals with Parkinson disease (PD) experience a range of deficits of body systems and activities. A clinical test is needed that is reliable, valid, applicable to physical therapist practice, and appropriate for use in early and mid-stages of the disease. PROFILE PD is one such scale, consisting of 24 items that would typically be assessed during the physical therapist's examination and evaluation of individuals with PD. The purpose of this article is to report on clinimetric properties of the PROFILE PD and to make the test available for use. Interrater reliability was determined using the intraclass correlation coefficient. Construct validity was determined by comparing scores on the PROFILE PD with the gold standard (Unified Parkinson's Disease Rating Scale [UPDRS]) as well as scales of physical activity and participation. Construct validity and structure of the PROFILE PD were further examined using exploratory factor analysis using principal component analysis with Promax rotation that allows a correlated factor structure. Interrater reliability of the PROFILE PD was high (ICC = 0.97). Construct validity was demonstrated with the UPDRS (r = 0.86, P Physical Functional Performance test (r = -0.62, P < 0.0001). Principal component analysis demonstrated that the test comprises a single scale. The PROFILE PD is a reliable and valid scale that can be used to quantify alterations in body systems and activity of individuals in early and mid-stages of PD. Use of the scale can provide an overall summary of the impact of PD on body systems and activities.
Salinas, J L; Pérez, M P; Viniegra, L; Armando Barriguete, J; Casillas, J; Valencia, A
In this paper a family evaluation instrument called systemic-psychodynamic family evaluation model is described. Also, the second stage of the validation study of this instrument is presented (which deals with the inter-observers variation). Twenty families were studied. They were assessed always by the same interviewers designated as experts. They are all family therapy specialists and their assessment was used as the evaluation reference standard or "gold standard". The observers were psychiatrists without previous training in family therapy. For the purpose of the interview, both experts and observers were blind to the medical diagnosis of the patients. During the first stage of the validation study the observers did not have a reference guide which resulted in a low concordance rating. For the second stage, a 177 item guide was used and a considerable increase in the concordance rating was observed. Validation studies like the one used here are of considerable value to increase the reliability and further utilisation of evaluation instruments of this type.
Sørensen, Per; Birket-Smith, M; Wattar, U
Hypochondriasis is common in the clinic and in the community. Cognitive behavioural therapy (CBT) has been found to be effective in previous trials. Psychodynamic psychotherapy is a treatment routinely offered to patients with hypochondriasis in many countries, including Denmark. The aim...... of this study was to test CBT for hypochondriasis in a centre that was not involved in its development and compare both CBT and short-term psychodynamic psychotherapy (STPP) to a waiting-list control and to each other. CBT was modified by including mindfulness and group therapy sessions, reducing the therapist...
Beidas, Rinad S; Marcus, Steven; Aarons, Gregory A; Hoagwood, Kimberly E; Schoenwald, Sonja; Evans, Arthur C; Hurford, Matthew O; Hadley, Trevor; Barg, Frances K; Walsh, Lucia M; Adams, Danielle R; Mandell, David S
Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist-Family Revised. Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of
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Fleischman, Sari; Shorey, Hal S
Attachment anxiety has been depicted as an undesirable therapist characteristic based on findings that preoccupied therapists, relative to those with other attachment styles, report more ruptures in the therapeutic alliance. What has not been considered, however, is the extent to which attachment dynamics are related to theoretical orientations and how attachment styles and theoretical orientations combine to predict therapists' perceptions of the quality of their alliances. The present surveyed 290 licensed psychologists nationally. Results revealed that even within a sample of primarily secure psychologists, higher 15 levels of attachment anxiety correlated positively with the endorsement of psychodynamic orientations, and negatively with the endorsement of cognitive-behavioral orientations and self-reported alliance quality. Endorsement of cognitive-behavioral orientations, in turn, correlated positively with therapist-reported alliance quality. The results are discussed in terms of the extent to which attachment dimensions should be considered in therapists' understandings of their therapeutic alliances.
Leavy, Patricia G.
This paper discusses N. B. Ralph's (1980) four stages of development for the novice therapist, focusing on the fourth stage (therapists become aware of their own feelings and reactions to the therapeutic process) through the author's experience in therapy. The therapist as client is discussed according to Karen Horney's classification of neurotic…
Full Text Available BACKGROUND: Experimental psychology has only recently provided supporting evidence for Freud's and Janet's description of unconscious phenomena. Here, we aimed to assess whether specific abilities, such as personal psychodynamic experience, enhance the ability to recognize unconscious phenomena in peers - in other words, to better detect implicit knowledge related to individual self-experience. METHODOLOGY AND PRINCIPAL FINDINGS: First, we collected 14 videos from seven healthy adults who had experienced a sibling's cancer during childhood and seven matched controls. Subjects and controls were asked to give a 5-minute spontaneous free-associating speech following specific instructions created in order to activate a buffer zone between fantasy and reality. Then, 18 raters (three psychoanalysts, six medical students, three oncologists, three cognitive behavioral therapists and three individuals with the same experience of trauma were randomly shown the videos and asked to blindly classify them according to whether the speaker had a sibling with cancer using a Likert scale. Using a permutation test, we found a significant association between group and recognition score (ANOVA: p = .0006. Psychoanalysts were able to recognize, above chance levels, healthy adults who had experienced sibling cancer during childhood without explicit knowledge of this history (Power = 88%; p = .002. In contrast, medical students, oncologists, cognitive behavioral therapists and individuals who had the same history of a sibling's cancer were unable to do so. CONCLUSION: This experiment supports the view that implicit recognition of a subject's history depends on the rater's specific abilities. In the case of subjects who did have a sibling with cancer during childhood, psychoanalysts appear better able to recognize this particular history.
relation to his very successful brother. The fact that he will soon have to start his career is also an ongoing stressor. Non-dynamic factors. A family history of depression points towards the likely contribution of genetic factors in the etiology of his depression. Psychodynamic explanation. • Personality structure. “P” is a sensitive ...
In her book 'An Unquiet Mind' the psychologist Kay Jamison gives a moving ... Department of Psychiatry, University of Pretoria, Weskoppies Hospital, Pretoria, South Africa. Abstract: This ... psychodynamic formulation is unfortunately seldom incorporated in the psychiatric presentation of patients; guidelines are therefore ...
A treatment model is described by which psychodynamic clinicians can guide parents to become the primary change agents when their child is the identified patient. Three cases are presented where brief treatment, in which guided clinical interventions were largely carried out by the parents, led to sustained improvement in the child. Advantages of the approach and clinical issues regarding tis application are discussed.
Chui, Harold; Hill, Clara E; Kline, Kathryn; Kuo, Patty; Mohr, Jonathan J
Studies on therapist factors have mostly focused on therapist traits rather than states such as affect. Research related to therapist affect has often looked at therapist baseline well-being or therapist reactions, but not both. Fifteen therapists and 51 clients rated pre- and postsession affect, as well as postsession working alliance and session quality, for 1,172 sessions of individual psychotherapy at a community clinic. Therapists' affect became more positive when clients were initially positive and when clients became more positive over the session, and became more negative when clients were initially negative and when clients became more negative over the session. Furthermore, when therapists were initially positive in affect and when therapists became more positive over the session, clients rated the session quality to be high. Conversely, when therapists were initially negative in affect and when therapists became more negative over the session, clients rated the session quality and working alliance low. On open-ended questions, therapists reported mood shifts in 67% of sessions (63% positive, 50% negative). Positive affect change was attributed to collaborating with the client, perceiving the client to be engaged, or being a good therapist. Negative affect change was attributed to having a difficult client, perceiving the client to be in distress, or being a poor therapist. Thus, therapist state affect at presession and change in affect across a session may independently contribute to the process and outcome of therapy sessions. The examination of within-therapist variables over the course of therapy may further our understanding of therapist factors. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Full Text Available The technology for evaluating patient-provider interactions in psychotherapy-observational coding-has not changed in 70 years. It is labor-intensive, error prone, and expensive, limiting its use in evaluating psychotherapy in the real world. Engineering solutions from speech and language processing provide new methods for the automatic evaluation of provider ratings from session recordings. The primary data are 200 Motivational Interviewing (MI sessions from a study on MI training methods with observer ratings of counselor empathy. Automatic Speech Recognition (ASR was used to transcribe sessions, and the resulting words were used in a text-based predictive model of empathy. Two supporting datasets trained the speech processing tasks including ASR (1200 transcripts from heterogeneous psychotherapy sessions and 153 transcripts and session recordings from 5 MI clinical trials. The accuracy of computationally-derived empathy ratings were evaluated against human ratings for each provider. Computationally-derived empathy scores and classifications (high vs. low were highly accurate against human-based codes and classifications, with a correlation of 0.65 and F-score (a weighted average of sensitivity and specificity of 0.86, respectively. Empathy prediction using human transcription as input (as opposed to ASR resulted in a slight increase in prediction accuracies, suggesting that the fully automatic system with ASR is relatively robust. Using speech and language processing methods, it is possible to generate accurate predictions of provider performance in psychotherapy from audio recordings alone. This technology can support large-scale evaluation of psychotherapy for dissemination and process studies.
Xiao, Bo; Imel, Zac E; Georgiou, Panayiotis G; Atkins, David C; Narayanan, Shrikanth S
The technology for evaluating patient-provider interactions in psychotherapy-observational coding-has not changed in 70 years. It is labor-intensive, error prone, and expensive, limiting its use in evaluating psychotherapy in the real world. Engineering solutions from speech and language processing provide new methods for the automatic evaluation of provider ratings from session recordings. The primary data are 200 Motivational Interviewing (MI) sessions from a study on MI training methods with observer ratings of counselor empathy. Automatic Speech Recognition (ASR) was used to transcribe sessions, and the resulting words were used in a text-based predictive model of empathy. Two supporting datasets trained the speech processing tasks including ASR (1200 transcripts from heterogeneous psychotherapy sessions and 153 transcripts and session recordings from 5 MI clinical trials). The accuracy of computationally-derived empathy ratings were evaluated against human ratings for each provider. Computationally-derived empathy scores and classifications (high vs. low) were highly accurate against human-based codes and classifications, with a correlation of 0.65 and F-score (a weighted average of sensitivity and specificity) of 0.86, respectively. Empathy prediction using human transcription as input (as opposed to ASR) resulted in a slight increase in prediction accuracies, suggesting that the fully automatic system with ASR is relatively robust. Using speech and language processing methods, it is possible to generate accurate predictions of provider performance in psychotherapy from audio recordings alone. This technology can support large-scale evaluation of psychotherapy for dissemination and process studies.
Locati, Francesca; Rossi, Germano; Parolin, Laura
Several authors have identified a bidirectional link between patient metacognitive functioning and the therapeutic alliance. Specifically, metacognition might be enhanced by a positive alliance with the clinician, whereas metacognitive deficits might impede the alliance. Interestingly, the therapist's technical interventions might influence both therapeutic alliance and metacognitive functioning. However, little is known about the interactions between these dimensions. The aim of the present study is to explore these interactions more fully in the earliest phase of the therapeutic process. Participants included 24 patients and 12 therapists in training. The Metacognition Assessment Scale-Revised, Collaborative Interaction Scale, and Psychodynamic Intervention Rating Scale were employed in the first three sessions of psychotherapy. Sequential analyses revealed that different therapist interventions co-occurred with three different levels of the therapeutic alliance: A first level characterized by a positive collaboration, a second characterized by a neutral collaboration, and a third characterized by ruptures. Importantly, the patient's metacognitive functioning was found to mediate the relationship between the therapeutic intervention and the therapeutic alliance in the positive and neutral levels of collaboration but not in the ruptures one. These findings suggest that a specific interdependence exists among the therapeutic alliance, technical intervention, and metacognitive functioning. Clinical or methodological significance of this article: From a methodological standpoint, the originality of the present study lies in the combination of an interactionist approach, which conceives process factors as interrelated dimensions interacting in non-additive and often nonlinear ways, with analyses at both micro- and macro-analytic levels (i.e., sequential and mediation analyses). From a theoretical standpoint, findings of the present study indicate that specific
Ventegodt, Søren; Kandel, Isack; Merrick, Joav
Sexual transference and countertransference can make therapy slow and inefficient when libidinous gratification becomes more important for both the patient and the therapist than real therapeutic progress. Sexual transference is normal when working with a patient's repressed sexuality, but the therapeutic rule of not touching often hinders the integration of sexual traumas, as this needs physical holding. So the patient is often left with sexual, Oedipal energies projected onto the therapist as an "idealized father" figure. The strong and lasting sexual desire for the therapist without any healing taking place can prolong therapy for many years, as it often does in psychodynamic psychotherapy and psychoanalysis. We call this problem "Freud's Trap". Freud used intimate bodywork, such as massage, in the beginning of his career, but stopped, presumably for moral and political reasons. In the tradition of psychoanalysis, touch is therefore not allowed. Recent research in clinical holistic medicine (CHM), salutogenesis, and sexual healing has shown that touch and bodywork (an integral part of medicine since Hippocrates) are as important for healing as conversational therapy. CHM allows the patient to regress spontaneously to early sexual and emotional traumas, and to heal the deep wounds on body, soul, and sexual character from arrested psychosexual development. CHM treats sexuality in therapy more as the patient's internal affair (i.e., energy work) and less as a thing going on between the patient and the therapist (i.e., transference). This accelerates healing, and reduces sexual transference and the need for mourning at the end of therapy.
Clinical suggests that partners of psychotherapy patients often have powerful feelings about the therapy and therapist. The repercussions of psychotherapy on those close to the patient are rarely considered. A small exploratory study was therefore conducted. All patients who had completed at least two months of weekly psychodynamic psychotherapy in 1990 at an out-patient unit of a psychiatric hospital (n = 35) and had a partner with whom they were living at the time of starting therapy (n = 23) were contacted. Eight gave permission for their partner to be contacted directly. All eight partners agreed to participate in a semi-structured interview exploring their perceptions of the effects of the therapy on a number of family relationships. The impact of the process of the study was also investigated by means of a questionnaire sent to all partners some weeks after the interview. Considerable changes were perceived to have taken place in association with therapy affecting not only the relationship between the couple but also their parenting relationship, the children, and at time members of the extended family. Partner's views about the direction of such changes seemed to influence other perceptions about the therapy. The repercussions of individual psychotherapy may well spread extensively within a family. This further blurs the boundary between individual and family therapy, both theoretically and clinically. Research procedures are themselves a major intervention and may have a considerable emotional impact on participants.
Decker, Suzanne E.; Nich, Charla; Carroll, Kathleen M.; Martino, Steve
Background Few measures exist to examine therapist empathy as it occurs in session. Aims A nine-item observer rating scale, called the Therapist Empathy Scale (TES), was developed based on Watson’s (1999) work to assess affective, cognitive, attitudinal, and attunement aspects of therapist empathy. The aim of this study was to evaluate the inter-rater reliability, internal consistency, and construct and criterion validity of the TES. Method Raters evaluated therapist empathy in 315 client sessions conducted by 91 therapists, using data from a multi-site therapist training trial (Martino et al., 2010) in Motivational Interviewing (MI). Results Inter-rater reliability (ICC = .87 – .91) and internal consistency (Cronbach’s alpha = .94) were high. Confirmatory factor analyses indicated some support for single-factor fit. Convergent validity was supported by correlations between TES scores and MI fundamental adherence (r range .50 –.67) and competence scores (r range .56 – .69). Discriminant validity was indicated by negative or nonsignificant correlations between TES and MI-inconsistent behavior (r range .05 – −.33). Conclusions The TES demonstrates excellent inter-rater reliability and internal consistency. Results indicate some support for a single-factor solution and convergent and discriminant validity. Future studies should examine the use of the TES to evaluate therapist empathy in different psychotherapy approaches and to determine the impact of therapist empathy on client outcome. PMID:23481373
Karg, O; Bubulj, C; Esche, B; Geiseler, J; Bonnet, R; Mäder, I
Because of the expected significant growth in the elderly population and respiratory diseases, the topic of "delegation of physician's duties" is of increasing importance to the German health-care system. In 2004 the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP)) established the new profession: respiratory therapist. A curriculum was defined which offers training for certified nurses and physiotherapists. Respiratory therapists evaluate, treat, document and care for patients with pulmonary disorders. Under appropriate supervision a licensed respiratory therapist performs some of the work previously done by physicians at the same quality of care. The first respiratory therapists have finished their professional training in Germany. Most of these respiratory therapists are now employed in hospital-based positions requiring their specific skills. Generally, the increased medical responsibility and the increased degree of decision-making possibilities associated with the new profession contribute to a better job satisfaction. However, this is not yet true for all the newly employed respiratory therapists. Only few of the new graduate respiratory therapists were awarded higher salaries. It is a strongly recommendation to the heads of medical departments and the human resources managers of hospitals that they should recognise the increased qualifications of nurses and physiotherapists who become respiratory therapists by appropriate remuneration.
Full Text Available Orientation: The researchers constructed a Systems Psychodynamic Wellness Model (SPWM by merging theory and concepts from systems psychodynamics and positive psychology. They then refined the model for application in organisations during a Listening Post (LP that comprised experienced subject experts.Research purpose: The purpose of the research was to construct and refine the SPWM in order to understand psychological wellness at the individual, group and organisational levels.Motivation for the study: There is no psychological wellness model that integrates the principles of systems psychodynamics and positive psychology. Systems psychodynamics traditionally focuses on so-called negative behaviour whilst positive psychology tends to idealise positive behaviour. This research tried to merge these views in order to apply them to individual, group and organisational behaviour.Research design, approach and method: The researchers used qualitative, descriptive and conceptual research. They conducted an in-depth literature study to construct the model. They then refined it using the LP.Main findings: The researchers identified 39 themes. They categorised them into three different levels. Three first-level themes emerged as the highest level of integration: identity, hope and love. The nine second-level themes each consisted of three more themes. They were less complex and abstract than the first-level themes. The least complex 27 third-level themes followed.Practical/managerial implications: One can apply the SPWM as a qualitative diagnostic tool for understanding individual, group and organisational wellness and for consulting on systemic wellness.Contribution/value-add: The SPWM offers a model for understanding individual, group and organisational wellness and for consulting on systemic wellness.
Shear, M K; Cooper, A M; Klerman, G L; Busch, F N; Shapiro, T
Current psychiatric research on panic disorder and its treatment are heavily influenced by neurobiological and cognitive-behavioral models rather than psychodynamic propositions, and psychodynamic treatment is generally considered to be of little benefit in amelioration of symptoms. However, because neither of the current models fully explains the clinical psychopathology, etiology, or pathogenesis of panic disorder, there is a need for further model building. The authors suggest that a psychodynamic approach may add to the understanding of patients with panic disorder. They base their psychodynamic formulation on pilot interviews with nine patients with panic disorder, published reports of psychological characteristics of patients with panic disorder, and data from infant and animal research on temperament. Interview results included the following: 1) all of the patients described themselves as fearful, nervous, or shy as children, 2) they remembered their parents as angry, frightening, critical, or controlling, 3) they frequently indicated discomfort with aggression, 4) most described chronic feelings of low self-esteem, 5) their spouses were characterized as passive, kind, and nonaggressive, and 6) stressors associated with frustration and resentment preceded the onset of panic. The authors propose a model in which inborn neurophysiological irritability predisposes to early fearfulness. Exposure to parental behaviors that augment fearfulness results in disturbances in object relations and persistence of conflicts between dependence and independence, which predispose to fears of feeling trapped, suffocated, and unable to escape and/or feeling alone and unable to get help. Catastrophic fears of helplessness in the face of suffocation or abandonment are easily accessible.(ABSTRACT TRUNCATED AT 250 WORDS)
Full Text Available Orientation: The researcher described the systems psychodynamics of boundary management in organisations. The data showed how effective boundary management leads to good holding environments that, in turn, lead to containing difficult emotions.Research purpose: The purpose of the research was to produce a set of theoretical assumptions about organisational boundaries and boundary management in organisations and, from these, to develop a set of hypotheses as a thinking framework for practising consulting psychologists when they work with boundaries from a systems psychodynamic stance.Motivation for the study: The researcher used the belief that organisational boundaries reflect the essence of organisations. Consulting to boundary managers could facilitate a deep understanding of organisational dynamics.Research design, approach and method: The researcher followed a case study design. He used systems psychodynamic discourse analysis. It led to six working hypotheses.Main findings: The primary task of boundary management is to hold the polarities of integration and differentiation and not allow the system to become fragmented or overly integrated. Boundary management is a primary task and an ongoing activity of entire organisations.Practical/managerial implications: Organisations should work actively at effective boundary management and at balancing integration and differentiation. Leaders should become aware of how effective boundary management leads to good holding environments that, in turn, lead to containing difficult emotions in organisations.Contribution/value-add: The researcher provided a boundary-consulting framework in order to assist consultants to balance the conceptual with the practical when they consult.
Curt Fleck, H
psychical area, no real improvement is obtained by psychoanalytic measures. Also, if one should succeed in transferring the patients in the acute state to a mental therapist in spite of the rapid reduction of their somatic pain complex, the prognosis for the more functionally concerned ones would then be burdened cosiderably by the long period of difficult differentiation against the largely somatic progression of the discs.
The family therapist performs specific activities associated with his functions as a therapist, consultant, and intermediary. The intermediary function is based upon concepts associated with symbolic interactionism. (Author)
Walker, Anne Nehlig; Barry, Tammy D.; Bader, Stephanie H.
The current study examined whether both parents and therapists perceived changes in adaptive social behaviors in children with an autism spectrum disorder (ASD) following a summer treatment camp. Participants included 12 children (11 male, 1 female; 83% Caucasian; aged 3-7 years) diagnosed with an ASD who attended a 4-week summer camp designed to…
Tasca, Giorgio A; Foot, Meredith; Leite, Catherine; Maxwell, Hilary; Balfour, Louise; Bissada, Hany
This mixed method systematic case study applied an interpersonal stage model of the therapeutic process to examine interpersonal processes among a highly adherent Group Psychodynamic-Interpersonal Psychotherapy (GPIP) therapist and a highly adherent Group Cognitive Behavioral Therapy (GCBT) therapist and their groups of binge eating disordered (BED) patients. This is the first case study to apply the interpersonal stage model of psychotherapy to compare GCBT and GPIP methods and the first to apply the model to group therapy. Early-, middle-, and late-stage transcribed video recordings of sequential interactions among therapists and patients in each of these two time-limited group therapies were analyzed with the Structural Analysis of Social Behavior (SASB). We also provide qualitative presentations of the transcripts from each stage as context for the quantitative analyses. BED patients in both groups achieved positive outcomes for binge eating and depression. Consistent with their treatment model, the GPIP therapist was more autonomy-giving, whereas the GCBT therapist was more controlling/directive. The GPIP therapist and her group had high levels of interpersonal complementary interaction sequences in the early stage followed by lower complementarity in the middle stage. The GCBT therapist and her group showed a high-low-high pattern of complementarity across the three stage of therapy. However, overall the GPIP group had higher levels complementarity than the GCBT group. This mixed method case study of group processes based on an interpersonal stage model of psychotherapy suggested specific therapist behaviors in each modality to maximize positive therapeutic interactions at each stage of group therapy. (c) 2011 APA, all rights reserved.
It has long been known that the rate of depression is high among women with infants and young children. In recent research a psychodynamic therapy group was found to be beneficial for a self-selected, postnatal subgroup of women who were of middle socio-economic status (SES), educated and who met DSM-IV criteria for clinical or subclinical depression. The current study sought to replicate these findings with individual psychodynamic therapy and to compare outcomes for three psychodynamic treatment conditions: individual, group, and combined individual and group. Patients began and left treatment from each of the three psychodynamic therapy conditions on a self-determined basis. Pre- and postintervention DSM-IV Global Assessment of Functioning (GAF) were obtained by reliable blind raters. A ten-variable, self-administered postintervention outcome questionnaire provided further data. Women (n = 58) in all three therapeutic conditions showed statistically significant improvement in their pre-to-post GAF and large treatment effects. On the questionnaire, they indicated that they were affected positively by all three conditions. Statistically significant differences among treatment conditions favored the individual treatment. Psychodynamic therapy appears well suited for the population of women in this study, especially when administered on an individual basis. The model employed here emphasized receiving and developing empathic emotional attunement, insight into one's relationships and early experiences, and a process for expressing feelings and resolving problems. Compared to group and combination therapies, the individual treatment may afford the greatest opportunity for receiving and developing these features and, thus, the best outcomes.
Pellegrini, Dario W.
This paper reflects the author's journey into an area of psychology which is not dominant in Educational Psychology discourse, namely psychodynamic psychology. Two psychodynamic mechanisms, namely splitting and projection are explained, and then the author describes and critiques how these mechanisms have proved useful in his practice. Two case…
Two cases of attempted suicide by adolescents, following the separation from an idealised first sexual partner, are presented to illustrate psychodynamic issues often overlooked in clinical assessment. Absent fathers and father figures and other psychodynamic issues are explored. Journal of Child and Adolescent Mental ...
This article aims to describe the difference between descriptive and dynamic psychiatry. As part of the latter every psychiatrist should be able to construct a psychodynamic formulation. A psychodynamic formulation, an indication of psychological mindedness, helps the psychiatrist to recognize the unique, personal aspects ...
Old men are overrepresented in the whole of all suicides. In contrast, only very few elderly men find their way to specialised treatment facilities. Elderly accept psychotherapy more rarely than younger persons. Therefore presentations on the psychodynamics of suicidality in old men are rare and mostly casuistical. By means of a stepwise reconstructable qualitative case comparison of five randomly chosen elderly suicidal men with ideal types of suicidal (younger) men concerning biography, suicidal symptoms and transference, psychodynamic hypothesis of suicidality in elderly men are developed. All patients came into psychotherapy in a specialised academic out-patient clinic for psychodynamic treatment of acute and chronic suicidality. The five elderly suicidal men predominantly were living in long-term, conflictuous sexual relationships and also had ambivalent relationships to their children. Suicidality in old age refers to lifelong existing intrapsychic conflicts, concerning (male) identity, self-esteem and a core conflict between fusion and separation wishes. The body gets a central role in suicidal experiences, being a defensive instance modified by age and/or physical illness, which brings up to consciousness aggressive and envious impulses, but also feelings of emptiness and insecurity, which have to be warded off again by projection into the body. In transference relationships there are on the one hand the regular transference, on the other hand an age specific turned around transference, with their counter transference reactions. The chosen methodological approach serves the systematic finding of hypotheses with a higher degree in evidence than hypotheses generated from single case studies. Georg Thieme Verlag KG Stuttgart - New York.
Ingram, Douglas H
In practice, the classroom teaching of sequentially developing elements of theory and practice in psychodynamic psychiatry to hardworking residents can founder on residents' frequent absences, on-call pages, late arrivals, and early departures. These obstacles can be partially overcome by focusing narrowly on topics that can be explored within the length of a single lecture. Introduction to dynamic psychiatry can be accomplished in this teaching milieu through application of pedagogical techniques of humor, sharply delineated case material, surprise, group participation, demonstrated immediacy of application, theater, and an avoidance of arcane terminology or nuanced theoretical differences.
Kivlighan, Dennis M; Gelso, Charles J; Ain, Stacie; Hummel, Ann M; Markin, Rayna D
The relationship between treatment progress (as rated by both clients and therapists) and real relationship (also rated by both clients and therapists) was decomposed into between-therapist and within-therapist (between-client) effects and analyzed using the actor-partner interdependence model. We reanalyzed a subset of the data, 12 therapists and 32 clients, from Gelso et al.'s (2012) study of brief, theoretically diverse outpatient treatment. Consistent with and extending previous research, clients whose therapists provided higher average levels of client-perceived real relationship across the clients treated by a given therapist had better progress ratings from both themselves and their therapists. Within each therapist's caseload, differences between clients in client- or therapist-rated real relationship were unrelated to either client- or therapist-rated outcome. Clients whose therapists provided higher average levels of therapist-perceived real relationship, across the clients treated by the therapist, had worse progress ratings from the therapists. The results provide additional evidence for the importance of between-therapist differences in therapeutic relationship qualities, both client and therapist rated. (c) 2015 APA, all rights reserved).
CHALLENGING PROBLEMS OF HYPERTENSION MANAGEMENT: THE EFFECT OF INCREASED HEART RATE AND COMORBIDITIES ON THE CHOICE OF ANTIHYPERTENSIVE THERAPY IN PRACTICE OF CARDIOLOGIST AND THERAPIST. The Conclusion of the Expert Council
G. P. Arutyunov
Full Text Available The conclusion of the Expert Council "Challenging problems of hypertension management: the effect of increased heart rate and comorbidities on the choice of antihypertensive therapy in practice of cardiologist and therapist" is presented. Topical issues of hypertensive patient’s treatment, the role of heart rate in hypertension and ways to influence it are considered. The possibility of treatment of hypertensive patients with trandolapril/verapamil SR fixed combination is analyzed separately. The data on the clinical efficacy and protective effects of trandolapril/verapamil SR fixed combination are presented.
Reviews the book, Psychodynamic diagnostics manual (PDM) by Alliance of Psychoanalytic Organizations (2006). This volume is divided into three major sections, Part 1--Classification of Adult Mental Heath Disorder, Part 2--Classification of Child and Adolescent Mental Health Disorder, and Part 3--Conceptual and Research Foundations for a Psychodynamically Based Classification System for Mental Health Disorders. Unlike the standard DSM which highlights the patient's presenting symptom (Axis I) with secondary consideration given to an underlying personality disorder (Axis II), the major thesis of classification scheme of this volume is that diagnostic evaluation should provide a more patient centered and a more clinically useful picture of the individual by understanding the symptom(s) through the essential dimensions of the patient's personality and mental functions (interpersonal and cognitive capacities). Part 3, which could stand on its own as a separate volume, is a thorough critique of psychotherapy outcome research in which the authors delineate how major design flaws have derived from "favoring what is measurable over what is meaningful." The authors cogently demonstrate that diagnostic assessment is a continuous effort toward providing individualized and clinically relevant evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Full Text Available Sexual transference and countertransference can make therapy slow and inefficient when libidinous gratification becomes more important for both the patient and the therapist than real therapeutic progress. Sexual transference is normal when working with a patient's repressed sexuality, but the therapeutic rule of not touching often hinders the integration of sexual traumas, as this needs physical holding. So the patient is often left with sexual, Oedipal energies projected onto the therapist as an “idealized father” figure. The strong and lasting sexual desire for the therapist without any healing taking place can prolong therapy for many years, as it often does in psychodynamic psychotherapy and psychoanalysis. We call this problem “Freud's Trap”. Freud used intimate bodywork, such as massage, in the beginning of his career, but stopped, presumably for moral and political reasons. In the tradition of psychoanalysis, touch is therefore not allowed. Recent research in clinical holistic medicine (CHM, salutogenesis, and sexual healing has shown that touch and bodywork (an integral part of medicine since Hippocrates are as important for healing as conversational therapy. CHM allows the patient to regress spontaneously to early sexual and emotional traumas, and to heal the deep wounds on body, soul, and sexual character from arrested psychosexual development. CHM treats sexuality in therapy more as the patient’s internal affair (i.e., energy work and less as a thing going on between the patient and the therapist (i.e., transference. This accelerates healing, and reduces sexual transference and the need for mourning at the end of therapy.
Tanzilli, Annalisa; Colli, Antonello; Del Corno, Franco; Lingiardi, Vittorio
The aim of this study was to examine the stability of the factor structure and psychometric properties of the Therapist Response Questionnaire (Betan, Heim, Zittel Conklin, & Westen, 2005; Zittel Conklin & Westen, 2003), a clinician report instrument able to measure the clinician's emotional reactions to the patient in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 332) of psychodynamic and cognitive-behavioral orientation completed the Therapist Response Questionnaire, as well as the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999a, 1999b), to assess personality disorders and level of psychological functioning, regarding a patient currently in their care. They also administered the Symptom Checklist-90-Revised (Derogatis, 1994) to the patients. Exploratory and confirmatory factor analyses revealed 9 distinct countertransference factors that were similar to 8 dimensions identified in the original version of the measure: (a) helpless/inadequate, (b) overwhelmed/disorganized, (c) positive/satisfying, (d) hostile/angry, (e) criticized/devalued, (f) parental/protective, (g) special/overinvolved, (h) sexualized, and (i) disengaged. These scales showed excellent internal consistencies and good validity. They were especially able to capture the quality and intensity of emotional states that therapists experience while treating personality-disordered patients, as well as to better differentiate them; additionally, they tapped into the complexity of clinicians' reactions toward patients experiencing severe psychiatric symptomatology. Results seem to confirm that Therapist Response Questionnaire is a valid and reliable instrument that allows to evaluate patterns of countertransference responses in clinically sensitive and psychometrically robust ways, regardless of therapists' orientations. The clinical and research implications of these findings are addressed. (c) 2016 APA, all rights reserved).
Full Text Available This theoretical article makes a contribution to the field of psychoanalytically informed neuroscience. First, central characteristics of psychoanalysis and neuroscience are briefly described leading into three epistemic dichotomies. Neuroscience versus psychoanalysis display almost opposing methodological approaches (reduction vs. expansion, test quality emphases (reliability vs. validity and meaning of results (correlation vs. explanation. The critical point is to reach an intermediate level: in neuroscience an adequate position integrating both aspects – objective and subjective – of dual-aspect monism, and in psychoanalysis the appropriate level for the scientific investigation of its central concepts. As a suggestion to reach that level in both fields the system of Operationalized Psychodynamic Diagnosis (OPD; OPD Task Force, 2008 is presented. Combining aspects of both fields, expansion and reduction as well as reliability and validity, OPD could be a fruitful tool to transfer psychodynamic constructs into neuroscience. The article closes with a short description of recent applications of OPD in neuroscience.
Frühauf, Sarah; Figlioli, Patrick; Caspar, Franz
In psychotherapy, therapist and patient influence each other constantly. We aimed to investigate how therapists respond to patient impression management and influence tactics. For 60 videotaped intake interviews, judges rated therapist responses to patient tactics as neutral, desired, or undesired from the patient perspective. Judges rated the therapist responses in 57% as neutral, in 40% as desired, and in 2% as undesired by the patients. The proportions of response outcomes varied across tactics. Therapist responses were unrelated to therapist and patient sex. Therapist experience was related to their responses to the tactic Supplication. Overall, some patient tactics seem to be more challenging for therapists than others. Awareness of such response tendencies can help therapists prepare their reactions to certain patient impression management and influence tactics. Implications for training and research are presented.
Full Text Available This paper aims to critically review the role of a psychodynamic psychologist integrated in a community outpatient clinic of a Psychiatric Department. It describes the characteristics of a psychodynamic intervention that is complementary to the psychiatric approach while sharing a common goal –the suffering patient – and enhancing the knowledge and understanding of several domains like psychopathology, diagnosis, treatment, rehabilitation and integration. Furthermore it describes how the use of Psychological Assessment led to the formulation of specific individual psychotherapies, spanning 14 years of clinical practice. The paper concludes with some considerations regarding the integration of Psychodynamic Psychology in a multidisciplinary mental health team, addressing issues such as the boundaries between technical characteristics, the appropriateness of language to other disciplines and psychodynamic implications of the different features of this clinical setting.
Delgado, Sergio V.
The treatment of children and adolescents with psychotherapy is gradually losing ground to psychopharmacology. The author reviews the value the various forms of psychotherapy have in the treatment of children and the importance of having a clear curriculum for teaching this skill in residency programs. Although the importance of psychodynamic psychotherapy has a long history in the treatment of children, the reluctance some faculty have in recommending this form of therapy may be due to limited experience and limited knowledge of its benefits. The author highlights that a psychodynamic diagnostic evaluation is essential to assess a child’s suitability for psychotherapy. The characteristics of children who will benefit from psychodynamic psychotherapy, their defense mechanisms, and optimal characteristics of their parents are reviewed. The qualifications a psychiatrist needs to succeed in this endeavor are discussed. Two cases illustrate not only the importance in the suitability of the patient, but also the application of psychodynamic theory to practice. PMID:19727254
Schafer, D Sue
The nature of managerial work in the commercial sector has not been studied since the 1970s, and little is known about the work of managers in the health care sector. In this study, the perceived importance of managerial role and skill categories among 3 groups of physical therapists were studied to better understand the work priorities of physical therapist managers. Two groups of subjects were physical therapist managers in hospitals or private practices. A third group consisted of faculty members in professional physical therapist education programs. Respondents (n=343) rated the importance of 75 managerial activities. Responses related to 16 predetermined work categories were placed in rank order by group. A multivariate analysis of variance (MANOVA) was used to identify differences among groups. All groups identified communication, financial control, entrepreneur, resource allocator, and leader as the 5 most important categories and rated technical expert and figurehead as least important. The MANOVA showed differences between faculty members and private practice managers in 15 work categories, between hospital-based managers and private practice managers in 9 categories, and between faculty members and hospital-based managers in 8 categories. Work setting appears to have an impact on level of importance placed on managerial work categories. The strongest candidates for "universal" physical therapist managerial work categories were communication, financial control, and resource allocator.
Walsh, Kenneth; Campbell, Steven; Ashby, Michael; Procter, Susan
In this article, we explore how the application of organizational psychodynamic theories might improve the understanding of unconscious forces influencing apparently rational and evidence-based processes such as the generation and implementation of health policy. There is a growing body of literature using psychodynamic theories to explore discontinuities in policy-making and the containment of anxiety in organizations. In this article, we focus on the dyadic relationship between policy forma...
Lorentzen, S; Ruud, T
Group therapy is used extensively within public mental health services, but more detailed knowledge is needed. All 25 health authorities in Norway were invited to describe their groups: theory, primary tasks, interventions, structure, patients and therapists. Four hundred twenty-six groups, 296 in community mental health centres and 130 in hospitals, were categorized into nine types, based on theoretical background. Psychodynamic groups were most frequent, followed by cognitive-behavioural, psycho-educative, social skills/coping and art/expressive groups. Weekly sessions of 90 min and treatment duration 12 months was most frequent. Main diagnosis for 2391 patients: depression (517), personality disorder (396), schizophrenia/psychosis (313) and social phobia (249). Patients with depression or personality disorder were mostly in psychodynamic groups, psychosis/bipolar disorder in psycho-educative groups. Cognitive-behavioural groups were used across several diagnoses. Most therapists were nurses, only 50% had a formal training in group therapy. There is a plethora of groups, some based on one theoretical school, while others integrate theory from several 'camps'. Patients with similar diagnosis were offered different group approaches, although some trends existed. More research evidence from regular clinical groups is needed, and clinician-researcher networks should be developed. More group therapists with formal training are needed. © 2013 John Wiley & Sons Ltd.
Moyers, Theresa B; Miller, William R
One of the largest determinants of client outcomes is the counselor who provides treatment. Therapists often vary widely in effectiveness, even when delivering standardized manual-guided treatment. In particular, the therapeutic skill of accurate empathy originally described by Carl Rogers has been found to account for a meaningful proportion of variance in therapeutic alliance and in addiction treatment outcomes. High-empathy counselors appear to have higher success rates regardless of theoretical orientation. Low-empathy and confrontational counseling, in contrast, has been associated with higher drop-out and relapse rates, weaker therapeutic alliance, and less client change. The authors propose emphasis on empathic listening skills as an evidence-based practice in the hiring and training of counselors to improve outcomes and prevent harm in addiction treatment. PsycINFO Database Record (c) 2013 APA, all rights reserved.
Full Text Available This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y, self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS of the SF-36 Health Survey. The potential moderator (M alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20 at pre-treatment and the predictor (X the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients’ alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists’ alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome (p < 0.05: a stronger alliance in the therapists’ perspective was beneficial for the outcome only for patients scoring above 61 on the TAS-20. This moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9 as a covariate to the moderation model. The results underline the importance of a good therapists’ view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.
Wallace, E R
Many writers have commented on the lack of Freud's usual level of logic and powers of persuasion in Moses and Monotheism. The majority attribute it to the significance of dynamic determinants in Freud himself--most notably, identification with Moses. Fromm (1972) says "one must assume that Freud's preoccupation with Moses was rooted in the deep unconscious identification with him" (p. 79). Unfortunately, the situation is much more complex. Although many pertinent observations have been made, what is needed is a detailed dissection of the text, a correlation with elements from Freud's personal life, and an overall psychoanalytic synthesis of the data. This paper makes a beginning in that direction, incorporating the ideas of other investigators with those of the author--but it is hoped that much more detailed analysis and biographical correlation will follow. There is a wealth of information about Freud in Moses and Monotheism and no one paper will exhaust it. In this examination no attempt will be made to evaluate Moses and Monotheism for its literary, psychohistorical, or scientific merit. The focus is on the psychodynamic determinants of Freud's essay.
Cameron, P M
Historical approaches of psychotherapy for depression are contrasted with current psychotherapeutic strategies. Now more strategies are focused, structured, time-limited, observable, testable, researchable and data based. The following depressive syndromes are reviewed in terms of the literature that demonstrates the effectiveness of psychotherapy: major depressive disorder, bipolar depressive disorder, depression associated with medical illness such as cancer, myocardial infarction and stroke, resistant depression post-traumatic stress disorder, grief reactions and depression during adolescence, mid-life and the geriatric period of the life cycle. A conceptual model favoring tripartite focus of intervention is recommended. Psychodynamic psychotherapy for depression must consider intrapsychic, interpersonal and family dynamics as well as social supports. A model for each population needs to be studied and developed further. Recommendations for current research are suggested. In the individual modification of psychotherapeutic approaches we must consider the varying maturity of ego defenses and the ego strength of the individual patient. Forty well-designed studies that demonstrate the effectiveness of psychotherapy in the depressive syndromes are quoted in this paper.
Beretta, Véronique; Despland, Jean-Nicolas; Drapeau, Martin; Michel, Luc; Kramer, Ueli; Stigler, Michael; de Roten, Yves
This study examines how patients' relationship patterns are reenacted with the therapist during the first sessions of psychotherapy. Forty (N = 40) outpatients treated with a Brief Psychodynamic Intervention were included in the study. Their narratives of relationship episodes with significant others (e.g., mother, father, romantic partner, colleagues) were compared with relationship episodes with their therapist using the Core Conflictual Relationship Theme method. The Core Conflictual Relationship Theme focuses on 3 aspects of patients' relationship narratives: what the patient wants from others or from self; how others react to his/her wish; and how the patient consequently reacts. Results showed that 60% of patients display similar relationship patterns with their therapist and with significant others. The patterns that were reenacted with the therapist were not the most pervasive ones but were similar to those found in relationship episodes involving parents or romantic partners. These findings provide some support for the clinical concept of repetition of internalized relational patterns with the therapist very early in psychotherapy. Clinical implications are discussed.
It has recently become evident that bipolar disorder exists in children and adolescents. The criteria for making the diagnosis of juvenile bipolar disorder (JBD) are in the process of being proposed for the fifth edition of the Diagnostic and Statistical Manual (DSM-V). In adults, a criterion for bipolar disorder is excessive involvement in pleasurable activities including hypersexuality. Recently, some clinicians and researchers have suggested that hypersexuality be included as a criterion for JBD as well. Although abnormal sexuality has been reported to be present in some youth thought to have JBD, the reason for this association is not yet clear. Hypersexuality may be primary and intrinsic to bipolar disorder in youth, secondary and associated with it as the result of psychosocial influences or psychodynamic factors, or due to general aggression and disruptive behavior. Not only have developmental psychosocial factors that may influence sexuality in children and adolescence not been fully investigated, but psychodynamic influences have been omitted from modern etiological constructs as well. This report discusses the importance of psychosocial and psychodynamic influences on the sexual experience and activity of bipolar children. It is proposed that a developmental, psychodynamically informed model is helpful in understanding sexuality in children and adolescents with bipolar disorder. It is also suggested that assessment of psychosocial and psychodynamic influences on the sexuality of bipolar children is necessary in order to adequately assess whether hypersexuality should be a criterion of bipolar disorder in youth.
Amira, Stephen; Abramowitz, Stephen I.
Undergraduates viewed a simulated therapy segment presented on four videotapes varying in traditionalism of the therapist's attire and office. Ratings of attraction were independent of therapist attire. Subjects' impressions were largely unaffected by office arrangements. Data refute formulations assigning therapist accoutrements a major role in…
Skaife, Sally; Jones, Kevin.; Pentaris, Panagiotis
This article reports the findings of a Likert scale survey that was sent to past graduates of the MA Art Psychotherapy, Goldsmiths, University of London asking them about the relevance of their experience in the Art Therapy Large Group (ATLG) to their subsequent employment as art therapists or work in another capacity. The ATLG comprises all the students and staff in a psychodynamically based experiential group that meets six times during the year. Survey questions were drawn from previously ...
Midgley, Nick; Cregeen, Simon; Hughes, Carol; Rustin, Margaret
This article presents a psychodynamic approach to understanding and treating adolescent depression, based largely on the manual for short-term psychoanalytic psychotherapy (STPP) for adolescents (11-17 years old) with moderate to severe depression, developed for the IMPACT Study from Great Britain. Although the authors make reference to longer-term psychodynamic treatments, the 28-session model (plus 7 sessions of parent/carer work) used in the IMPACT Study informs the psychodynamic approach presented herein. In the course of discussing the analytical framework for depression and the treatment, a single case study is presented throughout to graphically illustrate the clinical course and outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.
Diguer, Louis; Gamache, Dominick; Laverdière, Olivier
The aim of this study was to report on the development and the initial validation of the Object Relations Rating Scale (ORRS), which is a measure of in-session enactments of object relations that draws on a psychodynamic conceptualization of personality organization. Forty participants were included in the study, distributed among neurotic, borderline and psychotic personality organizations (PO). Results showed that the interrater reliability of this new measure is good. Two tests of criterion validity support the validity of the measure: the ORRS discriminates well between the three PO groups and it correlates in expected ways with five PO dimensions. Finally, ORRS scales that pertain to the degree of in-session object relation enactments correlated with a measure of transference intensity (convergent validity), and correlations with therapists experience were low as expected (discriminant validity).
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... guilt and difficulties with trust, intimacy and safety. This approach highlights the subjective experience of unexpected violence-induced trauma that overwhelms the ego and produces a state of helplessness. Psychodynamic phenomena, such as regression, defenses and the inner world of the adolescent are discussed in ...
The article reviews the literature on the psychodynamics of suicide, focusing on factors that will help in evaluating and treating the young suicidal patient. Articles published in refereed journals and books and book chapters based on such articles are the source of most of the material. Articles that first brought a new finding to notice are given preference. Methodological limitations and contradictions with the data of other studies are pointed out. The psychodynamic meaning of suicide for a patient derives from both affective and cognitive components. Rage, hopelessness, despair, and guilt are important affective states in which young patients commit suicide. The meanings of suicide can be usefully organized around the conscious (cognitive) and unconscious meanings given to death by the suicidal patient: death as reunion, death as rebirth, death as retaliatory abandonment, death as revenge, and death as self-punishment or atonement. Knowledge of the psychodynamics helps to distinguish which patients with any given diagnosis are at risk for suicide. Such knowledge is essential to the psychotherapeutic treatment of the young suicidal patient. Topics for future research include the role of anxiety in suicide; the capacity to bear hopelessness, rage, and other unpleasant affects without regression; the use of particular defense mechanisms in distinguishing the risk of either suicidal or violent behavior; and the relation of specific psychodynamic conflicts seen in suicidal patients to particular psychiatric diagnoses.
Elmes, Michael B.; Gemmill, Gary
Uses psychodynamic perspective to explore tendency of small groups to regress to group mindlessness, where critical thinking is sluggish and individual differences are suppressed. Discusses dynamics of small group mindlessness and the emergence of dissenter role. Suggests ways of enhancing group mindfulness. (Author/TE)
Cornelis, Shana; Desmet, Mattias; Van Nieuwenhove, Kimberly L. H. D.; Meganck, Reitske; Willemsen, Jochem; Inslegers, Ruth; Feyaerts, Jasper
The classical symptom specificity hypothesis (Blatt, 1974) particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; see Chapter 2) documented obsessional pathology to be rooted in profound ambivalences between autonomous and dependent interpersonal dynamics. Therefore, in the present empirical case study, concrete operationalizations of the classical symptom specificity hypothesis are contrasted to alternative hypotheses based on the observed complexities in Chapter 2. Dynamic associations between obsessional symptoms and interpersonal functioning is further explored, aiming at further contribution to theory building (i.e., through suggestions for potential hypothesis-refinement; Stiles, 2009). Similar to the first empirical case study (Chapter 1), Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of supportive-expressive psychodynamic therapy. In line with findings from Chapter 1, findings reveal close associations between obsessions and interpersonal dynamics, and therapist interventions focusing on interpersonal conflicts are documented as related to interpersonal and symptomatic alterations. Observations predominantly accord to the ambivalence-hypothesis rather than to the classical symptom specificity hypothesis. Yet, meaningful differences are observed in concrete manifestations of interpersonal ambivalences within significant relationships. Findings are again discussed in light of conceptual and methodological considerations; and limitations and future research indications are addressed. PMID:28649214
Cornelis, Shana; Desmet, Mattias; Van Nieuwenhove, Kimberly L H D; Meganck, Reitske; Willemsen, Jochem; Inslegers, Ruth; Feyaerts, Jasper
The classical symptom specificity hypothesis (Blatt, 1974) particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; see Chapter 2) documented obsessional pathology to be rooted in profound ambivalences between autonomous and dependent interpersonal dynamics. Therefore, in the present empirical case study, concrete operationalizations of the classical symptom specificity hypothesis are contrasted to alternative hypotheses based on the observed complexities in Chapter 2. Dynamic associations between obsessional symptoms and interpersonal functioning is further explored, aiming at further contribution to theory building (i.e., through suggestions for potential hypothesis-refinement; Stiles, 2009). Similar to the first empirical case study (Chapter 1), Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of supportive-expressive psychodynamic therapy. In line with findings from Chapter 1, findings reveal close associations between obsessions and interpersonal dynamics, and therapist interventions focusing on interpersonal conflicts are documented as related to interpersonal and symptomatic alterations. Observations predominantly accord to the ambivalence-hypothesis rather than to the classical symptom specificity hypothesis. Yet, meaningful differences are observed in concrete manifestations of interpersonal ambivalences within significant relationships. Findings are again discussed in light of conceptual and methodological considerations; and limitations and future research indications are addressed.
Wiltink, Jörg; Hoyer, Jürgen; Beutel, Manfred E.; Ruckes, Christian; Herpertz, Stephan; Joraschky, Peter; Koranyi, Susan; Michal, Matthias; Nolting, Björn; Pöhlmann, Karin; Salzer, Simone; Strauss, Bernhard
Objectives Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. Research Design and Methods In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. Results Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. Conclusions We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. Trial Registration Controlled-trials.com/ISRCTN53517394 PMID:26785255
Gazzillo, Francesco; Lingiardi, Vittorio; Del Corno, Franco; Genova, Federica; Bornstein, Robert F; Gordon, Robert M; McWilliams, Nancy
The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses. A parental and disengaged response was associated with the depressive, anxious, and dependent personality disorders; an exclusively parental response with the phobic personality disorder; and a parental and criticized response with narcissistic disorder. Dissociative disorder evoked a helpless and parental response in the treating clinicians whereas somatizing disorder elicited a disengaged reaction. An overwhelmed and disengaged response was associated with sadistic and masochistic personality disorders, with the latter also associated with a parental and hostile/criticized reaction; an exclusively overwhelmed response with psychopathic patients; and a helpless response with paranoid patients. Finally, patients with histrionic personality disorder evoked an overwhelmed and sexualized response in their clinicians whereas there was no specific emotional reaction associated with the schizoid and the obsessive-compulsive disorders. Clinical implications of these findings were discussed. (c) 2015 APA, all rights reserved).
Full Text Available Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT. No study has addressed which patient variables predict outcome of PDT for social anxiety disorder.In the largest multicenter trial on psychotherapy of social anxiety (SA to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems and outcome was analysed using logistic and linear regressions.Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems with a limited proportion of incremental variance (5.5 to 10 percent, while, e.g., shame, self-esteem or harm avoidance did not.We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research.Controlled-trials.com/ISRCTN53517394.
Wiltink, Jörg; Hoyer, Jürgen; Beutel, Manfred E; Ruckes, Christian; Herpertz, Stephan; Joraschky, Peter; Koranyi, Susan; Michal, Matthias; Nolting, Björn; Pöhlmann, Karin; Salzer, Simone; Strauss, Bernhard; Leibing, Eric; Leichsenring, Falk
Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. Controlled-trials.com/ISRCTN53517394.
Full Text Available The classical symptom specificity hypothesis (Blatt, 1974 particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; see Chapter 2 documented obsessional pathology to be rooted in profound ambivalences between autonomous and dependent interpersonal dynamics. Therefore, in the present empirical case study, concrete operationalizations of the classical symptom specificity hypothesis are contrasted to alternative hypotheses based on the observed complexities in Chapter 2. Dynamic associations between obsessional symptoms and interpersonal functioning is further explored, aiming at further contribution to theory building (i.e., through suggestions for potential hypothesis-refinement; Stiles, 2009. Similar to the first empirical case study (Chapter 1, Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of supportive-expressive psychodynamic therapy. In line with findings from Chapter 1, findings reveal close associations between obsessions and interpersonal dynamics, and therapist interventions focusing on interpersonal conflicts are documented as related to interpersonal and symptomatic alterations. Observations predominantly accord to the ambivalence-hypothesis rather than to the classical symptom specificity hypothesis. Yet, meaningful differences are observed in concrete manifestations of interpersonal ambivalences within significant relationships. Findings are again discussed in light of conceptual and methodological considerations; and limitations and future research indications are addressed.
Taylor, Graeme J
Although Freud considered castration to be one of the two major anxieties of human life, the castration complex has been relatively neglected in contemporary psychoanalytic writing and is insufficiently discussed in presentations of clinical cases. This article discusses the relevance of the concept to contemporary psychoanalysis and psychodynamic psychotherapy, in particular the important contributing role of castration conflicts in the pathogenesis of a wide range of clinical symptoms. The author begins by briefly reviewing some classical and contemporary psychoanalytic ideas about castration to show how the concept has broadened and is currently used not only to signify fear of damage to or loss of the genital, but also metaphorically to indicate a threat to or loss of any valued human characteristic or function. He outlines Brenner's distinction between castration anxiety and castration depression, and reviews the role of childhood trauma in intensifying castration conflicts. He then illustrates the clinical application of these ideas by describing aspects of his psychotherapeutic work with three male patients who presented with a variety of symptoms and distressing psychological experiences that were gradually resolved through the analysis of underlying castration anxiety and/or castration depression. Although castration anxiety is frequently intermingled with separation anxiety, the author concludes that with many traumatized patients castration conflicts are in the foreground and the therapist needs to focus on the patient's proneness to humiliation, powerlessness, and shame.
Clopton, James R.; Haydel, Jill
Psychologists (N=236) rated the desirability of various levels of eight therapist characteristics, including sex, for the optimal therapist for the presented case. Optimal ratings indicated that subjects thought it desirable for the therapist and the client to be of the same sex. (Author)
Jung, Esther; Wiesjahn, Martin; Rief, Winfried; Lincoln, Tania M
The quality of therapeutic alliance is a consistent and stable predictor of therapy outcome. Recent studies have shown therapist characteristics to be relevant predictors of the alliance in psychological therapies in general. However, little is known about the specific therapist characteristics that explain differences in therapeutic alliance in cognitive behavioural therapy for psychosis (CBTp). The aim of this study was to identify relevant therapist characteristics that predict early therapeutic alliance in CBTp. Forty-eight patients with a DSM-IV diagnosis of a psychotic disorder participating in a CBTp trial and 11 therapists were included in the analysis. Therapist characteristics as perceived by the patients (empathy, genuineness, positive regard, competence, and convincingness) were assessed at baseline. Alliance was assessed after the fifth therapy session. Data were analyzed using bivariate correlations and multivariate hierarchic regression analysis. All therapist characteristics were positively associated with patient-rated alliance. Patient characteristics were not significantly associated with alliance and did not predict alliance in the multivariate analysis. Regression analysis revealed therapist genuineness and competence to significantly predict higher patient-rated alliance. Our results suggest that perceived therapist genuineness is the most relevant predictor of patient-rated therapeutic alliance in CBTp. Future trials using control samples with other mental disorders could clarify whether this finding is specific to CBTp. Therapist training concepts for increasing beneficial therapist qualities are needed. The patients' perception of the therapist as empathic, genuine, accepting, competent and convincing is associated with therapeutic alliance in CBTp. Perceived therapist genuineness and competence are the most relevant predictors of patient-rated therapeutic alliance. Training and supervision should focus on increasing basic therapist
Pec, Ondrej; Bob, Petr; Pec, Jan; Hrubcova, Adela
The purpose of this study was to test whether a psychodynamically based group psychotherapeutic programme might improve symptoms, social functions, or quality of life in patients with schizophrenia spectrum disorders and to investigate factors that might predict clinical improvement or dropouts from the programme. A quantitative prospective cohort study. We have investigated 81 patients with schizophrenia spectrum disorders who participated in a 9-month psychodynamically based psychotherapeutic day programme. The patients were assessed at the beginning and end of the programme, and then at 1-year follow-up. The assessment included psychotic manifestations (HoNOS), quality of life (WHOQOL-BREF), demographic data, and daily doses of medication. 21 patients dropped out from the programme, and 46 patients succeeded in undergoing follow-up assessment. The psychotic manifestations (self-rating version of HoNOS) and quality of life measured with WHOQOL-BREF (domains of social relationships and environment) were significantly improved at the end of the programme and at follow-up. However, the manifestations on the version for external evaluators of HoNOS were improved only at follow-up. Years of psychiatric treatment, number of hospitalizations or suicide attempts, and experience of relationships with a partner were negatively related to clinical improvement, whereas symptom severity, current working, or study activities were related positively. The results show that a group psychodynamic programme may improve the clinical status and quality of life of patients with schizophrenia spectrum disorders. This type of programme is more beneficial for patients with higher pre-treatment symptom severity and the presence of working or study activities. A psychodynamically based group programme improves the clinical status and quality of life in patients with schizophrenia spectrum disorders. Data indicate that changes on the subjective level are detectable by the end of the
Nash, David A; Friedman, Jay W; Kardos, Thomas B; Kardos, Rosemary L; Schwarz, Eli; Satur, Julie; Berg, Darren G; Nasruddin, Jaafar; Mumghamba, Elifuraha G; Davenport, Elizabeth S; Nagel, Ron
In 1921, New Zealand began training school dental nurses, subsequently deploying them throughout the country in school-based clinics providing basic dental care for children. The concept of training dental nurses, later to be designated dental therapists, was adopted by other countries as a means of improving access to care, particularly for children. This paper profiles six countries that utilise dental therapists, with a description of the training that therapists receive in these countries, and the context in which they practice. Based on available demographic information, it also updates the number of dental therapists practising globally, as well as the countries in which they practice. In several countries, dental therapy is now being integrated with dental hygiene in training and practice to create a new type of professional complementary to a dentist. Increasingly, dental therapists are permitted to treat adults as well as children. The paper also describes the status of a current initiative to introduce dental therapy to the United States. It concludes by suggesting that dental therapists can become valued members of the dental team throughout the world, helping to improve access to care and reducing existing disparities in oral health.
Meystre, Claudia; Pascual-Leone, Antonio; de Roten, Yves; Despland, Jean-Nicolas; Kramer, Ueli
A variation of task analysis was used to build an empirical model of how therapists may facilitate client assimilation process, described in the Assimilation of Problematic Experiences Scale. A rational model was specified and considered in light of an analysis of therapist in-session performances (N = 117) drawn from six inpatient therapies for depression. The therapist interventions were measured by the Comprehensive Psychotherapeutic Interventions Rating Scale. Consistent with the rational model, confronting interventions were particularly useful in helping clients elaborate insight. However, rather than there being a small number of progress-related interventions at lower levels of assimilation, therapists' use of interventions was broader than hypothesized and drew from a wide range of therapeutic approaches. Concerning the higher levels of assimilation, there was insufficient data to allow an analysis of the therapist's progress-related interventions.
Hara, Kimberley M; Aviram, Adi; Constantino, Michael J; Westra, Henny A; Antony, Martin M
Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients' subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist-client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients' ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist's caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.
Fishkin, Ralph; Fishkin, Lana; Leli, Ubaldo; Katz, Barbara; Snyder, Elise
For several years, the China American Psychoanalytic Alliance (CAPA) has provided treatment, training, and supervision to Chinese mental health professionals over the Internet. The lack of Chinese analysts and mentors has created an intense demand for psychodynamic psychotherapy training and treatment that CAPA is addressing using Skype™ and other distance communication technologies. This article describes the project, its history, scope, and activities, and the experiences of CAPA teachers and clinicians in exploring and developing the usefulness and power of this very new teaching method. Some particular characteristics of Chinese culture have become apparent as a result of the teaching experience. Aspects of the transference and countertransference that are shaped by the virtual nature of the technology are discussed, using case material. Our hope is that, in helping to train our Chinese students in psychodynamic psychotherapy, they will go on to train future generations of clinicians. This model of teaching and training could also be applied in other underserved areas.
Dybbroe, Betina; Hansson, Birgitte
be made accessible methodologically and methodically by combining a psychodynamic approach with an autoethnographic approach. The methodical question is therefore how the researcher can conduct introspection and at the same time reflect upon and analyse the central object of investigation. The approach......This article takes the stance that the subjectivity of the researcher is an integral part of the research process. It should be studied as a key to understanding the interrelational processes of meaning in an interview situation. The article demonstrates how the subjectivity of the researcher can...... is psychoanalytically informed, but autoethnography became the actual vehicle for moving beyond reflections on the psychodynamics represented in the texts. The researcher ventured into an introspection of not only the texts, but also her own feelings, fantasies, and bodily experiences at the time of the interview...
Heikkilä, J; Karlsson, H; Taiminen, T; Lauerma, H; Ilonen, T; Leinonen, K-M; Wallenius, E; Virtanen, H; Heinimaa, M; Kaljonen, A; Salokangas, R K R
The aim of this study was to relate measures of psychoanalytically derived personality traits to descriptive diagnosis and psychopathology in severe mental disorders. Sixty-one consecutive first-episode patients with schizophrenia, bipolar disorder and severe major depression were interviewed. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP) and compared with the DSM-IV diagnosis and symptom clusters derived from the BPRS. There were no marked differences in personality traits between the three diagnostic groups, between schizophrenia and affective disorders or between psychotic and non-psychotic illness. However, personality traits had significant associations with symptoms, especially with the emotional retardation cluster. Our findings do not support the hypothesis that severe mental disorders would differ from each other in terms of long-standing psychodynamic personality profiles. Certain dysfunctional personality traits may predict especially negative emotional symptoms and possibly also predispose a person to them.
Campo, Marc A.; Weiser, Sherri; Koenig, Karen L.
Background: Job stress has been associated with poor outcomes. In focus groups and small-sample surveys, physical therapists have reported high levels of job stress. Studies of job stress in physical therapy with larger samples are needed. Objective: The purposes of this study were: (1) to determine the levels of psychological job demands and job control reported by physical therapists in a national sample, (2) to compare those levels with national norms, and (3) to determine whether high demands, low control, or a combination of both (job strain) increases the risk for turnover or work-related pain. Design: This was a prospective cohort study with a 1-year follow-up period. Methods: Participants were randomly selected members of the American Physical Therapy Association (n=882). Exposure assessments included the Job Content Questionnaire (JCQ), a commonly used instrument for evaluation of the psychosocial work environment. Outcomes included job turnover and work-related musculoskeletal disorders. Results: Compared with national averages, the physical therapists reported moderate job demands and high levels of job control. About 16% of the therapists reported changing jobs during follow-up. Risk factors for turnover included high job demands, low job control, job strain, female sex, and younger age. More than one half of the therapists reported work-related pain. Risk factors for work-related pain included low job control and job strain. Limitations: The JCQ measures only limited dimensions of the psychosocial work environment. All data were self-reported and subject to associated bias. Conclusions: Physical therapists’ views of their work environments were positive, including moderate levels of demands and high levels of control. Those therapists with high levels of demands and low levels of control, however, were at increased risk for both turnover and work-related pain. Physical therapists should consider the psychosocial work environment, along with other
Kowalski, Christopher; Bhalla, Ruchi
The Disney movie Frozen is the fifth highest grossing movie of all time. In order to better understand this phenomenon and to hypothesize as to why the movie resonated so strongly with audiences, we have interpreted the movie using psychodynamic theory. We pay particular attention to the themes of puberty, adolescence and sibling relationships and discuss examples of ego defenses that are employed by the lead character in relation to these concepts.
Malancharuvil, Joseph M
Empathic difficulty is a highly consequential characteristic of antisocial personality structure. The origin, maintenance, and possible resolution of this profound deficit are not very clear. While reconstructing empathic ability is of primary importance in the treatment of antisocial personality, not many proven procedures are in evidence. In this article, the author offers a psychodynamic formulation of the origin, character, and maintenance of the empathic deficiency in antisocial personality. The author discusses some of the treatment implications from this dynamic formulation.
Nissen-Lie, Helene A; Havik, Odd E; Høglend, Per A; Monsen, Jon T; Rønnestad, Michael Helge
Research suggests that the person of the psychotherapist is important for the process and outcome of psychotherapy, but little is known about the relationship between therapists' personal experiences and the quality of their therapeutic work. This study investigates 2 factors (Personal Satisfactions and Personal Burdens) reflecting therapists' quality of life that emerged from the self-reports of a large international sample of psychotherapists (N = 4,828) (Orlinsky & Rønnestad, 2004, 2005) using the Quality of Personal Life scales of the Development of Psychotherapists Common Core Questionnaire (Orlinsky et al., 1999). These factors were investigated as predictors of alliance levels and growth (using the Working Alliance Inventory) rated by both patients and therapists in a large (227 patients and 70 therapists) naturalistic outpatient psychotherapy study (Havik et al., 1995). The Personal Burdens scale was strongly and inversely related to the growth of the alliance as rated by the patients, but was unrelated to therapist-rated alliance. Conversely, the factor scale of therapists' Personal Satisfactions was clearly and positively associated with therapist-rated alliance growth, but was unrelated to the patients' ratings of the alliance. The findings suggest that the working alliance is influenced by therapists' quality of life, but in divergent ways when rated by patients or by therapists. It seems that patients are particularly sensitive to their therapists' private life experience of distress, which presumably is communicated through the therapists' in-session behaviors, whereas the therapists' judgments of alliance quality were positively biased by their own sense of personal well-being.
Xiao, Henry; Hayes, Jeffrey A; Castonguay, Louis G; McAleavey, Andrew A; Locke, Benjamin D
Although dropout from psychotherapy has received substantial attention, the impacts of nonattendance on client outcome across a course of psychotherapy have not been well researched. All in-person psychotherapy treatments require clients to actually attend sessions to generate positive symptomatic results, and missed sessions have at least a time and financial cost. Furthermore, it is plausible that therapist differences exist for client attendance rates. The present study examined impacts of nonattendance, particularly early in a course of treatment, comparing the effects of canceled and no-showed appointments on overall symptom reduction and rate of change while accounting for therapist effects. Using multilevel hierarchical regression, the impact of nonattendance on symptom reduction and rate of change was modeled on 5,253 clients (67.2% female, 72.3% white) across 83 therapists gathered from a practice research network. Results suggested that no-shows, but not cancellations, had negative impacts on the magnitude and rate of symptom change, with larger effects when occurring before the third session. Therapist effects on attendance also were identified; therapists varied greatly on nonattendance percentages of their clients after the third attended session. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Nissen-Lie, Helene A; Rønnestad, Michael Helge; Høglend, Per A; Havik, Odd E; Solbakken, Ole Andrè; Stiles, Tore C; Monsen, Jon T
There are reasons to suggest that the therapist effect lies at the intersection between psychotherapists' professional and personal functioning. The current study investigated if and how the interplay between therapists' (n = 70) professional self-reports (e.g., of their difficulties in practice in the form of 'professional self-doubt' and coping strategies when faced with difficulties) and presumably more global, personal self-concepts, not restricted to the professional treatment setting (i.e., the level of self-affiliation measured by the Structural Analysis of Social Behaviour (SASB) Intrex, Benjamin, ), relate to patient (n = 255) outcome in public outpatient care. Multilevel growth curve analyses were performed on patient interpersonal and symptomatic distress rated at pre-, post- and three times during follow-up to examine whether change in patient outcome was influenced by the interaction between their therapists' level of 'professional self-doubt' and self-affiliation as well as between their therapists' use of coping when faced with difficulties, and the interaction between type of coping strategies and self-affiliation. A significant interaction between therapist 'professional self-doubt' (PSD) and self-affiliation on change in interpersonal distress was observed. Therapists who reported higher PSD seemed to evoke more change if they also had a self-affiliative introject. Therapists' use of coping strategies also affected therapeutic outcome, but therapists' self-affiliation was not a moderator in the interplay between therapist coping and patient outcome. A tentative take-home message from this study could be: 'Love yourself as a person, doubt yourself as a therapist'. Copyright © 2015 John Wiley & Sons, Ltd. The findings of this study suggest that the nature of therapists' self-concepts as a person and as a therapist influences their patients' change in psychotherapy. These self-concept states are presumably communicated through the therapists
Driesssen, E.; Van Henricus, L.; Schoevers, R.A.; Cuijpers, P.; van Aalst, G.; Don, F.J.; Hendriksen, M.; Kool, S.; Molenaar, P.J.; Peen, J.; Dekker, J.J.M.
Background: Previous research has shown that Short Psychodynamic Supportive Psychotherapy (SPSP) is an effective alternative to pharmacotherapy and combined treatment (SPSP and pharmacotherapy) in the treatment of depressed outpatients. The question remains, however, how Short Psychodynamic
This article considers how a framework for understanding group and organisational behaviour, systems-psychodynamics, can be utilised by educational psychologists taking up an organisational consultancy role to work with schools as whole systems. It outlines the three main theories that constitute a systems-psychodynamic perspective and considers…
... good supportive shoes, like sneakers, when using crutches. Learning by Playing Kids learn by playing, so physical therapists often have toys for kids to use. You might find balls, benches, swings, slides, and sometimes even interactive video games in a pediatric therapy gym. Kids can have ...
... therapists help people of all ages with different speech and language disorders. Here are some of them: articulation (say: ar-tik-yuh-LAY-shun) disorders: This when a kid has trouble saying certain sounds or saying words correctly. "Run" might come out ...
De Vries, Dawn R.
The work of occupational (OT), physical (PT), and recreational therapists (RT), as well as speech- language pathologists (SLP), is interrelated and requires effective teamwork and collaboration to optimize patient outcomes and satisfaction. Literature shows that health care professionals are ill prepared to work in an interprofessional manner due…
... feel better. Therapists do their work mainly by listening to and talking with kids. Different types of ... it! — a therapist can help them learn the skills to solve it, do better, and feel better. ...
Fisher, Craig D
Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosure of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions.
Full Text Available The paper focuses on the essentials of psychoanalytic process and change and the question of how the neural correlates and mechanisms of psychodynamic psychotherapy can be investigated. The psychoanalytic approach aims at enabling the patient to remember, repeat and work through concerning explicit memory. Moreover, the relationship between analyst and patient establishes a new affective configuration which enables a reconstruction of the implicit memory. If psychic change can be achieved it corresponds to neuronal transformation.Individualized neuro-imaging requires controlling and measuring of variables that must be defined. Two main methodological problems can be distinguished: The design problem addresses the issue of how to account for functionally related variables in an experimentally independent way. The translation problem raises the question of how to bridge the gaps between different levels of the concepts presupposed in individualized neuro-imaging (e.g. the personal level of the therapist and the client, the neural level of the brain.An overview of individualized paradigms, which have been used until now is given, including Operationalized Psychodynamic Diagnosis (OPD-2 and the Maladaptive Interpersonal Patterns Q-Start (MIPQS. The development of a new paradigm that will be used in fMRI experiments, the Interpersonal Relationship Picture Set (IRPS, is described. Further perspectives and limitations of this new approach concerning the design and the translation problem are discussed.
Coen, S J
To avoid the passions of love and hate between them, therapists and patients construct and preserve negative barriers of angry criticism, dissatisfaction, and sadomasochism. This review aims to help therapists tolerate and work with loving feelings between patient and therapist for the benefit of the patient.
Full Text Available Orientation: Followers’ experiences of leadership in their organisations were qualitatively explored and described from a systems psychodynamic perspective. The findings revealed a very negative view on how leadership treats followership, and that leadership is seen as inconsistent.Research purpose: The purpose of the research was to describe followership’s experiences of organisational leadership from a systems psychodynamic perspective.Motivation for the study: Organisational leadership is under tremendous pressure to perform and often under attack, especially if they do not appear to be caring and supportive. The research was planned to better understand the unconscious nature of this phenomenon.Research design, approach and method: Qualitative, descriptive research was used. Data was collected through psychodynamic Listening Posts and analysed using discourse analysis. Working hypotheses were formulated per theme and integrated into the research hypothesis.Main findings: Six themes manifested, namely a negative leadership view; idealisation of the past and blaming the present; obsession with race and gender; constantly changing identity; unfinished business and the future; and cope and hope.Practical/managerial implications: Leadership seem to focus more on business than followership issues which leads to followers feeling disregarded and de-authorised. As a result followers withhold authorisation from leadership which may be instrumental in leaderships’ difficulties to manage change and transformation effectively. Leadership development needs to incorporate the self-authorisation of leaders as well as the invitation of authorisation by leaders.Contribution/value-add: The data would be useful to leadership towards understanding, repairing and optimising their relationships and organisational impact through people.
Full Text Available Orientation: The researcher applied role analysis from the systems psychodynamic perspective to executives in state departments to improve their awareness of the unconscious diversity dynamics that affect their roles.Research purpose: The purpose of this research was to describe the application of systems psychodynamic role analysis and to determine its trustworthiness in assisting executives to work effectively with conscious and unconscious diversity dynamics in their organisations.Motivation for the study: Executives generally struggle to understand the deeper meaning of diversity behaviour that manifests inside and around them, leading to conflict. Without understanding the unconscious meaning of the behaviour, organisations founder easily. Awareness of below-the-surface behaviour leads to insight and taking responsibility for diversity-related behaviours.Research design, approach and method: The researcher coached six executives in South African state departments over a period of 10 months. The coaching addressed and analysed the executives’ organisational roles. She analysed the data using discourse analysis.Main findings: Themes relating to the diversity dynamics of gender, race, ethnicity, authority, disability, language, age, de-authorisation of diversity work and the coaching process emerged. The coaching assisted the executives to gain insights into below-the-surface diversity dynamics, to address diversity in a sustained manner and to take up their organisational roles more effectively.Practical/managerial implications: Coached executives will have a more objective and dynamic experience of diversity issues that manifest in organisations, between colleagues and within themselves.Contribution/value-add: Executive coaching from a systems psychodynamic perspective displays trustworthiness in improving participants’ diversity awareness, especially with regard to gender, race, ethnicity and authorisation.
Rubin, John S; Greenberg, Maurice
Psychogenic voice disorders are not infrequently encountered in the busy voice clinic. A clinician-friendly psychodynamic model and a multidisciplinary management approach are presented which have proven helpful for our voice team and our patients. In essence the formulation revolves around an "event" occurring, which may be either organic or psychological in nature. The ensuing dysphonia then leads to emotional consequences which in turn have physical consequences on the vocal tract. The situation can become reinforcing and illness behaviors develop. Elucidating this event/process to the patient improves the likelihood of a successful long-term outcome. The diagnostic and management roles of the various team members are discussed.
Li, Thomas Cheuk Wing
This article discusses the psychodynamic factors behind the popularity of one form of Internet activity, online social networking (SN). It views online SN as an extension of the social self, organized in a way that is more controllable than real life relating. The SN platforms reward its users with reassuring surfaces and novel self-object experiences while at the same time induces much anxiety. The addictive quality of online SN is understood in the context of collapse of dialectical space and the defensive use of this technology.
Spermon, Deborah; Darlington, Yvonne; Gibney, Paul
Complex trauma describes that category of severe, chronic interpersonal trauma usually originating in the formative years of a child. In the adult, this can result in global dissociative difficulties across areas of cognitive, affective, somatic, and behavioral functions. Targeting this field of traumatic pathology, this article reviews the contributions and developments within one broad approach: psychodynamic theory and practice. Brief descriptions of aspects of analytical, Jungian, relational, object relations, and attachment therapeutic approaches are given, along with understandings of pathology and the formulation of therapeutic goals. Major practices within client sessions are canvassed and the issues of researching treatment outcomes are discussed.
René van Eeden
Full Text Available Orientation: Globalisation and accelerating rates of change characterise the work environment.Research purpose: The aim of this research was to study the impact of the change process at a plant of a South African production company.Motivations for the study: Problems were experienced in terms of production and a need for transformation at different levels was expressed. Co-dependence in the environment necessitated exploration of intra-organisational dynamics.Research design, approach and method: The study focused on the management team at a specifc plant, but by applying the systems psychodynamic perspective it was possible to also explore the mutual effect of relationships with other systems in the organisation, the company as a whole and the environment. Respondents included the directors of manufacturing and of human resources, the general manager, an 11-member management team and staff representatives. Semi-structured one-to-one interviews, group interviews and a group consultation session were held.Main findings: Hypotheses were formulated regarding the change experienced in the company, the overemphasis of control in the various systems, efforts to move from dependency to interdependence, personal authority as a requirement for interdependent functioning and problems with interrelatedness.Practical/managerial implications: The study illustrates the application of the systems psychodynamic approach in exploring the interaction between and mutual infuence of various organisational systems, especially in times of change.Contribution/value add: At a broader level, the study contributes to the understanding of the application of the theory as well as suggesting the use of a methodology. Recommendations for an intervention of this nature were also made.
Full Text Available Clinical holistic medicine (CHM has developed into a system that can also be helpful with mentally ill patients. CHM therapy supports the patient through a series of emotionally challenging, existential, and healing crises. The patient’s sense of coherence and mental health can be recovered through the process of feeling old repressed emotions, understanding life and self, and finally letting go of negative beliefs and delusions. The Bleuler's triple condition of autism, disturbed thoughts, and disturbed emotions that characterizes the schizophrenic patient can be understood as arising from the early defense of splitting, caused by negative learning from painful childhood traumas that made the patient lose sense of coherence and withdraw from social contact. Self-insight gained through the therapy can allow the patients to take their bodily, mental, and spiritual talents into use. At the end of therapy, the patients are once again living a life of quality centered on their life mission and they relate to other people in a way that systematically creates value. There are a number of challenges meeting the therapist who works with schizophrenic and psychotic patients, from the potential risk of experiencing a patient's violence, to the obligation to contain the most difficult and embarrassing of feelings when the emotional and often also sexual content of the patient’s unconsciousness becomes explicit. There is a long, well-established tradition for treating schizophrenia with psychodynamic therapy, and we have found that the combination of bodywork and psychotherapy can enhance and accelerate the therapy and might improve the treatment rate further.
Hegarty, Angela M
Drs. Simopoulos and Cohen argue that knowledge of one's unconscious processes improves the forensic psychiatrist's capacity to manage complex forensic situations and to generate forensic formulations and opinions that are demonstrably more valid and reliable, much like competence in cultural assessment and formulation. In practice, the challenges posed by the application of these principles in forensic settings are far outweighed by the potential benefit. Forensic practice is informed by many specialties. Forensic psychiatrists do not have to complete full training in these disciplines to make use of the knowledge and perspectives they offer. The same may not be true of psychodynamic assessment and formulation. Although much can be learned from supervision, case seminars, conferences, and reading, such knowledge does little to foster awareness of one's unconscious processes that by definition operate outside awareness and thus contribute to the vitiating effect of bias. To date, the only method whereby psychiatrists can effectively come to appreciate their own unconscious processes in action is arguably through their own analysis conducted in the course of training in analysis or psychodynamic psychotherapy. © 2015 American Academy of Psychiatry and the Law.
Full Text Available Orientation: Organisational bullying experiences manifest themselves as an intense unconscious systemic dynamic involving the bully, the victim and the organisational culture. The relatedness between the objects is characterised by valences and mutual defence mechanisms such as splitting, projection and projective identification.Research purpose: The purpose of this research was to describe organisational bullying experiences from the system psychodynamic perspective.Motivation for the study: Individual psychology tends to simplify organisational bullying by focussing on the bully’s symptomatic behaviour. Systems psychodynamic thinking focuses on the behavioural dynamics in the relationship between the bully and victim, and the relatedness of both with the organisational system.Research design, approach and method: Qualitative and descriptive research, using six participants as case studies, was undertaken. Data was gathered through Free Association Narrative Interviewing and analysed using discourse analysis.Main findings: Three themes manifested themselves, namely, snakes and hyenas, a complex interconnected dyad, and the institutionalisation of bullying. The research hypothesis integrating these three themes was presented.Practical/managerial implications: In resolving organisational bullying Industrial Organisational psychologists need to pursue this phenomenon not only in terms of its symptoms, but in a holistic, systemic and role related manner addressing all of its parts.Contribution/value-add: The systemic understanding of organisational bullying implies the complexity of studying the behaviour of all parts – the bully, the victim, their dyadic relationship as well as how bullying is institutionalised in the organisational setting, climate and culture.
Full Text Available Orientation: The unconscious impact of organisational transformation is often neglected and even denied. This research revealed the manifestation and impact of high levels and different forms of anxiety experienced by employees during transformation.Research objective: The objective was to study and describe the manifesting systems psychodynamic behaviour amongst support staff during organisational transformation.Motivation for the study: Organisational transformation is mostly researched from a leadership viewpoint. Little research data are available on the experiences of support staff on the receiving end of decisions about and implementation of transformation.Research design, approach and method: A qualitative approach within the phenomenological hermeneutic interpretive stance was used. The research was set in a government organisation. A semi-structured interview with four conveniently and purposefully chosen support staff members was thematically analysed using systems psychodynamics as theoretical paradigm.Main findings: Four themes manifested, namely de-authorisation and detachment, being bullied and seduced by leadership, the organisation in the mind as incompetent, and a dangerous and persecutory system. In the discussion, the basic assumptions and relevant constructs are interpreted.Practical implications: Understanding the transformation experiences of support staff could assist the industrial psychologist to facilitate appropriate support in coaching more junior staff towards increasing wellness and work performance.Contribution: Organisational transformation is highlighted as an anxiety provoking experience especially on the lower levels of the organisation. Its potentially deep and complex psychological impact could possibly derail parts of the system if not managed in a psychologically contained manner.
In a time when manic-depressive disease became bipolar disorder, and it is conceptualized and treated almost as a fully medical illness, such as epilepsy, we found worth returning to some psychodynamic aspects underlying this condition. Conventionally, we depart from the concept of melancholy, to introduce in a second time, the mania, as a liberating solution of the depression. To Abraham (1912), mania is the liberation from suffering imposed by the reality principle For Freud (1915), mania becomes a leak from the ego face a tyrannical superego (the encounter of ego and the ego ideal). Klein (1934) explains that the mania serves to counter the depressive position and thus avoid the guilt inside of ego. For Racamier (1979), mania is clearly a frantic negation of the anguish and emotional suffering. Today, some authors as Chabot and Husain try to define the manic depression organization, with the help of projective tests. This personality structure would be between psychosis and borderline. An axial element of this structure is the research for an affective symbiosis with each other. These concept, strongly resemble the "syntony", from Bleuler. We trace the evolution of manic depression from a psychodynamic and structural point of view, with particular interesting in the concept of syntony.
Oster, J; Melches, J
The members of the Bundesarbeitsgemeinschaft Künstlerische Therapien (BAG KT - "Working Committee of Art Therapies of the Federal Republic of Germany") decided to carry out an analysis of the occupational group of art therapists, in the form of an online inquiry. For this purpose, a questionnaire covering all fields of art therapies was developed, recording socio-demographic and qualification data, data of different fields of activity, patient characteristics, institutional conditions and setting as well as data on reimbursement. 2303 evaluable data sets are available. Here, the main focus is on art therapists in the health care sector according to SGB (N=2134). 83% of them are female, 56% work in the field of emergency medicine and curative treatment, followed by rehabilitation and youth welfare. In all sectors, specialization in music and art therapy predominates. 57% of the therapists have a special graduate degree in art therapy methods, 83% have a graduate degree. 42% have a license to work as an alternative non-medical practitioner. Nearly all of them use methods of quality management. The results highlight the implementation of art therapies in health care. © Georg Thieme Verlag KG Stuttgart · New York.
Danielle E Levac
Full Text Available Therapists use motor learning strategies (MLSs to structure practice conditions within stroke rehabilitation. Virtual reality (VR-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use.A pre-post design evaluated a knowledge translation (KT intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision.The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001. Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944. On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092. Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach.The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.
Levac, Danielle E; Glegg, Stephanie M N; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E; Velikonja, Diana
Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.
Westra, Henny A; Constantino, Michael J; Arkowitz, Hal; Dozois, David J A
Little is known about factors differentiating more and less effective therapists or the mechanisms through which therapists influence outcome. In the present study, the performance of a small sample of 4 therapists was compared in the context of delivering cognitive-behavioral psychotherapy (CBT) to 32 clients with generalized anxiety disorder. More effective therapists were characterized by higher observer-rated CBT competence, higher client outcome expectations and client treatment credibility assessments, and higher early treatment client ratings of therapeutic alliance quality. Higher early CBT competence was associated with higher client midtreatment outcome expectations, which in turn were associated with better posttreatment outcomes. Although these findings are preliminary given the small sample of therapists and clients, they suggest that the common factor of outcome expectations might be a mechanism through which the specific factor of psychotherapist competence exerts its influence on treatment outcome. The implications of these findings and directions for future research are discussed. (c) 2011 APA, all rights reserved.
Geller, Shari Melissa; Greenberg, Leslie S; Watson, Jeanne Cherry
The authors developed two versions of a therapeutic presence measure, based on an earlier model of presence (Geller & Greenberg, 2002)-Therapeutic Presence Inventory-therapist (TPI-T) and client (TPI-C) versions-to measure in-session therapeutic presence. They explored their reliability and validity in two studies. In the first, items generated from the previously established model were subjected to analyses and expert ratings. In the second study, therapists and clients rated therapists' presence postsession. Therapists also completed the Relationship Inventory, and clients assessed two additional factors: session outcome, using the Client Task Specific Measure-Revised, and therapeutic alliance, using the Working Alliance Inventory. Findings revealed that both versions of the TPI had good reliability and construct validity. However, TPI-T had low predictive validity and the TPI-C showed good predictive validity. In particular, clients reported positive therapeutic alliance and change following sessions when they felt their therapist was present with them.
Rosenbaum, Bent; Harder, Susanne; Knudsen, Per
During recent decades, the field of treatment of schizophrenia has lacked empirical, systematic outcome studies that support psychodynamic psychotherapy as an evidence-based intervention for patients with schizophrenia. The Danish schizophrenia project (DNS) compared psychodynamic psychotherapy f.......000) and GAF(symptom) (p = 0.010) significantly favored SPP in combination with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for patients with schizophrenic first-episode psychoses....
Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin
Selection for psychotherapy may be improved by identifying predictors of non-responding to treatment, but there are only few studies of non-responding in short-term psychodynamic group therapy. We analyzed potential socio-demographic and clinical predictors in a sample of 239 patients in 39...... to explore before selection of patients to short-term time-limited psychodynamic group therapy....... sessions of psychodynamic group psychotherapy, including self-reported symptoms, personality, and extra-therapeutic events. Non-responding was assessed by the Symptom Check List-90-Revised Global Severity Index (SCL-90-R GSI) according to Jacobson and Truax’s Reliable Change Index. Non...
Korte, Alexander; Beier, Klaus M; Vukorepa, Julia; Mersmann, Maik; Albiez, Verena
Gender identity disorder (GID), gender dysphoria (GD) respectively, is considered a multifactorial disease whose etiology is subject to complex bio-psycho-social conditions, each with different weighting. As a result, therapists, who treat children and adolescents with GID/GD, have to deal with a very heterogeneous group with individually varying causes, differing psychopathology and varying disease progression. In addition to general psychiatric aspects of development, particularly psychiatric comorbidity, but also the different individual psychodynamics--i. e. the specific constellation of conflicts and possible ego deficits and structural deficits in the learning history of the person are of differential importance. In regard to the indication for gender reassignment measures this sometimes is relevant for the decision. The difficulties arising for decision making and the usefulness of a systematic evaluation of case reports as a basis for further optimization of the treatment recommendations are illustrated by two case reports. In the course of this, also the disadvantages and potential dangers of too early diagnostic definition and introduction of gender somato-medical and legal measures are shown exemplarily.
Steel, Catherine; Macdonald, James; Schroder, Thomas
Previous reviews have found equivocal evidence of an association between therapists' internalized relational models and the therapeutic relationship and have neglected empirical literature based on Sullivan's notion of introject. This review expanded upon previous reviews to examine the effect of therapist internalized relational models on a broader conceptualization of the therapeutic relationship. Systematic search processes identified 22 papers measuring therapist attachment and/or introject and therapeutic relationship: 19 on therapist attachment, 5 on introject with 2 overlapping. Overall, despite heterogeneity in design and variable methodological quality, evidence suggests that therapist attachment affects therapeutic relationship quality, observed in client-rated evaluation, therapist negative countertransference, empathy, and problems in therapy. Interaction effects between client and therapist attachment style were also found. Evidence suggesting that therapist introject also affects therapeutic relationship quality, including therapists' manner and feelings toward their clients, was stronger. Evidence clearly shows that therapists' internalized relational models affect the therapeutic relationship. More research is necessary to clarify exactly how therapist and client internalized relational models interact and translate these findings into clinical practice. © 2017 Wiley Periodicals, Inc.
Hamblen, Jessica L; Norris, Fran H; Gibson, Laura; Lee, Linda
In this paper we examine the effectiveness of disseminating Cognitive Behavioral Therapy for Postdisaster Distress (CBT-PD) to community therapists in Baton Rouge, Louisiana following Hurricane Katrina. One hundred four therapists attended a two-day training in CBT-PD with on-going case consultation. Pre- and post-training, therapists rated eight core cognitive behavioral therapy elements on their importance, how well they understood how to deliver the element, and how confident they were in their ability to deliver the element. Post-training they completed a CBT-PD knowledge questionnaire and session fidelity forms. Seventy-seven clients completed satisfaction questionnaires and reported on how often they utilized the skills taught in CBT-PD. Therapists showed significant improvements in their ratings of the importance of various elements of cognitive behavioral therapy, their knowledge and understanding of those elements, and their confidence that they could use them effectively. Immediately following the training 90% of therapists demonstrated excellent retention of CBT-PD. Self-report measures from both therapists and clients indicated that critical session elements were delivered. This work suggests that CBT-PD can be applied in a real-world setting and that community therapists can be trained in relatively short time spans with on-going support. This finding is especially important in the disaster field given that communities are likely to find themselves in emergency situations in which a number of non-expert trauma therapists will need to deliver trauma services.
Westmacott, Robin; Hunsley, John; Best, Marlene; Rumstein-McKean, Orly; Schindler, Dwayne
Contextual variables potentially influencing premature termination were examined. Clients (n=83) and therapists (n=35) provided parallel data on early working alliance, psychotherapy termination decision (unilateral vs. mutual), clients' reasons for termination, and barriers to treatment participation. When clients unilaterally ended therapy, therapists were only partially aware of either the extent of clients' perceived improvements or their dissatisfaction. When termination was mutually determined, there were no differences between client and therapist ratings of termination reasons. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by clients and therapists, all clients rated the early alliance and barriers to treatment more highly than did therapists. Results have implications for understanding premature termination and suggest future research examining the utility of therapist feedback regarding contextual variables in terms of retaining clients in therapy.
Kivlighan, D. Martin, III
Although evidence suggests that the benefits of psychodynamic treatments are sustained over time, presently it is unclear whether these sustained benefits are superior to non-psychodynamic treatments. Additionally, the extant literature comparing the sustained benefits of psychodynamic treatments compared to alternative treatments is limited with methodological shortcomings. The purpose of the current study was to conduct a rigorous test of the growth of the benefits of psychodynamic treatments relative to alternative treatments across distinct domains of change (i.e., all outcome measures, targeted outcome measures, non-targeted outcome measures, and personality outcome measures). To do so, the study employed strict inclusion criteria to identify randomized clinical trials that directly compared at least one bona fide psychodynamic treatment and one bona fide non-psychodynamic treatment. Hierarchical linear modeling (Raudenbush, Bryk, Cheong & Congdon, du Toit, 2011) was used to longitudinally model the impact of psychodynamic treatments compared to non-psychodynamic treatments at post-treatment and to compare the growth (i.e., slope) of effects beyond treatment completion. Findings from the present meta-analysis indicated that psychodynamic treatments and non-psychodynamic treatments were equally efficacious at post-treatment and at follow-up for combined outcomes ( k = 20), targeted outcomes (k =19), non-targeted outcomes (k =17), and personality outcomes (k =6). Clinical implications, directions for future research, and limitations are discussed.
Trimboli, Frank; Marshall, Rycke L; Keenan, Charles W
This article presents a guide for conceptualizing psychological difficulties across the broad spectrum of personality and symptom disorders. A psychodynamic model is used to organize these disorders along a structural continuum of severity. The authors propose that seven key indices of personality functioning be evaluated: cognition, affect, self-object relations, interpersonal relations, defenses, superego functioning, and primary dynamics. The results are then employed to determine where the patient should be placed along a continuum of nine diagnostic categories of ego development and their associated disorders. These include "normal," neurotic trait, and neurotic symptom organization; high-, mid-, and low-level borderline organization; and affective, cognitive-affective, and cognitive psychotic organization. An accurate evaluation of the seven variables will permit a more precise formulation of the nature and severity of the patient's difficulties, which will hopefully result in more accurate and appropriate treatment planning. Examples of the application of this model to a common symptom complaint are provided.
Bouwkamp, C G; den Berg, M P Lambregtse-Van; Kievit, A J A; Kushner, S A
A positive family history for psychiatric disorders is the most important risk indicator for developing psychopathology. Often, the psychological consequences of a positive family history are insufficiently acknowledged. AIM: To provide insight into the psychodynamics of children who grow up in a family with psychopathology, such as psychosis, to demonstrate how these effects can last a lifetime, and to suggest ways in which such effects might be prevented. METHOD: We review the relevant literature, discuss theoretical concepts, and make clinical recommendations. RESULTS: Parental psychopathology, including psychosis, can have a strong and lasting influence on the child's identity and sense of self. CONCLUSION: A positive family history for psychiatric disorders has the potential to seriously disrupt the normal development of identity and sense of self. Various types of psychosocial interventions might be able to reduce these harmful effects.
Downey, Jennifer I
Recent psychiatric attention to the bipolar spectrum conditions (Bipolar I, Bipolar II, and Bipolar NOS Disorders in the DSM-IV-TR) has revealed that many more individuals are affected by bipolar disorder (BD) than was earlier appreciated. Increased sexual thoughts, impulses, and risk-taking sexual behavior are recognized symptoms of the bipolar conditions when individuals are manic or hypomanic. There is little scientific information on the prevalence of symptoms of driven sexuality in individuals with the less severe forms of BD as well as those individuals with severer forms of the disorder who are recovering or have recovered from an episode of mania or hypomania. This article discusses the use of developmentally oriented psychotherapy for an individual with a bipolar spectrum condition whose symptoms were well controlled on medications except for her driven sexuality. Current concepts in psychodynamic psychotherapy offer a way to understand and treat sexual symptoms in many individuals with less severe or partially treated BD.
Silje M. Ormhaug
Full Text Available Objective: Client ratings of the therapeutic alliance are an important predictor of outcome in the treatment of traumatized adolescents and adults, but less is known about the therapists’ perspective. The aim of this study was to investigate how therapists’ ratings relate to the adolescents’ perspective, how individual therapist and adolescent ratings relate to change in symptoms and treatment satisfaction, and whether discrepant alliance perspectives impact treatment outcome. Method: The sample consisted of 156 youth (mean age 15.1, range 10–18, randomized to trauma-focused cognitive behavioral therapy or treatment as usual, and alliance ratings from 62 therapists. Alliance was measured midtreatment with the Therapeutic Alliance Scale for Children, and the factor structure of the two scales was analyzed with exploratory factor analyses. A change in posttraumatic symptoms was assessed with the Child PTSD Symptom Scale (CPSS and the Clinicial-Administered PTSD Scale for Children and Adolescents (CAPS-CA. Results: Therapist and client perspectives on the alliance were significantly, but moderately, associated (intraclass correlations [ICC]=0.54, p<0.001. Both scales predicted adolescent treatment satisfaction but only the client scale was significantly related to change in symptoms. Factor analyses revealed differences in factor structure with therapist ratings organized around bond and task dimensions and adolescent ratings organized by item valence. Higher therapist ratings compared to adolescent ratings predicted higher residual PTS symptoms. Discussion: Although adolescent and therapist alliance ratings are moderately associated, results suggest that the ratings are differentially associated with outcomes. These findings, along with results indicating important differences in factor structure, imply that adolescent and therapist ratings are not interchangeable. Future studies should investigate how therapists can improve their
Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin
BACKGROUND. Drop-out from psychotherapy is common and represents a considerable problem in clinical practice and research. Aim. To explore pre-treatment predictors of early and late drop-out from psychodynamic group therapy in a public outpatient unit for non-psychotic disorders in Denmark. Methods. Naturalistic design including 329 patients, the majority with mood, neurotic and personality disorders referred to 39-session group therapy. Predictors were socio-demographic and clinical variables, self-reported symptoms (Symptom Check List-90-Revised) and personality style (Millon Clinical Multiaxial Inventory-II). Drop-out was classified into early and late premature termination excluding patients who dropped out for external reasons. Results. Drop-out comprised 20.6% (68 patients) of the sample. Logistic regression revealed social functioning, vocational training, alcohol problems and antisocial behavior to be related to drop-out. However, early drop-outs had prominent agoraphobic symptoms, lower interpersonal sensitivity and compulsive personality features, and late drop-outs cognitive and somatic anxiety symptoms and antisocial personality features. Clinical and psychological variables accounted for the major part of variance in predictions of drop-out, which ranged from 15.6% to 19.5% (Nagelkerke Pseudo R-Square). Conclusion. Social functioning was consistently associated with drop-out, but personality characteristics and anxiety symptoms differentiated between early and late drop-out. Failure to discriminate between stages of premature termination may explain some of the inconsistencies in the drop-out literature. Clinical implications. Before selection of patients to time-limited psychodynamic groups, self-reported symptoms should be thoroughly considered. Patients with agoraphobic symptoms should be offered alternative treatment. Awareness of and motivation to work with interpersonal issues may be essential for compliance with group therapy.
Creed, Torrey A; Wolk, Courtney Benjamin; Feinberg, Betsy; Evans, Arthur C; Beck, Aaron T
Policy-makers, payers, and consumers often make decisions based on therapists' reported theoretical orientations, but little is known about whether these labels represent actual or potential skills. Prior to CBT training, therapists (n = 321) reported theoretical orientations. Experts rated CBT competency using the Cognitive Therapy Rating Scale Therapy at pre-, mid-, and post-training. CBT- and non-CBT identified therapists showed equivalent, non-competent baseline CBT skills. CBT-identified therapists showed greater CBT skills at mid-training, but by end of training, groups evidenced equivalent achieved competency. Baseline CBT orientations were neither valid, nor useful markers of later competency. Policy, clinical and research implications are discussed.
Jensen, Hans Henrik; Mortensen, Erik L.; Lotz, Martin
Background. Psychodynamic group psychotherapy may not be an optimal treatment for anxiety and agoraphobic symptoms. We explore remission of SCL-90-R Global Severity Index (GSI) and target symptoms in 39 sessions of psychodynamic group therapy. Methods. SCL-90-R ?target symptom? profile and GSI remission according to Danish norms were identified in 239 patients and evaluated according to reliable and clinical significant change. Results. Four major groups of target symptom cases (depression, i...
D.Comm. The globalisation of the South African economy since 1994 has emphasised the need for a new form of leadership, with specific emphasis on authentic and transformational leadership. By understanding the psychodynamic aspects that drive the transformational leader organisations will be able to identify and develop transformational leaders. A real need exists to understand the psychodynamic attributes of transformational leaders and how these attributes affect their behaviour and effe...
Stefini, Annette; Salzer, Simone; Reich, Günter; Horn, Hildegard; Winkelmann, Klaus; Bents, Hinrich; Rutz, Ursula; Frost, Ulrike; von Boetticher, Antje; Ruhl, Uwe; Specht, Nicole; Kronmüller, Klaus-Thomas
The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in favor of PDT. CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Lord, Sarah Peregrine; Sheng, Elisa; Imel, Zac E.; Baer, John; Atkins, David C.
Empathy is a basic psychological process that involves the development of synchrony in dyads. It is also a foundational ingredient in specific, evidence-based behavioral treatments like motivational interviewing (MI). Ratings of therapist empathy typically rely on a gestalt, “felt sense” of therapist understanding and the presence of specific verbal behaviors like reflective listening. These ratings do not provide a direct test of psychological processes like behavioral synchrony that are theorized to be an important component of empathy in psychotherapy. To explore a new objective indicator of empathy, we hypothesized that synchrony in language style (i.e., matching how statements are phrased) between client and therapists would predict gestalt ratings of empathy over and above the contribution of reflections. We analyzed 122 MI transcripts with high and low empathy ratings based on the Motivational Interviewing Treatment Integrity (MITI) global rating scale. Linguistic inquiry and word count was used to estimate language style synchrony (LSS) of adjacent client and therapist talk turns. High empathy sessions showed greater LSS across 11 language style categories compared to low empathy sessions (p empathy vs. low empathy sessions (d = 0.62). Regression analyses showed that LSS was predictive of empathy ratings over and above reflection counts; a 1 SD increase in LSS is associated with 2.4 times increase in the odds of a high empathy rating, controlling for therapist reflections (odds ratio = 2.4, 95% CI: 1.36, 4.24, p empathy ratings are related to synchrony in language style, over and above synchrony of content as measured by therapist reflections. Novel indicators of therapist empathy may have implications for the study of MI process as well as the training of therapists. PMID:25892166
Weinrach, Stephen G.
Presents interview with cognitive therapist Aaron Beck in which Beck describes cognitive therapy; the contributions of Freud, Maslow, Rogers, and Ellis; cultural, class, and gender issues; training of cognitive-behavior therapists; and the future direction of treatment of anxiety and depression. (ABL)
Full Text Available The American Psychiatric Association removed homosexuality from its list of mental disorders in 1974. Before that, for more than a century, homosexuality and bisexuality were assumed to be mental illnesses. Studies have shown that there is no difference between homosexual and heterosexual individuals with regard to psychological functioning. However, an effect of stress related to stigmatisation was observed in the cases of homosexuality. Such kind of stress may increase the risk of suicide attempts, substance abuse, human immunodeficiency virus (HIV/acquired immunodeficiency syndrome (AIDS, and emotional distress. Findings of researches have suggested that there is a need for better education and training of mental health practitioners in this area. Therefore, in the present paper, few cases of homosexuality are discussed in the context of effect of stigmatisation and aspects of intimate relationships in these individuals. Further, the role of psychologists/professionals as therapists in providing their help to homosexual clients has also been presented.
Simonson, Norman R.; Bahr, Susan
In this evaluation of the effects of therapist disclosure on subject disclosure and attraction to therapist during a first interview, Professional and Paraprofessional therapists disclosed either personal disclosure, demographic disclosure or no disclosure. (Author/EK)
Full Text Available The mostly linear and mechanistic nature of the nursing manager role is rapidly becoming more dynamic and systemic. The change involves task and people management within a constantly changing organisational identity, taking up multiple leadership roles, having to authorise oneself and others in a complex matrix system, and managing conscious and unconscious psychological boundaries within and between conflicting systems. The aim of this study was to describe the systems psychodynamic learning experiences of nursing managers during leadership coaching. The coaching task was to provide learning opportunities to the individual leader, towards gaining insight into conscious and unconscious leadership dynamics in terms of anxiety, task, role, authorisation, boundaries and identity. A qualitative research design was used. Six nursing managers attended ten leadership coaching sessions over ten weeks. Field notes and reflective essays were analysed using systems psychodynamic discourse analysis. The findings indicated clarity and authorisation in the participants’ primary task and normative roles; anxiety and de-authorisation in their experiential and phenomenal roles; anxiety in boundary management related to the misuse of power by others; and the continuous exploration of their leadership role identity towards achieving integration. Participants’ learning experiences were evaluated in terms of criteria for organisational learning, after which a general hypothesis was formulated.
Die meestal liniêre en meganistiese aard van die verpleegbestuursrol is vinnig besig om na ’n meer dinamiese en sistemiese rol te verander. Die verandering behels taak- en mensbestuur binne 'n steeds veranderende organisasie-identiteit, waar 'n verskeidenheid rolle opgeneem word, die self en ander in 'n komplekse matrikssisteem bemagtig word, en waartydens bewuste en onbewuste sielkundige grense in en tussen botsende sisteme bestuur
W. J. De Jager
Full Text Available This research aims to measure the impact of a leadership development programme presented from the systems psychodynamic stance. The aim was to develop psychoanalytically informed change leaders to lead change and transformation in the continuously changing and transforming New Economy network organisation. In order to do this, a group relations training programme was presented for 30 leaders. Qualitative assessment using grounded theory during post-intervention focus groups interviewing indicated the group’s awareness of psychodynamic leadership behaviour such as the regression towards frequent pathological leadership personality characteristics, regression towards unconscious group- and organizational processes such as the basic assumption group, the covert coalition and socially structured defense systems against change and transformation. Insight was also gained in the new leadership role and the taking up of personal authority in the network organisation that needs to function as a systemic whole. Limitations in the study are noted and Recommendations are made to enhance change leader skills for leadership in the New Economy network organisation. OpsommingHierdie navorsing poog om die impak van ‘n leierskapsontwikkelingsprogram wat aangebied is vanuit die sistemiese psigodinamiese perspektief, te evalueer. Die doel was om psigoanalitiese ingeligte leiers te ontwikkel om verandering en transformasie in die gedurige veranderende en transformerende Nuwe Ekonomie netwerk organisasie, te lei. Ten einde dit te bolwerk is. ‘n Groep -verhoudinge-opleidingsprogram is aangebied vir 30 leiers. Kwalitatiewe evaluasie deur van begrondingsteorie gebruik te maak gedurende, die post-intervensie fokus groepe het ‘n groepbewustheid aangedui van psigodinamiese leierskapgedrag soos die regressie na dikwelse patologiese leierskapspersoonlikheidskenmerke, regressie in onbewustelike groep- en organisatoriese prosesse soos die basiese aanname-groep, die
Valdes, Kristin; Naughton, Nancy; Burke, Casey J
To investigate whether there was a difference in Patient-Rated Wrist Hand Evaluation (PRWHE) scores between patients with and without comorbidities who receive regular supervised therapy provided by a certified hand therapist (CHT) compared with patients who were provided with a home exercise program and were regularly monitored. Fifty patients with a diagnosis of distal radius fractures and volar plate fixation were enrolled in a prospective, randomized clinical trial comparing those who received therapy under the supervision of a CHT with those enrolled in a home exercise program that was instructed and monitored by a CHT. The primary outcome measure (PRWHE) and secondary outcome measures, total arc of motion for wrist flexion and extension, supination and pronation, and grip strength, were assessed at 12 weeks. The primary outcome measure for both groups was also gathered at 6 months. There were no statistically significant differences between the final scores of the PRWHE, wrist or forearm motion, pain, or grip strength between groups. Effect size calculations revealed that both groups experienced a large effect size for all outcomes. Supervised clinic-based therapy is equally beneficial for patients without complications. Clinic-based therapy may be preferable for patients with noteworthy complications after a distal radius fracture with volar plate fixation. Patients with decreased finger motion and various comorbidities may benefit from therapy provided in a clinic under the supervision of a certified hand therapist. Therapeutic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Teusner, D N; Amarasena, N; Satur, J; Chrisopoulos, S; Brennan, D S
Oral health therapists (OHTs) are an emerging workforce whose training incorporates the skills of dental hygienists (DHs) and dental therapists (DTs). There are concerns that OHTs are underutilized. This study compares the employment characteristics and applied practice scope of OHTs with those of DTs and DHs. Members of two professional associations representing DHs, DTs and OHTs, were surveyed by mail. Data collected included demographic and employment characteristics and clinical activity on a typical practice day. Applied practice scope was described by calculating the proportion of practitioners that had provided ≥1 of a selected range of key services. Log binomial regression was used to compare OHTs to DTs and DHs. The response rate was 60.6% (n = 1083) and of these 90.9% were employed. Preventive services dominated service provision. The proportion of OHTs that provided fluoride applications (77%) was higher than the proportion of DTs (53%, p 0.05). Overall, the applied practice scope of OHTs appeared to differ from DTs and DHs. © 2015 Australian Dental Association.
Marmarosh, Cheri L; Kivlighan, Dennis M; Bieri, Kathryn; LaFauci Schutt, Jean M; Barone, Carrie; Choi, Jaehwa
The purpose of this study was to test the notion that complementary attachments are best for achieving a secure base in psychotherapy. Specifically, we predicted third to fifth session alliance from client- and therapist-rated attachment style interactions. Using a combined sample of 46 therapy dyads from a community mental health clinic and university counseling center, the client- and therapist-perceived therapy alliance, attachment anxiety, and attachment avoidance were examined at the beginning of therapy. The results of an Actor-Partner Interdependence Model (APIM; Kenny & Cook, 1999, Partner effects in relationship research: Conceptual issues, analytic difficulties, and illustrations. Personal Relationships, 6, 433-448.) indicated that there was no direct effect of either client or therapist attachment style on therapist or client early ratings of the alliance. One significant interaction emerged and indicated that client-perceived alliance was influenced by therapist and client attachment anxiety. The client-perceived early alliance was higher when more anxious therapists worked with clients with decreasing anxiety. The client early alliance was higher when less anxious therapists worked with clients with increasing anxiety. The findings partially support the notion that different attachment configurations between the therapist and client facilitate greater alliance, but this was the case only when assessing client-perceived early alliance and only with regards to the dimension of attachment anxiety. There were no significant main effects or interactions when exploring therapist-perceived alliance. Implications of the findings are discussed along with recommendations for future study and clinical training. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Over the last 30 years psychiatry and psychoanalysis have moved in substantially divergent directions. Psychiatry has become rich in methodology but conceptually limited, with a drift toward biological reductionism. Psychoanalysis has remained relatively limited in methodology, but conceptually rich. The rich methodology of psychiatry has led to major contributions in discovering gene by environment interactions, the importance of early adversity, and to recognition of the serious problem posed by treatment resistance. However, psychiatry's biologically reductionistic conceptual focus interferes with the development of a nuanced clinical perspective based on emerging knowledge that might help more treatment resistant patients become treatment responders. This article argues that recognition of the problem of treatment resistance in psychiatry creates a need for it to reconnect with the conceptual richness of psychoanalysis in order to improve patient care. Psychodynamic psychiatry is defined as the relevant intersection of psychiatry and psychoanalysis where this reconnection can occur. I will suggest selected aspects of psychoanalysis that are especially relevant to psychiatry in improving outcomes in work with treatment resistant patients.
Viederman, M; Hymowitz, P
This paper elaborates a psychodynamic-developmental model as a framework for understanding the wide range of adaptive and maladaptive responses to the self-care requirements of diabetes. Early life experience participates with other factors in influencing the ease with which diabetics implement diabetic control. This model emphasizes the importance of the mother-child interaction during the second phase of development, the toddler phase, at which time the child begins to establish a sense of autonomy and control over his own body and its functions, with bowel training viewed as a paradigm for body control. It is postulated that certain types of mothers such as controlling-intrusive mothers, overprotective mothers, or guilty, indifferent, or rejecting mothers create problems for the child related to the development of autonomy and the sense of comfortable and pleasurable control over his bodily functions. Conflicts generated during this period are reactivated with the onset of diabetes and lead to difficulty in implementing control. In some situations where conflicts with the caretaker figure were predominantly limited to aspects of control, trusting relations acted as a substrate for change and improvement in control in a supportive medical environment. Specific management recommendations based upon this model are presented.
Bögels, Susan M; Wijts, Paul; Oort, Frans J; Sallaerts, Steph J M
Comparing the overall and differential effects of psychodynamic psychotherapy (PDT) versus cognitive behavior therapy (CBT) for social anxiety disorder (SAD). Patients with a primary SAD (N = 47) were randomly assigned to PDT (N = 22) or CBT (N = 27). Both PDT and CBT consisted of up to 36 sessions (average PDT 31.4 and CBT 19.8 sessions). Assessments took place at waitlist: pretest, after 12 and 24 weeks for those who received longer treatment: posttest, 3-month and 1-year follow-up. Changes in the main outcome measure self-reported social anxiety composite, as well as in other psychopathology, social skills, negative social beliefs, public self-consciousness, defense mechanisms, personal goals, independent rater's judgments of SAD and general improvement, and approach behavior during an objective test, were analyzed using multilevel analysis. No improvement occurred during waitlist. Treatments were highly efficacious, with large within-subject effect sizes for social anxiety, but no differences between PDT and CBT on general and treatment-specific measures occurred. Remission rates were over 50% and similar for PDT and CBT. Personality disorders did not influence the effects of PDT or CBT. PDT and CBT are both effective approaches for SAD. Further research is needed on the cost-effectiveness of PDT versus CBT, on different lengths PDT, and on patient preferences and their relationship to outcome of PDT versus CBT. © 2014 Wiley Periodicals, Inc.
Mosher, James K; Stiles, William B
In this study, we examined how clients internalize their therapists, understanding this phenomenon through the lens of the assimilation model, a theory of psychological change. The assimilation model describes people as comprised of multiple voices, each voice being a representation of interrelated experiences organized around significant people or events. In this study, we interviewed five former psychotherapy clients and asked them to describe how they experienced, and continue to experience, their therapists internally. On the basis of these interviews, we extended the assimilation model by constructing an account of how clients' experiences of their therapists are internalized. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Sotero, Luciana; Cunha, Diana; da Silva, José Tomás; Escudero, Valentín; Relvas, Ana Paula
This study aimed to compare therapists' observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists' contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients' engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists' alliance-building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research. © 2016 Family Process Institute.
Manne, Sharon L.; Kashy, Deborah A.; Rubin, Stephen; Hernandez, Enrique; Bergman, Cynthia
Objective: The goal was to understand both therapist and patient perspectives on alliance and session progress for women in treatment for gynecological cancer. We used a longitudinal version of the one-with-many design to partition variation in alliance and progress ratings into therapist, patient/dyad, and time-specific components. We also…
Nagel, Julie J
Performance anxiety, or stage fright, is anxiety aroused about potential mishaps in performance that expose feared inadequacies before an audience and which evoke feelings of embarrassment and humilation. For affected musicians, performance anxiety can be emotionally devastating, as their career choice in music may be terminated or severely compromised. This paper focuses on the cognitive and psychodynamic literature about music performance anxiety, with the emphasis that for treatment "one size does not fit all." It reviews the factors underlying performance anxiety and those factors which can exacerbate the condition in musicians. The two major clinical treatment modalities within contemporary psychology, cognitive behavior therapy (CBT) and psychodynamic treatments, are reviewed. While there are more empirical studies of CBT in various populations in the literature, until recently there was an indifference to empirical research by psychodynamic investigators. However, meta-analyses show strong efficacy for psychodynamic psychotherapy (in various disorders, not specifically music performance anxiety), but also that the benefits of psychodynamic psychotherapy may endure longer and increase with time.
Masoe, Angela V; Blinkhorn, Anthony S; Taylor, Jane; Blinkhorn, Fiona A
To investigate factors that influence Dental Therapists and Oral Health Therapists (Therapists) plan preventive oral health care for adolescents attending New South Wales (NSW) Public Oral Health Services. A cross-sectional postal survey using two clinical vignettes were used to record the preventive care treatment plans offered by Therapists working across sixteen NSW Local Health Districts (LHDs). Data were tabulated and Chi square statistics were used in the analysis. One hundred and seventeen Therapists returned questionnaires giving a 64.6% response rate. The participants highlighted the importance of offering oral hygiene instruction (97.0%); dietary advice (95.0%) and topical fluoride applications (74.0%). Recommended home use products included fluoride toothpaste 5000ppmF (59.0%) and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (57.7%). Over 50% used fissure sealants. More respondents (88%) would utilise Motivational Interviewing strategies for a patient with dental caries concerns, however, only 63% would use this technique for a patient in pain (pdental disease, suggesting a need for Clinical Directors to consider providing more advice to Therapists on the scientific basis of preventing dental caries. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Accurso, Erin C.; Garland, Ann F.
This study examined the temporal stability and cross-informant agreement on multiple perspectives of child and caregiver alliance with therapists in usual care psychotherapy. Baseline predictors of alliance were also examined. Children with disruptive behavior problems (n=209) and their caregivers were followed for up to 16 months after initiating psychotherapy at a community-based clinic. Alliance was rated by children, caregivers, and therapists every four months for as long as families par...
Lee, Byoung-kwon; Seo, Dong-kwon; Lee, Jang-Tae; Lee, A-Ram; Jeon, Ha-Neul; Han, Dong-Uk
[Purpose] This study was conducted to provide basic data for solutions to reduce the turnover rate of physical therapists. It should help create efficient personnel and organization management by exploring the impact of the work environment and work-related stress on turnover intention and analyzing the correlation between them. [Subjects and Methods] A survey was conducted with 236 physical therapists working at medical institutions in the Daejeon and Chungcheong areas. For the analysis on t...
This paper reviews what is known about the effectiveness of the more controversial use of psychodynamic and cognitive-behavioral psychotherapy with people who have mental retardation. It examines self-management approaches (problem solving, anger management, and cognitive therapy) and psychodynamic psychotherapy. The paper concludes that there has…
Daniels, Rachael Anne; Holdsworth, Emma; Tramontano, Carlo
Client engagement in substance misuse treatment programs is directly associated with positive treatment outcomes. The nature of these programs means there are often difficulties engaging and retaining clients, but authors have consistently found a strong therapeutic alliance is associated with client engagement. While research has focused on the association between the alliance and engagement, the factors that influence the therapeutic alliance have received less attention. To examine therapists' characteristics, namely therapists' stress and empathy levels, as potential predictors of client engagement and the therapeutic alliance, within an adolescent substance misuse group treatment program. The sample included 84 adolescent clients and 14 therapists from a Secure Training Centre in England. Client engagement in the treatment program was observed, while self-reporting measures assessed the therapeutic alliance (client and therapist-rated), and therapists' stress and empathy levels. Multiple regression analysis revealed that therapists' stress levels negatively influenced the therapeutic alliance and had a curvilinear relationship with client engagement, indicating that stress is not exclusively negatively related to engagement. Although stress was found to negatively impact both cognitive and affective empathy, neither cognitive nor affective empathy were significantly related to client engagement or the therapeutic alliance. This study demonstrates the importance of therapist characteristics on client engagement and the therapeutic alliance. Within practice stress can have a positive impact on clients' engagement. Nevertheless, therapists may need additional support to deal with stress effectively. Therapists' empathy may too be fundamental to client engagement, but only it if is perceived by clients.
... Programs Support Groups Organizations Learn More About OCD Obsessive compulsive disorder (OCD) and related disorders affect more than 1 ... Listing Types Therapists Clinics & Programs Support Groups Organizations Obsessive compulsive disorder (OCD) and related disorders affect more than 1 ...
Full Text Available Background: Health professions like dentistry, nursing and physical therapy have been reported at high risk for developing workrelated musculoskeletal disorders. Results of studies conducted in these occupational groups may help formulate prevention strategies. However, no such data among physical therapists has been reported in India. Material and Methods: We conducted an online survey among 100 physiotherapists in Delhi. Results: The response rate was 75%. The prevalence of work-related musculoskeletal disorders is found to be high since 92% of them reported to feel some pain after joining physical therapy which affects daily activities and even sometimes forces them to change their work. Physical therapists specialty, gender, furniture used in clinic and duration of patient contact are found to be related to the pain development (p < 0.05. Conclusions: We need to emphasize the role of ergonomics and techniques of patient handling in development of work-related pain symptoms. Med Pr 2015;66(4:459–469
Blanco-Barrera, Ramón; Spínola Elías, Yolanda; Garrido Muñoz de Arenillas, Rocío
"Art Therapy for an Art Therapist" was an experiential workshop presented at the 5thInternational Health Humanities Conference, Arts and Humanities for improving Social Inclusion, Education and Health: creative practice and mutuality – held in Seville (Spain), from September 15th to 17th, 2016. The main enquiry proposed to the audience was how to conduct an art therapy workshop for an art therapist. This key question addressed an important role in our teaching model, since it was designed to ...
George, Carol; Buchheim, Anna
The following case study is presented to facilitate an understanding of how the attachment information evident from Adult Attachment Projective Picture System (AAP) assessment can be integrated into a psychodynamic perspective in making therapeutic recommendations that integrate an attachment perspective. The Adult Attachment Projective Picture System (AAP) is a valid representational measure of internal representations of attachment based on the analysis of a set of free response picture stimuli designed to systematically activate the attachment system (George and West, 2012). The AAP provides a fruitful diagnostic tool for psychodynamic-oriented clinicians to identify attachment-based deficits and resources for an individual patient in therapy. This paper considers the use of the AAP with a traumatized patient in an inpatient setting and uses a case study to illustrate the components of the AAP that are particularly relevant to a psychodynamic conceptualization. The paper discusses also attachment-based recommendations for intervention.
Paula Giovana Furlan
Full Text Available Introduction: The expansion of the working field of occupational therapists in non-hospital environments and asylums in the last few decades, which came along with the territorial health practices in the National Health System, shows the relationship between the possibilities of professional performance and the existing public policies, including management functions and services. Objectives: To characterize the role of occupational therapists in the management of primary health care in the Distrito Federal and the professional knowledge used in this practice. Method: This was a qualitative research with production and analysis of data carried out through ethnography. Data were produced with aid of observations, field diary, semi-structured interviews and literature review. The study subjects were two occupational therapists from the State Secretariat of Health of the Distrito Federal who work in the management of primary health care. Results: The expansion of the concept of health has resulted in the incorporation of different professionals to compose the management of service and programs. The role of occupational therapists depends on their knowledge about management, collective projects and integral health care. Occupational therapists of this study work on central management and welfare programs to specific populations. Conclusion: The research made it possible to analyze the expansion of the working space of occupational therapists, contributing to future discussions on professional training. It was evident that the formation of the professional core provides subsidies for a larger management practice, such as skills for group and team work, and the work with socially excluded people.
Characteristics of art therapists in rehabilitative therapy Objectives: This study examines the sociodemographic, qualification- and activity-related characteristics of art therapists working in the field of rehabilitation. In 2013, an analysis of occupational groups was carried out in Germany, with the objective of describing the art therapists working there.A total of 2,303 complete datasets were submitted. From this group, those therapists mainly working in the field of rehabilitation/follow-up care/participation of disabled persons (according to Social Security Code VI and IX, n = 302) were selected and described. Most art therapists are female (average age 45 years) and largelywork part-time. Music and art therapy are the most common venues.More than 80% have a graduate degree. Methods of quality management are used.More than half of the therapists working in rehabilitation hospitals are employed in the field of psychosomatic medicine. Both individual and group therapy (each patient attending 1-2 times a week) are common. The results provide an overview of art therapy in the field of rehabilitation and show the spread in rehabilitation. Further research is indicated.
Protopopescu, Xenia; Gerber, Andrew J
This article provides a selective review of the neuroscience and child-psychoanalytic literature, focusing on areas of significant overlap and emphasizing comprehensive theories in developmental neuroscience and child psychoanalysis with testable mechanisms of action. Topics include molecular biology and genetics findings relevant to psychotherapy research, neuroimaging findings relevant to psychotherapy, brain regions of interest for psychotherapy, neurobiologic changes caused by psychotherapy, use of neuroimaging to predict treatment outcome, and schemas as a bridging concept between psychodynamic and cognitive neuroscience models. The combined efforts of neuroscientists and psychodynamic clinicians and theorists are needed to unravel the mechanisms of human mental functioning. Copyright © 2013 Elsevier Inc. All rights reserved.
Restek-Petrović, Branka; Orešković-Krezler, Nataša; Grah, Majda; Mayer, Nina; Bogović, Anamarija; Mihanović, Mate
Work with dreams in the group analysis represents an important part of the analytical work, with insight into unconscious experiences of the individual dreamer, and his transferrential relations with the therapist, other members of the group, and with the group as a whole. The way dreams are addressed varies from one therapist to another, and in line with that, members of the group have varying frequency of dreams. In groups of psychotic patients dreams are generally rarely discussed and interpreted by the group, with analysis mainly resting on the manifested content. This paper describes a long-term group of psychotic patients which, after sharing the dreams of several members and daydreams of one female patient, their interpretation and reception in the group achieved better cohesion and improved communication and interaction, i.e. created a group matrix. Furthermore, through the content of dreams in the group, traumatic war experiences of several of the group members were opened and discussed, which brought with it recollections of the traumatic life situations of other group members. In expressing a daydream, a female member of the group revealed the background for her behaviour which was earlier interpreted as a negative symptom of the illness.
Accurso, Erin C; Garland, Ann F
This study examined the temporal stability and cross-informant agreement on multiple perspectives of child and caregiver alliance with therapists in usual care psychotherapy. Baseline predictors of alliance were also examined. Children with disruptive behavior problems (n = 209) and their caregivers were followed for up to 16 months after initiating psychotherapy at a community-based clinic. Alliance was rated by children, caregivers, and therapists every 4 months for as long as families participated in treatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine whether child and caregiver alliance differed across time, as well to examine factors associated with each perspective on alliance. Intraclass correlations between child, caregiver, and therapist reports of alliance were also examined. Alliance was rated relatively high overall across perspectives. Clients (children and caregivers) tended to report the strongest and most stable alliance, while therapists reported the weakest alliance and perceived deteriorations in child alliance over time. Inter-informant agreement was variable for child and caregiver alliance; agreement was moderate between clients and therapists. Several predictors of alliance emerged, including child gender, anxiety diagnosis, caregiver race/ethnicity, and therapist experience. This study provides methodological information about reports of therapeutic alliance across time and informants that can inform current efforts to understand the alliance-outcome association. 2015 APA, all rights reserved
Yonatan-Leus, Refael; Tishby, Orya; Shefler, Gaby; Wiseman, Hadas
This study examined whether therapists' honesty, humor style, playfulness, and creativity would retrospectively predict the outcomes of therapies ended five years earlier. In the Jerusalem-Haifa study, 29 therapists treated 70 clients in dynamic psychotherapy for 1 year. The Outcome Questionnaire 45 scores were collected at five time points. Five years later, the therapists were contacted via email and asked to fill out honesty, humor styles, playfulness, and creativity self-report questionnaires. Five were excluded since they had only one client in the study each. The remaining 24 therapists treated 65 clients out of whom 20 therapists with 54 clients completed the questionnaires. Therapists' Aggressive Humor Style (AHS) was a significant negative predictor of clients' symptom change over time. The therapists' honesty scores were positively correlated with symptom change. That is, higher AHS therapists were more effective, while higher honesty therapists were less effective. Therapists' inferred traits of Honesty-Humility and AHS may influence the effectiveness of their treatments.
Goodfellow, Lynda Thomas
When 975 respiratory therapists evaluated their critical thinking behaviors, they rated themselves highest in prioritizing, troubleshooting, and communicating and lowest in anticipating. Age and education level did not influence ratings; experience in respiratory care and gender affected ratings in troubleshooting, decision making, and…
Stone, Michael H
Despite Freud's dictum that dreams are the royal road to the unconscious, the use of dream analysis by therapists working with Borderline Personality Disorder and other severe psychiatric conditions has in the past two decades has fallen into a state of decline, if not outright neglect. The reasons why are not altogether clear, though some have said that the growing popularity of ego psychology and other movements in the domain of psychoanalysis have perhaps pushed dream analysis to one side. To me this marginalization seems unjustified. I hope to demonstrate in this article the enduring utility of dream analysis in working with the more severely disordered patients, with the aim of revivifying its application--and its efficacy--in our work with such patients.
Full Text Available Abstract Background Many authors, as well as the American Physical Therapy Association, advocate that physical therapists adopt practice patterns based on research evidence, known as evidence-based practice (EBP. At the same time, physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy. The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP. Methods The study used a 69 item mailed self-completion questionnaire. The questionnaire had four major sections. The first three sections were each drawn from a different theoretical framework and from different authors' work. The instrument was developed to capture the propensity of physical therapists to adopt EBP, characteristics of the social system in the workplace of physical therapists, personal characteristics of physical therapists, and selected demographic variables of physical therapists. The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America. A random sample of 1320 potential participants was drawn. Results 939 questionnaires were returned for a response rate of 73%. 831 of the participants' questionnaires were useable and became the basis for the study. There was a moderate association between desire for learning (r = .36, r2 = .13, highest degree held (r = .29, r2 = .08, practicality (r = .27, r2 = .07 and nonconformity (r = .24, r2 = .06 and the propensity to adopt EBP. A negative correlation was found between age, years licensed and percentage of time in direct patient care. The findings demonstrated that the best three variables for predicting the propensity to adopt EBP in physical therapy were: desire for learning, highest degree held, and practicality. Conclusion The study confirms there is no single factor to
Xiao, Henry; Castonguay, Louis G; Janis, Rebecca A; Youn, Soo Jeong; Hayes, Jeffrey A; Locke, Benjamin D
Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counseling centers. The present study examined potential predictors of dropout using a large data set (N = 10,147 clients, 481 therapists) that was gathered through a college counseling center practice research network as a replication and extension of recent findings regarding therapist effects on dropout. The final model resulted in a dropout rate of 15.9% and a therapist effect of 9.51% on dropout variance. Therapist demographic variables were investigated, though none were found to be significant. Variables found to be predictive of increased likelihood of dropping out included higher levels of general presenting concerns, alcohol-related distress, and current financial stress. Ultimately, this study showed that therapists may play an important role in the likelihood of client dropout, and that additional research should be conducted to identify additional predictors, particularly at the therapist and center level. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Zilcha-Mano, Sigal; Solomonov, Nili; Chui, Harold; McCarthy, Kevin S; Barrett, Marna S; Barber, Jacques P
Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient's contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients' self-reported and diagnostician-rated depressive symptoms. Overall, the findings demonstrate that the therapists' contribution to the alliance-outcome association was explained mainly by prior symptomatic levels. However, when a time lag of several sessions was introduced between alliance and symptoms, a positive association emerged between alliance at 1 time point and symptomatic distress assessed several sessions later in the treatment, controlling for previous symptomatic level. The findings were similar whether or not we controlled for the patient's perspective on the alliance. Taken together, the findings attest to the importance of improving therapists' ability to detect deterioration in the alliance. (c) 2015 APA, all rights reserved).
Wiswede, Daniel; Taubner, Svenja; Buchheim, Anna; Münte, Thomas F.; Stasch, Michael; Cierpka, Manfred; Kächele, Horst; Roth, Gerhard; Erhard, Peter; Kessler, Henrik
Objective Neurobiological models of depression posit limbic hyperactivity that should normalize after successful treatment. For psychotherapy, though, brain changes in patients with depression show substantial variability. Two critical issues in relevant studies concern the use of unspecific stimulation experiments and relatively short treatment protocols. Therefore changes in brain reactions to individualized stimuli were studied in patients with depression after eight months of psychodynamic psychotherapy. Methods 18 unmedicated patients with recurrent major depressive disorder were confronted with individualized and clinically derived content in a functional MRI experiment before (T1) and after eight months (T2) of psychodynamic therapy. A control group of 17 healthy subjects was also tested twice without intervention. The experimental stimuli were sentences describing each participant's dysfunctional interpersonal relationship patterns derived from clinical interviews based on Operationalized Psychodynamic Diagnostics (OPD). Results At T1 patients showed enhanced activation compared to controls in several limbic and subcortical regions, including amygdala and basal ganglia, when confronted with OPD sentences. At T2 the differences in brain activity between patients and controls were no longer apparent. Concurrently, patients had improved significantly in depression scores. Conclusions Using ecologically valid stimuli, this study supports the model of limbic hyperactivity in depression that normalizes after treatment. Without a control group of untreated patients measured twice, though, changes in patients' brain activity could also be attributed to other factors than psychodynamic therapy. PMID:25275317
Parker, Ben; Turner, William
Objective: To assess the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. Method: The Cochrane Collaboration's criteria for data synthesis and study quality assessment were used. Electronic bibliographic databases and web searches were used to identify randomized and…
Bögels, S.M.; Wijts, P.; Oort, F.J.; Sallaerts, S.J.M.
Objectives: Comparing the overall and differential effects of psychodynamic psychotherapy (PDT) versus cognitive behavior therapy (CBT) for social anxiety disorder (SAD). Design: Patients with a primary SAD (N = 47) were randomly assigned to PDT (N = 22) or CBT (N = 27). Both PDT and CBT consisted
Full Text Available We investigated the treatment effect of psychodynamic short-term therapy complemented with bodywork on patients who presented with physical illness at the Research Clinic for Holistic Medicine in Copenhagen. Psychodynamic short-term therapy was complemented with bodywork (Marion Rosen to help patients confront old emotional pain from childhood trauma(s. Patients were measured with a five-item quality of life and health questionnaire (QOL5, a one-item questionnaire of self-assessed quality of life (QOL1, and four questions on self-rated ability to love and to function sexually, socially, and at work (ability to sustain a full-time job. Most of the patients had chronic pain that could not be alleviated with drugs. Results showed that 31 patients with the experience of being severely physically ill (mostly from chronic pain, in spite of having consulted their own general practitioner, entered the study. The holistic approach and body therapy accelerated the therapy dramatically and no significant side effects were detected. After the intervention, 38.7% did not feel ill (1.73 < NNT < 4.58 (p = 0.05. Psychodynamic short-term therapy complemented with bodywork can help patients. When the patients responded to the therapy, the self-assessed mental health, relationship with partner, ability to work, self-assessed quality of life, relationships in general, measured QOL (with the validated questionnaire QOL5, and life's total state (mean of health, QOL and ability were significantly improved, statistically and clinically. Most importantly, all aspects of life were improved simultaneously, due to induction of Antonovsky-salutogenesis. The patients received in average 20 sessions over 14 months at a cost of 1600 EURO. For the treatment responders, the treatment seemingly provided lasting benefits.
Wressle, Ewa; Samuelsson, Kersti
Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. This study explores how occupational therapists in Sweden perceive research utilization. The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice "very or rather often", although 49% (n = 225) of the therapists noted that they "very seldom or never" discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.
Santa Ana, Elizabeth J; Carroll, Kathleen M; Añez, Luis; Paris, Manuel; Ball, Samuel A; Nich, Charla; Frankforter, Tami L; Suarez-Morales, Lourdes; Szapocznik, José; Martino, Steve
Despite the fact that the number of Hispanic individuals in need of treatment for substance use problems is increasing internationally, no studies have investigated the extent to which therapists can provide empirically supported treatments to Spanish-speaking clients with adequate fidelity. Twenty-three bilingual Hispanic therapists from five community outpatient treatment programs in the United States were randomly assigned to deliver either three sessions of motivational enhancement therapy (MET) or an equivalent number of drug counseling-as-usual (CAU) sessions in Spanish to 405 Spanish-speaking clients randomly assigned to these conditions. Independent ratings of 325 sessions indicated the adherence/competence rating system had good to excellent interrater reliability and indicated strong support for an a priori defined fundamental MET skill factor. Support for an advanced MET skill factor was relatively weaker. The rating scale indicated significant differences in therapists' MET adherence and competence across conditions. These findings indicate that the rating system has promise for assessing the performance of therapists who deliver MET in Spanish and suggest that bilingual Spanish-speaking therapists from the community can be trained to implement MET with adequate fidelity and skill using an intensive multisite training and supervision model.
Nielsen, Arthur C
Couple therapy is a complex undertaking that proceeds best by integrating various schools of thought. Grounded in an in-depth review of the clinical and research literature, and drawing on the author's 40-plus years of experience, this paper presents a comprehensive, flexible, and user-friendly roadmap for conducting couple therapy. It begins by describing "Couple Therapy 1.0," the basic conjoint couple therapy format in which partners talk to each other with the help of the therapist. After noting the limitations of this model, the paper introduces upgrades derived from systemic, psychodynamic, and behavioral/educational approaches, and shows how to combine and sequence them. The most important upgrade is the early focus on the couple's negative interaction cycle, which causes them pain and impedes their ability to address it. Using a clinical case example, the paper shows how all three approaches can improve couple process as a prerequisite for better problem solving. Additional modules and sequencing choice points are also discussed, including discernment counseling and encouraging positive couple experiences. © 2017 Family Process Institute.
Dumas, Helene M; Fragala-Pinkham, Maria A; Rosen, Elaine L; Klar, Diana; Lombard, Kelly; Smith, Hilary; Shewokis, Patricia A; Oʼneil, Margaret E
To document physical therapist intervention activities and cardiorespiratory response for young children with chronic respiratory insufficiency. Twelve children born prematurely, 6 to 30 months chronological age and admitted to inpatient pulmonary rehabilitation for oxygen and/or ventilation weaning, were included. During 3 intervention sessions, a second physical therapist recorded intervention activity and heart rate (HR), oxygen saturation (SaO2), and respiratory rate. Total time and median HR, SaO2, and respiratory rate for each activity were calculated. An analysis of variance was used to compare HR and SaO2 across activity based on intersession reliability. Sitting activities were most frequent and prone least frequent. Median cardiorespiratory measures were within reference standards for age. No adverse effects were seen during intervention and no significant difference was found in HR and SaO2 among intervention activities. Young children with chronic respiratory insufficiency are able to tolerate intervention with close monitoring by the physical therapist.
Ten Napel-Schutz, Marieke C; Abma, Tineke A; Bamelis, Lotte L M; Arntz, Arnoud
Implementation of new effective treatments involves training, supervision and quality control of therapists, who are used to utilize other methods. Not much is known about therapists' views on how new psychotherapy methods should be taught. The purpose of this study is to get insight in how experienced therapists experience the training in a new method so that training methods for experienced therapists can be improved. Qualitative research using focus groups. For an RCT on the effectiveness of schema therapy (ST) for six personality disorders more than 80 therapists were trained in ST. They applied the ST-protocol after 4-day training, with peer supervision and limited expert supervision. Sixteen of these trained ST therapists from seven health institutions participated in the focus groups. The transcripts and records of the focus groups were analyzed on repeating themes and subthemes and in terms of higher order categories. Therapists appreciated didactical learning methods but particularly valued experiential learning. Especially, novice ST therapists missed role plays, feedback to learn required skills and attitudes, and attention to their resistance to new techniques (e.g., empathic confrontation and imagery). Peer supervision gave emotional recognition, but therapists lacked regular advice from an ST-expert. In teaching a new therapeutic method didactic teaching is necessary, but experiential learning is decisive. Experiential learning includes practicing the new therapy and reflecting on one's experiences, including resistance against new methods. Emphatic confrontation, case conceptualization, role play, peer supervision and opportunities to ask an expert supervisor during peer supervision are found to be helpful. Copyright © 2016 John Wiley & Sons, Ltd. Especially by Eperiential learning besides didactic learning. By practicing with many role plays including feedback. By reflecting on one's experiences including resistance against ingredients of the new
Lee, Sun Wook; Taylor, Renee; Kielhofner, Gary
Objective. To identify how therapists choose and use the Model of Human Occupation (MOHO). Method. A systematic random sample of 1,000 occupational therapists was surveyed as to whether they used MOHO in their practice. Those who were using MOHO were then sent a detailed questionnaire; 259 therapists responded to the survey questionnaire, forming a response rate of 60.2 percent. Results. A total of 80.7% of therapists indicated that they had used MOHO in their practice. A number of factors influenced therapists' choice to use MOHO. The most frequently cited factors were therapists' judgment that MOHO fit their own practice philosophy and their clients' needs. Most therapists used multiple means of learning about MOHO, and the number of means they used was related to both self-reported levels of knowledge and utilization of this model. Many therapists are also actively engaged in sharing their knowledge and utilization of this model. Conclusion. Multiple factors contribute to therapists' choice and use of MOHO. Therapists actively make a decision to use MOHO in practice and put forth substantial efforts to learn and share their knowledge of MOHO.
Keng, Shian-Ling; Waddington, Emma; Lin, Xiangting Bernice; Tan, Michelle Su Qing; Henn-Haase, Clare; Kanter, Jonathan W
Functional Analytic Psychotherapy (FAP) is a behavioral psychotherapy intervention that emphasizes the development of an intimate and intense therapeutic relationship as the vehicle of therapeutic change. Recently, research has provided preliminary support for a FAP therapist training (FAPTT) protocol in enhancing FAP competency. The present study aimed to expand on this research by examining the effects of FAPTT on FAP-specific skills and competencies and a set of broadly desirable therapist qualities (labelled awareness, courage and love in FAPTT) in a sample of therapist trainees in Singapore. The study also evaluated the feasibility and acceptability of FAP in the Singaporean context. Twenty-five students enrolled in a master's in clinical psychology program were recruited and randomly assigned to receive either eight weekly sessions of a FAPTT course or to a waitlist condition. All participants completed measures assessing empathy, compassionate love, trait mindfulness, authenticity and FAP-specific skills and competencies pre- and post-training, and at 2-month follow-up. A post-course evaluation was administered to obtain participants' qualitative feedback. Results indicated that compared with the waitlisted group, FAPTT participants reported significant increases in overall empathy, FAP skill and treatment acceptability from pre- to post-training. Improvements were observed on several outcome variables at 2-month follow-up. Participants reported finding the training to be both feasible and acceptable, although several raised issues related to the compatibility of the treatment with the local cultural context. Overall, the findings suggest that FAPTT is effective for improving specific FAP competencies and selected broadly desirable therapist qualities among therapist trainees. Copyright © 2016 John Wiley & Sons, Ltd. Functional Analytic Therapy (FAP) therapist training protocol was effective in improving empathy and FAP skills among Singaporean therapist
Starrost, Klaus; Geyh, Szilvia; Trautwein, Anke; Grunow, Jutta; Ceballos-Baumann, Andres; Prosiegel, Mario; Stucki, Gerold; Cieza, Alarcos
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) is gaining recognition in physical therapy. The Extended ICF Core Set for Stroke is a practical tool that represents a selection of categories from the whole classification and can be used along with the ICF qualifier scale to describe patients' functioning and disability following stroke. The application of the ICF qualifier scale poses the question of interrater reliability. The primary objective of this investigation was to study the agreement between physical therapists' ratings of subjects' functioning and disability with the Extended ICF Core Set for Stroke and with the ICF qualifier scale. Further objectives were to explore the relationships between agreement and rater confidence and between agreement and physical therapists' areas of core competence. A monocentric, cross-sectional reliability study was conducted. A consecutive sample of 30 subjects after stroke participated. Two physical therapists rated the subjects' functioning in 166 ICF categories. The interrater agreement of the 2 physical therapists was moderate across all judgments (observed agreement=51%, kappa=.41). Interrater reliability was not related to rater confidence or to the physical therapists' areas of core competence. The present study suggests potential improvements to enhance the implementation of the ICF and the Extended ICF Core Set for Stroke in practice. The results hint at the importance of the operationalization of the ICF categories and the standardization of the rating process, which might be useful in controlling for rater effects and increasing reliability.
Mumby, Katharyn; Bowen, Audrey; Hesketh, Anne
To discover how reliably speech and language therapists could diagnose apraxia of speech using their clinical judgement, by measuring whether they were consistent (intra-rater reliability), and whether their diagnoses agreed (inter-rater reliability). Video clips of people with communication difficulties following stroke were rated by four speech and language therapists who were given no definition of apraxia of speech, no training, and no opportunity for conferring. Videos were made of people following stroke in their homes. Ratings of the videos were carried out in the university lab under controlled conditions. Forty-two people with communication difficulties such as aphasia, apraxia of speech and dysarthria took part, and four specialist speech and language therapists acted as raters. Speech and language therapists' ratings of the presence and severity of apraxia of speech using videos. Intra-rater reliability was high for diagnosing (1) the presence of apraxia of speech (Cohen's kappas ranging from 0.90 to 1.00; 0.93 overall), and (2) the severity of apraxia of speech (kappa 0.84 to 0.92; 0.90 overall). The inter-rater reliability was also high for both the presence of apraxia of speech (kappa 0.86) and severity of apraxia of speech (0.74). Despite controversy over its nature and existence, specialist speech and language therapists show high levels of agreement on the diagnosis of apraxia of speech using their clinical judgement.
Kivlighan, Dennis M; Marmarosh, Cheri L; Hilsenroth, Mark J
Actor-partner interdependence modeling (APIM; Kashy & Kenny, 2000) was used to study the early therapeutic alliance in 74 clients being treated by 29 therapists to explore the relationship between the alliance and treatment progress, while prioritizing the dyadic nature of the alliance. The APIM examines collaboration/influence by modeling the impact of one dyad member's alliance ratings on the other member's session impact rating (partner effects). In terms of the alliance, the results revealed significant client-actor effects for client ratings of session depth and positivity as well as significant therapist-actor effects for therapist ratings of session smoothness and positivity. For client-rated alliance, there were also significant client-partner effects for therapist ratings of session depth. For clients who made a reliable change in treatment, an increase in client-reported alliance was related to therapist reporting more arousal in the 3rd session. For clients who did not make a reliable change in treatment, client-reported alliance was not related to therapist arousal. Limitations of the study and implications of the findings are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Linda Finlay (2011). Phenomenology for Therapists: Researching the Lived World. Chichester, UK: Wiley Blackwell ISBN-10:0470666455. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers ...
Discusses how the therapist can serve as a translator when communication becomes toxic or confusing. Describes ways for the counselor to soften hostile messages and harden passive messages. Gives an example of a clarifying interpretation and identifies other uses of translations. (RJM)
West, William; Goss, Phil
This paper presents the findings from the second of an ongoing series of focus group encounters between spiritually minded counsellors and those engaged in pastoral care within a religious tradition. For this study we recruited five Jungian influenced therapists and three pastoral care workers two of whom were explicitly Buddhists. The data was…
Korelitz, Ann; Schulder, Diane
Discusses a pilot study in which joint consultations with a family therapist and a matrimonial attorney were offered to 10 couples and one woman contemplating divorce. Videotaped sessions. Suggests joint consultations can be useful in helping couples understand the psychological and legal implications of conflicts expressed during separation.…
Stroke survivors who are classified with a Functional Ambulation Category (FAC) of 2, typically are able to ambulate on level surfaces, but intermittently require manual contact of a physical therapist to assist their balance during walking. In order to execute Activities of Daily Living (ADL’s),
Isaacs, Christine D.; And Others
A training program using written manuals, videotaped models, rehearsal, role plays, and performance feedback was effective in increasing the instruction, informing, and praising skills of five graduate students in family therapist training. Subjects worked with parents and their developmentally handicapped or behavior problem preschoolers. (CL)
Ben Thabet, J; Zouari, N; Charfeddine, F; Zouari, L; Maâlej, M
Constitutional mythomania presents several diagnostic, aetiopathogenic and forensic problems for the doctor. We have discussed these aspects through the analysis of a case report. The case report relates to a 43 year-old man, who was subjected to a penal expertise following the emission of cheques without provision. During the examination, he pretended being both a doctor and a lawyer at the same time. He was in charge, among other things, of sale contracts dealing sometimes with high value transactions, obviously without following the required legal procedure. He was pursued subsequently for many other affairs of swindle. Data collected from his medical file indicated that he was the only boy of his family. Since his father had suffered from psychotic episodes, his grandfather had reared him; which he did it in a strictly religious way. He spent his childhood isolated. He was 15 years old when his grandfather died. He had then expressed religious and megalomaniac ideas that had motivated psychiatric management. Later on, he expressed imaginative ideas evoking unsystematized delusion (he pretended to have made a trip to America and to have seen a fish flying and turning into a woman). From a psychodynamic point of view, constitutional mythomania is considered as a borderline personality. It reflects an important narcissisic cleavage. The deceitfulness of the mythomaniac allows him to keep in touch with reality and to avoid mental disintegration. The recognition, by others, of these delusions allows the mythomaniac to have access to his proper level of existence. For a while, to the experts our patient appeared to be suffering from schizophrenia. Therefore, we can apply the Maleval theory to him, which identifies four periods as delusion structuring levels in psychosis : P0 (consequence of the phallic signification deficiency, it includes anxiety, annihilation, perplexity, interrogative attitude), P1 (stage of paranoid delusion), P2 (stage of paranoiac delusion
Driessen, E.; Smits, N.; Dekker, J.J.M.; Peen, J.; Don, F.J.; Kool, S.; Westra, D.; Hendriksen, M.; Cuijpers, P.; Van, H.L.
Minimal efficacy differences have been found between cognitive behavioral therapy (CBT) and psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential
Jakobsen, Janus Christian; Hansen, Jane Lindschou; Simonsen, Erik
Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Interpersonal psychotherapy and other psychodynamic therapies may be effective interventions for major depressive disorder, but the effects have only had limited assessment...
Dirkse, Dale; Hadjistavropoulos, Heather D; Hesser, Hugo; Barak, Azy
Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) involves elements of expressive writing through secure messaging with a therapist. Expressive writing has been associated with psychological and physical health benefits in past research; furthermore, certain linguistic dimensions in expressive writing have been identified as particularly beneficial to health, such as less frequent use of negative emotion words and greater use of positive emotion words. No research, to date, has analyzed linguistic dimensions in client communication over the course of therapist-assisted ICBT for individuals with symptoms of generalized anxiety. This naturalistic study examined messages sent to therapists during the course of ICBT using linguistic analysis, and explored covariation of word use with symptom improvement. Data were obtained from patients with symptoms of generalized anxiety (N = 59) who completed 12 modules of therapist-assisted ICBT and rated symptoms of anxiety, depression, and panic at the beginning of each module. Linguistic analysis categorized text submitted to therapists into different word categories. Results found that patients' use of negative emotion, anxiety, causation, and insight words reduced over the course of treatment, while past tense words increased. Furthermore, negative emotion words significantly covaried with symptom ratings over the course of treatment. While causal statements cannot be made, findings improve our understanding of patient communication in ICBT and suggest that the further study of linguistic dimensions as psychological indicators and the potential utility of expressive writing strategies in therapist-assisted ICBT may be worthwhile.
Hertlein, Katherine M; Piercy, Fred P
In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists' age, therapists' gender, how religious therapists reported they were, and the extent of therapists' personal experience with infidelity.
Morris, Richard J.; Suckerman, Kenneth R.
Female snake-phobic subjects were assigned to one of three treatments: warm automated therapist procedure, cold automated therapist procedure, or control. Results showed significantly more improvement among subjects in the first group. (Author)
Zuroff, David C; McBride, Carolina; Ravitz, Paula; Koestner, Richard; Moskowitz, D S; Bagby, R Michael
Differences between therapists in the average outcomes their patients achieve are well documented, and researchers have begun to try to explain such differences (Baldwin & Imel, 2013). Guided by Self-Determination Theory (Deci & Ryan, 2000), we examined the effects on outcome of differences between therapists in their patients' average levels of autonomous and controlled motivation for treatment, as well as the effects of differences among the patients within each therapist's caseload. Between and within-therapist differences in the SDT construct of perceived relational support were explored as predictors of patients' motivation. Nineteen therapists treated 63 patients in an outpatient clinic providing manualized interpersonal therapy (IPT) for depression. Patients completed the BDI-II at pretreatment, posttreatment, and each treatment session. The Impact Message Inventory was administered at the third session and scored for perceived therapist friendliness, a core element of relational support. We created between-therapists (therapist-level) scores by averaging over the patients in each therapist's caseload; within-therapist (patient-level) scores were computed by centering within each therapist's caseload. As expected, better outcome was predicted by higher levels of therapist-level and patient-level autonomous motivation and by lower levels of therapist-level and patient-level controlled motivation. In turn, autonomous motivation was predicted by therapist-level and patient-level relational support (friendliness). Controlled motivation was predicted solely by patient self-critical perfectionism. The results extend past work by demonstrating that both between-therapists and within-therapist differences in motivation predict outcome. As well, the results suggest that therapists should monitor their interpersonal impact so as to provide relational support. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Kim, Byeong-Jo; Lee, Jung-Hoon
[Purpose] The aim of this paper was to report the efficacy of kinesiology taping for recovery from wrist pain and limited range of motion (ROM) in a physical therapist with repetitive strain injuries. [Subjects] A 32 year-old male physical therapist developed recurring severe pain in the dominant wrist and limited active ROM with extremely painful supination. [Methods] The kinesiology tape was applied to the lumbricals, musculi interossei dorsales, palmares, the wrist extensor and flexor muscles, and the wrist joint for 3 weeks for an average of 10 h/day. [Results] After application of the kinesiology tape, the Numeric Pain Rating Scale and Patient-rated Wrist Evaluation scores decreased, and the Patient-Specific Functional Scale score increased in comparison with the initial score. [Conclusion] Repeated kinesiology taping of the wrist muscles and joint could be an effective method for recovery from occupational wrist disorders experienced by physical therapists.
Zickgraf, Hana F.; Chambless, Dianne L.; McCarthy, Kevin S.; Gallop, Robert; Sharpless, Brian A.; Milrod, Barbara L.; Barber, Jacques P.
Objective The contributions of disorder severity, comorbidity and interpersonal variables to therapists’ adherence to a cognitive–behavioural treatment (CBT) manual were tested. Method Thirty-eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24-session protocol rated therapists’ adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients’ behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the structured clinical interview for DSM-IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory—short form. Results The higher the patients’ resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence. Conclusions Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists’ ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. PMID:25882924
Parker, Ben; Turner, William
The sexual abuse of children and adolescents is a significant worldwide problem. It is associated with a wide variety of negative psychological, social and physical consequences for the victims. These effects can often be seen immediately following sexual abuse, but they may manifest later on and sometimes only in adult life. There are a number of different interventions aimed at helping children and adolescents who have been sexually abused, and psychoanalytic/psychodynamic psychotherapy has a long-established tradition of being used for such victims. In this review, we set out to find the evidence for its effectiveness specifically in children and adolescents who have been sexually abused. To assess the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. We searched the following databases in May 2013: CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, Conference Proceedings Citation Index - Social Science and Humanities, LILACS and WorldCat. We also searched three trials registers, checked the reference lists of relevant studies and contacted known experts. Randomised and quasi-randomised trials comparing psychoanalytic/psychodynamic psychotherapy with treatment as usual or no treatment/waiting list control for children and adolescents up to age of 18 who had experienced sexual abuse at any time prior to the intervention. The review authors (BP and WT) independently screened search results to identify studies that met eligibility criteria. No studies were identified that met the inclusion criteria for this review. There are no randomised and quasi-randomised trials that compare psychoanalytic/psychodynamic therapy with treatment as usual, no treatment or waiting list control for children and adolescents who have been sexually abused. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic
Kelly, Jennifer F; Greene, Beverly
Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice. PsycINFO Database Record (c) 2010 APA, all rights reserved.
This qualitative study examined how a group of families and their therapists described helpful therapy. The qualitative analysis generated family and therapist perspectives. As a double description, the therapist and family perspectives highlighted conversation, participation, and relationship as three core areas of helpful therapy. These are…
Sluijs, E.M.; Zee, J. van der; Kok, G.J.
This article describes differences between physical therapists in terms of the attention they pay to educating patients. The differences between therapists were identified from audiotaped treatment sessions of 1837 patients, recorded by physical therapists in non-institutional care in the
Klinger, Rebecca S.; Ladany, Nicholas; Kulp, Lauren E.
The purpose of this study was to identify events in which therapists felt embarrassment, shame, or both in a therapy session and to investigate the relationship of the embarrassing-shameful events with the therapist reactions. Ninety-three therapists participated in this study, and the most frequent events reported were having a scheduling…
Rijken, P.M.; Dekker, J.
Objectives: To provide an overview of the numbers of patients with selected chronic diseases treated by rehabilitation therapists (physical therapists, occupational therapists, exercise therapists and podiatrists). The study was performed to get quantitative information on the degree to which
Huijg, Johanna M; Dusseldorp, Elise; Gebhardt, Winifred A; Verheijden, Marieke W; van der Zouwe, Nicolette; Middelkoop, Barend J C; Duijzer, Geerke; Crone, Mathilde R
Physical therapists play an important role in the promotion of physical activity (PA) and the effectiveness of PA interventions. However, little is known about the extent to which they implement PA interventions following the intervention protocol and about the factors influencing their implementation behaviors. The study objective was to investigate physical therapists' implementation fidelity regarding PA interventions, including completeness and quality of delivery, and influencing factors with a Theoretical Domains Framework-based questionnaire. The study was based on a cross-sectional design. A total of 268 physical therapists completed the Determinants of Implementation Behavior Questionnaire. Questions about completeness and quality of delivery were based on components and tasks of PA interventions as described by the Royal Dutch Society for Physical Therapy. Multilevel regression analyses were used to identify factors associated with completeness and quality of delivery. High implementation fidelity was found for the physical therapists, with higher scores for completeness of delivery than for quality of delivery. Physical therapists' knowledge, skills, beliefs about capabilities and consequences, positive emotions, behavioral regulation, and the automaticity of PA intervention delivery were the most important predictors of implementation fidelity. Together, the Theoretical Domains Framework accounted for 23% of the variance in both total completeness and total quality scores. The cross-sectional design precluded the determination of causal relationships. Also, the use of a self-report measure to assess implementation fidelity could have led to socially desirable responses, possibly resulting in more favorable ratings for completeness and quality. This study enhances the understanding of how physical therapists implement PA interventions and which factors influence their behaviors. Knowledge about these factors may assist in the development of strategies to
Millsteed, Jeannine; Redmond, Janice; Walker, Elizabeth
This study explored how occupational therapists in private practice developed the business skills needed to operate a successful private practice. The literature shows that many small-business owner-managers have poorly developed business skills, and some experience high rates of failure. This indicates that to be successful in private practice, occupational therapists need to gain mastery of management competencies in addition to their professional clinical competencies. A qualitative study, using in-depth interviews, collected data from twenty-six self-employed occupational therapists on their experiences of becoming a small-business owner-manager. A narrative analysis built an understanding about how these therapists developed their business competencies. Analysis revealed the factors affecting the development of business competencies were interactions between the initial motivations for start-up, growth aspirations and engagement with external business environments. Business competencies developed through a combination of formal learning prior to starting their businesses, and informal learning once their businesses were in operation. Lower level learning occurred in the routine and operational processes, with higher level learning through discontinuous events resulting in a transformation in the therapists' understanding about themselves as business owner-managers. Findings led to a proposition that occupational therapists make the transition to becoming successful small-business owner-manager through management learning that includes elements of self-reflection, identifying environmental opportunities and risks, developing capabilities, and strategic planning for growth and development. It provides insights on what occupational therapists need to consider to become successful small-business owner-managers. © 2016 Occupational Therapy Australia.
Groswasser, Z; Stern, M J
This article describes a conceptual psychodynamic model for understanding the neurobehavioral manifestations of acute central nervous system damage (ACNSD) displayed by patients during the rehabilitation process. According to the proposed model, patientsO behavioral responses are viewed as their only means of emotional expression and therefore may not be considered entirely abnormal when viewed from the perspective of patientsO interpersonal contexts. An improved understanding of the dynamic processes through which recovering patients with ACNSD journey may lead to better interaction between the patient and the therapeutic environment, the interdisciplinary team, and family members. Combining this proposed psychodynamic model with an emerging understanding of the neurobehavioral foundations of aggression and depression may also lead to a more rational approach to intervention with various psychopharmacologic agents. During the rehabilitation process, understanding patients' cognitive deficits, motivational drives, and emotional needs and proper implementation of medical and environmental treatment can ultimately lead to a better psychosocial outcome.
Manetta, Christopher T; Gentile, Julie P; Gillig, Paulette Marie
Psychodynamic psychotherapy is effective for a variety of mental health symptoms. This form of psychotherapy uses patient self reflection and self examination, as well as the therapeutic relationship between the patient and psychiatrist, to explore maladaptive coping strategies and relationship patterns of the patient. A thorough understanding of resistance and the core conflictual relationship theme afford the psychiatrist the ability to facilitate this work. In this article, the composite case illustrates some of the psychodynamic psychotherapy techniques that can be employed in a psychotherapy case. In this example, the case is about a certified public accountant that came to treatment because of an acute stressor that put her career goals at risk. An acute episode or event can bring to light chronic and ongoing symptoms, which have had a remitting and relapsing course, and leave the patient unable to compensate on his or her own.
Fraher, Amy L
Systems psychodynamics is an interdisciplinary field amalgamating a triad of influences -the practice of psychoanalysis, the theories and methods of the field of group relations, and the task and boundary awareness of open systems perspectives. Although systems psychodynamics is not a new field of study, there has been a general lack of awareness of its roots, how its formative elements have become intertwined over the years, and the role of the Tavistock Institute in developments in the field. This article provides a synthesis of this history and focuses, in particular,on the intellectual foundations of the Tavistock method of working experientially with groups and the application of this method to the study of organizations.
Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin
Abstract Background. Psychodynamic group psychotherapy may not be an optimal treatment for anxiety and agoraphobic symptoms. We explore remission of SCL-90-R Global Severity Index (GSI) and target symptoms in 39 sessions of psychodynamic group therapy. Methods. SCL-90-R “target symptom” profile...... to phobic anxiety and anxiety patients, patients with interpersonal sensitivity obtained overall the most optimal outcome. The phobic anxiety scale, social network support, and years of school education were independent predictors of GSI remission, and a low anxiety score and absence of phobic anxiety...... and GSI remission according to Danish norms were identified in 239 patients and evaluated according to reliable and clinical significant change. Results. Four major groups of target symptom cases (depression, interpersonal sensitivity, anxiety, and phobic anxiety) covered 95.7% of the sample. As opposite...
de Souza, Fabrício S; Ladeira, Carlos E; Costa, Leonardo O P
This was a cross-sectional observational study. (i) to investigate whether Brazilian physical therapists make clinical decisions for patients with low back pain based upon clinical practice guidelines and (ii) to determine whether the physical therapists are able to recognize differential diagnoses of low back pain associated with red or yellow flags. Early adherence to clinical practice guidelines may accelerate recovery and reduce the costs associated with low back pain. It is unknown whether Brazilian physical therapists follow clinical practice guidelines to make their clinical decisions in the treatment of patients with low back pain. The sample consisted of physical therapists from two Brazilian physical therapy associations. The data were collected via electronic survey and face-to-face interviews. The survey was composed of six hypothetical clinical cases of low back pain, which served as a basis to evaluate clinical decisions and adherence to clinical practice guidelines for low back pain. The study participants had 27 possible answers for each clinical case and could choose up to five answers. The results were analyzed in three ways: full adherence, partial adherence, or no adherence to the recommendations from clinical practice guidelines. A total of 530 physical therapists were invited and 189 participated in the study (response rate = 35.6%). Full adherence to the guidelines was low for all six cases (rates ranging from 5%-24%). Partial adherence to the guidelines was higher when compared with full adherence (rates ranging from 32%-75%). The participants were more likely to identify differential diagnoses associated with yellow flags than with red flags. Brazilian physical therapists are not using the best available evidence in their clinical decision making for patients with low back pain. Wider dissemination of clinical practice guidelines should be urgently undertaken. 2.
Dashtipour, Parisa; Vidaillet, Bénédicte
International audience; Psychoanalytic approaches to leadership centre on emotions and the role of the leader as the manager of emotion (Gabriel, 2011). These perspectives have often focused on the dysfunctions of leadership, the way in which leaders contribute to ‘dark’ and unhealthy organizational lives. In contrast to such approaches, in this paper we draw from Christophe Dejours’ psychodynamic theory of work, in order to explore what role leaders could play to facilitate health in organiz...
At present homosexuality is not regarded as a mental disorder in contrast to a long period in the past when it was treated as a disease. The majority of psychodynamic approach representatives adhered to the estimation of nontraditional sexual orientation as a psychopathic state. Homosexuality was often viewed as a symptom of a major psychic impairment like confused self-identity, but with time the authors came to a conclusion that homosexuality is an alternative, yet possible type of psychos...
Wiltink, Jörg; Hoyer, Jürgen; Beutel, Manfred E.; Ruckes, Christian; Herpertz, Stephan; Joraschky, Peter; Koranyi, Susan; Michal, Matthias; Nolting, Björn; Pöhlmann, Karin; Salzer, Simone; Strauss, Bernhard; Leibing, Eric; Leichsenring, Falk
OBJECTIVES: Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. RESEARCH DESIGN AND METHODS: In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatmen...
Hesslow, Thomas; Nilsson, Maja; Johansson, R.; Färdig, S.; Jansson, A.; Jonsson, L.; Karlsson, J.; Hesser, H.; Ljótsson, B.; Frederick, R.J.; Lilliengren, Peter; Carlbring, Per; Andersson, Gerhard
Social anxiety disorder is one of the most common mental health disorders. Effective treatments exist, but limited access and high costs causes many sufferers to remain untreated. As not all patients accept the CBTmodel of psychopathology, alternative treatments are desirable. We conducted two studies to help establish the efficacy of a psychodynamic model of guided self-help (IPDT). In the first study (N=72) participants were randomized to either ten weeks of IPDT or a waiting list control c...
Teusner, D N; Amarasena, N; Satur, J; Chrisopoulos, S; Brennan, D S
Dental service provision rates are necessary for workforce planning. This study estimates patient and service rates for oral health therapists (OHTs), dental hygienists (DHs) and dental therapists (DTs). To identify important variables for workforce modelling, variations in rates by practice characteristics were assessed. A cross-sectional self-complete mailed questionnaire collected demographic and employment characteristics, and clinical activity on a self-selected typical day of practice. Private and public dental practices in Australia. Members of the two professional associations representing DHs, DTs and OHTs. For each practitioner type, means and adjusted rate ratios of patients per hour, services per visit and preventive services per visit were estimated. Comparisons by practice characteristics were assessed by negative binomial regression models. Response rate was 60.6% (n = 1,083), 90.9% were employed of which 86.3% were working in clinical practice and completed the service log. Mean services per patient visit provided by OHTs, DHs and DTs were 3.7, 3.5 and 3.3 and mean preventive services per patient were 2.1, 2.1 and 1.8 respectively. For all three groups, adjusting for explanatory variables, the rate of preventive services per patient varied significantly by practice type (general or specialist) and by the proportion of child patients treated. Services rates varied by age distribution of patients and type of practice. If these factors were anticipated to vary over-time, then workforce planning models should consider accounting for the potential impact on capacity to supply services by these dental workforce groups.
Farrell, Nicholas R; Deacon, Brett J
Although client preferences are an integral component of evidence-based practice in psychology (American Psychological Association, 2006), relatively little research has examined what potential mental health consumers value in the psychotherapy they may receive. The present study was conducted to examine community members' preferences for the scientific and relational aspects of psychotherapy for different types of presenting problems, and how accurately therapists perceive these preferences. Community members (n = 200) were surveyed about the importance of scientific (e.g., demonstrated efficacy in clinical trials) and relational (e.g., therapist empathy) characteristics of psychotherapy both for anxiety disorders (e.g., obsessive-compulsive disorder) and disorder-nonspecific issues (e.g., relationship difficulties). Therapists (n = 199) completed the same survey and responded how they expected the average mental health consumer would. Results showed that although community members valued relational characteristics significantly more than scientific characteristics, the gap between these two was large for disorder-nonspecific issues (d = 1.24) but small for anxiety disorders (d = .27). Community members rated scientific credibility as important across problem types. Therapists significantly underestimated the importance of scientific characteristics to community members, particularly in the treatment of disorder-nonspecific issues (d = .74). Therapists who valued research less in their own practice were more likely to underestimate the importance of scientific credibility to community members. The implications of the present findings for understanding the nature of client preferences in evidence-based psychological practice are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.
Leichsenring, Falk; Beutel, Manfred; Leibing, Eric
Social phobia is a very frequent mental disorder characterized by an early onset, a chronic unremitting course, severe psychosocial impairments and high socioeconomic costs. To date, no manual for the psychodynamic treatment of social phobia exists. After a brief description of the disorder, a manual for a short-term psychodynamic treatment of social phobia is presented. The treatment is based on Luborsky s supportive-expressive (SE) therapy, which is complemented by treatment elements specific to social phobia. The treatment includes the characteristic elements of SE therapy, that is, setting goals, focus on the Core Conflictual Relationship Theme (CCRT) associated with the patient s symptoms, interpretive interventions to enhance insight into the CCRT, and supportive interventions, in particular fostering a helping alliance. In order to tailor the treatment more specifically to social phobia, treatment elements have been added, for example informing the patient about the disorder and the treatment, a specific focus on shame and on unrealistic demands, and encouraging the patient to confront anxiety-producing situations. More directive interventions are included as well, such as specific prescriptions to stop persisting self-devaluations. The treatment manual is presently being used in a large-scale randomized controlled multicenter study comparing short-term psychodynamic psychotherapy and cognitive-behavioral therapy in the treatment of social phobia.
Steinert, Christiane; Schauenburg, Henning; Dinger, Ulrike; Leichsenring, Falk
With a lifetime prevalence of about 17% depression is the most common mental disorder. Psychotherapy is efficacious in the treatment of depression, with no significant differences between different forms of psychotherapies. For psychodynamic therapy (PDT) various models proved to be efficacious in randomized controlled trials (RCTs). As a consequence the evidence for PDT is scattered between different forms or orientations of PDT entailing problems regarding psychotherapy training and the transfer of research into clinical practice. Thus, our aim was to develop a unified protocol for the dynamic treatment of depression that is based on those models of PDT that proved efficacious in randomized controlled trials (RCTs). As a first step we conducted a systematic search of RCTs investigating manualized or manual-based individual psychodynamic therapy for depressive disorders in adults that proved to be efficacious compared to comparison conditions. 11 studies fulfilled our inclusion criteria. In a second step we systematically reviewed the studies with regard to the treatment concepts they had applied. 7 highly consistent treatment components could be identified. We conceptualized them in the form of 7 interrelated treatment modules which constitute the unified psychodynamic protocol for depression. The protocol may enhance the empirical status of PDT and facilitate both psychotherapy training as well as the transfer of research to clinical practice. Through the focused use of techniques that proofed efficacious it is expected to bring more benefit to depressed patients and therefore also have a positive impact on the health care system. © Georg Thieme Verlag KG Stuttgart · New York.
Sharp, D M; Power, K G; Swanson, V
BACKGROUND: Panic disorder, with and without agoraphobia, is a prevalent condition presenting in general practice. Psychological treatments are effective but are limited by restricted availability. Interest has grown in methods by which the efficiency and thus availability of psychological treatments can be improved, with particular emphasis on reduced therapist contact formats. AIM: To evaluate the relative efficacy in a primary care setting of a cognitive behaviour therapy (CBT) delivered at three levels of therapist contact: standard contact, minimum contact, and bibliotherapy. METHOD: A total of 104 patients were randomly allocated to receive standard therapist contact, minimum therapist contact or bibliotherapy, with 91 patients completing treatment. All patients received an identical treatment manual and were seen by the same psychologist therapist. Outcome was reported in terms of brief global ratings of severity of illness, change in symptoms, and levels of social disruption. These brief measures were chosen to be suitable for use in general practice and were used at treatment entry and endpoint. RESULTS: The standard therapist contact group had the strongest and most comprehensive treatment response, showing significant differences from the bibliotherapy group on all, and the minimum therapist contact group on some, endpoint measures. Some reduction in efficacy was therefore found for the reduced therapist contact groups. CONCLUSION: The standard therapist contact group showed the greatest treatment efficacy in the present study. As it was of notably shorter duration than many other current formulations of CBT, it represents a useful and efficient treatment for panic disorder and agoraphobia in primary care. PMID:11224967
Sinai, Dana; Gur, Merav; Lipsitz, Joshua D
We assessed therapist adherence to interpersonal therapy (IPT) and supportive therapy (ST) in a controlled trial for social anxiety disorder. Raters blindly scored n = 133 videotapes from 53 participants using the Collaborative Study Psychotherapy Rating Scale (CSPRS). Results reveal statistical differences across groups, but higher than expected overlap. Greater use of IPT in beginning sessions predicted better outcome in both therapies. Suboptimal adherence may be due to the crossed design in which the same therapists delivered both IPT and ST. Since switching between different approaches is a clinical reality for integrative psychotherapists, these findings may have important clinical implications.
As an older woman therapist, I find that my life experience grounds me in my work with people of all ages and backgrounds as they deal with life crises, aging issues, and loss. People with whom I work in therapy appreciate the fact that I am older and have had varied life experiences. Gender issues are still central to my work with clients whether I am working with a man or a woman. I am an integrative therapist, with a background in cognitive-behavioral therapy and gestalt therapy. Therapists need to help clients to identify less with their aging bodies and our culture's view of attractiveness, shifting instead to a paradigm that values life experience and the cultivation of wisdom. We need to find ways of embracing what we have learned about life instead of extolling youthful values. As I get older, I more fully appreciate a constructivism framework and life-cycle perspective, focusing on making sense of clients' life narratives. Storytelling and memoirs have both provided a framework for working with clients on coping with the many changes and challenges of life that bring them to therapy and added another layer to my integrative therapeutic work. © 2015 Wiley Periodicals, Inc.
Sigera, Ponsuge Chathurani; Tunpattu, Tunpattu Mudiyanselage Upul Sanjeewa; Jayashantha, Thambawitage Pasan; De Silva, Ambepitiyawaduge Pubudu; Athapattu, Priyantha Lakmini; Dondorp, Arjen; Haniffa, Rashan
The availability and role of physical therapists in critical care is variable in resource-poor settings, including lower middle-income countries. The aim of this study was to determine: (1) the availability of critical care physical therapist services, (2) the equipment and techniques used and needed, and (3) the training and continuous professional development of physical therapists. All physical therapists working in critical care units (CCUs) of state hospitals in Sri Lanka were contacted. The study tool used was an interviewer-administered telephone questionnaire. The response rate was 100% (N=213). Sixty-one percent of the physical therapists were men. Ninety-four percent of the respondents were at least diploma holders in physical therapy, and 6% had non-physical therapy degrees. Most (n=145, 68%) had engaged in some continuous professional development in the past year. The majority (n=119, 56%) attended to patients after referral from medical staff. Seventy-seven percent, 98%, and 96% worked at nights, on weekends, and on public holidays, respectively. Physical therapists commonly perform manual hyperinflation, breathing exercises, manual airway clearance techniques, limb exercises, mobilization, positioning, and postural drainage in the CCUs. Lack of specialist training, lack of adequate physical therapy staff numbers, a heavy workload, and perceived lack of infection control in CCUs were the main difficulties they identified. Details on the proportions of time spent by the physical therapists in the CCUs, wards, or medical departments were not collected. The availability of physical therapist services in CCUs in Sri Lanka, a lower middle-income country, was comparable to that in high-income countries, as per available literature, in terms of service availability and staffing, although the density of physical therapists remained very low, critical care training was limited, and resource limitations to physical therapy practices were evident. © 2016
David P. G. van den Berg
Full Text Available Background: Despite robust empirical support for the efficacy of trauma-focused treatments, the dissemination proves difficult, especially in relation to patients with comorbid psychosis. Many therapists endorse negative beliefs about the credibility, burden, and harm of such treatment. Objective: This feasibility study explores the impact of specialized training on therapists’ beliefs about trauma-focused treatment within a randomized controlled trial. Method: Therapist-rated (n=16 credibility, expected burden, and harm expectancies of trauma-focused treatment were assessed at baseline, post-theoretical training, post-technical training, post-supervised practical training, and at 2-year follow-up. Credibility and burden beliefs of therapists concerning the treatment of every specific patient in the trial were also assessed. Results: Over time, therapist-rated credibility of trauma-focused treatment showed a significant increase, whereas therapists’ expected burden and harm expectancies decreased significantly. In treating posttraumatic stress disorder (PTSD in patients with psychotic disorders (n=79, pre-treatment symptom severity was not associated with therapist-rated credibility or expected burden of that specific treatment. Treatment outcome had no influence on patient-specific credibility or burden expectancies of therapists. Conclusions: These findings support the notion that specialized training, including practical training with supervision, has long-term positive effects on therapists’ credibility, burden, and harm beliefs concerning trauma-focused treatment.
Daniela Zippin Knijnik
Full Text Available OBJETIVOS: O objetivo deste estudo é verificar a efetividade do tratamento psicodinâmico em grupo de pacientes com fobia social generalizada. MÉTODOS: 30 pacientes foram incluídos em um estudo randomizado, simples-cego, comparando Terapia Psicodinâmica de Grupo (TPG com um Grupo de Controle Placebo com Credibilidade (CPC. A TPG foi conduzida em 12 sessões de terapia de orientação psicodinâmica em grupo. Os pacientes do grupo controle receberam um pacote de aulas-discussões e tratamento de apoio por 12 semanas, que foi comparado à TPG. Todos os participantes preencheram a Escala de Liebowitz para Ansiedade Social (LSAS, a Escala Hamilton de Ansiedade (HAM-A e a Escala de Impressão Clínica Global (CGI, na entrevista inicial e na 12ª semana de tratamento. Os dados foram analisados com uma ANOVA de medidas repetidas. Pacientes em vigência de tratamento farmacológico ou psicoterápico foram excluídos. RESULTADOS: Ambos os grupos apresentaram melhora na maioria das medidas. Na LSAS, os pacientes da TPG obtiveram melhora superior aos do grupo controle, ao cabo de 12 semanas (F1,28=4.84, p=0.036. Nas medidas basais dos sujeitos que completaram o estudo, não houve diferença entre os grupos em variáveis demográficas e de desfecho. CONCLUSÃO: Neste estudo, a TPG foi superior ao tratamento placebo com credibilidade no tratamento da fobia social generalizada, em um ensaio clínico randomizado, simples-cego, de 12 semanas.OBJECTIVES: The aim of this study is to assess the effectiveness of psychodynamic group therapy in patients with generalized social phobia. METHODS: Thirty patients were included in a randomized single-blind clinical trial comparing psychodynamic group treatment (PGT with a credible placebo control group (CPC. PGT was carried out within a 12-session psychodynamically-oriented group psychotherapy. Control patients received a treatment package of lecture-discussion and support group for 12 weeks which was compared to PGT
Eichenberg, Christiane; Grabmayer, Gloria; Green, Nikos
Serious games are computer or video games that contain elements that are specifically designed for the purpose of education or training. Serious games are increasingly being used within healthcare, but their introduction into and application in psychotherapeutic settings as an e-mental health treatment modality raises questions for both patients and therapists. Current research demonstrates the potential role and effectiveness of serious games within a psychotherapeutic context. However, a limited understanding of patients' and therapists' existing knowledge and experience of serious games, as well as of their readiness to utilize and apply them for the treatment of psychological conditions, requires further investigation. Acceptance, experience, and requirements for the utilization of serious games in therapeutic contexts were assessed through online surveys with German-speaking patients (n = 260) and psychotherapists (n = 234). Respondents' answers were analyzed by a combination of descriptive and inferential statistics by using SPSS. Current knowledge regarding serious games was very limited, with only 10.4% of patients and 11.5% of therapists reporting existing knowledge. However, a general openness toward the concept was observed: 88% of patients and 90% of therapists could envisage a therapeutic use. Patients (rs = 0.169, p = 0.006) who self-rated their level of computer and video game expertise as high were more likely to consider use within psychotherapy, compared with patients who self-rated their expertise as low. Therapists who currently play computer and video games perceive fewer disadvantages of serious game application in a psychotherapeutic context (p = 0.097). Consideration of serious game use was differentiated by the therapeutic approach (p = 0.003), specific mental disorders (highest rated relevant cases: anxiety disorders, affective disorders, disorders regarding impulse control, and adjustment disorders), and patient
Schneider, Luke H; Hadjistavropoulos, Heather D; Faller, Y Nichole
A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.
Schoenwald, Sonja K; Chapman, Jason E; Sheidow, Ashli J; Carter, Rickey E
This study investigated relations among therapist adherence to an evidence-based treatment for youth with serious antisocial behavior (i.e., Multisystemic Therapy), organizational climate and structure, and youth criminal charges on average 4 years posttreatment. Participants were 1,979 youth and families treated by 429 therapists across 45 provider organizations. Results showed therapist adherence predicted significantly lower rates of youth criminal charges independently and in the presence of organizational variables. Therapist perceptions of job satisfaction and opportunities for growth and advancement relative to the organizational average predicted youth criminal charges, as did organizational average levels of participation in decision making. These associations washed out in the presence of adherence, despite the fact that job satisfaction and growth and advancement were associated with adherence.
Bucci, Sandra; Seymour-Hyde, Annily; Harris, Alison; Berry, Katherine
Working alliance has been shown to be important in influencing the outcome of therapy. Research evidence suggests that characteristics of both clients and therapists impact on the development of the working alliance. Although attachment theory is well researched, there is relatively limited research on the relationship between both therapist and client attachment style and the working alliance; traditionally, research has placed greater emphasis on client characteristics. The current study examines the extent to which both client and therapist self-reported attachment styles are related to the working alliance. Thirty clients and 42 therapists were recruited from primary care psychology services. Thirty client-therapist dyads were examined. Participants completed self-report measures of anxiety and depression, attachment style and working alliance at a single time point. Client and therapist attachment security were not independently related to working alliance. However, there was a significant association between therapist insecure attachment and alliance in more symptomatic clients. There was also some evidence that therapists and clients with oppositional attachment styles reported more favourable alliances. The study suggests that the relationship between therapist attachment style and alliance is not straightforward. It is likely that the complexity of clients' presenting problems, coupled with interaction between client-therapist attachment styles, influences the therapeutic alliance. Therapist insecure attachment may negatively affect the therapeutic alliance in more symptomatic clients. It is important to consider the interaction between client and therapist attachment and how these interactions influence the therapeutic alliance. Therapists should be aware of their own personal attachment style and reflect on how this might manifest during the therapeutic process. Copyright © 2015 John Wiley & Sons, Ltd.
Landry, Michel D; Hack, Laurita M; Coulson, Elizabeth; Freburger, Janet; Johnson, Michael P; Katz, Richard; Kerwin, Joanne; Smith, Megan H; Wessman, Henry C Bud; Venskus, Diana G; Sinnott, Patricia L; Goldstein, Marc
Health human resources continue to emerge as a critical health policy issue across the United States. The purpose of this study was to develop a strategy for modeling future workforce projections to serve as a basis for analyzing annual supply of and demand for physical therapists across the United States into 2020. A traditional stock-and-flow methodology or model was developed and populated with publicly available data to produce estimates of supply and demand for physical therapists by 2020. Supply was determined by adding the estimated number of physical therapists and the approximation of new graduates to the number of physical therapists who immigrated, minus US graduates who never passed the licensure examination, and an estimated attrition rate in any given year. Demand was determined by using projected US population with health care insurance multiplied by a demand ratio in any given year. The difference between projected supply and demand represented a shortage or surplus of physical therapists. Three separate projection models were developed based on best available data in the years 2011, 2012, and 2013, respectively. Based on these projections, demand for physical therapists in the United States outstrips supply under most assumptions. Workforce projection methodology research is based on assumptions using imperfect data; therefore, the results must be interpreted in terms of overall trends rather than as precise actuarial data-generated absolute numbers from specified forecasting. Outcomes of this projection study provide a foundation for discussion and debate regarding the most effective and efficient ways to influence supply-side variables so as to position physical therapists to meet current and future population demand. Attrition rates or permanent exits out of the profession can have important supply-side effects and appear to have an effect on predicting future shortage or surplus of physical therapists. © 2016 American Physical Therapy
Bryant, Christina; Lewis, Prudence; Bennell, Kim L; Ahamed, Yasmin; Crough, Denae; Jull, Gwendolen A; Kenardy, Justin; Nicholas, Michael K; Keefe, Francis J
Physical therapists are well established as providers of treatments for common, painful, and disabling conditions, such as knee osteoarthritis (OA). Thus, they are well placed to deliver treatments that integrate physical and psychosocial elements. Attention is usually given to outcomes of such programs, but few studies have examined the processes and outcomes of training physical therapists to deliver such treatments. The aim of this study was to describe the processes in training physical therapists: (1) to deliver a standardized pain coping skills treatment and (2) to evaluate the effectiveness of that training. This study was an analysis of data relating to therapist performance in a randomized clinical trial. Eleven physical therapists were trained to deliver a 10-session pain coping skills training program for people with knee OA as part of a randomized controlled trial (N=222). The initial training was provided in a workshop format and included extensive, ongoing supervision by a psychologist and rigorous use of well-defined performance criteria to assess competence. Adherence to the program, ratings of performance, and use of advanced skills were all measured against these criteria in a sample (n=74, 10%) of the audio recordings of the intervention sessions. Overall, the physical therapists achieved a very high standard of treatment delivery, with 96.6% adherence to the program and mean performance ratings all in the satisfactory range. These results were maintained throughout the intervention and across all sessions. Only 10% of the delivered sessions were analyzed, and the physical therapists who took part in the study were a self-selected group. This study demonstrated that a systematic approach to training and accrediting physical therapists to deliver a standardized pain coping skills program can result in high and sustained levels of adherence to the program. Training fidelity was achieved in this group of motivated clinicians, but the supervision
Full Text Available Orientation: The researchers conducted a literature review to analyse the assumptions of systems psychodynamics, the Tavistock model of group relations, object relations theory and the most relevant constructs in the systems psychodynamic perspective. They then described the assumptions and most relevant constructs in the positive psychology perspective in order to analyse theoretically the psychological effect of large-scale sports events on a community or country. The objective of the empirical study was to investigate some of the unconscious emotions, fears, anxieties and conflicts (dynamics that prevailed in South Africa before the 2010 Fédération Internationale de Football Association (FIFA World Cup and some of the positive emotional experiences associated with it.Research purpose: The objective of this study was to analyse and describe the psychological experiences of South Africans before the 2010 FIFA World Cup.Research design, approach and method: The researchers conducted the study from the systems psychodynamic and positive psychology perspectives. The study comprised a qualitative, explorative and social phenomenological study. The researchers conducted interviews with a wide range of their colleagues and clients.Main findings: The results seemed to indicate that South Africans had had a number of positive and negative experiences before the 2010 FIFA World Cup.Practical/managerial implications: The researchers presented the findings as a number of systems psychodynamic and positive psychology themes.Contribution/value-add: This study presents original research that contributes valuable new knowledge to the positive psychology and systems psychodynamic perspectives.
Wiltink, Jörg; Ruckes, Christian; Hoyer, Jürgen; Leichsenring, Falk; Joraschky, Peter; Leweke, Frank; Pöhlmann, Karin; Beutel, Manfred E
Despite growing evidence for manualized psychodynamic treatments, there is a lack of studies on their transfer to routine practice. This is the first study to examine the effects of an additional training in manualized Short Term Psychodynamic Psychotherapy (STPP) on the outcome in routine psychotherapy for social anxiety disorder (SAD). The study is an extension to a large RCT comparing STPP to Cognitive-Behavioral Therapy of SAD. The manualized treatment was designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners were randomized to training in manualized STPP (mSTPP) vs. treatment as usual without a specific training (tauSTPP). A total of 109 patients were enrolled (105 started treatment; 75 completed at least 20 treatment sessions). Assessments were conducted pre-treatment, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 and 12 months after termination of treatment. Remission as primary outcome was defined by the Liebowitz-Social-Anxiety-Scale (LSAS) score ≤30. Secondary outcomes were response (at least 31% reduction in LSAS), treatment duration and number of sessions, changes in social anxiety (LSAS, SPAI), depression (BDI), clinical global impression (CGI), and quality of life (EQ-5D). Remission rates of mSTPP (9%) resp. tauSTPP (16%) and also response rates of 33% resp. 28% were comparable between the two treatment approaches as well as treatment duration and number of sessions. Most of the within-group differences (baseline to 25 sessions) indicated moderate to large improvements in both treatments; within-group differences from baseline to 12 months follow-up (LSAS, SPAI, BDI, CGI) were large ranging from d = -0.605 to d = -2.937. Benefits of mSTPP were limited to single outcomes. Findings are discussed with regard to implementation and dissemination of empirically validated treatments in psychodynamic training and practice. SAD patients with a high comorbidity
Full Text Available Purpose: To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. Methods: In two regions in The Netherlands continuing education (CE programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. Results: Sixty-three physical therapists out of 193 practices (33% participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. Conclusions: Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale.
Feasibility and acceptability of two incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: a pilot study to inform a randomized controlled trial.
Beidas, Rinad S; Becker-Haimes, Emily M; Adams, Danielle R; Skriner, Laura; Stewart, Rebecca E; Wolk, Courtney Benjamin; Buttenheim, Alison M; Williams, Nathaniel J; Inacker, Patricia; Richey, Elizabeth; Marcus, Steven C
Informed by our prior work indicating that therapists do not feel recognized or rewarded for implementation of evidence-based practices, we tested the feasibility and acceptability of two incentive-based implementation strategies that seek to improve therapist adherence to cognitive-behavioral therapy for youth, an evidence-based practice. This study was conducted over 6 weeks in two community mental health agencies with therapists (n = 11) and leaders (n = 4). Therapists were randomized to receive either a financial or social incentive if they achieved a predetermined criterion on adherence to cognitive-behavioral therapy. In the first intervention period (block 1; 2 weeks), therapists received the reward they were initially randomized to if they achieved criterion. In the second intervention period (block 2; 2 weeks), therapists received both rewards if they achieved criterion. Therapists recorded 41 sessions across 15 unique clients over the project period. Primary outcomes included feasibility and acceptability. Feasibility was assessed quantitatively. Fifteen semi-structured interviews were conducted with therapists and leaders to assess acceptability. Difference in therapist adherence by condition was examined as an exploratory outcome. Adherence ratings were ascertained using an established and validated observational coding system of cognitive-behavioral therapy. Both implementation strategies were feasible and acceptable-however, modifications to study design for the larger trial will be necessary based on participant feedback. With respect to our exploratory analysis, we found a trend suggesting the financial reward may have had a more robust effect on therapist adherence than the social reward. Incentive-based implementation strategies can be feasibly administered in community mental health agencies with good acceptability, although iterative pilot work is essential. Larger, fully powered trials are needed to compare the effectiveness of
Driessen, Ellen; Van, Henricus L.; Don, Frank J.; Peen, Jaap; Kool, Simone; Westra, Dieuwertje; Hendriksen, Marielle; Schoevers, Robert A.; Cuijpers, Pim; Twisk, Jos W. R.; Dekker, Jack J. M.
Objective: The efficacy of psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of psychodynamic therapy with that of cognitive-behavioral therapy (CBT), hypothesizing nonsignificant differences and the
Driessen, E.; Van Henricus, L.; Don, F.J.; Peen, J.; Kool, S.; Westra, D.; Hendriksen, M.; Schoevers, R.; Cuijpers, P.; Twisk, J.W.R.; Dekker, J.J.M.
Objective: The efficacy of psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of psychodynamic therapy with that of cognitive-behavioral therapy (CBT), hypothesizing nonsignificant differences and the
Driessen, E.; Van, H.L.; Don, F.J.; Peen, J.; Kool, S.; Westra, D.; Hendriksen, M.; Schoevers, R.A.; Cuijpers, P.; Twisk, J.W.R.; Dekker, J.J.H.
OBJECTIVE The efficacy of psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of psychodynamic therapy with that of cognitive-behavioral therapy (CBT), hypothesizing nonsignificant differences and the
From the beginning of clinical psychoanalysis, analysts have been at risk of succumbing to yearnings for intimacy and contact that are stirred up by the heat of the analytic encounter. Recently, as theoretical developments have encouraged us to create moments of meeting (Stern et al. 1998) and have urged us to tolerate the feelings stimulated by enactments, these risks have increased. The author points out that foregoing the realization of this yearning within the analytic relationship and the resultant mourning for the loss of a fantasy or illusion carries a heavy personal price tag for the therapist. © 2013 The Psychoanalytic Quarterly, Inc.
Dickstein, Ruth; Deutsch, Judith E
Motor imagery is the mental representation of movement without any body movement. Abundant evidence on the positive effects of motor imagery practice on motor performance and learning in athletes, people who are healthy, and people with neurological conditions (eg, stroke, spinal cord injury, Parkinson disease) has been published. The purpose of this update is to synthesize the relevant literature about motor imagery in order to facilitate its integration into physical therapist practice. This update also will discuss visual and kinesthetic motor imagery, factors that modify motor imagery practice, the design of motor imagery protocols, and potential applications of motor imagery.
de Roten, Yves; Ambresin, Gilles; Herrera, Fabrice; Fassassi, Sylfa; Fournier, Nicolas; Preisig, Martin; Despland, Jean-Nicolas
For severe and chronic depression, inpatient treatment may be necessary. Current guidelines recommend combined psychological and pharmacological treatments for moderate to severe depression. Results for positive effects of combined treatment for depressed inpatients are still ambiguous. This randomised controlled trial examined the efficacy of adding an intensive and brief psychodynamic psychotherapy (IBPP) to treatment-as-usual (TAU) for inpatients with DSM-IV major depressive episode. The primary outcomes were reduction in depression severity, and response and remission rates at post-treatment, 3-month and 12-month follow-up points. A linear mixed model analysis (N=149) showed a higher reduction in the observer-rated severity of depressive symptoms at each follow-up point for the IBPP condition compared with the TAU condition (post-treatment ES=0.39, 95%CI 0.06-0.71; 3-month ES=0.46, 95%CI 0.14-0.78; 12-month ES=0.32, 95%CI 0.01-0.64). Response rate was superior in the IBPP group compared with the TAU group at all follow-up points (post-treatment OR =2.69, 95%CI 1.18-6.11; 3-month OR=3.47, 95%CI 1.47-8.25; 12-month OR=2.26, 95%CI 1.02-4.97). IBPP patients were more likely to be remitted 3 months (OR=2.82, 95%CI 1.12-7.10) and 12 months (OR=2.93, 95%CI 1.12-7.68) after discharge than TAU patients. Heterogeneous sample with different subtypes of depression and comorbidity. IBPP decreased observer-rated depression severity up to 12 months after the end of treatment. IBPP demonstrated immediate and distant treatment responses as well as substantial remissions at follow-up. IBPP appears to be a valuable adjunct in the treatment of depressed inpatients. Copyright © 2016 Elsevier B.V. All rights reserved.
de Jong, K
Routine outcome monitoring (ROM) can only improve the quality of mental health care if the therapist is prepared to accept ROM-feedback. However, most implementation procedures tend to focus on the organisation of the measurements rather than on the role of the therapist. To obtain a better understanding of the characteristics of the therapist which influence his/her attitude to the use of the feedback that ROM generates. Therapists were asked to complete two questionnaires that measured their attitude to rom feedback. Six months later several therapists were asked to complete a questionnaire that measured the barriers of the use of ROM feedback. Therapists with a preference for external feedback and therapists who felt that the feedback was valuable had a positive attitude to ROM. Barriers that prevented therapists from using feedback included the need to attend to other pressing tasks and a lack of time. In ROM implementation procedures more attention needs to be given to the role of the therapist.
To investigate whether the use of recorded music enhances therapy outcome in psychodynamic trauma therapy for women with Complex PTSD, outcome measures of three groups of patients were compared. One group received 50 hours of outpatient trauma therapy with the Bonny Method of Guided Imagery...... and Music (GIM), another group received 50 hours of outpatient trauma therapy with Psychodynamic Imaginative Trauma Therapy (PITT). The third group was a waiting-list control group of women who had to wait at least nine months for therapy. The participants filled out questionnaires measuring symptoms....... Participants treated with GIM showed significantly better outcome in all measurements than participants treated with PITT. This indicates that the use of music is beneficial for women with Complex PTSD treated with psychodynamic trauma therapy....
Full Text Available Abstract Background A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions. Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion Despite the large number of studies
Huppert, Jonathan D; Kivity, Yogev; Barlow, David H; Gorman, Jack M; Shear, M Katherine; Woods, Scott W
Although the alliance-outcome correlation is well established, no published studies to date have separated between therapists' and patients' contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists' and patients' contribution to the alliance on outcome and attrition in one trial. Alliance ratings were obtained from patients and therapists early and late in treatment (n = 133). Data were analyzed using multi-level modeling controlling for early symptom change. No therapist effects were found. The patients' contribution to the alliance predicted outcome (in both panic severity and anxiety sensitivity) and attrition. The therapists' contribution to the alliance predicted attrition but not outcome. Results suggest that the patient's contribution to the alliance plays an important role in CBT for PDA and that including common factors into research on CBT may help elucidate treatment processes. Copyright © 2013 Elsevier Ltd. All rights reserved.
Richard J. Rosenthal
ão evitativo de comportamento e defesas psicodinâmicas.OBJECTIVE: The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. METHOD: After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970 psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. RESULTS: A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. CONCLUSIONS: A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.
Søren Ventegodt; Isack Kandel; Joav Merrick
Sexual transference and countertransference can make therapy slow and inefficient when libidinous gratification becomes more important for both the patient and the therapist than real therapeutic progress. Sexual transference is normal when working with a patient's repressed sexuality, but the therapeutic rule of not touching often hinders the integration of sexual traumas, as this needs physical holding. So the patient is often left with sexual, Oedipal energies projected onto the therapist ...
Mariani, Rachele; Maskit, Bernard; Bucci, Wilma; De Coro, Alessandra
The referential process is defined in the context of Bucci's multiple code theory as the process by which nonverbal experience is connected to language. The English computerized measures of the referential process, which have been applied in psychotherapy research, include the Weighted Referential Activity Dictionary (WRAD), and measures of Reflection, Affect and Disfluency. This paper presents the development of the Italian version of the IWRAD by modeling Italian texts scored by judges, and shows the application of the IWRAD and other Italian measures in three psychodynamic treatments evaluated for personality change using the Shedler-Westen Assessment Procedure (SWAP-200). Clinical predictions based on applications of the English measures were supported.
Papapietro, Daniel J; Barbo, Elizabeth
Much of the literature on filicide explores acute psychosis, sociopathy, or malignant narcissism (psychiatrically ill versus not psychiatrically ill) as primary explanations of why parents kill children. In this issue, Hatters Friedman et al. review the literature on acute psychiatric symptoms in an effort to identify key risk factors for filicide that might have predictive value. In this commentary, we assert the argument that filicide is a complex phenomenon that is the result of more than just psychosis or environmental stressors and that, because not all parents who become psychiatrically ill kill, there may be specific risk factors related to individual underlying psychodynamic conflicts.
Martens, Willem H J
In this article the psychodynamic link between loneliness and sadism is examined on basis of a case report of the sadistic and cannibalistic serial killer Jeffery Dahmer. Envy, shame/rage mechanism, a disturbed oral-sadistic development, castration fear and severe feelings of inferiority, the conviction of being unlovable and unacceptable, need to diminish tension, powerful and sadistic fantasies as a consequence of inadequate and frustrated parenting, and reality distortion appear to be involved in sadistic etiology. © 2011 N.P.A.P.
Full Text Available Orientation: This study explores individual stories of trauma and their dissonance with the official, dominant discourse on trauma in the South African Police Service (SAPS from a systems psychodynamic perspective.Research purpose: The purpose of the research was, firstly, to explore how trauma experienced by South African Police Service members is constructed or ‘talked about’ and made sense of. Questions and issues that are considered relevant to the primary purpose are: which aspects of the working environment do members consider to be the most stressful, traumatic and difficult to cope with, and what is the effect of the change and transition processes on members’ working experiences?Motivation for the study: The authors set out to explore the role of systems psychodynamics in the experience of trauma and stress in the SAPS.Research design, approach and method: Through this qualitative, explorative, social phenomenological study, contributing circumstances and processes are included as additional discourses in an attempt to deepen understanding. The epistemology viewpoint of the study is found in the social constructionism and the data comprise 15 essays by members of the SAPS, all of which have been analysed from the perspective of systems psychodynamics.Main findings: Although the effect of trauma on police officers can never be negated, the way in which they deal with trauma seems to be different from what was initially believed. Further, their experience of stress is not solely the result of traumatic experiences but rather the result of traumatic experiences and systems psychodynamics operating within their organisation – which includes both organisational stressors or dynamics and transformation dynamics.Practical/managerial implications: The history of psychological trauma indicates that constructions of traumatic stress are strongly related to cultural, social and political circumstances. Current psychoanalytic thinking
Kutcher, S; Marton, P; Szalai, J; Kennedy, B
The specificity of psychodynamic hypotheses regarding the onset of adolescent psychosis was assessed in a group of rigorously diagnosed psychotic (N = 75) and depressed (N = 53) adolescents. None of the four operationally defined psychodynamic hypotheses purported to be etiologically specific in the onset of adolescent psychotic illness: success and its opportunities; intimacy and its attempts; intent to act autonomously; or involved in insight-oriented psychotherapy was more commonly observed in the psychotic than the depressed group, thereby not supporting the hypotheses. The consequences of this finding are discussed.
Ivezić, Slađana Štrkalj; Petrović, Branka Restek; Urlić, Ivan; Grah, Majda; Mayer, Nina; Stijačić, Dubravka; Jendričko, Tihana; Martić-Biočina, Sanja
The hereby presented guidelines for the use of psychodynamic psychotherapy are based on references and research in the field of individual and group therapy and they refer to psychotherapy for patients suffering from the first psychotic episode, schizophrenia, schizoaffective psychosis, bipolar disorder and paranoid psychosis. The aim was to provide an overview of present literature and to give recommendations based on current knowledge. Clinical experience and research of the outcomes of psychodynamic psychotherapy encourage positioning of such treatments among recommendations for treating various mental disorders, as well as in the field of psychotherapy of patients with psychotic disorders (PD).
Bossmann, Tanja; Kirchberger, Inge; Glaessel, Andrea; Stucki, Gerold; Cieza, Alarcos
Osteoarthritis is a common chronic disease associated with functional impairments and activity limitations, as well as participation restrictions. The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Osteoarthritis is an application of the ICF and represents the typical spectrum of problems in functioning of patients with osteoarthritis. To validate the Comprehensive ICF Core Set for Osteoarthritis from the perspective of physical therapists. Physical therapists experienced in the treatment of patients with osteoarthritis were asked about patients' problems, resources and aspects of the environmental factors treated by physical therapists in patients with osteoarthritis in a three-round, electronic-mail survey using the Delphi technique. Responses were linked to the ICF. Seventy-two experts from 22 countries named 744 meaningful concepts that covered all ICF components. One hundred and fifty-two ICF categories were linked to these answers, 32 concepts were linked to the not-yet-developed personal factors component, and 14 issues were not covered by a single ICF category. Twelve ICF categories were not represented in the Comprehensive ICF Core Set for Osteoarthritis, although at least 75% of the participants rated them as important. The content validity of the ICF was widely supported by the physical therapists. However, several issues were raised that were not covered and need to be investigated further. Copyright © 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Lloyd, Chris; King, Robert
This study investigated the extent to which occupational therapists and social workers employed in Australian mental health settings are affected by burnout. Questionnaires were sent to occupational therapists and social workers who had indicated that they were interested in participating in the study. An overall response rate of 76.6% (n = 304) was achieved. The outcome measure was the Maslach Burnout Inventory (comprising emotional exhaustion, depersonalisation and personal accomplishment scales). There were no significant differences, with respect to any of the three burnout scales, between occupational therapists and social workers. Both groups experienced high emotional exhaustion, moderate depersonalisation, and high personal accomplishment. Levels of burnout were not significantly different between inpatient and community staff. These results suggested that, while occupational therapists and social workers reported emotional exhaustion, there was less evidence of depersonalisation and they reported very high personal accomplishment in their work. Results are congruent with those of previous studies and it is argued that the focus of future research should be on identifying characteristics of mental health work that contribute to emotional exhaustion.
These aspects, in the backdrop of a lack of self-management of a therapist, could result in impaired judgement and substandard performance in the workplace. The purpose of this study included exploring and describing the experiences of private somatology therapists in selfmanagement, from which recommendations for ...
Places the development of the debate over false or recovered memories in its social and historical context. Identifies some of the ethical and legal implications of this area of work for therapists by using the Drama Triangle. Outlines ethical dilemmas for therapists and some of the implications for therapeutic practice. (RJM)
When therapists discover that phenomena are not necessarily what they appear to be, they feel unsettled and confused about their responsibilities and what it means to live and die as a human being. The study reveals that therapists experience a profound legacy of guilt, doubt and fear when a client commits suicide.
Vervaeke, G.A.C.; Vertommen, H; Storms, G
Although since the 1980s a majority of therapists were found to believe that values are embedded in psychotherapy (Garfield and Bergin, 1994), values are seldom a part of explicit interaction between client and therapist in clinical practice. One possible reason for the discrepancy between the
Mead, Eugene; Crane, D. Russell
This paper presents an empirical approach to supervision and training of marriage and family therapists. Advantages from the use of the empirical approach include a systematic investigation of the skills and competencies of the therapists, and establishing the basis for the scientific study of supervision. Two case studies are given. (Author)
Nielsen, Mandy; Keefe, Francis J; Bennell, Kim; Jull, Gwendolen A
The importance of the biopsychosocial model in assessment and management of chronic musculoskeletal conditions is recognized. Physical therapists have been encouraged to develop psychologically informed practice. Little is known about the process of physical therapists' learning and delivering of psychological interventions within the practice context. The aim of this study was to investigate physical therapists' experiences and perspectives of a cognitive-behavioral-informed training and intervention process as part of a randomized controlled trial (RCT) involving adults with painful knee osteoarthritis. A qualitative design was used. Participants were physical therapists trained to deliver pain coping skills training (PCST). Eight physical therapists trained to deliver PCST were interviewed by telephone at 4 time points during the 12-month RCT period. Interviews were audiorecorded, transcribed verbatim into computer-readable files, and analyzed using Framework Analysis. Thematic categories identified were: training, experience delivering PCST, impact on general clinical practice, and perspectives on PCST and physical therapist practice. Physical therapists reported positive experiences with PCST and program delivery. They thought that their participation in the RCT had enhanced their general practice. Although some components of the PCST program were familiar, the therapists found delivering the program was quite different from regular practice. Physical therapists believed the PCST program, a 3- to 4-day workshop followed by formal mentoring and performance feedback from a psychologist for 3 to 6 months and during the RCT, was critical to their ability to effectively deliver the PCST intervention. They identified a number of challenges in delivering PCST in their normal practice. Physical therapists can be trained to confidently deliver a PCST program. The physical therapists in this study believed that training enhanced their clinical practice. Comprehensive
Full Text Available Short-term psychodynamic psychotherapy (STPP complemented with bodywork improved 31 of 54 patients (57.4%, 95% CI: 43.21–70.77% who rated themselves mentally ill before treatment. Calculated from this we find 1.41 500. Of the 54 patients, 40% had already had traditional treatment that did not help them. Bodywork helped the patients to confront repressed painful feelings from childhood and this seemingly accelerated and improved the therapy. The patients received in average 20 sessions over 14 months at a cost of 1600 EURO. For the treatment responders, all measured aspects of life (on a five point Likert Scale improved significantly, simultaneously, and radically: somatic health (from 2.9 to 2.3, self-esteem/relationship to self (from 3.5 to 2.3, relationship to partner (from 4.7 to 2.9 [no partner was rated as “6”], relationship to friends (from 2.5 to 2.0, ability to love (from 3.8 to 2.4, self-assessed sexual ability (from 3.5 to 2.4, self-assessed social ability (from 3.2 to 2.1, self-assessed working ability (from 3.3 to 2.4, and self-assessed quality of life (from 4.0 to 2.3. Quality of life as measured with QOL5 improved (from 3.6 to 2.3 on a scale from 1 to 5; p < 0.001. This general improvement strongly indicated that the patient had healed existentially, i.e., had experienced what Aaron Antonovsky (1923–1994 called “salutogenesis”, defined as the process exactly the opposite of pathogenesis. For the treatment responders, the treatment provided lasting benefits, without the negative side effects of drugs. A lasting, positive effect might also prevent many different types of problems in the future.
Kayyali, Ruba; Alamri, Atif; Eid, Mohamad; Iglesias, Rosa; Shirmohammadi, Shervin; El Saddik, Abdulmotaleb; Lemaire, Edward
Haptic-based virtual rehabilitation systems have recently become a subject of interest. In addition to the benefits provided by virtual rehabilitation, the haptic-based systems offer force and tactile feedback which can be for upper and lower extremity rehabilitation. In this paper, we present a system that uses haptics, in conjunction with virtual environments, to provide a rich media environment for motor rehabilitation of stroke patients. The system also provides Occupational Therapists (OTs) with a Graphical User Interface (GUI) that enables them to configure the hardware and virtual exercises and to monitor patients' performance. We also present an analysis of the system by a group of OTs from the Ottawa General Hospital, Rehabilitation Center. The OT's feedback, both the positives and negatives, and the results of the assessment test are also presented.
Sonkin, D J
This article addresses the issue of a therapist's duty to warn and protect victims of domestic violence. In three different cases, California courts have found therapists liable for violent acts perpetrated by clients in their care. Based on the landmark Tarasoff case that mandated the therapist to report threats made by their clients regarding a specific victim, the courts have now extended the therapist's duty to include the reporting of those clients they assess as dangerous but who have not made specific threats, as well as the protection of unintended victims of violence, such as children. Therapists are concerned that the courts are expecting them to be clairvoyant and that psychologists may not be able to predict dangerousness. This article will discuss these concerns in light of the current state of the art regarding the prediction of dangerousness and its relationship to domestic violence. The author suggests specific clinical interventions for victims and perpetrators of domestic violence.
Bialosky, Joel E.; Simon, Corey B.; Bishop, Mark D.; George, Steven Z.
Physical therapists internationally provide spinal manipulative therapy (SMT) to patients with musculoskeletal pain complaints. SMT has been a part of physical therapist practice since the profession’s beginning. Early physical therapist clinical decision making for SMT was influenced by the approaches of osteopathic and orthopedic physicians at the time. Currently a segmental clinical decision making approach and a responder clinical decision making approach are two of the more common models through which physical therapist clinical use of SMT is directed. The focus of segmental clinical decision making is upon identifying a dysfunctional vertebral segment with the application of SMT to restore mobility and/or alleviate pain. The responder clinical decision making approach attempts to categorize individuals based on a pattern of signs and symptoms suggesting a likely positive response to SMT. The present manuscript provides an overview of common physical therapist clinical decision making approaches to SMT and presents areas requiring further study in order to optimize patient response. PMID:22197083
Fisher, Hadar; Atzil-Slonim, Dana; Bar-Kalifa, Eran; Rafaeli, Eshkol; Peri, Tuvia
Accumulating evidence suggests that the therapeutic alliance and clients' contact with emotions during therapy sessions can be effective in reducing their suffering outside of sessions. However, the complex associations among these determinants are not yet clear. Using data collected in therapy on a session-by-session basis, this study explored (a) the temporal associations between emotional experience and the therapeutic alliance; (b) the temporal associations between emotional experience and clients' level of functioning; and (c) the direct and indirect associations among emotional experience, the therapeutic alliance, and functioning. Clients (N = 101) undergoing psychodynamic therapy completed a functioning and distress measure prior to each session, and reported on their emotional experience and perceived alliance strength following each session. Longitudinal multilevel models indicated that higher therapeutic alliance scores at the end of 1 session predicted a greater emotional experience in the next session but that emotional experience did not predict subsequent levels of alliance. The results provided evidence of reciprocal prediction in which a previous emotional experience predicted a subsequent change in functioning and vice versa. Finally, the alliance predicted emotional experience, which, in turn, predicted functioning; hence, alliance strength indirectly predicted clients' level of functioning. Findings indicate that emotional experience and the therapeutic alliance are important determinants of the therapeutic process, which contribute to predict clients' improvement in functioning within psychodynamic treatment. (c) 2016 APA, all rights reserved).
Knight, Zelda Gillian
Just as Freud used stages of psychosexual development to ground his model of psychoanalysis, it is possible to do the same with Erik Erikson's stages of development with regards to a model of psychodynamic psychotherapy. This paper proposes an eight-stage model of psychodynamic psychotherapy linked to Erik Erikson's eight stages of psychosocial development. Various suggestions are offered. One such suggestion is that as each of Erikson's developmental stages is triggered by a crisis, in therapy it is triggered by the client's search. The resolution of the search often leads to the development of another search, which implies that the therapy process comprises a series of searches. This idea of a series of searches and resolutions leads to the understanding that identity is developmental and therapy is a space in which a new sense of identity may emerge. The notion of hope is linked to Erikson's stage of Basic Trust and the proposed model of therapy views hope and trust as essential for the therapy process. Two clinical vignettes are offered to illustrate these ideas. Psychotherapy can be approached as an eight-stage process and linked to Erikson's eight stages model of development. Psychotherapy may be viewed as a series of searches and thus as a developmental stage resolution process, which leads to the understanding that identity is ongoing throughout the life span. Copyright © 2017 John Wiley & Sons, Ltd.
Lacy, Timothy; Hughes, John D.
Objective: Psychotherapy and biological psychiatry remain divided in psychiatry residency curricula. Behavioral neurobiology and neuropsychiatry provide a systems-level framework that allows teachers to integrate biology, psychodynamics, and psychology. Method: The authors detail the underlying assumptions and outline of a neural systems-based…
Monti, Fiorella; Tonetti, Lorenzo; Ricci Bitti, Pio Enrico
The aim of the present study was to compare the effectiveness of cognitive-behavioural (CBT) and psychodynamic (PDT) therapies in the treatment of anxiety among university students. To this aim, the Symptom Questionnaire (SQ) was completed by 30 students assigned to CBT and by 24 students assigned to PDT, both at the beginning and at the end of…
Cooper, Andrew A; Strunk, Daniel R; Ryan, Elizabeth T; DeRubeis, Robert J; Hollon, Steven D; Gallop, Robert
Previous psychotherapy research has examined the therapeutic alliance and therapist adherence as correlates or predictors of symptom change. While some initial evidence suggests the alliance is associated with risk of dropout in cognitive behavioral treatment for depression, evidence of such relations has been limited to date. We examined the relation of these psychotherapy process variables and dropout in the context of cognitive therapy for depression when provided in combination with pharmacotherapy. Patients were randomized to the CT plus pharmacotherapy condition of a clinical trial for chronic or recurrent depression. Consistent with the spirit of personalized medicine, patients were treated until they met remission and recovery criteria (or reached the maximum allowable time in the study). In a sample of 176 patients, we examined observer-rated alliance and therapist adherence in the first three CT sessions as potential predictors of treatment dropout. The therapeutic alliance and one facet of therapist adherence (i.e., Behavioral Methods/Homework) predicted reduced odds of dropout. Therapist use of Negotiating/Structuring predicted greater likelihood of dropout, but only when other variables were included in the model. Process ratings were not available for concurrent pharmacotherapy sessions. A minority of patients did not have session recordings available. Results are consistent with the possibility that the therapeutic alliance and therapists' focus on homework and behavioral methods promote treatment retention in combined treatment for depression. Copyright © 2015 Elsevier Ltd. All rights reserved.
Mahony, Georgia; Haracz, Kirsti; Williams, Lauren T
Poor diet is a contributing factor to the high rates of obesity and related comorbidities in people with severe mental illness, and dietary change is a key treatment strategy. Providing healthy lifestyle interventions is a recognised role for occupational therapists. However, the existing literature fails to elucidate boundaries of this role. To begin to address this gap in the literature, this study explored the attitudes, actions and beliefs of mental health occupational therapists about providing diet-related interventions. Semi-structured interviews were conducted with mental health occupational therapists working in one Area Health Service in New South Wales. Purposive sampling was used. Data were analysed using Constructivist Grounded Theory methods, where meaning is co-constructed by, and the theory ultimately grounded in the experiences of, the participant and researcher. The participants felt confident providing clients with interventions to promote diet-related skill development and providing general healthy eating education to support this development. However, they were not comfortable providing clients with specific dietary advice. Participants identified a need for further training and support to enhance their effectiveness in providing healthy eating education and highlighted the need for more dietitians in mental health services. The occupational therapists in this study identified clear boundaries of their role in providing diet-related interventions for people with severe mental illness. Suggestions for improvement in this area included further training for occupational therapists as well as increased access to dietitians for those services that lie outside the occupational therapy role. © 2012 The Authors Australian Occupational Therapy Journal © 2012 Occupational Therapy Australia.
In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.
Brischetto, C M; Merluzzi, T V
Therapy has been construed as a interpersonal influence process (Johnson & Matross, 1977; Strong, 1978). Consistent with that framework the present study investigated the effects of therapist sex and level of expertness on the perceptions of Ss in an initial interview. Male and female interviewers who were introduced as expert or nonexpert met individually for a 15-minute period of time with 60 male undergraduates. The Ss then rated the interviewers on perceived expertness, attractiveness, trustworthiness, persuasiveness, and their liking for the interviewer. Results indicated that male experts were rated lower in social attractiveness; however, introductions did not affect either perceived expertness or trustworthiness. The results suggest that reasonably competent therapist behavior may result in neutralizing sources of differential expertness. However, the degree of expertness may be used as a source of differential social or interpersonal attraction.
Colli, Antonello; Tanzilli, Annalisa; Dimaggio, Giancarlo; Lingiardi, Vittorio
The aim of this study was to examine the relationship between therapists' emotional responses and patients' personality disorders and level of psychological functioning. A random national sample of psychiatrists and clinical psychologists (N=203) completed the Therapist Response Questionnaire to identify patterns of therapists' emotional response, and the Shedler-Westen Assessment Procedure-200 to assess personality disorders and level of psychological functioning in a randomly selected patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week). There were several significant relationships between therapists' responses and patients' personality pathology. Paranoid and antisocial personality disorders were associated with criticized/mistreated countertransference, and borderline personality disorder was related to helpless/inadequate, overwhelmed/disorganized, and special/overinvolved countertransference. Disengaged countertransference was associated with schizotypal and narcissistic personality disorders and negatively associated with dependent and histrionic personality disorders. Schizoid personality disorder was associated with helpless/inadequate responses. Positive countertransference was associated with avoidant personality disorder, which was also related to both parental/protective and special/overinvolved therapist responses. Obsessive-compulsive personality disorder was negatively associated with special/overinvolved therapist responses. In general, therapists' responses were characterized by stronger negative feelings when working with lower-functioning patients. Patients' specific personality pathologies are associated with consistent emotional responses, which suggests that clinicians can make diagnostic and therapeutic use of their responses to patients.
Liedberg, Gunilla M; Björk, Mathilda; Hensing, Gunnel
Women and men are shaped over the courses of their lives by culture, society and human interaction according to the gender system. Cultural influences on individuals' social roles and environment are described in occupational therapy literature, but not specifically from a gender perspective. The purpose of this qualitative study was to explore how a sample of occupational therapists perceives the 'gender' concept. Four focus group interviews with 17 occupational therapists were conducted. The opening question was: 'How do you reflect on the encounter with a client depending on whether it is a man or a woman?' The transcribed interviews were analysed and two main themes emerged: 'the concept of gender is tacit in occupational therapy' and 'client encounters'. The occupational therapists expressed limited theoretical knowledge of 'gender'. Furthermore, the occupational therapists seemed to be 'doing gender' in their encounters with the clients. For example, in their assessment of the client, they focussed their questions on different spheres: with female clients, on the household and family; with male clients, on their paid work. This study demonstrated that occupational therapists were unaware of the possibility that they were 'doing gender' in their encounters with clients. There is a need to increase occupational therapists' awareness of their own behaviour of 'doing gender'. Furthermore, there is a need to investigate whether gendered perceptions will shorten or lengthen a rehabilitation period and affect the chosen interventions, and in the end, the outcome for the clients. © 2010 The Authors. Australian Occupational Therapy Journal © 2010 Australian Association of Occupational Therapists.
Burckell, Lisa A; Goldfried, Marvin R
Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Cooper, Zafra; Doll, Helen; Bailey-Straebler, Suzanne; Bohn, Kristin; de Vries, Dian; Murphy, Rebecca; O'Connor, Marianne E; Fairburn, Christopher G
Recent research interest in how best to train therapists to deliver psychological treatments has highlighted the need for rigorous, but scalable, means of measuring therapist competence. There are at least two components involved in assessing therapist competence: the assessment of their knowledge of the treatment concerned, including how and when to use its strategies and procedures, and an evaluation of their ability to apply such knowledge skillfully in practice. While the assessment of therapists' knowledge has the potential to be completed efficiently on the Web, the assessment of skill has generally involved a labor-intensive process carried out by clinicians, and as such, may not be suitable for assessing training outcome in certain circumstances. The aims of this study were to develop and evaluate a role-play-based measure of skill suitable for assessing training outcome and to compare its performance with a highly scalable Web-based measure of applied knowledge. Using enhanced cognitive behavioral therapy (CBT-E) for eating disorders as an exemplar, clinical scenarios for role-play assessment were developed and piloted together with a rating scheme for assessing trainee therapists' performance. These scenarios were evaluated by examining the performance of 93 therapists from different professional backgrounds and at different levels of training in implementing CBT-E. These therapists also completed a previously developed Web-based measure of applied knowledge, and the ability of the Web-based measure to efficiently predict competence on the role-play measure was investigated. The role-play measure assessed performance at implementing a range of CBT-E procedures. The majority of the therapists rated their performance as moderately or closely resembling their usual clinical performance. Trained raters were able to achieve good-to-excellent reliability for averaged competence, with intraclass correlation coefficients ranging from .653 to 909. The measure was
Full Text Available Aim: Even though there is substantial evidence that play based therapies produce significant change, the specific play processes in treatment remain unexamined. For that purpose, processes of change in long-term psychodynamic play therapy are assessed through a repeated systematic assessment of three children’s Play Profiles, which reflect patterns of organization among play variables that contribute to play activity in therapy, indicative of the children’s coping strategies, and an expression of their internal world. The main aims of the study are to investigate the kinds of Play Profiles expressed in treatment, and to test whether there is emergence of new and more adaptive Play Profiles using dynamic systems theory as a methodological framework.Methods and Procedures: Each session from the long-term psychodynamic treatment (mean number of sessions = 55 of three 6 year old good outcome cases presenting with Separation Anxiety were recorded, transcribed and coded using items from the Children's Play Therapy Instrument, created to assess the play activity of children in psychotherapy, generating discrete and measurable units of play activity arranged along a continuum of four play profiles: Adaptive, Inhibited, Impulsive, and Disorganized. The play profiles were clustered through K-means Algorithm, generating 7 discrete states characterizing the course of treatment and the transitions between these states were analyzed by Markov Transition Matrix, Recurrence Quantification Analysis (RQA and odds ratios comparing the first and second halves of psychotherapy.Results: The Markov Transitions between the states scaled almost perfectly and also showed the ergodicity of the system meaning that the child can reach any state or shift to another one in play. The RQA and odds ratios showed two trends of change, first concerning the decrease in the use of less adaptive strategies, second regarding the reduction of play interruptions.Conclusions: The
Spinelli, Margaret G; Endicott, Jean; Goetz, Raymond R
The randomized controlled trial in which both the patient and the treating clinician are kept blinded to the treatment is the "gold standard" for treatment research assignment. However, in psychotherapy research, evaluations can only be single blind; thus, such studies are inherently more limited. A 12-week, bilingual, parallel-design, controlled clinical treatment trial compared interpersonal psychotherapy for antepartum depression (IPT-P) with a parenting education program (PEP) provided to a control group. An outpatient sample of 142 women who met DSM-IV criteria for major depressive disorder was randomly assigned to IPT-P or PEP between September 2005 and May 2011. Only 110 cases were assessed at baseline and had at least 1 other treatment week of paired ratings by a therapist and a blinded independent evaluator (IE). The 17-item Hamilton Depression Rating Scale and the Clinical Global Impressions Scale were administered weekly by a therapist and every 4 weeks by a blinded IE. We examined cross-informant agreement on ratings of mood and global improvement and severity. Nonblinded therapists consistently rated the IPT-P treatment group as more improved than the PEP control group throughout treatment, whereas the ratings by the blinded IE were significantly higher than the therapist ratings, indicating less improvement in the IPT-P group compared with the control group. The ratings suggest that rater bias may have caused the therapist raters to perceive subjects as more improved because of the expectation that IPT-P would be more effective than the PEP control condition. Ratings in psychotherapy research must be made by anonymous participation in treatment and an independent clinical evaluator who is blind to all therapy.
José Alvaro Marques Marcolino
Full Text Available INTRODCTION: Therapeutic alliance is a key component of the psychotherapeutic process. This study estimated the impact of the therapeutic alliance as measured by CALPAS-P in an individual brief psychodynamic psychotherapy program. METHODS: To study the impact of the therapeutic alliance patients in psychotherapy answered to the CALPAS-P at the first and third session and to the Self-report Questionnaire (SRQ-20, to the Beck Depression Inventory (BDI and to the Hamilton Anxiety Scale at the beginning and at the end of psychotherapy. RESULTS: The study of the impact of the therapeutic alliance in brief psychodynamic psychotherapy showed that higher TUI scores in the first session were significantly associated to the improvement on the BDI. Patients with best scores in the working alliance, measured at the third PWC session had also significant symptomatic changes. DISCUSSION: The study of the impact of the therapeutic alliance in brief psychotherapy indicated that patients who perceived that their therapists had the best capability to understand and to be involved in their issues had best results in reducing depressive symptoms and patients with higher capability to form the working alliance reached the best psychotherapy outcomes.INTRODUÇÃO: A aliança terapêutica é um conceito central do processo psicoterápico. Este estudo avaliou o impacto da aliança terapêutica em um programa de psicoterapia individual psicodinâmica breve. MÉTODO: Para o estudo do impacto da aliança, pacientes em psicoterapia responderam, ao início e ao final de cada psicoterapia, ao Questionário de auto-avaliação (SRQ-20, ao Inventário de Depressão de Beck (BDI e à Escala de Ansiedade de Hamilton. Responderam também a CALPAS-P ao término da primeira e da terceira sessão. RESULTADOS: Os resultados mostraram que os pacientes com uma pontuação mais alta da TUI na primeira sessão tiveram um impacto significativo sobre a mudança da sintomatologia medida
Calderita, Luis Vicente; Manso, Luis J; Bustos, Pablo; Suárez-Mejías, Cristina; Fernández, Fernando; Bandera, Antonio
Cog also endows the robot with abilities for high-level planning, monitoring, and learning. Thus, THERAPIST engages the patient through different games or activities, and adapts the session to each individual. RoboCog successfully integrates a deliberative planner with a set of modules working at situational or sensorimotor levels. This architecture also allows THERAPIST to deliver responses at a human rate. The synchronization of the multiple interaction modalities results from a unique scene representation or model. THERAPIST is now a socially interactive robot that, instead of reproducing the phrases or gestures that the developers decide, maintains a dialogue and autonomously generate gestures or expressions. THERAPIST is able to play simple games with human partners, which requires humans to perform certain movements, and also to capture the human motion, for later analysis by clinic specialists. The initial hypothesis was validated by our experimental studies showing that interaction with the robot results in highly attentive and collaborative attitudes in pediatric patients. We also verified that RoboCog allows the robot to interact with patients at human rates. However, there remain many issues to overcome. The development of novel hands-off rehabilitation therapies will require the intersection of multiple challenging directions of research that we are currently exploring.
Calderita, Luis Vicente; Manso, Luis J; Bustos, Pablo; Fernández, Fernando; Bandera, Antonio
interactive process. But RoboCog also endows the robot with abilities for high-level planning, monitoring, and learning. Thus, THERAPIST engages the patient through different games or activities, and adapts the session to each individual. Results RoboCog successfully integrates a deliberative planner with a set of modules working at situational or sensorimotor levels. This architecture also allows THERAPIST to deliver responses at a human rate. The synchronization of the multiple interaction modalities results from a unique scene representation or model. THERAPIST is now a socially interactive robot that, instead of reproducing the phrases or gestures that the developers decide, maintains a dialogue and autonomously generate gestures or expressions. THERAPIST is able to play simple games with human partners, which requires humans to perform certain movements, and also to capture the human motion, for later analysis by clinic specialists. Conclusions The initial hypothesis was validated by our experimental studies showing that interaction with the robot results in highly attentive and collaborative attitudes in pediatric patients. We also verified that RoboCog allows the robot to interact with patients at human rates. However, there remain many issues to overcome. The development of novel hands-off rehabilitation therapies will require the intersection of multiple challenging directions of research that we are currently exploring. PMID:28582242
Calache, Hanny; Hopcraft, Matthew S
Dental therapists are increasingly been seen as part of the solution to assist in improving access to dental care for underserved populations. The aim of this article is to report the outcomes of an educational bridging program designed to provide university-educated dental therapists with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients aged 26+ years. Ten dental therapists completed an educational program approved by the Dental Practice Board of Victoria as a pilot. Feedback from patients and supervising and supporting dentists was provided during the project. Supervising and supporting dentists rated the knowledge and clinical skills of participants as good to high at the completion of the education program and considered them safe to treat adults patients. Patients were very satisfied with the dental treatment provided. Eight participants successfully completed the assessment and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients. Feedback from patients and dentists indicated that, following the completion of an educational bridging program, dental therapists with a university education were able to develop the knowledge and skills required to treat adult patients aged 26+ years without the prescription or supervision of a dentist. Enabling dental therapists to treat adult patients may have a role to play in improving access to dental care for underserved populations. © 2011 American Association of Public Health Dentistry.
Many today suffer from an imbalance between life and life on the screen. When extreme, such as excessive gaming, clinicians retreat to familiar explanations, such as "Internet addiction." But the addiction concept is of limited value, limiting both research and treatment options. This article discusses an alternative. Pathological overuse is seen as a failed solution in which people become entrapped by technology's promise of delivering that which only life can offer, such as the grand adventure simulated in World of Warcraft. A two-part treatment approach of such "simulation entrapment" is described in which both the original problem and the entrapment are treated, the former by traditional psychodynamic psychotherapy and the later by highlighting differences between the technologically mediated experience and traditional experiences of being bodies together. The case of a college student suffering from pathological shame with excessive gaming as the failed solution is offered as an illustration. © 2012 Wiley Periodicals, Inc.
Silverman in 1983 held that the unconscious encoding of MOMMY AND I ARE ONE triggers a fantasy of symbiotic union with the good mother of early childhood. In contrast, later Sohlberg and Birgegard contended that MOMMY AND I triggers associations to similarity issues with mother, associations that may be influenced by the words following MOMMY AND I. Although their messages produce, lmost invariably, no reportable sensation, Sohlberg and Birgegard claimed strong evidence for the influence of such messages on perception, motivation, and memory, 10 ays poststimulation and suggestive evidence 4 mo. later. Their findings are not compelling evidence for these claims; and there is no evidence that any result was associated with the unconscious encoding of the psychodynamic meaning of a multiword message.
Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin
compared with the other two groups. Early improving patients were less likely to have participated in short-term groups, and only one third participated in additional treatment compared with more than 69% of the other patients. Severe and socially affected psychiatric patients, and patients with anxiety...... and socio-demographic characteristics. Late improvers, as compared with early improvers, were characterized by anxiety symptoms and lack of network support after controlling for GSI at admission. Similarly, deteriorating patients had longer duration of illness and less favourable social characteristics...... and agoraphobic symptoms may be less optimally treated in short-term time limited psychodynamic groups. There is an obvious need for diversity of treatment offers, better integration of psycho-social treatment components, and long-term open ended treatment....
Harder, Susanne; Køster, Anne; Valbak, Kristian
OBJECTIVES: The long-term outcomes of several approaches to intervention targeting social functioning in schizophrenia are not well documented. Contemporary supportive psychodynamic psychotherapy (SPP) aims to improve social functioning. The aim of the present study was to investigate the long...... up for 5 years (N = 269). The SPP targeted interpersonal relationships, emotion regulation, social cognition, and self-coherence. RESULTS: Significant between-group effects in favor of SPP+ST on social functioning, overall symptoms, and positive psychotic symptoms were found during the period...... of active SPP intervention. These differential effects, however, were not sustained after end of additional SPP at 5-year follow-up. CONCLUSION: The findings are in line with results from other approaches targeting social functioning in schizophrenia and support SPP as a valuable treatment. Further research...
This article will address the issue of using understandings of psychodynamic interrelations as a means to grasp how social and cultural dynamics are processed individually and collectively in narratives. I apply the two theoretically distinct concepts of inter- and intrasubjectivity to gain insight...... of social education, I demonstrate how the often conflicting demands and expectations are being played out in the interrelational tension between the researcher (myself) and the interviewee or narrator. In a confrontation with "inner" expectations and concerns regarding a future profession and one's ability...... to cope, and the "outer" socially and culturally embedded discourses as they are played out in the objectives of self-development and education, the narrative about a forthcoming internship is filled with tension and contradiction. In this article I will demonstrate how such tensions and contradictions...
Shapiro, E R
The author reviews the psychodynamics and developmental psychology of the borderline patient as described in the literature on intensive therapy, early mother-child interaction, and family interaction. Focusing on the borderline patient's characteristic difficulties in intimate relationships, he describes the patient's use of splitting and projective identification as seen in the characteristic transference-countertransference interaction in intensive therapy. These primitive defensive mechanisms, which are also utilized by family members, appear to contribute to a failure of empathic responses both during the child's early development and in the family interactions during his adolescence. The author concludes that conceptual attempts to relate adult and child phenomena, although highly speculative, create new and useful perspectives for the treatment of the borderline patient.
Naumoska, Ljubica; Ristovska, Frosina; Dojcinovski, Ilija
The aim of this study is to explore the psychodynamic of stress at CDH patients and the perceived level of life stress events as a risk factor in the development of the stress-related illness (coronary heart disease).
Barlow, David H.; Gorman, Jack M.; Shear, M. Katherine; Woods, Scott W.
Although the alliance–outcome correlation is well established, no published studies to date have separated between therapists’ and patients’ contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists’ and patients’ contribution to the alliance on outcome and attrition in one trial. Alliance ratings were obtained from patients and therapists early and late in treatment (n = 133). Data were analyzed using multi-level modeling controlling for early symptom change. No therapist effects were found. The patients’ contribution to the alliance predicted outcome (in both panic severity and anxiety sensitivity) and attrition. The therapists’ contribution to the alliance predicted attrition but not outcome. Results suggest that the patient's contribution to the alliance plays an important role in CBT for PDA and that including common factors into research on CBT may help elucidate treatment processes. PMID:24275067
Nakai, Yasushi; Takiguchi, Tetsuya; Matsui, Gakuyo; Yamaoka, Noriko; Takada, Satoshi
Abnormal prosody is often evident in the voice intonations of individuals with autism spectrum disorders. We compared a machine-learning-based voice analysis with human hearing judgments made by 10 speech therapists for classifying children with autism spectrum disorders ( n = 30) and typical development ( n = 51). Using stimuli limited to single-word utterances, machine-learning-based voice analysis was superior to speech therapist judgments. There was a significantly higher true-positive than false-negative rate for machine-learning-based voice analysis but not for speech therapists. Results are discussed in terms of some artificiality of clinician judgments based on single-word utterances, and the objectivity machine-learning-based voice analysis adds to judging abnormal prosody.
Therapist's role and dilemmas faced in treating a gender dysphoric client are discussed. Examines ethical and moral issues relating to transsexualism and discusses the appropriateness of art therapy as a treatment for transsexual clients. (SNR)
Vega, Victoria P
The purpose of this study was to examine possible relationships between personality, burnout level, longevity, and demographic variables among professional music therapists. The Sixteen Personality Factor Questionnaire (16PF) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) were used to test personality and burnout. Subjects were 137 professional music therapists from all seven American Music Therapy Association (AMTA) regions with an overall average longevity of 17.85 years. The 16PF showed the personality traits that most describe music therapists are emotional sensitivity, reasoning, apprehension, warmth, openness to change, self-reliance, extraversion, anxiety, abstractedness, rule-consciousness, and self-control. Logistic regressions showed that the personality factor of anxiety (p burnout level was in the average range, in essence this study described the profile of music therapists who are staying and thriving in the profession.
Peters-Scheffer, N.C.; Didden, H.C.M.; Korzilius, H.P.L.M.; Sturmey, P.
Early intensive behavioral intervention is generally effective for children with autism spectrum disorder but is associated with variability in treatment outcome and quality of treatment delivery may contribute to this. This study examined the relationship between therapist personality, attitude
Kolodny, Susan; And Others
This paper presents brief case summaries of four patient suicides; explores the reactions of each therapist; presents conclusions regarding the mourning process following patients' suicides; and puts forth implications and suggestions for training programs. (Author)
Goldfried, Marvin R; Burckell, Lisa A; Eubanks-Carter, Catherine
Although cognitive-behavior therapy emphasizes between-session change, therapist self-disclosure within the session can be an effective tool for strengthening the therapeutic bond and facilitating client change. After noting the use of self-disclosure in other theoretical orientations, we place self-disclosure in the context of cognitive-behavioral theories of reinforcement and modeling. Clinical vignettes illustrate the use of therapist self-disclosure to provide feedback on the interpersonal impact made by the client, enhance positive expectations and motivation, strengthen the therapeutic bond, normalize the client's reaction, reduce the client's fears, and model an effective way of functioning. Therapists need to observe appropriate boundaries when self-disclosing, and in particular, should consider their own motivations for self-disclosing. Although more research is needed on the effects of self-disclosure, cognitive-behavior therapists have found that self-disclosure can be a powerful intervention. Copyright 2003 Wiley Periodicals, Inc.
Full Text Available Background/Aim. Working alliance, as a collaborative part of the therapeutic relationship has been proven to be one of the most powerful therapeutic factors in psychotherapy in general, regardless many technical differences between numerous psychotherapeutic modalities. On the other hand, transference is the basic concept of psychodynamic psychotherapy, and, according to the psychoanalytic theory and practice, it forms a major part of the therapeutic relationship. The aim of our paper was to determine the differences between the groups of patients with low, middle, and high working alliance scores and the dropout group in transference patterns, sociodemographic and clinical parameters, during the early phase of psychodynamic psychotherapy. Methods. Our sample consisted of 61 non-psychotic patients, randomly selected by the method of consecutive admissions and treated with psychoanalytic psychotherapy in the outpatient clinical setting. The patients were prospectively followed during 5 initial sessions of the therapeutic process. The working alliance inventory and Core conflictual relationship theme method were used for the estimation of working alliance and transference patterns, respectively. According to the Working Alliance Inventory scores, four groups of patients were formed and than compared. Results. Our results show a significant difference between the groups of patients with low, middle, and high working alliance inventory scores and the dropout group on the variable - transference patterns in the therapeutic relationship. Conclusion. Disharmonious transference patterns are more frequent in patients who form poor quality working alliance in the early phase of psychotherapy, or early dropout psychotherapy. It is of great importance to recognize transference patterns of a patient at the beginning of the psychotherapeutic process, because of their potentially harmful influence on the quality of working alliance.
Johann Roland Kleinbub
Full Text Available Background: Evidence of psychological treatment efficacy is strongly needed in ALS, particularly regarding long-term effects.Methods: Fifteen patients participated in a hypnosis treatment and self-hypnosis training protocol after an in-depth psychological and neurological evaluation. Patients’ primary caregivers and 15 one-by-one matched control patients were considered in the study.Measurements of anxiety, depression and quality of life were collected at the baseline, post-treatment, and after 3 and 6 months from the intervention. Bayesian linear mixed-models were used to evaluate the impact of treatment and defense style on patients’ anxiety, depression, quality of life, and functional impairment (ALSFRS-r, as well as on caregivers’ anxiety and depression.Results: The statistical analyses revealed an improvement in psychological variables’ scores immediately after the treatment. Amelioration in patients’ and caregivers’ anxiety as well as caregivers’ depression, were found to persist at 3 and 6 months follow-ups. The observed massive use of primitive defense mechanisms was found to have a reliable and constant buffer effect on psychopathological symptoms in both patients and caregivers. Notably, treated patients decline in ALSFRS-r score was observed to be slower than that of control group’s patients.Discussion: Our brief psychodynamic hypnosis-based treatment showed efficacy both at psychological and physical levels in patients with ALS, and was indirectly associated to long-lasting benefits in caregivers. The implications of peculiar psychodynamic factors and mind-body techniques are discussed. Future directions should be oriented toward a convergence of our results and further psychological interventions, in order to delineate clinical best practices for ALS.
Full Text Available Given their flexibility, online interventions may be useful as an outpatient treatment option to support vocational reintegration after inpatient rehabilitation. To that purpose we devised a transdiagnostic psychodynamic online intervention to facilitate return to work, focusing on interpersonal conflicts at the workplace often responsible for work-related stress.In a randomized controlled trial, we included employed patients from cardiologic, psychosomatic and orthopedic rehabilitation with work-related stress or need for support at intake to inpatient rehabilitation after they had given written consent to take part in the study. Following discharge, maladaptive interpersonal interactions at the workplace were identified via weekly blogs and processed by written therapeutic comments over 12 weeks in the intervention group (IG. The control group (CG received an augmented treatment as usual condition. The main outcome, subjective prognosis of gainful employment (SPE, and secondary outcomes (psychological complaints were assessed by means of online questionnaires before, at the end of aftercare (3 months and at follow-up (12 months. We used ITT analyses controlling for baseline scores and medical group.N = 319 patients were enrolled into IG and N = 345 into CG. 77% of the IG logged in to the webpage (CG 74% and 65% of the IG wrote blogs. Compared to the CG, the IG reported a significantly more positive SPE at follow-up. Measures of depression, anxiety and psychosocial stressors decreased from baseline to follow-up, whereas the corresponding scores increased in the CG. Correspondingly, somatization and psychological quality of life improved in the IG.Psychodynamic online aftercare was effective to enhance subjective prognosis of future employment and improved psychological complaints across a variety of chronic physical and psychological conditions, albeit with small effect sizes.
Kleinbub, Johann R.; Palmieri, Arianna; Broggio, Alice; Pagnini, Francesco; Benelli, Enrico; Sambin, Marco; Sorarù, Gianni
Background: Evidence of psychological treatment efficacy is strongly needed in ALS, particularly regarding long-term effects. Methods: Fifteen patients participated in a hypnosis treatment and self-hypnosis training protocol after an in-depth psychological and neurological evaluation. Patients' primary caregivers and 15 one-by-one matched control patients were considered in the study. Measurements of anxiety, depression and quality of life (QoL) were collected at the baseline, post-treatment, and after 3 and 6 months from the intervention. Bayesian linear mixed-models were used to evaluate the impact of treatment and defense style on patients' anxiety, depression, QoL, and functional impairment (ALSFRS-r), as well as on caregivers' anxiety and depression. Results: The statistical analyses revealed an improvement in psychological variables' scores immediately after the treatment. Amelioration in patients' and caregivers' anxiety as well as caregivers' depression, were found to persist at 3 and 6 months follow-ups. The observed massive use of primitive defense mechanisms was found to have a reliable and constant buffer effect on psychopathological symptoms in both patients and caregivers. Notably, treated patients decline in ALSFRS-r score was observed to be slower than that of control group's patients. Discussion: Our brief psychodynamic hypnosis-based treatment showed efficacy both at psychological and physical levels in patients with ALS, and was indirectly associated to long-lasting benefits in caregivers. The implications of peculiar psychodynamic factors and mind-body techniques are discussed. Future directions should be oriented toward a convergence of our results and further psychological interventions, in order to delineate clinical best practices for ALS. PMID:26136710
Zwerenz, Rüdiger; Becker, Jan; Gerzymisch, Katharina; Siepmann, Martin; Holme, Martin; Kiwus, Ulrich; Spörl-Dönch, Sieglinde; Beutel, Manfred E
Given their flexibility, online interventions may be useful as an outpatient treatment option to support vocational reintegration after inpatient rehabilitation. To that purpose we devised a transdiagnostic psychodynamic online intervention to facilitate return to work, focusing on interpersonal conflicts at the workplace often responsible for work-related stress. In a randomized controlled trial, we included employed patients from cardiologic, psychosomatic and orthopedic rehabilitation with work-related stress or need for support at intake to inpatient rehabilitation after they had given written consent to take part in the study. Following discharge, maladaptive interpersonal interactions at the workplace were identified via weekly blogs and processed by written therapeutic comments over 12 weeks in the intervention group (IG). The control group (CG) received an augmented treatment as usual condition. The main outcome, subjective prognosis of gainful employment (SPE), and secondary outcomes (psychological complaints) were assessed by means of online questionnaires before, at the end of aftercare (3 months) and at follow-up (12 months). We used ITT analyses controlling for baseline scores and medical group. N = 319 patients were enrolled into IG and N = 345 into CG. 77% of the IG logged in to the webpage (CG 74%) and 65% of the IG wrote blogs. Compared to the CG, the IG reported a significantly more positive SPE at follow-up. Measures of depression, anxiety and psychosocial stressors decreased from baseline to follow-up, whereas the corresponding scores increased in the CG. Correspondingly, somatization and psychological quality of life improved in the IG. Psychodynamic online aftercare was effective to enhance subjective prognosis of future employment and improved psychological complaints across a variety of chronic physical and psychological conditions, albeit with small effect sizes.
Lewis, Andrew J; Dennerstein, Michelle; Gibbs, Petah M
Short-term psychodynamic psychotherapy (STPP) is a widely practised form of psychological intervention. Given that the Roth and Fonagy (1996) review concluded that there was a lack of confirming evidence for STPP, the current review is focused on studies published between 1996 and 2006 that evaluate the efficacy of STPP. As a result of a systematic literature review, 18 studies were found that met inclusion criteria consistent with those used by Roth and Fonagy (1996) for selection of studies, patient groupings and definition of therapeutic method. In general these studies add to an increasing body of evidence suggesting that STPP can be an effective psychological treatment for individuals experiencing mental health problems. Specifically, for depression STPP can be equal in effects to other psychological treatments and is significantly better than no treatment in the short term. Furthermore, emerging process data indicate that there is a significant relationship between the use of specific psychodynamic therapeutic techniques and the alleviation of depressive symptoms. Increasing evidence has emerged to support STPP as a treatment for generalized anxiety disorder, panic disorder and some personality disorders. There remains limited evidence for the use of STPP treatment for patients with anxiety disorders that relate more to stress. Very limited and inconclusive evidence currently exists to support STPP as a treatment for bipolar disorder, eating disorders and drug dependency. Future research needs to include broader assessment measures, long-term follow up, studies that maintain an identifiable focus, and research that includes a focus on psychotherapy process variables as they interact with outcomes.
Fowler, Kelly L
The purpose of this correlational study was to investigate the relations between professional well-being (as characterized by positive attitudes toward work and longevity as a practicing music therapist) and the following factors: age, level of education, income, attitudes regarding the workplace (e.g., perceived control, feeling valued, as well as the amount of perceived comfort and input into administrative policies), attitudes toward work as measured by the Maslach Burnout Inventory (Maslach & Jackson, 1986a), and measures of stress and stress management as measured by the Stress Profile (Nowack, 1999a). Participants included 49 music therapists who had between one to 36 years of work experience. Correlations indicated that those respondents with greatest professional longevity tended to have higher ratings on items regarding cognitive coping strategies (e.g., positive appraisal and threat minimization) and greater perception of personal achievement. These correlational results are related to psychological theories regarding occupational burnout and cognitive hardiness.
de la Pena, Cristina Muniz; Friedlander, Myrna L.; Escudero, Valentin; Heatherington, Laurie
Sequential analyses examined associations between the working alliance and therapist-adolescent communication patterns in 10 Spanish cases of brief conjoint family therapy. Early sessions with strong versus problematic alliances, rated by observers, were selected for coding of relational control communication patterns. No differences were found in…
Discussion: This study confirmed the rate of prevalence of work-related musculoskeletal disorders and injuries in occupational and physical therapists, with wrist and lumbar being the most affected. The promotion of therapist’s knowledge about MSD and following ergonomic principles and new approaches in the treatment may lower or prevent MSD.
Bartle-Haring, Suzanne; Shannon, Samuel; Bowers, David; Holowacz, Eugene
Therapeutic alliance has been acknowledged as one of the catalysts for change within a therapeutic relationship. The contributions of therapists' characteristics to alliance are not often studied. From a Bowen System's Theory perspective, the therapist's level of differentiation would be highly relevant to the development of a therapeutic alliance. The hypothesis for this study was that therapists who are able to take a more differentiated stance in therapy will build a stronger therapeutic alliance. To test this hypothesis, multilevel modeling procedures were performed, using data from nine therapists and 93 couple cases collected at a large, Midwestern university. Therapist differentiation of self was found to be weakly associated with the clients' perception of therapeutic alliance across the early sessions of therapy, but not in the expected direction. Although the results were unexpected, this study provides an example of the potential of examining therapist characteristics from within one model of therapy, that can be applied across various clients and various models of therapy. © 2016 American Association for Marriage and Family Therapy.
Chiarello, Lisa; Effgen, Susan K
: The purpose of this project was to revisit the 1990 American Physical Therapy Association Section on Pediatrics policy statement and competencies for physical therapists in early intervention and update their content to reflect present practice, legislation, and terminology. : A review of the literature and competencies for early intervention professionals was completed. Surveys of six focus groups of parents of children with disabilities were conducted to ascertain their perspectives of the knowledge and skills important for therapists. This information was integrated into a listing of competencies expected of physical therapists working in early intervention. The competencies were reviewed regionally and nationally by experts in the field and therapists practicing in early intervention. : Nine content areas with specific competencies were identified in which early intervention physical therapists should have expertise. The primary change in the content between the 1990 and 2005 competencies is the addition of service provision in natural environments. : Physical therapists who work in early intervention require specific skills and knowledge to effectively serve infants, toddlers, and their families. Competencies are useful to guide professional development.
van den Houten, Marijn M L; Spruijt, Steffie; Fokkenrood, Hugo J P; Scheltinga, Marc R M; Teijink, Joep A W
Smartphone apps provide novel ways for triggering lifestyle change by coupling objective measurements of health behavior with tailored feedback. Little is known about end-user preferences regarding the content of mobile health (mHealth) interventions. The aim of this study was to assess smartphone use and preferences regarding app content among intermittent claudication patients and their treating physical therapists. A cross-sectional survey was sent via an internal email system to 1,514 physical therapists specialized in treating patients with intermittent claudication. They were asked to complete one questionnaire themselves and administer a second to their intermittent claudication patients currently under treatment. Data on participant characteristics and smartphone use were collected from all respondents. The preferred app components were obtained from participants owning a smartphone. Binary logistic regression analysis was used to explore the adjusted association between age and attained educational level, and smartphone use. The response rate of therapists was 40.8% (617/1,514), and a total of 488 patients completed the survey. After excluding incomplete forms, a total of 615 physical therapist forms and 483 patient forms were analyzed. Overall, 40.6% of patients and 95% of therapists owned a smartphone. Higher educational level was associated with smartphone ownership (adjusted odds ratio = 2.46, 95% confidence interval (CI) = 1.41-4.27, P = 0.001). Compared to patients aged ≥75 years, lower age was associated with higher odds of owning a smartphone (adjusted odds ratios for patients aged ≤54 years = 21.27, 95% CI = 6.82-66.30, P intermittent claudication patients in possession of a smartphone included monitoring treadmill-measured walking distances (71%), global positioning system tracking of walks (50%), and daily physical activity monitoring (49%). Physical therapists were most interested in global positioning system tracking of walks (89
Xie, Cheng-Long; Wang, Xiao-Dan; Chen, Jie; Lin, Hua-Zhen; Chen, Yi-He; Pan, Jia-Lin; Wang, Wen-Wen
Numerous practice guidelines have recommended cognitive behavioral therapy (CBT) and psychodynamic therapy as a treatment of choice for depression in Parkinson's disease (PD). However, no recent meta-analysis has examined the effects of brief psychotherapy (which includes both CBT and psychodynamic therapy) for adult depression in PD. We decided to conduct such a systematic review and meta-analysis. We included randomized controlled trials (RCTs) examining the effects of brief psychotherapy compared with control groups, other support nursing, or pharmacotherapy. The quality of included studies was strictly evaluated. Twelve studies including 766 patients met all inclusion criteria. The result showed that brief psychotherapy could evidently improve the HAMD (p depression in PD patients. But one reason to undermine the validity of findings is high clinical heterogeneity and low methodological quality of the included trials.
Lacy, Timothy; Hughes, John D
Psychotherapy and biological psychiatry remain divided in psychiatry residency curricula. Behavioral neurobiology and neuropsychiatry provide a systems-level framework that allows teachers to integrate biology, psychodynamics, and psychology. The authors detail the underlying assumptions and outline of a neural systems-based neuroscience course they teach at the National Capital Consortium Psychiatry Residency Program. They review course assessment reports and classroom observations. Self-report measures and teacher observations are encouraging. By the end of the course, residents are able to discuss both neurobiological and psychodynamic/psychological concepts of distributed biological neural networks. They verbalize an understanding that psychology is biology, that any distinction is artificial, and that both are valuable. A neuroscience curriculum founded on the underlying principles of behavioral neurobiology and neuropsychiatry is inherently anti-reductionistic and facilitates the acquisition of detailed information as well as critical thinking and cross-disciplinary correlations with psychological theories and psychotherapy.
The Psychoanalytic-interactional Method (PIM): A Psychodynamic Treatment for Adolescents with Severe Disorders of Personality Functioning The psychoanalytic-interactional method (PIM) was developed as a psychodynamic treatment for adult patients with severe disorders of personality functioning (Streeck u. Leichsenring, 2015). However, it is also well suited for the treatment of adolescent patients because its techniques fit with specific conditions of adolescence. A modified version of the PIM for adolescents (Streeck-Fischer, Cropp, Streeck, Salzer, 2016) has proven to be efficacious. The paper describes the basic principles of the PIM and names aspects that have to be taken into account in the treatment of adolescents with severe disorders of personality functioning. Finally, previous empirical results regarding the PIM treatment in adolescence are presented.
Zwerenz, Rüdiger; Becker, Jan; Johansson, Robert; Frederick, Ronald J; Andersson, Gerhard; Beutel, Manfred E
Mental disorders have become a major health issue, and a substantial number of afflicted individuals do not get appropriate treatment. Web-based interventions are promising supplementary tools for improving health care for patients with mental disorders, as they can be delivered at low costs and used independently of time and location. Although psychodynamic treatments are used frequently in the face-to-face setting, there has been a paucity of studies on psychodynamic Web-based self-help interventions. The objective of this study was to determine the feasibility and preliminary efficacy of a transdiagnostic affect-focused psychodynamic Web-based self-help intervention designed to increase emotional competence of patients with mental disorders. A total of 82 psychotherapy inpatients with mixed diagnoses were randomized into two groups. Following discharge, the intervention group (IG) got access to a guided version of the intervention for 10 weeks. After a waiting period of 10 weeks, the wait-list control group (WLCG) got access to an unguided version of the intervention. We reported the assessments at the beginning (T0) and at the end of the intervention, resp. the waiting period (T1). The primary outcome was satisfaction with the treatment at T1. Secondary outcome measures included emotional competence, depression, anxiety, and quality of life. Statistical analyses were performed with descriptive statistics (primary outcome) and analysis of covariance; a repeated measurement analysis of variance was used for the secondary outcomes. Effect sizes were calculated using Cohen d and data were analyzed as per protocol, as well as intention-to-treat (ITT). Patients were chronically ill, diagnosed with multiple diagnoses, most frequently with depression (84%, 58/69), anxiety (68%, 47/69), personality disorder (38%, 26/69), and depersonalization-derealization disorder (22%, 15/69). A majority of the patients (86%, 36/42) logged into the program, of which 86% (31
Penttinen, Henna; Wahlström, Jarl; Hartikainen, Katja
This case study examined reflexivity and the assimilation of problematic experiences, especially its progress within and between the Assimilation of Problematic Experiences Scale (APES) Stages 2-3, in group psychotherapy for social phobia. The data consisted of all of one client's turns expressing the two voices of her main problematic experience in 12 sessions, and all replies by the therapist in direct connection to them. The client's utterances were rated on the APES. A detailed analysis of 13 conversational passages revealed that progress in assimilation happened only when the client took a reflexive stance towards her inner experience or outer actions. There were a few instances when she took a reflexive stance, but no progress in assimilation could be noted. A qualitative analysis of three conversational episodes showed how therapist responsiveness facilitated the client's increased reflexivity and progress in assimilation. Reflexivity appears to be a necessary condition for progress in assimilation both at APES Stages 2 and 3, but the model should recognize that reflexivity can appear in diverse forms and at different levels. Therapist responsiveness and sensitivity to the client's assimilation process is crucial for a successful transition from Stage 2 to Stage 3.
Trad, Megan; Johnson, Jordan
To identify the effects of workplace bullying in the radiation therapy department on job performance and explore the environment and morale of individuals who work with a bully. A quantitative research study was designed to assess the prevalence and effects of bullying in the radiation therapy workplace. A total of 308 radiation therapists participated in the study for a return rate of 46%. Of those, 194 indicated that workplace bullying was present either in their current workplace or in a previous radiation therapy environment and that it negatively affected job performance and satisfaction. Findings of this study indicate a need for evaluation of the radiation therapy workplace, education on how to identify and prevent bullying behavior, and better communication among members of the radiation therapy environment. Participants indicated that working in a hostile environment led to forgetfulness, ineffective communication, and perceived discrepancies in promotion and treatment by management. Any bullying behavior contributes to an overall toxic work environment, which is unhealthy and unsafe for patients and therapists. Those who manage therapists should promote a culture of safety and embrace their staff's independence.
Lee, Byoung-Kwon; Seo, Dong-Kwon; Lee, Jang-Tae; Lee, A-Ram; Jeon, Ha-Neul; Han, Dong-Uk
[Purpose] This study was conducted to provide basic data for solutions to reduce the turnover rate of physical therapists. It should help create efficient personnel and organization management by exploring the impact of the work environment and work-related stress on turnover intention and analyzing the correlation between them. [Subjects and Methods] A survey was conducted with 236 physical therapists working at medical institutions in the Daejeon and Chungcheong areas. For the analysis on the collected data, correlational and linear regression analyses were conducted using the SPSS 18.0 program and Cronbach's alpha coefficient. [Results] The results showed a statistically significant positive correlation between turnover intention and work-related stress but a statistically significant negative correlation respectively between turnover intention and work environment. Work-related stress (β=0.415) had a significant positive impact on turnover intention and work environment (β=-0.387) had a significant negative impact on turnover intention. [Conclusion] To increase satisfaction level with the profession as well as the workplace for physical therapists, improvement of the work environment was the most necessary primary improvement.
Sibel Halfon; Alev Cavdar; Franco Orsucci; Guenter Karl Schiepek; Silvia Andreassi; Alessandro Giuliani; Giulio de Felice
Aim: Even though there is substantial evidence that play based therapies produce significant change, the specific play processes in treatment remain unexamined. For that purpose, processes of change in long-term psychodynamic play therapy are assessed through a repeated systematic assessment of three children’s “play profiles,” which reflect patterns of organization among play variables that contribute to play activity in therapy, indicative of the children’s coping strategies, and an express...
Novick, Kerry Kelly; Novick, Jack
To address the neglect of the importance of parent work in the psychodynamic psychotherapy of children and adolescents, the authors present a model of concurrent dynamic parent work that has demonstrated success with patients of all ages. The model includes dual goals for all therapies, addresses the challenge of confidentiality by differentiating privacy and secrecy, and emphasizes the importance of parent work throughout treatment. Copyright © 2013 Elsevier Inc. All rights reserved.
Scanlan, Justin Newton; Still, Megan
Employee wellbeing is an important issue for mental health services. Poor employee wellbeing (i.e., high levels of burnout or low job satisfaction) is associated with poorer consumer outcomes and higher staff turnover. This study set out to examine factors related to job satisfaction, turnover intention and burnout in a group of occupational therapists in mental health. Thirty-four occupational therapists (response rate approximately 60%) in a metropolitan public mental health service participated in a whole-of-service workforce survey. The survey included measures of job satisfaction, turnover intention, burnout, job hindrances, job challenges and job resources and questions about positive and negative aspects of positions and factors that attracted employees to their current position. Burnout was associated with lower job satisfaction and higher turnover intention. Higher job satisfaction was associated with rewards (remuneration and recognition) as well as cognitively challenging work. The variables most significantly associated with poorer wellbeing (higher turnover intention and burnout) were recipient contact demands (perception that contact with service users or families was demanding), and feelings of stress or fatigue. This study provides a detailed analysis of factors associated with job satisfaction, turnover intention and burnout in a group of occupational therapists working in mental health. To promote workforce wellbeing and enhanced retention, interventions to minimise burnout should be implemented and evaluated. These strategies should focus on enhancing job resources such as supervisor support, feedback and participation in decision making as well as building the personal resilience of occupational therapists working in mental health. © 2013 Occupational Therapy Australia.
Vieira, Edgar R; Svoboda, Stephanie; Belniak, Alexandra; Brunt, Denis; Rose-St Prix, Colleen; Roberts, Lisa; da Costa, Bruno R
To evaluate the rates and characteristics of musculoskeletal disorders (MSDs) in physical therapists (PTs) according to their specialty and setting. Participants completed an online questionnaire including 15 demographic questions, 7 work-related and 8 injury-related questions for 9 different body parts. Complete responses were obtained from 121 PTs; 96% reported MSD symptoms during the previous 12 months, 64% affecting at least 3 body parts. The body parts with the highest prevalence of symptoms were the low back (66%) and the neck (61%). For PTs specialized in acute care, geriatrics and pediatrics, the body part most commonly affected was the low back, while for PTs specialized in orthopedics and neurology, the body part most commonly affected was the neck. Regarding work settings, the low back was the most commonly affected for PTs working in skilled nursing facilities, outpatient clinics and hospitals, and the neck in PTs working in academic and home health settings. MSDs are common among PTs; the body parts most often affected were the low back and neck. The prevalence and body parts affected varied by practice setting and specialty area. The findings can help informing the design of evidence-based rehabilitation, prevention, training and educational programs. Rehabilitation of injured physical therapists needs to address the symptoms of the multiple body parts that are usually affected (e.g. back, wrists and hands). Rehabilitation of injured physical therapists needs to take into consideration their job demands, practice setting and specialty area. The findings can inform the design of rehabilitation, prevention, training and educational programs for physical therapists.
Madson, Timothy J; Hollman, John H
Cross-sectional survey. To examine how many physical therapists use traction, the patients for whom traction is used, the preferred delivery modes/parameters of traction, the supplemental interventions used with traction, and whether professional characteristics influence traction usage. Several systematic reviews and clinical guidelines have questioned the effectiveness of traction for managing low back pain, yet some patients may benefit from lumbar traction. While traction usage among physical therapists in other countries has been described, usage among physical therapists in the United States has not been examined. We surveyed a random sample of 4000 Orthopaedic Section members of the American Physical Therapy Association. Associations among respondents' professional characteristics and survey responses were explored with chi-square analyses (α = .05). The response rate was 25.5% (n = 1001), and 76.6% (n = 767) of respondents reported using traction. Most (58.4%) of the respondents used traction for patients with signs of nerve root compression, though many (31.4%) did not. Common delivery modes included manual methods (68.3%) and mechanical tables (44.9%), most often supplemental to other interventions (eg, stabilization exercises, postural education). Levels of professional preparation (doctoral/masters level versus bachelors/certificate level) were associated with many variables, as was attainment of an orthopaedic specialist certification. Most of the orthopaedic physical therapists in the United States who responded to our survey reported that they used lumbar traction, though not necessarily consistent with proposed criteria that identify patients most likely to benefit from traction. They used various traction delivery modes/parameters and used traction within comprehensive plans of care incorporating multiple interventions. Professional characteristics (education levels and clinical specialist credentialing) were associated with traction usage.
Leichsenring, Falk; Schauenburg, Henning
There is evidence that psychotherapy is helpful in depressive disorders, with no significant differences between psychotherapies. For psychodynamic therapy (PDT) various models prove to be efficacious. Thus, the evidence for PDT is "scattered" between different forms of PDT, also implying problems in training of psychotherapy and in transferring research to clinical practice. A unified protocol based on empirically-supported methods of PDT in depression may contribute to solve these problems Systematic search for randomized controlled trials fulfilling the following criteria: (a) individual psychodynamic therapy (PDT) of depressive disorders, (b) treatment manuals or manual-like guidelines, (c) PDT proved to be efficacious compared to control conditions, (d) reliable measures for diagnosis and outcome, and (f) adult patients. Fourteen RCTs fulfilled the inclusion criteria. By a systematic review of the applied methods of PDT seven treatment components were identified. A high consistency between components was found. The components were conceptualized in the form of seven interrelated treatment modules. A unified psychodynamic protocol for depression may enhance the empirical status of PDT, facilitate both the training in psychotherapy and the transfer of research to clinical practice and may have an impact on the health care system. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available Abstract Background There is a lack of psychotherapeutic trials of treatments of comorbid depression in cancer patients. Our study determines the efficacy of a manualized short-term psychodynamic psychotherapy and predictors of outcome by personality and quality of the therapeutic relationship. Methods/design Eligible breast cancer patients with comorbid depression are assigned to short-term psychodynamic psychotherapy (up to 20 + 5 sessions or to treatment as usual (augmented by recommendation for counseling center and physician information. We plan to recruit a total of 180 patients (90 per arm in two centers. Assessments are conducted pretreatment, after 6 (treatment termination and 12 months (follow-up. The primary outcome measures are reduction of the depression score in the Hospital Anxiety and Depression Scale and remission of depression as assessed by means of the Structured Clinical Interview for DSM IV Disorders by independent, blinded assessors at treatment termination. Secondary outcomes refer to quality of life. Discussion We investigate the efficacy of short-term psychodynamic psychotherapy in acute care and we aim to identify predictors for acceptance and success of treatment. Trial registration ISRCTN96793588
McCallum, Christine A; Mosher, Peter D; Jacobson, Peri J; Gallivan, Sean P; Giuffre, Suzanne M
Many factors affect student learning throughout the clinical education (CE) component of professional (entry-level) physical therapist education curricula. Physical therapist education programs (PTEPs) manage CE, yet the material and human resources required to provide CE are generally overseen by community-based physical therapist practices. The purposes of this systematic review were: (1) to examine how the construct of quality is defined in CE literature and (2) to determine the methodological rigor of the available evidence on quality in physical therapist CE. This study was a systematic review of English-language journals using the American Physical Therapy Association's Open Door Portal to Evidence-Based Practice as the computer search engine. The search was categorized using terms for physical therapy and quality and for CE pedagogy and models or roles. Summary findings were characterized by 5 primary themes and 14 subthemes using a qualitative-directed content analysis. Fifty-four articles were included in the study. The primary quality themes were: CE framework, CE sites, structure of CE, assessment in CE, and CE faculty. The methodological rigor of the studies was critically appraised using a binary system based on the McMaster appraisal tools. Scores ranged from 3 to 14. Publication bias and outcome reporting bias may be inherent limitations to the results. The review found inconclusive evidence about what constitutes quality or best practice for physical therapist CE. Five key constructs of CE were identified that, when aggregated, could construe quality.
Ethical dilemmas arise when physical therapists encounter conflicts between loyalty to their patients and loyalty to their employers. This type of ethical conflict is called "the dilemma of the double agent." If physical therapists perceive themselves as agents of their patients, their employment may be threatened. If physical therapists perceive themselves as agents of their employers, their patients may suffer physical or psychological harm. The double-agent dilemma is illustrated in this article by a hypothetical case study derived from sports physical therapy. Three ethical theories--egoism, utilitarianism, and formalism--are used to analyze the conflict and formulate solutions. A second conflict also is raised between patient autonomy and medical paternalism. As physical therapists become more autonomous, they will assume increased responsibility. Inherent in this increased responsibility is the obligation to recognize and confront ethical dilemmas in physical therapy practice. Resolving ethical dilemmas is difficult, but use of ethical theories can help in the systematic examination of basic assumptions and principles. This article introduces therapists to three ethical theories and presents a model for ethical decision making.
Siengsukon, Catherine F; Al-Dughmi, Mayis; Stevens, Suzanne
Sleep disturbances occur in one third of the US population, and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control has deemed insufficient sleep to be a public health problem. Knowledge about sleep and skills to screen sleep disorders and to promote sleep health have been recommended for physical therapists. Furthermore, in survey studies, physical therapists overwhelmingly agree that sleep is important for health and poor sleep impairs function. Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory. Sleep disruptions occur across the life span and in individuals with various conditions that are typically treated by physical therapists. Therefore, the purpose of this perspective paper is to (1) discuss the relevance of sleep to physical therapist practice, (2) recommend tools to screen for the 3 most common sleep disorders, and (3) provide suggestions for how therapists can integrate sleep health in prevention, health promotion, and wellness interventions. © 2017 American Physical Therapy Association.
Haarman, Juliet A M; Maartens, Erik; van der Kooij, Herman; Buurke, Jaap H; Reenalda, Jasper; Rietman, Johan S
During gait training, physical therapists continuously supervise stroke survivors and provide physical support to their pelvis when they judge that the patient is unable to keep his balance. This paper is the first in providing quantitative data about the corrective forces that therapists use during gait training. It is assumed that changes in the acceleration of a patient's COM are a good predictor for therapeutic balance assistance during the training sessions Therefore, this paper provides a method that predicts the timing of therapeutic balance assistance, based on acceleration data of the sacrum. Eight sub-acute stroke survivors and seven therapists were included in this study. Patients were asked to perform straight line walking as well as slalom walking in a conventional training setting. Acceleration of the sacrum was captured by an Inertial Magnetic Measurement Unit. Balance-assisting corrective forces applied by the therapist were collected from two force sensors positioned on both sides of the patient's hips. Measures to characterize the therapeutic balance assistance were the amount of force, duration, impulse and the anatomical plane in which the assistance took place. Based on the acceleration data of the sacrum, an algorithm was developed to predict therapeutic balance assistance. To validate the developed algorithm, the predicted events of balance assistance by the algorithm were compared with the actual provided therapeutic assistance. The algorithm was able to predict the actual therapeutic assistance with a Positive Predictive Value of 87% and a True Positive Rate of 81%. Assistance mainly took place over the medio-lateral axis and corrective forces of about 2% of the patient's body weight (15.9 N (11), median (IQR)) were provided by therapists in this plane. Median duration of balance assistance was 1.1 s (0.6) (median (IQR)) and median impulse was 9.4Ns (8.2) (median (IQR)). Although therapists were specifically instructed to aim for the
Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo
[Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.
Gustavson, A M; Falvey, J R; Jankowski, C M; Stevens-Lapsley, J E
Frailty is an emerging and immediate public health concern given the growing aging population. The condition of frailty is characterized by a reduction in physiologic reserve, which places frail older adults at considerable risk for further functional decline, hospitalization, institutionalization, and death. Recent research suggests that frailty may be reversible, which could result in significant improvement in public health. Thus, a strong impetus exists to develop strategies for frail older adults that achieve the Triple Aim through better promotion of population health, optimization of patient experiences, and delivery of high-quality care at minimal cost. Physical therapists often treat frail older adults, yet how physical therapists can contribute to preventing or reversing frailty in healthcare settings has not been described, and may potentially influence patient outcomes and healthcare spending. Therefore, the purpose of this publication is to outline the potential role of physical therapists in achieving the Triple Aim for the frail older adult population.
Domes, Christopher M; Kruger, Cori L
Effective treatment of orthopedic injuries requires a multidisciplinary team, including physical and occupational therapists, athletic trainers, massage therapists, and acupuncturists. Orthopedic surgeons commonly encounter these practitioners but may not be familiar with the training, credentialing, and most importantly, the appropriate use of members of this team. There are general similarities in practice locations as well as types of symptoms addressed by the providers discussed, which include the treatment of physical pain, evaluation and treatment of physical impairment, and some facilitation of adaptation to the limitations caused by injuries. Across the 5 types of providers discussed there are widely varying training and licensing requirements, specializations, and continuing education requirements to maintain licensure. This article provides a focused review of these members of the multidisciplinary team and highlights the current American Academy of Orthopaedic Surgeons recommendations for the use of occupational and physical therapists for orthopedic conditions, including hip fractures, total hip arthroplasty, and anterior cruciate ligament reconstruction. Copyright 2015, SLACK Incorporated.
Nicolosi, J; Byrd, A D; Potts, R W
There is currently controversy regarding whether sexual reorientation or conversion therapies are ethical and effective forms of treatment for dissatisfied homosexually oriented people. We present the results of a survey of 206 psychotherapists who practice sexual conversion therapy. 187 therapists said they believed homosexuality is a developmental disorder and that the 1973 decision by the American Psychiatric Association to "depathologize" homosexuality was politically motivated and unscientific. The therapists believe that the majority of dissatisfied homosexually oriented clients who seek conversion therapy benefit from it, experiencing both changes in their sexual orientation and improved psychological functioning. We conclude that therapists who persist in providing reorientation therapy do so because they believe it is an effective and ethical treatment option for their clients.
Full Text Available This study explored consultants’ experiences of transference and counter-transference when conducting group relations training from the systems psychodynamic stance. A phenomenological research design was used with semistructured interviews conducted on a purposive sample of 13 organisational development consultants in a financial institution. The data was analysed by means of content analysis. The results showed that consultants have varied receptiveness in terms of receiving projections and managing transference. These differences involve triggers, characteristics and systemic valence. The consultants experienced counter- transference on five different cognitive and emotional levels. Distinguishing between personal and group emotions, receiving projections and managing transference, all contribute to the complexity of organisational consulting. Opsomming Hierdie studie het ondersoek ingestel na konsultante se ervarings van oordrag en teen-oordrag tydens groepverhoudingsopleiding vanuit die sistemiese psigodinamiese posisie. ’n Fenomenologiese navorsingsontwerp is gebruik met semi-gestruktureerde onderhoude gevoer met ’n doelgerigte steekproef van 13 organisasie ontwikkelingskonsultante in ’n finansiële instelling. Die data is ontleed deur middel van inhoudsontleding. Die resultate het aangetoon dat konsultante uiteenlopende ontvanklikheid het wat betref die ontvangs van projeksies en die hantering van oordrag. Hierdie verskille behels snellers, kenmerke en sistemiese valensie. Die konsultante het teen-oordrag ervaar op vyf verskillende kognitiewe and emosionele vlakke. Om onderskeid te tref tussen persoonlike en groep-emosies, die ontvang van projeksies en die hantering van oordrag, dra alles by tot die kompleksiteit van konsultering.
Full Text Available The aim of this research was to explore the dynamic nature of leader and team behaviour during organizational change, using five different organisational constellations or neurotic personality styles, namely the paranoid, schizoid, depressive, compulsive and histrionic styles. Qualitative research was conducted, comprising of two focus groups with eight psychologists consulting regularly to organisational change. The data was content analysed and interpreted from the systems psychodynamic stance. Each style’s leader and team behavioural manifestations are discussed. The findings and recommendations can be used by consulting psychologists towards understanding and implementing organisational change dynamics. Opsomming Die doel van hierdie navorsing was om die dinamiese aard van leier- en spangedrag tydens organisasieverandering te eksploreer, deur gebruik te maak van vyf verskillende organisasie konstelasies of neurotiese persoonlikheids style, naamlik die paranoide, skisoide, depressiewe, kompulsiewe en histrioniese style. Kwalitatiewe navorsing is uitgevoer, bestaande uit twee fokusgroepe met agt sielkundiges wat gereeld konsulteer in die veld van organisasieverandering. Die data is aan inhoudsanalise onderwerp en geinterpreteer vanuit die sisteem-psigodinamiese benadering. Elke styl se leier en span gedrag word bespreek. Die bevindinge en aanbevelings kan gebruik word deur sielkundiges in konsultasies ten einde organisasieveranderingsdinamika te verstaan en te implementeer.
Full Text Available This article will address the issue of using understandings of psychodynamic interrelations as a means to grasp how social and cultural dynamics are processed individually and collectively in narratives. I apply the two theoretically distinct concepts of inter- and intrasubjectivity to gain insight into how social and cultural dynamics are processed as subjective experiences and reflected in the interrelational space created in narrative interviews with trainee social educators. By using a combination of interactionist theory and psychosocial theory in the analysis of an interview with a student of social education, I demonstrate how the often conflicting demands and expectations are being played out in the interrelational tension between the researcher (myself and the interviewee or narrator. In a confrontation with “inner” expectations and concerns regarding a future profession and one’s ability to cope, and the “outer” socially and culturally embedded discourses as they are played out in the objectives of self-development and education, the narrative about a forthcoming internship is filled with tension and contradiction. In this article I will demonstrate how such tensions and contradictions are valuable sources of information in understanding the process of becoming a social educator.
Jéssica Emanoeli Moreira da Costa
Full Text Available Socio-educational Reintegration Workers play a role in the custody, safety and monitoring of teenagers, complying with socio-educational measures for having infringed the law according to Brazil’s Child and Teenager Statute. This study in terms of public policies has to do with education and sanction. Further, it discusses collective defense strategies from social reintegration workers, who deal on a daily basis with teenagers in conflict with the law. The methodology applied is based upon Work Psychodynamics. The study concludes that given their strong unity, social reintegration workers protect themselves from work-related pathologies given that they preserve themselves from isolation by inserting themselves in a space of intersubjective relations that support their work and keep them from fear and anxiety. Collective strength comes through cooperation built around the almost prison-like discipline shown towards teenagers deprived of their freedom. This discipline disguises a collective defense strategy that denies the fact that teenagers in conflict with the law are in a vulnerable psychosocial situation. This collective defense strategy serves under current work conditions to protect social reintegration workers from the fear of building a close relationship with teenagers given the certainty that this relationship will leave the first group at risk and unprotected.
Baum-Baicker, Cynthia; Sisti, Dominic A
To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons "wise." Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle's intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom.
Full Text Available This research explored the systems psychodynamic behaviour manifesting in the context of employment equity practices within three South African information technology organisations. In-depth interviews with the human resources practitioners involved, elicited seven themes around fantasies of power/opportunities, splits and defences, projective identification, paranoia, idealisation/competence, envy/guilt and coping styles. It was hypothesised that the experience around employment equity in these organisations got stuck in the paranoid-schizoid position, that the system was unconsciously colluding to keep the status quo, and that idealisation was projected on the white subgroup while denigration was projected on previously disadvantages employees and candidates. Recommendations for more optimal coping with these behaviours were formulated. Opsomming Hierdie navorsing het die sistemies psigodinamiese gedrag ondersoek wat gemanifesteer het in die konteks van gelyke indiensneming in drie Suid-Afrikaanse inligtingstegnologie organisasies. Indiepte onderhoude met die betrokke menslike hulpbron praktisyns het sewe temas na vore gebring wat insluit fantasieë oor mag/geleenthede, spleet en verdedigings, projektiewe identifikasie, paranoia, idealisering/kompetensie, afguns/skuld en coping style. Die hipotese is geformuleer dat die ervaring rondom gelyke indiensneming in hierdie organisasies vasgehak het in die paranoïde-skisoïde posisie, dat die stelsel onbewustelik saamsweer om die status quo te handhaaf, en dat idealisering geprojekteer word op die wit subgroep terwyl swartsmeerdery geprojekteer word op die voorheen benadeelde werknemers en kandidate. Aanbevelings oor meer optimale coping met hierdie gedrag is geformuleer.
Quay, Herbert C; Hogan, Anne E; Donohue, Keith F
We report on data provided by a nationwide panel of 23 infant mental health (IMH) experts who provided numerical ratings of the relative importance of 143 competencies desirable for licensed mental health therapists working with infants/children birth to 5 years of age and their families/caregivers. The competencies were developed based on prior state and national efforts and our own experience in training IMH therapists. The competencies were grouped conceptually into seven areas: (a) Normal infant and toddler development; (b) Atypical development (perturbations in development); (c) Emotional/behavioral disorders in infants and young children; (d) Assessment; (e) Intervention; (f) Community resources and referrals; and (g) Organization, communication, and collaboration. We calculated means, SDs, 95% confidence intervals to rank order each competency. We conducted reliability analyses and tested for mean differences in ratings for the seven areas. Interrater and intraclass correlations were modest, likely the result of restriction of range in the ratings. The seven areas showed high levels of internal consistency and, with few exceptions, did not significantly differ in the means of their ratings. The utility of the competencies are discussed as a framework for training and professional development for IMH clinicians. Copyright © 2009 Michigan Association for Infant Mental Health.
Theodore I. King II, Ph.D, L.Ac.
Full Text Available Using a cross-sectional descriptive study design, surveys were mailed to 200 randomly selected certified hand therapists of the American Society of Hand Therapists (ASHT to determine how they document analog dynamometer and pinch gauge dial readings. Three different needle settings for the dynamometer and pinch gauge were presented in picture format. For each instrument, one needle setting was just above a gauge marker, one was just below a gauge marker, and one was set exactly between two gauge markers. A total of 126out of 200 surveys were returned for a participation rate of 63%. For the dynamometer readings, therapists estimated the exact strength reading between the two gauge markers 78.3% of the time. For the pinch gauge readings, therapists rounded to the nearest dial marker 76.5% of the time when the needle was just above or just below a dial marker and 61.9% of the time they estimated the reading when the needle was placed exactly between two dial markers.
Short-term intensive psychodynamic group therapy versus cognitive-behavioral group therapy in day treatment of anxiety disorders and comorbid depressive or personality disorders: study protocol for a randomized controlled trial.
Suszek, Hubert; Holas, Paweł; Wyrzykowski, Tomasz; Lorentzen, Steinar; Kokoszka, Andrzej
Psychodynamic and cognitive-behavioral group therapies are frequently applied in day hospitals for the treatment of anxiety disorders and comorbid depressive or personality disorders in Poland and other Eastern European countries. Yet there is not enough evidence as to their effectiveness in this environment; this study addresses this gap. The aim of the study is to determine the effectiveness of these two kinds of day treatment care consisting of intensive, short-term group psychodynamic and cognitive-behavioral therapy, for patients with anxiety disorders and/or comorbid depressive or personality disorders. Our objectives are to: 1) show the effectiveness of each treatment in a day-care setting relative to the wait-list control group; 2) demonstrate the relative short- and long-term effectiveness of the two active treatments; 3) carry out a preliminary examination of the predictors and moderators of treatment response; 4) carry out a preliminary examination of the mediators of therapeutic change; and 5) compare the impact of both methods of treatment on the outcome of the measures used in this study. In this randomized controlled trial, a total of 199 patients with anxiety disorders and comorbid depressive and/or personality disorders will be assigned to one of three conditions: 1) psychodynamic group therapy; 2) cognitive-behavioral group therapy; or 3) wait-list control group. The therapy will last 12 weeks. Both treatments will be manualized (the manuals will address comorbidity). Primary outcome measures will include self-reported symptoms of anxiety, observer-rated symptoms of anxiety, global improvement, and recovery rate. Secondary outcome measures will include the number of pathological personality traits, depression, self-esteem, defense mechanisms, beliefs about self and others, interpersonal problems, object relations, parental bonding, meta-cognition, and quality of life. Measures will be taken at baseline, post-treatment, and at six months following
Ahmed, Farooq; Dugdale, Charlotte; Malik, Ovais; Waring, David
Orthodontic therapists (OTs) are the most recent addition to the orthodontic clinical team. The General Dental Council (GDC) and the British Orthodontic Society have formulated guidance and guidelines relating to their scope of practice and level of supervision, however there has been no contemporary UK-based research investigating practice and supervision of OTs. The aim of this study was to investigate the scope of practice and level of supervision of OTs working in the UK. Ethical approval was received from the University of Manchester Research Ethics Committee. An anonymous postal questionnaire was dispatched using postal details acquired through the British Orthodontic Societies mailing list. Three mailings of the questionnaire were conducted. A 74% response rate was achieved. OTs routinely conducted 16 of the 20 procedures from their scope of practice. Uncommon procedures included fitting headgear (24%), lingual appliances (27%), inserting or removing temporary anchorage devices (20%), and taking facebow record (18%). A total of 62% of OTs took patient consent for treatment. 59% were supervised through a written prescription with no direct supervision. OTs were directly supervised for only a quarter of their clinical practice. Orthodontists viewing frequency for OTs varied significantly, and was found to be the following: every 2-4 visits (36%), every other visit (35%), and every visit (26%). OTs mostly carried out the scope of practice as permitted by the GDC. Procedures uncommon to routine orthodontic practice were also uncommon to Orthodontic therapist clinical practice. OTs work mostly through written prescription with no direct supervision.
Brooks, B A
I developed and sent a questionnaire to the directors of entry-level physical therapy programs to determine if course work taken in an associate degree program could be credited toward requirements leading to a higher degree or certificate in physical therapy. I sent 86 questionnaires; 45 were returned. Results of the survey revealed that basic science courses taken by the physical therapist assistant (PTA) students are more likely to be credited (up to half of the respondents replied positively) toward a higher degree or certificate than are technical courses like therapeutic exercise, fundamentals of physical therapy, or physical modalities. Moreover, as many as 79 percent of the respondents reported that PTAs would not be granted transfer credit for their technical courses. Of those respondents whose programs do give credit for the technical courses, the courses are usually considered as elective hours. Although the concept of upward mobility appears to remain viable in the educational philosophy of the American Physical Therapy Association, students who view the associate degree program as an entry point into a physical therapy program must be aware of the problems of acceptance of PTA credits in an entry-level physical therapy program.
The intention of the authors was to focus specifically on their lived experience with a view to observing how the different historically situated contexts have influenced the incremental shift in the acquisition of the skills of the Gestalt therapist. It is the authors' contention that Gestalt therapeutic training needs to transcend the ...
Discusses importance of addressing culture, values, and aesthetics in training of art therapists. Illustrates how students can be guided to discover and examine influence which culture has on their own and others' perceptions of different modes of artistic expression. Contends that newly gained sensibility can give direction to students'…
of people with substance abuse disorders would be best dealt with by social services or health services. If therapists them- selves reflect honestly on their approaches to the treatment of substance dependent clients in practice, I dare say most, or at least some, of us would fall short of adequate and efficient client care.
If therapists them- selves reflect honestly on their approaches to the treatment of substance dependent clients in practice, I dare say most, or at least some, of us ... The paper will focus on motivational interviewing, autonomy, virtue, human rights, duty to care, justice and common ... play an “add-on” role in its development.
Stewart-Bussey, Elysabeth L.; Schneider, Lawrence J.
According to a 1975 survey conducted by the National Clearinghouse for Smoking and Health, attitudes toward smoking are becoming increasingly negative. While studies assessing the impact of counselor smoking on clients suggest that no overwhelmingly harmful impact on clients' perceptions of therapists occurs, the issue of the impact of counselor's…
Beck, Judith S.
Several important developments have evolved in the supervision of cognitive therapists in the past few years. Five such developments are: (1) the conscious structuring of the supervision session to conform to the suggested structure of the therapy session; (2) increased emphasis on quickly and efficiently conceptualizing patients, refining the…
Peters-Scheffer, Nienke; Didden, Robert; Korzilius, Hubert; Sturmey, Peter
Early intensive behavioral intervention is generally effective for children with autism spectrum disorder but is associated with variability in treatment outcome and quality of treatment delivery may contribute to this. This study examined the relationship between therapist personality, attitude toward individuals with a disability, and perceived…
Hurt, Amy A.; Grist, Cathy Lann; Malesky, Lann A., Jr.; McCord, David M.
Background: Applied behaviour analysis (ABA) therapists typically work one-to-one with children with autism for extended periods of time, which often leads to high levels of job-related stress, lower levels of job satisfaction, increased frequency of occupational "burnout" and higher than average job turnover (Journal of Autism…
Hills, Caroline; Ryan, Susan; Warren-Forward, Helen; Smith, Derek R
'Generation Y' is a descriptor of those therapists born between 1982 and 2000. According to generational theory, each generation have unique characteristics due to the social and historical factors they have experienced during their formative years. Occupational therapy educators have reported on 'Generation Y' characteristics observed in occupational therapy students. This study aimed to investigate if managers considered there was a 'Generation Y' therapist and their observed characteristics in practice, as well as successful management strategies used to maximise their potential in the workplace. A hard copy survey based on the 'Generation Y' literature was sent to all managers listed on an Australian University database. Almost all respondents considered there was a 'Generation Y' therapist. Overall, managers reported characteristics of this staff group as being hard working, confident with technology, needing positive feedback and demanding professional development opportunities. Managers also reported that this group may be a challenge to retain in work positions. Managers also viewed 'Generation Y' staff as a positive energy and considered that in the future they will be of benefit to the profession. While there may be generational differences between therapists in the workplace, inclusive management styles may be the most appropriate management approach. Career guidance, facilitating creativity, increasing work responsibility and integrating new technologies like social networking into practice may be appropriate strategies for this staff group, to facilitate both their professional development and to retain them in the profession. © 2013 Occupational Therapy Australia.
Harris, Steven M.; Hays, Kelli Wenner
Limited empirical information exists on whether or not marriage and family therapists are having sexuality-related discussions with their clients. When helping professionals ignore client sexuality, the potential for unintended negative outcomes increases. The researchers surveyed 175 clinical members of the American Association for Marriage and…
Denton, Wayne H.
Discusses ethical and practical concerns family therapists face when using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R), including incompatibility of orientations, stigma associated with diagnosing, being asked to misrepresent diagnoses to third-party payers, and competency of some family therapists…
Jul 4, 2013 ... Limited research has been undertaken in the field of somatology in South Africa. This article on self-management is the first qualitative research report related to self-management of the somatology therapist. Research method and design. Design. In this study, a qualitative, descriptive, exploratory and.
Turgeon, Jean; Hay, John A.
Responses from 55 of 82 male occupational therapists in Ontario were differentiated by length of work experience (median = 7 years). Less experienced therapists were less satisfied and more inclined to consider leaving, but they did not feel more isolated. (SK)
Fuller, R L
The author discusses the impact of the therapist's pregnancy on the therapist, patient, and therapeutic work. The therapist experiences the phases of pregnancy while negotiating affective and physical changes, shifts in identity, and new demands on her repertoire of therapeutic techniques. The patient may experience anger, fear of abandonment, infantile pregnancy fantasies, intensified sexual feelings, sibling rivalry with and/or envy of the therapist, and a move to a more complex level of object relations. The interplay between patient and therapist is discussed using selected, brief, clinical vignettes. The role of the supervisor of the therapist is explored. The author proposes and develops a new view of pregnancy as consisting of five phases: prepregnancy (planning), early, middle, and late pregnancy, and postpregnancy (return and consolidation). A literature review is incorporated in the presentation of the case material. The author concludes that the therapist's pregnancy usually facilitates the therapeutic process and leads to emotional growth in the patient and the therapist.
Liddell, Alice E; Allan, Steven; Goss, Ken
Compassion-focused therapy (CFT) has shown promising results for a range of clinical presentations. This study explored the therapeutic competencies required to deliver CFT and organized these into a coherent framework. The Delphi method was used to explore and refine competencies for delivering CFT in three rounds of data collection. The first round involved interviews with 12 experts in CFT. Data were analysed using template analysis to generate a draft competency framework. The main competencies were used to create a survey for rounds two and three involving CFT experts and practitioners. Data collected from the surveys were used to refine the competencies. The CFT competency framework (CFT-CF) that was produced comprised 25 main competencies within six key areas of competence. The areas were as follows: competencies in creating safeness, meta-skills, non-phase-specific skills, phase-specific skills, knowledge and understanding and use of supervision. The main competencies included several subcompetencies specifying knowledge, skills and attributes needed to demonstrate the main competence. Overall, there was consensus on 14 competencies and 20 competencies exceeded an 80% agreement level. Some of the CFT competencies overlapped with existing therapies, whilst others were specific to CFT. The CFT-CF provides useful guidance for clinicians, supervisors and training programmes. Further research could develop the CFT-CF into a therapist rating scale in order to measure the outcome of training and to assess treatment fidelity in clinical trials. The compassion-focused therapy competency framework (CFT-CF) identifies therapeutic competencies that overlap with existing treatments as well as those specific to compassion-focused therapy (CFT). The CFT-CF builds guidance for the competencies required to deliver CFT in a range of clinical settings. The CFT-CF provides guidance for those training CFT therapists. The CFT-CF could be used as a basis to develop a therapist
Psicoterapia psicodinâmica breve: estratégia terapêutica e mudança no padrão de relacionamento conflituoso Brief psychodynamic therapy: therapeutic strategy and change in the conflictual relationship pattern
Elisa Medici Pizão Yoshida
Full Text Available Examinaram-se possíveis relações entre mudanças no padrão de relacionamento conflituoso de paciente, de 48 anos, submetida a psicoterapia breve psicodinâmica, e a estratégia terapêutica adotada pela terapeuta. Foi também avaliada a "magnitude" da mudança em sintomas psicopatológicos ao final do processo e entrevistas de acompanhamento (3 e 6 meses, com instrumentos de autorrelato: Inventário Beck de Depressão (BDI, Escala de Alexitimia de Toronto (TAS, Escala de Avaliação de Sintomas-40 (EAS-40, Escala Fatorial de Ajustamento Emocional/ Neuroticismo (EFN. A avaliação do padrão relacional baseou-se no Tema Central de Relacionamento Conflituoso - CCRT e a estratégia terapêutica, no grau de "expressividade vs. apoio" das intervenções. Os resultados mostraram melhoras clinicamente significantes nos sintomas e mudança parcial do padrão central de relacionamento. As intervenções terapêuticas foram mais expressivas no início e mais suportivas à medida que mudanças positivas eram observadas. É necessária cautela na generalização dos resultados. A abordagem metodológica permite comparar diferentes indivíduos.This study aimed to evaluate possible association between change in the conflictual relationship pattern of a 48 year-old, woman, assisted on brief psychodynamic therapy, and the therapist's therapeutic strategy. Yet it was evaluated the magnitude of change of psychopathological symptoms at the end and follow-up interviews (3 and 6 months according to self-report measures: Beck Depression Inventory (BDI, Toronto Alexithymia Scale (TAS, Symptom Assessment Scale40 (EAS-40, Emotional Adjustment/ Neuroticism Factorial Scale (EFN. The relationship pattern was assessed based on the Core Conflictual Relationship Theme - CCRT method and the therapeutic strategy according to the degree of expressiveness vs supportiveness of the therapist's interventions. Results pointed out to clinically significant improvement on symptoms
Kikkert, Martijn J; Driessen, Ellen; Peen, Jaap; Barber, Jacques P; Bockting, Claudi; Schalkwijk, Frans; Dekker, Jeff; Dekker, Jack J M
Barber and Muenz (1996) reported that cognitive behavior therapy (CBT) was more effective than interpersonal therapy (IPT) for depressed patients with elevated levels of avoidant personality disorder, while IPT was more effective than CBT in patients with elevated levels of obsessive-compulsive personality disorder. These findings may have important clinical implications, but have not yet been replicated. We conducted a study using data from a randomized clinical trial comparing the efficacy of CBT and short-term psychodynamic supportive psychotherapy in the outpatient treatment of depression. We found no evidence indicating that avoidant patients may benefit more from CBT compared to short-term psychodynamic supportive therapy (SPSP). Our results indicate that treatment effect does not depend on the level of avoidance, or obsessive-compulsiveness personality disorders further examine the influence of personality disorders on the effectiveness of CBT or psychodynamic therapy in the treatment of depression. Copyright © 2016 Elsevier B.V. All rights reserved.
Seifert, Anna M; Stotz, Nicole; Metz, Alexia E
To gather information on occupational therapy practitioners' use and opinions of apps, an online survey was distributed to occupational therapy practitioners licensed in the state of Ohio. The survey sought information regarding clinical populations and skill areas for which apps are used, potential barriers to use of apps and preferred apps/app features. OTs working in medical and education-based settings and with clients of all ages responded to the survey. Over half (53%) reported not using apps in therapy, with "not having access to the technology at work" being the leading reason endorsed. Of practitioners who did report using apps, the majority used them with ≤25% of their case load and primarily used tablets to do so. Clinicians indicated that they use apps for a wide variety of reasons, including to promote skill building and to support the therapeutic process. Preferred features included the ability to grade difficulty up/down, multiple uses and accurate feedback. Recommendations from peers were the most commonly reported way respondents found new apps. The results suggest that occupational therapy practitioners employ clinical reasoning when implementing apps in therapy. Possible ways to improve access to apps for therapists who would like to implement them are discussed. Implications for Rehabilitation Many occupational therapy practitioners are using apps with at least a portion of their caseloads. Therapists select apps based on peer recommendations, most commonly selecting those which promote skill building and support the therapeutic process. More therapists might make use of apps if potential barriers were reduced or eliminated, including availability of technology in the clinical practice setting, therapist training and education, therapist input into app development and an enhanced evidence base.
Freedman, Sara A; Tuval Mashiach, Rivka
Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients' experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions. Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress. These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion. These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality.
O'Connor, Siobhan; Pettigrew, Catharine M
There is currently a paucity of research investigating what speech and language therapists, in particular, perceive are the greatest barriers to implementing evidence-based practice. The purpose of this study was to investigate the perceived barriers that are faced by speech and language therapists in southern Ireland when attempting to implement evidence-based practice. A 34-item questionnaire was sent to 39 therapists working in several counties in southern Ireland. The survey received an 82.1% (n = 32) response rate. The results of the study indicated that certain barriers are perceived to prevent evidence-based practice being implemented successfully. The most significant barrier affecting evidence-based practice implementation was reported to be a lack of time to read research (71.9%). Additional barriers that were found to be the most significant were the research having methodological inadequacies (62.5%) and insufficient time to implement new ideas (59.4%). Other important factors identified as being significant barriers to the implementation of evidence-based practice were those associated with the quality and presentation of the research, workplace setting, and lack of skills of the therapist. Associations between specific barriers and workplace setting or grade were also investigated. Some possible reasons for these barriers and the implications for clinical practice are also discussed. This small study suggests that therapists agreed that evidence-based practice is essential to the practice of speech and language therapy. There are, however, barriers in place that are perceived to prevent its successful implementation. It is hoped that because these barriers have been identified, individual clinicians and organizations can be proactive in aiming to provide an evidence-based service to their clients.
McCombie, Randy P.
Purpose: The purpose of this study was to survey occupational therapists (OTs) and occupational therapy assistants (OTAs) on their attitudes toward a possible move to the entry-level doctorate as the mandated singular point of entry into the profession for OTs. Method: The study surveyed a random sample of 600 OTs and 600 OTAs from two…
Bruschini, Marco; Carli, Antonella; Burla, Franco
Healthcare workers are exposed to work related stresses that significantly increase their risk of burnout. To evaluate and compare burnout and work related stress levels in three categories of health professionals: physiotherapists, speech therapists and occupational therapists. A convenience sample of 391 health professionals participated, including 210 physiotherapists, 101 speech therapists and 80 occupational therapists. We collected general socio-demographic information and administered the standardized Italian version of the Maslach Burnout Inventory (MBI) and the Health and Safety Executive (HSE) Management Standards Indicator Tool. We found the proportion of professionals with high-risk scores in the three dimensions of the MBI to be as follows: Emotional Exhaustion 32%, Depersonalisation 13% and Personal Accomplishment 9%. Overall, 14% of participants were at high risk of burnout. No significant differences were found between the three professional categories. Five subscales of the HSE were associated with burnout: Control (p burnout. There are common mechanisms underlying burnout in the different professional groups investigated. Further research in occupational health in rehabilitation settings is needed to prevent burnout.
Minnen, A. van; Keijsers, G.P.J.
Several researchers have reported on therapists' symptoms as a result of trauma treatment, such as disruptions in cognitive schemata and symptoms resembling PTSD-symptoms. Thus far, however, no studies compared the symptoms of trauma therapists and non-trauma therapists. In the present study, both
Chapman, Jason E.; Schoenwald, Sonja K.
The current study investigated relations among ethnic similarity in caregiver-therapist pairs of youth participating in Multisystemic Therapy, therapist adherence, and youth long-term behavioral and criminal outcomes. Participants were 1,979 youth and families treated by 429 therapists across provider organizations in 45 sites. Relations were…
Shanklin, Jennifer E.
This work includes a discussion of the concept of self-efficacy, originally introduced by Albert Bandura, as it pertains to the therapist-trainee. Therapist self-efficacy has only recently gained attention theoretically as well as empirically. Measures used to assess the self-efficacy of the therapist are highlighted as well as factors…
Brunink, Sharon A.; Schroeder, Harold E.
Findings indicated that expert therapists were similar in their communication of empathy, the basis for their therapeutic relationships. Theoretical orientation, however, differentially influenced use of direct guidance and facilitative techniques, interview content, therapist self-disclosure, therapist initiative, and supportive therapy climate.…
Discusses views of art historian, artist, and art critic concerning the integration of identities of the art therapist and the exhibiting artist. Considers whether art therapist functions to serve others whereas exhibiting artist functions to serve or express himself/herself. Examines implications of the art therapist's message for the art world…
Chambless, Dianne L; Milrod, Barbara; Porter, Eliora; Gallop, Robert; McCarthy, Kevin S; Graf, Elizabeth; Rudden, Marie; Sharpless, Brian A; Barber, Jacques P
To identify variables predicting psychotherapy outcome for panic disorder or indicating which of 2 very different forms of psychotherapy-panic-focused psychodynamic psychotherapy (PFPP) or cognitive-behavioral therapy (CBT)-would be more effective for particular patients. Data were from 161 adults participating in a randomized controlled trial (RCT) including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale (PDSS). Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d = -1.05, CI95% [-1.50, -0.60]), and later age of onset (d = -0.65, CI95% [-0.98, -0.32]) were predictive of greater change. Both variables were also significant moderators: patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 years old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment. Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
М. М. Pustovoyt
Full Text Available The problem of psychotic disorders with onset in the age of involution from broader perspective, guided by modern multidimensional paradigm, was never discussed before. Involutional psychosis is considered as a constellation of the biological changes that are irrefutable in this age period. Certain personality traits and coping strategies can be predisposing to psychotic response, as well as typical features of the “life curve” and external stressors that can run a psychotic reaction. The paper presents the result of our study. This study pays much attention to study of premorbid personality, with emphasis on characteristic features, peculiarities of the emotional reaction and motivation-behavioral area, which completely coincided with characteristics of the narcissistic personality disorder listed in DSM-V (2013. Aim: To explore the psychosomatic pathogenetic connections inherent involutionary psychosis, given pathogenic and pathoplastic impact of premorbid personality structure their syndromic form and dynamics, determine their place on the psychosomatic continuum and develop adequate and pathogenetic justified method of therapy. Methods. Data obtained by the clinical method were confirmed by the results of experimental psychological and neuropsychological researches. Results. Clinical characteristics of psychotic disorders in the patient population showed in the structure of psychosis the existence of two oppositely directed continuums: affective (depressive and delusional. This allows to allocate four main clinical forms of psychosis and their tendency to unite in two clusters that differed each other by the features, and also by their response to therapy and, therefore, by the prognosis. Conclusions: The psychodynamic approach to understanding the involutional psychosis, that was introduced by the author, got natural development in the proposed method of treatment that included complex medication and psychotherapy. The schemes of
Leichsenring, Falk; Leweke, Frank; Klein, Susanne; Steinert, Christiane
The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous criteria to define empirically supported psychotherapies. According to these criteria, 2 randomized controlled trials (RCTs) showing efficacy are required for a treatment to be designated as 'efficacious' and 1 RCT for a designation as 'possibly efficacious'. Applying these criteria modified by Chambless and Hollon, this article presents an update on the evidence for psychodynamic therapy (PDT) in specific mental disorders. A systematic search was performed using the criteria by Chambless and Hollon for study selection, as follows: (1) RCT of PDT in adults, (2) use of reliable and valid measures for diagnosis and outcome, (3) use of treatment manuals or manual-like guidelines, (4) adult population treated for specific problems and (5) PDT superior to no treatment, placebo or alternative treatment or equivalent to an established treatment. A total of 39 RCTs were included. Following Chambless and Hollon, PDT can presently be designated as efficacious in major depressive disorder (MDD), social anxiety disorder, borderline and heterogeneous personality disorders, somatoform pain disorder, and anorexia nervosa. For MDD, this also applies to the combination with pharmacotherapy. PDT can be considered as possibly efficacious in dysthymia, complicated grief, panic disorder, generalized anxiety disorder, and substance abuse/dependence. Evidence is lacking for obsessive-compulsive, posttraumatic stress, bipolar and schizophrenia spectrum disorder(s). Evidence has emerged that PDT is efficacious or possibly efficacious in a wide range of common mental disorders. Further research is required for those disorders for which sufficient evidence does not yet exist.
Silver, Ann-Louise S
The contributions of Silvano Arieti to the psychodynamic treatment of schizophrenia were pivotal at the time he wrote and lectured, but regretfully, they have slipped from current attention. They bear reviewing given the current era of biological reductionism in the treatment of psychoses in general. To illustrate Arieti's approach, he is imagined as the supervisor of a patient who was treated by the author during her psychiatric residency. Other clinical examples highlight the relevance of Arieti's philosophy for current work with patients suffering from psychotic disorders.
Silva, Tatiane M.; Costa, Lucíola C. M.; Costa, Leonardo O. P.
BACKGROUND: Evidence-Based Practice (EBP) has been widely used by health professionals. However, no study in Brazil has investigated the data regarding the knowledge and difficulties related to EBP from a representative sample of physical therapists. OBJECTIVE: To identify behavior, knowledge, skills, resources, opinions and perceived barriers of Brazilian physical therapists from the state of São Paulo regarding EBP. METHOD: A customized questionnaire about behavior, knowledge, skills, resources, opinions and perceived barriers regarding EBP was sent by email to a sample of 490 physical therapists registered by the Registration Board of São Paulo, Brazil. Physical therapists who did not respond to the questionnaire were contacted by telephone and/or letter. The data were analyzed descriptively. RESULTS: The final response rate was 64.4% (316/490). Because 60 physical therapists were no longer practicing, 256 answers were analyzed. The physical therapists reported that they routinely read scientific papers (89.5%) as a resource for professional development, followed by continuing education courses (88.3%) and books (86.3%). Approximately 35% of the respondents reported a clear understanding of the implementation of research findings in their practice; approximately 37% reported no difficulties in critically appraising scientific papers; and 67.2% strongly agreed that EBP is important for their practice. The most commonly reported barriers were related to difficulties in obtaining full-text papers (80.1%), using EBP may represent higher cost (80.1%) and the language of publication of the papers (70.3%). CONCLUSION: Physical therapists from São Paulo state believe that they have knowledge and skills to use EBP. Although they have favorable opinions regarding its implementation, they still encounter difficulties in implementing EBP successfully. PMID:26443977
Miller Robert W
Full Text Available Abstract Background We sought to determine the intra- and inter-radiation therapist reproducibility of a previously established matching technique for daily verification and correction of isocenter position relative to intraprostatic fiducial markers (FM. Materials and methods With the patient in the treatment position, anterior-posterior and left lateral electronic images are acquired on an amorphous silicon flat panel electronic portal imaging device. After each portal image is acquired, the therapist manually translates and aligns the fiducial markers in the image to the marker contours on the digitally reconstructed radiograph. The distances between the planned and actual isocenter location is displayed. In order to determine the reproducibility of this technique, four therapists repeated and recorded this operation two separate times on 20 previously acquired portal image datasets from two patients. The data were analyzed to obtain the mean variability in the distances measured between and within observers. Results The mean and median intra-observer variability ranged from 0.4 to 0.7 mm and 0.3 to 0.6 mm respectively with a standard deviation of 0.4 to 1.0 mm. Inter-observer results were similar with a mean variability of 0.9 mm, a median of 0.6 mm, and a standard deviation of 0.7 mm. When using a 5 mm threshold, only 0.5% of treatments will undergo a table shift due to intra or inter-observer error, increasing to an error rate of 2.4% if this threshold were reduced to 3 mm. Conclusion We have found high reproducibility with a previously established method for daily verification and correction of isocenter position relative to prostatic fiducial markers using electronic portal imaging.
Lockwood, Kylee J; Taylor, Nicholas F; Boyd, Jude N; Harding, Katherine E
Home visits by occupational therapists are a routine part of practice, but there remains little understanding about factors that are associated with the decision to complete a home visit. The aim of this study was to investigate the rate of pre-discharge home visits by occupational therapists for patients following hip fracture and explore factors associated with their occurrence. A retrospective cohort study including 293 patients admitted to a metropolitan health service following hip fracture. Multi-variate logistic regression was used to identify significant variables associated with receiving a home visit. Home visits were conducted by occupational therapists for 28% of patients admitted from a private residence, and for less than 5% of patients admitted from low-level residential care facilities. The variables significantly associated with receiving a home visit at a private residence were older age and being admitted to a rehabilitation ward, but the model only explained between 9% and 13% of the variance. Other clinical and socio-demographic variables evaluated were not associated with the provision of a home visit. About one in four people admitted to hospital from a private residence following hip fracture receive a home visit. The results suggest that whether or not a patient receives a home visit has little to do with socio-demographic or clinical factors at the time of admission to hospital. There remains much unexplained variation in whether or not a patient receives a home visit and this study highlights the diversity that exists in clinical practice. © 2016 Occupational Therapy Australia.
This study examined pre-internship fears of music therapy majors. Additional analysis included comparison of pre-internship fears of music therapy majors with pre-internship fears of music education majors. Subjects for this study were music therapy/music education majors at a large southeastern university (N = 61; N = 32) who were surveyed during the year prior to their internship. Utilizing identical procedures, each subject was asked to list the 3 greatest fears that they had concerning their internship. Two independent evaluators then classified the perceived fears based on a taxonomic structure developed during the initial study on pre-internship fears of music education majors. Reliability for the classification of pre-internship music therapy fears was.97. Ranking reported fears revealed a hierarchy of pre-internship fears and provided comparisons between the two populations. Analysis of data indicated that the music therapy interns listed "general preparation/being prepared" as their primary fear followed by issues relating to "failure/not cut out for therapy." The next most frequently noted fears related to concerns about "internship placement" and concerns about the "physical environment" (money, moving, housing, etc.). Music therapy subject responses were also examined in relationship to the responses of music education subjects. Subject responses revealed a very low fear concerning "discipline" for the music therapy majors, yet this category was the highest listed by the music education seniors. "Failure/not being cut out for teaching/therapy" was expressed as a concern with the next highest frequency by the education majors and was rated quite high by the therapy majors. Fears about the "physical environment including money, moving, etc." were quite high for the music therapy majors, yet these fears received very low ratings by the music education students. In addition, fears related to the "supervising teacher/placement" and "students not learning
Mokkink, Lidwine B; Terwee, Caroline B; van Lummel, Rob C; de Witte, Simon J; Wetzels, Leo; Bouter, Lex M; de Vet, Henrica C W
To assess the construct validity of the DynaPort KneeTest (KneeTest), which is a performance-based test to assess functioning of patients with knee osteoarthritis (OA). Scores on the KneeTest (KneeScore) were compared with observations of physical therapists of the patients' functional disability. The reliability of these observations was also assessed. Twelve physical therapists received identical video tapes showing the performance of 33 patients on the KneeTest. Each physical therapist rated the functional disability of each patient, performing the 23 activities of the KneeTest, on 23 Visual Analogue Scales (VAS(activity)). The 23 VAS(activity) scores were averaged into a VAS(average) score. At the end of the test, an overall rating for the general performance of the patient was given on a VAS(overall). Inter-observer Reliability was assessed for the VAS(activity) scores, VAS(average), and the VAS(overall). Inter-observer reliability of the VAS(average) was higher (ICC 0.85, 95% CI 0.74-0.92) than the VAS(overall) (ICC 0.65, 95% CI 0.51-0.77). The correlation between the KneeScore and the VAS(average), averaged over the 12 physiotherapists, was 0.86. The construct validity of the KneeTest was supported by the strong correlation with the ratings of the patients' disability by physical therapists. Given these findings and the high test-retest reliability of the KneeTest that was found in our previous study, we conclude that the KneeTest is a valid measure for assessing functioning in orthopedic and physical therapy research in patients with knee-OA before and after total knee replacement. Longitudinal validity has to be evaluated yet.
Weck, Florian; Richtberg, Samantha; Jakob, Marion; Neng, Julia M B; Höfling, Volkmar
The role of treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) is rarely investigated in psychotherapeutic treatment for health anxiety. This study aimed to investigate the role of the assessment perspective for the evaluation of treatment delivery factors and their relevance for treatment outcome. Therapist adherence, therapist competence, and therapeutic alliance were evaluated by independent raters, therapists, patients, and supervisors in 68 treatments. Patients with severe health anxiety (hypochondriasis) were treated with cognitive therapy or exposure therapy. Treatment outcome was assessed with a standardized interview by independent diagnosticians. A multitrait-multimethod analysis revealed a large effect for the assessment perspective of therapist adherence, therapist competence, and therapeutic alliance. The rater perspective was the most important for the prediction of treatment outcome. Therapeutic alliance and therapist competence accounted for 6% of the variance of treatment outcome while therapist adherence was not associated with treatment outcome. Therapist competence was only indirectly associated with treatment outcome, mediated by therapeutic alliance. Both therapeutic alliance and therapist competence demonstrated to be important treatment delivery factors in psychotherapy for health anxiety. A stronger consideration of those processes during psychotherapy for health anxiety might be able to improve psychotherapy outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Edwards, Heather; Dirette, Diane
ABSTRACT Health professionals have been identified as a high risk group for job-related stress and burnout. This study builds on the existing literature to examine the links between burnout and the development of professional values as well as the broad scope of occupational therapy, which may act as a hindrance to establishing a concise and well recognized professional identity. One hundred and twenty six occupational therapists completed the Maslach Burnout Inventory and the Professional Identity Questionnaire. The factors that contribute to the relationship between a lack of professional identity in the field of occupational therapy and the levels of burnout among occupational therapists are identified and implications for establishing a strong and healthy workforce in occupational therapy are discussed.
Bryan, J M; Geroy, G D; Isernhagen, S J
Industrial physical therapists (IPTs) are working as external consultants with business and industry to provide injury prevention and/or rehabilitation services. This consulting presents a very new practice setting for therapists and requires specialized nonclinical competencies. The purpose of this study was to identify these nonclinical competencies. The research was based on an evaluation research model using a stakeholder group. Stakeholders represented five groups: 1) IPTs, 2) continuing education providers, 3) business and industry employers of IPTs, 4) safety/risk managers, and 5) human resource development professionals. Thirty-five nonclinical competencies were identified through qualitative analysis of in-depth interviews with 17 subject matter experts representing the five groups. The competencies addressed marketing, program planning, managing the consulting process, training, and understanding organizations. This list of nonclinical competencies may serve as a self-assessment tool that IPTs can use to help plan their professional development. It may also facilitate planning continuing education programs for IPTs.
Moulden, Heather M; Firestone, Philip
This article reviews the descriptive and empirical literature examining vicarious traumatization in therapists treating sexual offenders. Vicarious traumatization in sexual offender therapists is described, including an examination of the relationships between vicarious traumatization and client, therapist, and setting and therapy characteristics. Special attention is given to those unique factors that contribute to the development of vicarious traumatization in this group, as well as consideration of why therapists treating offenders or victims may differ in their experience and development of vicarious traumatization. Evidence from the research reviewed suggests that sexual offender therapists do experience symptoms of vicarious traumatization. Factors most strongly associated with the development of vicarious traumatization in sexual offender therapists include professional experience, treatment setting, and coping strategies employed by the therapists. Implications and recommendations for professionals and policymakers are discussed.
non-peer-reviewed Stigma is considered the main barrier to recovery for people living with a mental illness. The process of stigma can be inconspicuous, operating through individual, systemic, institutional and structural levels and can leave those working in mental health care unsure of their role in the stigma process. Semi-structured interviews explored views of nine occupational therapists working in mental health, focusing on their perspectives of stigma and drawing on experiences of ...
Gupta, Sangeeta; Paterson, Margo L; Lysaght, Rosemary M; von Zweck, Claudia M
Work-related stress and burnout have been found to lead to job dissatisfaction, low-organizational commitment, absenteeism, and high turnover. The purpose of this study was to examine the burnout experiences of occupational therapists practicing in Ontario and to describe the practice implications and coping strategies employed. Data for this mixed methods study were collected using the Maslach Burnout Inventory-General Survey, Areas of Worklife Survey, focus groups, and interviews in the hermeneutics tradition. High levels of emotional exhaustion were reported by 34.8% of participants, high levels of cynicism by 43.5%, and low professional efficacy by 24.6%. Practice issues included excessive demands on time, conflict, and lack of autonomy and respect. Coping strategies included spending time with family and maintaining professional/personal balance, control of work responsibilities, maintaining a sense of humor, and self-awareness/self-monitoring. This study contributes to understanding the practice challenges for occupational therapists, factors that contribute to therapist burnout, and strategies employed to maintain competent practice.
Holt, Sheryl L; Kuperstein, Janice; Effgen, Susan K
Surveys have reported that most school-based physical therapists perceive ideal practices are not commonly implemented in their settings. Our aim was to obtain a more in-depth understanding of these perceptions through open-ended inquiry. Qualitative data were derived from voluntary open-ended responses provided upon completion of a survey regarding school-based physical therapy practice. Of the survey's 561 participants, 250 provided open-ended commentaries that were analyzed using interpretive phenomenology. Six qualitative themes emerged from the open-ended responses, including: In quest: Meeting students' school-based needs via physical therapy; Seeking relatedness: Finding working teams in the school system; Building understanding: Developing a voice/identity in the school context; Stretched beyond limits: Managing workloads; Networking: Coordinating services outside school to meet student needs; Defying definition: What does working in an educational model mean? School-based physical therapists seek to meet educationally relevant physical therapy needs of students, ages 3 to 21 years. Successes appear woven of a multitude of factors such as therapist expertise, team dynamics, and district supports.
The purpose of this document is to state the World Federation of Occupational Therapists' (WFOT) position on the use of telehealth for the delivery of occupational therapy services. Telehealth is the use of information and communication technologies (ICT) to deliver health-related services when the provider and client are in different physical locations. Additional terms used to describe this service delivery model include: tele-occupational therapy, telerehabilitation, teletherapy, telecare, telemedicine, and telepractice, among other terms. Telehealth may be used by occupational therapy practitioners for evaluation, intervention, monitoring, supervision, and consultation (between remote therapist, client, and/or local health-care provider) as permitted by jurisdictional, institutional, and professional regulations and policies governing the practice of occupational therapy. Occupational therapy services via telehealth should be appropriate to the individuals, groups and cultures served, and contextualized to the occupations and interests of clients. Important considerations related to licensure/registration, collaboration with local occupational therapists, client selection, consent to treat, professional liability insurance, confidentiality, personal and cultural attributes, provider competence/standards of care, reimbursement/payer guidelines, and authentic occupational therapy practice are discussed.
Haliburn, Joan; Stevenson, Janine; Halovic, Shaun
The psychotherapy of commonly occurring severe personality disorders-borderline, narcissistic, avoidant, dependent, obsessive compulsive, and schizoid-presents the therapist with a unique therapeutic challenge, as each personality disorder rarely occurs alone. Integration of what is most useful and what works in each model is being proposed to enable a more successful approach to the diversity of presentations. We describe the conversational model, some outcome research, and descriptive studies to illustrate this. Based in psychoanalytic theory, the conversational model is integrated with trauma theory, findings in memory research, linguistics, neurophysiological data, and, above all, on the observations of clinical experiences. Our emphasis in this article is on the treatment principles, methods, and techniques, along with case examples to illustrate what we mean. Case material is taken from audio recordings for which written informed consent was obtained for presentations and journal articles. Some changes have been made to maintain confidentiality.
Gregory, Robert J; Remen, Anna L
The authors introduce a manual-based treatment, labeled dynamic deconstructive psychotherapy, developed for those patients with borderline personality disorder who are most difficult to engage in therapy, such as those having co-occurring substance use disorders. This treatment model is based on the hypothesis that borderline pathology and related behaviors reflect impairment in specific neurocognitive functions, including association, attribution, and alterity that form the basis for a coherent and differentiated self. Dynamic deconstructive psychotherapy aims to activate and remediate neurocognitive self-capacities by facilitating elaboration of affect-laden interpersonal experiences and integration of attributions, as well as providing novel experiences in the patient-therapist relationship that promote self-other differentiation. Treatment involves weekly individual sessions for a predetermined period of time and follows sequential stages. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Vinnars, Bo; Barber, Jacques P; Norén, Kristina; Gallop, Robert; Weinryb, Robert M
Time-limited manualized dynamic psychotherapy was compared with community-delivered psychodynamic therapy for outpatients with personality disorders. In a stratified randomized clinical trial, 156 patients with any personality disorder diagnosis were randomly assigned either to 40 sessions of supportive-expressive psychotherapy (N=80) or to community-delivered psychodynamic therapy (N=76). Assessments were made at intake and 1 and 2 years after intake. Patients were recruited consecutively from two community mental health centers (CMHCs), assessed with the Structural Clinical Interview for DSM-IV Axis II Personality Disorders, and included if they had a diagnosis of any DSM-IV personality disorder. The outcome measures included the presence of a personality disorder diagnosis, personality disorder severity index, level of psychiatric symptoms (SCL-90), Global Assessment of Functioning Scale score, and number of therapy sessions. General mixed-model analysis of variance was used to assess group and time effects. In both treatment conditions, the global level of functioning improved while there were decreases in the prevalence of patients fulfilling criteria for a personality disorder diagnosis, personality disorder severity, and psychiatric symptoms. There was no difference in effect between treatments. During the follow-up period, patients who received supportive-expressive psychotherapy made significantly fewer visits to the CMHCs than the patients who received community-delivered psychodynamic therapy. Manualized supportive-expressive psychotherapy was as effective as nonmanualized community-delivered psychodynamic therapy conducted by experienced dynamic clinicians.
Full Text Available Introduction: Present study is aimed at investigating the effectiveness of psychodynamic psychotherapy on the personality characteristics of divorced and non-divorced women with low marital satisfaction. Materials and Methods: This clinical research conducted in the clients referred to Khane Roshan-e-Doost Psychological Studies Institute. They are evaluated clinically through interviews and questionnaires. So, 45 patients selected and divided in three equal groups of divorced women, non-divorced women (married with low marital satisfaction, and control group. Then, the groups of divorced and non-divorced women with low marital satisfaction participated in 24 sessions of psychodynamic psychotherapy. To collect data, Cattel’s 16-item questionnaire and Enrich marital satisfaction questionnaire were used. Data analyzed through multivariate analysis of covariance (MANCOVA. Results: The results of this study indicated that training of psychodynamic psychotherapy caused a significant change in personality traits in divorced women and in married women with low marital satisfaction. Only in factor B (intelligent - low intelligence and factor Q1 (conservatism there was no significant difference between experimental and control groups. The results of correlation between personality factors and low marital satisfaction pointed that there is a significant relationship between all factors of personality except the factor of conservatism. Conclusion: Based on the results, psychodynamic psychotherapy is effective in significant improvement of most of personality traits. Therefore, applying this method can be useful in improving marital personality traits, reducing divorce and maintaining mental health.
Louw, Adriaan; Puentedura, Emilio J; Zimney, Kory
Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery.
Kazdin, Alan E.; Whitley, Moira; Marciano, Paul L.
Background: We examined the therapeutic alliance in evidence-based treatment for children (N = 77, 19 girls, 58 boys, ages 6-14) referred clinically for oppositional, aggressive, and antisocial behavior. Method: Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at two points over the course…
Uhlig, S.; Dimitriadis, Theo; Hackvoort, Laurien; Scherder, E.J.A.
Music therapists use rap and singing for at-risk youth and young adults in different treatment settings. However, it is unclear how often and what kind of interventions they apply, and what kind of treatment goals are pursued. The purpose of this study was to examine approaches of music therapists
Full Text Available We had a success rate of treating low, self-assessed, global quality of life (measured by QOL1: How would you assess the quality of your life now? with clinical holistic medicine of 56.4% (95% CI: 42.3–69.7% and calculated from this the Number Needed to Treat (NNT as 1.43–2.36. We found that during treatment, (in average 20 sessions of psychodynamic psychotherapy complemented with bodywork at a cost of 1600 EURO, the patients entered a state of Antonovsky-salutogenesis (holistic, existential healing, which also improved their self-assessed health and general ability one whole step up a 5-point Likert Scale. The treatment responders radically improved their self-assessed physical health (0.6 step, self-assessed mental health (1.6 step, their relation to self (1.2 step, friends (0.3 step, and partner (2.1 step on a 6-step scale, and their ability to love (1.2 step and work (0.8 step, and to function socially (1.0 step and sexually (0.8 step. It seems that treatment with clinical holistic medicine is the cure of choice when the patients (1 present the triad of low quality of life, poor self-assessed physical and/or mental health, and poor ability to function; and (2 are willing to suffer during the therapy by confronting and integrating old emotional problems and trauma(s from the past. For these patients, the treatment provided lasting benefits, without the negative side effects of drugs. A lasting, positive effect might also prevent many different types of problems in the future. The therapy was “mindful” in its focus on existential and spiritual issues.
Full Text Available Background: Primary care (PC is an emerging practice setting for occupational therapy; however, few occupational therapists currently practice in this setting due to barriers, including uncertainty about reimbursement and the role of occupational therapists. This pilot study aimed to determine if PC providers and occupational therapists are receptive to occupational therapists as integrated interprofessional PC team members if barriers to inclusion are addressed. Method: After a brief educational paragraph explaining potential occupational therapy contributions to PC teams, the participants accessed a link to survey questions regarding their personal level of receptiveness to occupational therapy in PC. The questions comprised Likert scale and open-ended answers. Results: Of the Likert scale responses, 94%-99% provided by occupational therapists and 82%-97% provided by PC providers indicated possibly or yes to the inclusion of occupational therapists on the PC team. The descriptive responses were primarily supportive. Discussion: The majority of the occupational therapists and PC providers surveyed indicated support for including occupational therapists in primary care. This indicates that when barriers are addressed, occupational therapists and PC providers are receptive to the inclusion of occupational therapists as members of the interprofessional PC team.
Dunn, Graham; Bentall, Richard P.; Lewis, Shôn W.
Few studies have examined therapist effects and therapeutic alliance (TA) in treatments for chronic fatigue syndrome (CFS). Therapist effects are the differences in outcomes achieved by different therapists. TA is the quality of the bond and level of agreement regarding the goals and tasks of therapy. Prior research suffers the methodological problem that the allocation of therapist was not randomized, meaning therapist effects may be confounded with selection effects. We used data from a randomized controlled treatment trial of 296 people with CFS. The trial compared pragmatic rehabilitation (PR), a nurse led, home based self-help treatment, a counselling-based treatment called supportive listening (SL), with general practitioner treatment as usual. Therapist allocation was randomized. Primary outcome measures, fatigue and physical functioning were assessed blind to treatment allocation. TA was measured in the PR and SL arms. Regression models allowing for interactions were used to examine relationships between (i) therapist and therapeutic alliance, and (ii) therapist and average treatment effect (the difference in mean outcomes between different treatment conditions). We found no therapist effects. We found no relationship between TA and the average treatment effect of a therapist. One therapist formed stronger alliances when delivering PR compared to when delivering SL (effect size 0.76, SE 0.33, 95% CI 0.11 to 1.41). In these therapies for CFS, TA does not influence symptomatic outcome. The lack of significant therapist effects on outcome may result from the trial’s rigorous quality control, or random therapist allocation, eliminating selection effects. Further research is needed. Trial Registration: ISRCTN74156610 PMID:26657793
Lucy P Goldsmith
Full Text Available Few studies have examined therapist effects and therapeutic alliance (TA in treatments for chronic fatigue syndrome (CFS. Therapist effects are the differences in outcomes achieved by different therapists. TA is the quality of the bond and level of agreement regarding the goals and tasks of therapy. Prior research suffers the methodological problem that the allocation of therapist was not randomized, meaning therapist effects may be confounded with selection effects. We used data from a randomized controlled treatment trial of 296 people with CFS. The trial compared pragmatic rehabilitation (PR, a nurse led, home based self-help treatment, a counselling-based treatment called supportive listening (SL, with general practitioner treatment as usual. Therapist allocation was randomized. Primary outcome measures, fatigue and physical functioning were assessed blind to treatment allocation. TA was measured in the PR and SL arms. Regression models allowing for interactions were used to examine relationships between (i therapist and therapeutic alliance, and (ii therapist and average treatment effect (the difference in mean outcomes between different treatment conditions. We found no therapist effects. We found no relationship between TA and the average treatment effect of a therapist. One therapist formed stronger alliances when delivering PR compared to when delivering SL (effect size 0.76, SE 0.33, 95% CI 0.11 to 1.41. In these therapies for CFS, TA does not influence symptomatic outcome. The lack of significant therapist effects on outcome may result from the trial's rigorous quality control, or random therapist allocation, eliminating selection effects. Further research is needed.ISRCTN74156610.
Halfon, Sibel; Çavdar, Alev; Orsucci, Franco; Schiepek, Gunter K.; Andreassi, Silvia; Giuliani, Alessandro; de Felice, Giulio
Aim: Even though there is substantial evidence that play based therapies produce significant change, the specific play processes in treatment remain unexamined. For that purpose, processes of change in long-term psychodynamic play therapy are assessed through a repeated systematic assessment of three children’s “play profiles,” which reflect patterns of organization among play variables that contribute to play activity in therapy, indicative of the children’s coping strategies, and an expression of their internal world. The main aims of the study are to investigate the kinds of play profiles expressed in treatment, and to test whether there is emergence of new and more adaptive play profiles using dynamic systems theory as a methodological framework. Methods and Procedures: Each session from the long-term psychodynamic treatment (mean number of sessions = 55) of three 6-year-old good outcome cases presenting with Separation Anxiety were recorded, transcribed and coded using items from the Children’s Play Therapy Instrument (CPTI), created to assess the play activity of children in psychotherapy, generating discrete and measurable units of play activity arranged along a continuum of four play profiles: “Adaptive,” “Inhibited,” “Impulsive,” and “Disorganized.” The play profiles were clustered through K-means Algorithm, generating seven discrete states characterizing the course of treatment and the transitions between these states were analyzed by Markov Transition Matrix, Recurrence Quantification Analysis (RQA) and odds ratios comparing the first and second halves of psychotherapy. Results: The Markov Transitions between the states scaled almost perfectly and also showed the ergodicity of the system, meaning that the child can reach any state or shift to another one in play. The RQA and odds ratios showed two trends of change, first concerning the decrease in the use of “less adaptive” strategies, second regarding the reduction of play
Salbach, Nancy M; Veinot, Paula; Jaglal, Susan B; Bayley, Mark; Rolfe, Danielle
Understanding how to structure educational interventions and resources to facilitate physical therapists' application of the research literature is required. The objective of this study was to explore physical therapists' preferences for strategies to facilitate their access to, evaluation and implementation of the stroke research literature in clinical practice. In-depth, qualitative telephone interviews were conducted with 23 physical therapists who treat people with stroke in Ontario, Canada and who had participated in a previous survey on evidence-based practice. Data were analysed using a constant comparative approach to identify emergent themes. Participants preferred online access to research summaries or systematic reviews to save time to filter and critique research articles. To enable access in the workplace, an acceptable computer-to-staff ratio, permission to access web sites and protected work time were suggested. Participants considered personal digital assistants as excellent tools for quick access to online resources but were unsure of their advantage over a desktop computer. Therapists favoured use of non-technical language, glossaries of research terms and quality ratings of studies to ease understanding and appraisal. Teleconferencing or videoconferencing overcame geographical but not scheduling barriers to accessing education. To achieve behaviour change in clinical practice, therapists preferred multiple interactive, face-to-face education sessions in a group format, with opportunities for case-based learning and practice of new skills. Physical therapists prefer technology-assisted access to resources and education and favour attending multiple interactive, expert-facilitated education sessions incorporating opportunities for case-based learning and practice of new skills to change behaviour related to evidence-based practice. © 2010 Blackwell Publishing Ltd.
Hurt, Amy A; Grist, Cathy Lann; Malesky, Lann A; McCord, David M
Applied behaviour analysis (ABA) therapists typically work one-to-one with children with autism for extended periods of time, which often leads to high levels of job-related stress, lower levels of job satisfaction, increased frequency of occupational 'burnout' and higher than average job turnover (Journal of Autism Development, 39, 2009 and 42). This is particularly unfortunate, in that these vulnerable clients need stability and consistency in care, both of which are empirically related to clinical outcomes (Journal of Autism Development, 39, 2009 and 42). It is reasonable to assume that some individuals, by virtue of their personal characteristics, are better suited to this type of work than are others. The purpose of the this study was to investigate associations between personality traits, using the five-factor model of personality, and key job-related variables, including burnout and job satisfaction, in a sample of therapists (n = 113) who work one-to-one with individuals diagnosed with autism. Significant correlations were found between Neuroticism and all three subscales of burnout (Exhaustion, Cynicism and Professional Efficacy). Extraversion and Conscientiousness were significantly negatively correlated with Cynicism and positively correlated with Professional Efficacy. Agreeableness was positively associated with Professional Efficacy. Job satisfaction was correlated positively with Extraversion and negatively with Neuroticism. Level of perceived personal and professional support partially mediated the effect of personality traits on job satisfaction. These results may help to identify job applicants who are dispositionally less suited to this type of work, as well as currently employed therapists who are in need of support or intervention. © 2013 John Wiley & Sons Ltd.
Eichenberg, Christiane; Herzberg, Philipp Y
The increasing use of the Internet and its array of social networks brings new ways for psychotherapists to find out information about their patients, often referred to as patient-targeted googling (PTG). However, this topic has been subject to little empirical research; there has been hardly any attention given to it in Germany and the rest of Europe and it has not been included in ethical guidelines for psychotherapy despite the complex ethical issues it raises. This study explored German psychotherapists' behavior and experiences related to PTG, investigated how these vary with sociodemographic factors and therapeutic background, and explored the circumstances in which psychotherapists considered PTG to be appropriate or not. A total of 207 psychotherapists responded to a newly developed questionnaire that assessed their experience of and views on PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking professional therapy platforms. Most therapists (84.5%, 174/207) stated that they had not actively considered the topic of PTG. However, 39.6% (82/207) said that they had already looked for patient information online (eg, when they suspected a patient may have been lying) and 39.3% (81/207) knew colleagues or supervisors who had done so. Only 2.4% (5/207) of therapists had come across PTG during their education and training. It is essential to provide PTG as a part of therapists' education and training. Furthermore, the complex problems concerning PTG should be introduced into codes of ethics to provide explicit guidance for psychotherapists in practice. This report provides initial suggestions to open up debate on this topic.
Séfora Gomez Portela
Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.
Raquel Martins Sartori
Full Text Available The therapeutic process therapist requires skills that go beyond the theoretical and technical knowledge, the therapeutic relationship is a prerequisite for the success of behavioral psychotherapy variable. Supervision of clinical care is a fundamental skill development of the future therapist educational resource as well as to increase the supply conditions of a more appropriate psychotherapeutic customer service. The article reports on supervisory experience in the first client of a therapist in training showed behavioral patterns of aggression. The default client produced in therapist behaviors and feelings that hindered progress and therapeutic success. Supervision thus occupied a role in analyzing and modeling the behavior therapist as a strategy to increase the chances of success of the case. As a result of the strategies adopted in supervision, there were changes in the pattern of interaction between therapist and client training with his progress in the case.
Lysack, Cathy; Lichtenberg, Peter; Schneider, Brooke
We tested the effectiveness of an educational intervention in DVD format aimed at strengthening the mental health practices of occupational therapists working with older adults. The DVD intervention was tested in a pretest-posttest design. Occupational therapists (n = 30) completed a brief knowledge and attitude questionnaire; a chart review (n = 383) of therapists' (n = 20) patients at 3 mo before and 3 mo after DVD training was also conducted. Questionnaire data showed that the percentage of therapists with correct answers increased 20%-30% for 5 of the 11 knowledge items. Chart review data showed therapists spoke more often with their older patients about mood, depression, and cognitive impairment; screened more often for depression and cognitive impairment; and reported findings more often to the treatment team after training. Educational interventions can significantly improve therapists' mental health practice with older adults.
Larsen, Anette Enemark
A client-centered approach is on the health care agenda in many European countries (1), and amongst these Denmark (2). It is described as the foundation for Occupational Therapy (OT) (3), a code of professional conduct (4,5), and defined as a partnership between client and therapist (3). The goal...... is to empower a client to fulfil his/her occupational roles in a variety of environments, leading to an increase in intervention efficacy and client perception of intervention quality (3). However, it is known to be challenging (1,3). Given the importance of this approach, there has been limited exploration...
Brajković, Lovorka; Jevtović, Sasa; Bilić, Vedran; Bras, Marijana; Loncar, Zoran
Study objective is to determine the efficacy of brief supportive psychodynamic therapy in treating anxious-depressive disorder in Daily hospital within the Psychological Medicine Clinic. The study comprised a total of 45 male subjects, in which an admission to the Daily Hospital was indicated. On the occasion of the hospital admission, as well as following the completion of a one month-lasting partial hospitalisation within the Daily Hospital, the subjects had undergone testing using a number of psychological instruments. There weren't established statistically significant differences in clinical presentations of the treated patients. A partial, one month-lasting hospitalisation, did not yield any changes in clinical presentation an anxious-depressive disorder. Due to the fact that this psychotherapeutic method should be applied for quite some time in order to yield results, and is not expected to be effective in a close range, a one-month lasting treatment is definitely not long enough to be effective.
Tillman, Jane G
Psychotic spectrum disorders present treatment challenges for patients, families, and clinicians. This article addresses the history of the dualism in the field between biological and psychological approaches to mental disorders, and surveys the contemporary literature about the etiology and treatment of psychotic spectrum disorders. An integrative approach to treatment derived from work at Austen Riggs with previously treatment refractory patients with psychotic spectrum disorders is described that combines individual psycho- dynamic psychotherapy, psychopharmacology, family systems approaches, and intensive psychosocial engagement. Helping patients develop their own authority to join the treatment, use relationships for learning, and understand the meaning of their symptoms is central to the treatment at Austen Riggs. An extended case vignette of a patient diagnosed with a schizoaffective disorder is presented illustrating this integrative psychodynamic treatment approach.
At variance with a purely cognitivistic approach, an affect-centered model of mental functioning called `fractal affect-logic' is presented on the basis of current emotional-psychological and neurobiological research. Functionally integrated feeling-thinking-behaving programs generated by action appear in this model as the basic `building blocks' of the psyche. Affects are understood as the essential source of energy that mobilises and organises both linear and nonlinear affective-cognitive dynamics, under the influence of appropriate control parameters and order parameters. Global patterns of affective-cognitive functioning form dissipative structures in the sense of Prigogine, with affect-specific attractors and repulsors, bifurcations, high sensitivity for initial conditions and a fractal overall structure that may be represented in a complex potential landscape of variable configuration. This concept opens new possibilities of understanding normal and pathological psychodynamics and sociodynamics, with numerous practical and theoretical implications.
Angeletti, Gloria; Pompili, Maurizio; Innamorati, Marco; Santucci, Chiara; Savoja, Valeria; Goldblatt, Mark; Girardi, Paolo
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 hopelessness at the baseline (partial r = 0.62; P 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.
Cocks, N.; Cruice, M.
There is a growing body of research which has investigated the experience of the migrant health worker. However, only one of these studies has included speech and language therapists thus far, and then only with extremely small numbers. The aim of this study was to explore the experiences and perspectives of migrant speech and language therapists living in the UK. Twenty-three overseas qualified speech and language therapists living in the UK completed an online survey consisting of 36 questi...
Popper-Giveon, Ariela; Schiff, Elad; Ben-Arye, Eran
In 2008, an Integrative Oncology Program was implemented at the Clalit Oncology Service in Haifa, Israel, to promote patients' well-being during chemotherapy and advanced stages of disease. We hypothesized that studying the perceptions of Arab complementary and alternative medicine (CAM) therapists would facilitate development of a cross-culturally integrative oncology approach. Semi-structured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran and various CAM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care. Thematic analysis revealed that therapists act as go-betweens, mediating between patients and conventional physicians. Therapists translate diagnoses into Arabic and elucidate key concepts. They tend to perceive their role as gatekeepers accompanying patients through the conventional health system, referring them for further examinations, and providing CAM-based supportive care consultation. CAM therapists have an essential role in supportive care of Arab patients with cancer. Triangular patient-therapist-oncologist communication may have an impact on patients' experience and treatment quality. Recognition of CAM therapists as mediators between patients' health beliefs and conventional perceptions of care may improve doctor-patient dialogue and facilitate supportive care provision in a cross-cultural context. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Strangio, Annamaria M; Rinaldi, Lucio; Monniello, Gianluigi; Sisti, Leuconoe Grazia; de Waure, Chiara; Janiri, Luigi
The first aim of our study was to compare the characteristics and comorbidities of patients with eating disorders between those who suffered from a childhood abuse and those who did not. Our second aim was to analyze the differences in the outcome of the psychodynamic therapy between abused and not abused patients. Twenty-six adolescent patients with eating disorders were assessed. Adolescent were evaluated by a single expert psychiatrist by checklists and questionnaires: EDI 3, SCL 90, BIS11, Dissociative Experiences Scale, Global Assessment of Functioning, SCID II, and CTQ-Self control (SF). According to the results of CTQ-SF (cut-off ≥ 8), patients were divided into two groups: those who had experienced a history of abuse and those who had not. They underwent a psychodynamic psychotherapy and were assessed again after 12 months. Eleven patients (42.3%) had a history of abuse according to CTQ score. No significant differences were found in abused and not abused patients in their demographic, clinical, and comorbid characteristics (sex, age, type of eating disorder, comorbid impulse control, personality, and addictive disorders). Abused patients showed a significantly higher score in many scale. The psychotherapeutic intervention in patients with a history of abuse resulted only in a significant decrease in symptom checklist-90 (SCL-90) psychoticism dimension (p dimensions, the SCL-90 Global Severity Index, the Eating Disorder Inventory-3 interceptive deficits, and the dissociative experience scale. Regarding the first aim of our study, we proved that history of abuse is not significantly related to patient comorbidities. Regarding our second aim, history of abuse was related to patient improvement only for psychotic symptoms; whereas patients who had not experienced an abuse improved in a variety of symptoms. Thus, abuse history can be considered as a negative prognostic factor for patients with eating disorders undergoing dynamic psychotherapy. However
Lawlor, Caroline; Sharma, Bina; Khondoker, Mizanur; Peters, Emmanuelle; Kuipers, Elizabeth; Johns, Louise
Few studies have investigated service user satisfaction with cognitive behavioural therapy for psychosis (CBTp). This study explored its associations with clinical presentation and outcomes, retrospective expectations of progress, perceptions of the therapist, and demographic variables. One hundred and sixty-five service users completed self-report questionnaires pre- and post-CBTp in relation to the constructs of interest. Regression analyses explored associations with (1) overall satisfaction with therapy and (2) perceived progress, skills, and knowledge gained. Ninety-six per cent of service users reported satisfaction with therapy. Higher levels of overall satisfaction with, and perceived benefit from, therapy were associated with positive therapy expectations, positive ratings of therapist's personal qualities, competence and trustworthiness, lower pre-therapy depression, and improvements in quality of life. Symptom improvements were not related to overall satisfaction with therapy; however, with the exception of voices, better clinical outcomes were associated with subjective ratings of having made more progress and gained more CBT skills and knowledge. Demographic factors were not associated with satisfaction or perceived progress. In multiple regression analyses, expectations of progress showed the strongest associations with both satisfaction and perceived benefits. Other remaining significant associations consisted of perceptions of the therapist for satisfaction, and both pre-therapy levels of, and changes in, depression for perceived benefits. Qualitative feedback emphasized the importance of the therapeutic relationship and developing new coping strategies. The findings provide preliminary evidence that high levels of satisfaction with therapy are not contingent on good clinical outcomes and are instead associated with positive therapy expectations and perceptions of the therapist. Therapy expectations represent a neglected area of research and may
Williams, Meris; Haverkamp, Beth E
This qualitative study sought to explore and understand eating disorder (ED) therapists' perceptions of whether and how their personal ED histories had professional ethical relevance. Analysis of multiple interviews with 11 therapist-participants indicated that they perceived their personal ED histories as having substantial ethical relevance in their day-to-day practice with ED clients. The major categories of ethics experiences that emerged were: boundaries, therapist wellness, helpfulness of personal ED history, and openness regarding therapists' personal ED histories. The findings have practical utility for the education, training, and continuing education of ED-historied practitioners.
Owen, Jesse; Drinane, Joanna; Tao, Karen W; Adelson, Jill L; Hook, Joshua N; Davis, Don; Fookune, Natacha
There is growing evidence highlighting the existence of inequities in mental health treatments that occur on the basis of client race and ethnicity for some therapists. In particular, therapists vary in the degree to which their racial/ethnic minority clients unilaterally terminate as compared to White clients. Although therapists have been shown to be a key source of racial/ethnic mental health treatment disparities, less is known about what predicts which therapists will have larger disparities among their clients. With this in mind, the current study examined client unilateral termination within therapist caseloads, and then examined therapists' racial/ethnic comfort and general comfort as predictors of client unilateral termination. The sample included 23 counselors who treated 177 clients at a large university counseling center. The results indicated that therapists' racial/ethnic comfort was significantly associated with racial/ethnic disparities within their caseloads; however, therapists' general comfort was not. Implications for research and practice are offered. Therapists' racial/ethnic comfort may help explain disparities in unilateral termination.
Therapists seeing poor clients may ask if countries with greater income equality have less mental illness. If so, how should therapists respond? A review of epidemiological studies, theories of inequality and democratic reform movements in psychiatry and psychology leads to four arguments. (1) Increasing income equality improves the health of societies. (2) An elite opposes greater equality, partly by persuading the majority to consent to the existing order. (3) Therapists may inadvertently help in this persuasive effort. (4) However, therapists in democratic traditions create systems of care that support movements for greater income equality. © The Author(s) 2013.
Sterba, John A
...) and licensed-therapist-directed hippotherapy were identified, reviewed, and summarized for research design, methodological quality, therapy regimen, internal/external validity, results, and authors'conclusions...
The effect of adding psychodynamic therapy to antidepressants in patients with major depressive disorder. A systematic review of randomized clinical trials with meta-analyses and trial sequential analyses
Jakobsen, Janus Christian; Hansen, Jane Lindschou; Simonsen, Erik
Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Psychodynamic therapy may be a treatment option for depression, but the effects have only been limitedly assessed in systematic reviews.......Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Psychodynamic therapy may be a treatment option for depression, but the effects have only been limitedly assessed in systematic reviews....
This study surveys voice therapists regarding common diagnostic practices in patients referred for therapy with the diagnosis of muscle tension dysphonia (broadly defined as the "hyperfunctional" component of the dysphonia). Through postings on the e-mail list of the ASHA special interest division on voice, speech pathologists with at least 3 years' experience in stroboscopy and acoustic instrumentation were invited to complete the survey. Results from 53 completed surveys demonstrated that voice quality and patient self-perception are the sole assessments performed by all therapists. Voice quality, observation of body posture and movement, and probing the patient's ability to alter voice production are each significantly more likely to be performed than the more objective stroboscopic, acoustic, aerodynamic, and EGG assessments. Further, the tasks of defining specific therapy session goals and helping the patient to achieve a particular target skill are considered best served by measures of vocal quality, observation of body position and movement, and judging the patient's ability to alter voice production. For definition of the overall therapy goal, stroboscopy and patient perception scales are added to all of the subjective assessment measures as being important. Acoustic data are considered most important for patient reinforcement and outcomes assessment. Implications of these findings are discussed, and topics for further exploration are identified.
Cherney, Leora R; van Vuuren, Sarel
Telerehabilitation (telerehab) offers cost-effective services that potentially can improve access to care for those with acquired neurologic communication disorders. However, regulatory issues including licensure, reimbursement, and threats to privacy and confidentiality hinder the routine implementation of telerehab services into the clinical setting. Despite these barriers, rapid technological advances and a growing body of research regarding the use of telerehab applications support its use. This article reviews the evidence related to acquired neurologic speech and language disorders in adults, focusing on studies that have been published since 2000. Research studies have used telerehab systems to assess and treat disorders including dysarthria, apraxia of speech, aphasia, and mild Alzheimer disease. They show that telerehab is a valid and reliable vehicle for delivering speech and language services. The studies represent a progression of technological advances in computing, Internet, and mobile technologies. They range on a continuum from working synchronously (in real-time) with a speech-language pathologist to working asynchronously (offline) with a stand-in virtual therapist. One such system that uses a virtual therapist for the treatment of aphasia, the Web-ORLA™ (Rehabilitation Institute of Chicago, Chicago, IL) system, is described in detail. Future directions for the advancement of telerehab for clinical practice are discussed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Pustułka-Piwnik, Urszula; Ryn, Zdzisław Jan; Krzywoszański, Łukasz; Stożek, Joanna
Professional burnout results from prolonged exposure to chronic, job-related stressors. According to Christina Maslach, professional burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment. Literature includes a number of reports on burnout syndrome within health service, but hardly ever do they make any references to physiotherapists. The purpose of this study is assessment of the level of professional burnout in a group of physiotherapists and investigating relationships between the indices of burnout syndrome and selected demographic as well as organizational variables. The study group consisted of 151 physiotherapists with at least 3 years of experience, employed in various health service outposts in Krakow, Poland. The Maslach Burnout Inventory (MBI) was used to measure emotional exhaustion, depersonalization and personal accomplishment. A questionnaire for the description of socio-demographic and work characteristics was used as well. Job burnout among the physiotherapists was manifested by an increased emotional exhaustion and decreased sense of personal achievement. Emotional exhaustion was significantly higher among physi cal therapists working with adults and employed in hospitals, depersonalization was higher among men, hospital workers and employees with seniority from 15 to 19 years, personal accomplishment was decreased among men and less-educated therapists. The study confirmed that indicators of burnout in physiotherapists are significantly associated with selected demographic and organizational variables. It is necessary to undertake a more exhaustive study of burnout in this group of employees, and implement elements of prevention.
World Federation of Occupational Therapists
Full Text Available The purpose of this document is to state the World Federation of Occupational Therapists’ (WFOT position on the use of telehealth for the delivery of occupational therapy services. Telehealth is the use of information and communication technologies (ICT to deliver health-related services when the provider and client are in different physical locations. Additional terms used to describe this service delivery model include: tele-occupational therapy, telerehabilitation, teletherapy, telecare, telemedicine, and telepractice, among other terms. Telehealth may be used by occupational therapy practitioners for evaluation, intervention, monitoring, supervision, and consultation (between remote therapist, client, and/or local health-care provider as permitted by jurisdictional, institutional, and professional regulations and policies governing the practice of occupational therapy.Occupational therapy services via telehealth should be appropriate to the individuals, groups and cultures served,and contextualized to the occupations and interests of clients. Important considerations related to licensure/registration, collaboration with local occupational therapists, client selection, consent to treat, professional liability insurance, confidentiality, personal and cultural attributes, provider competence/standards of care, reimbursement/payer guidelines, and authentic occupational therapy practice are discussed.
Humphry, R; Link, S
This paper presents the results of a survey of 43 occupational therapy academic programs regarding their preparation of students to work with young children with special needs. The number of instructional hours devoted to topics related to services for infants or toddlers and their families varied greatly. Some programs plan an increase in hours but are limited by the total hours available within the curriculum. This paper also shares the recommendations of a panel of occupational therapists with expertise in early intervention and entry-level education. The panel was concerned with the quality of preparation of therapists entering early intervention programs and encouraged the profession to review the amount of course work within each curriculum that introduces students to basic knowledge and skills related to early intervention. Some knowledge, such as the consultant's role and working with families of persons who are physically or mentally challenged, are common to other practice areas. The panel stressed that students be taught strategies for obtaining the training necessary for postgraduate entry into a specialty area such as early intervention.
Harrison, Richard L; Westwood, Marvin J
This qualitative study identified protective practices that mitigate risks of vicarious traumatization (VT) among mental health therapists. The sample included six peer-nominated master therapists, who responded to the question, "How do you manage to sustain your personal and professional well-being, given the challenges of your work with seriously traumatized clients?" Data analysis was based upon Lieblich, Tuval-Mashiach, and Zilber's (1998) typology of narrative analysis. Findings included nine major themes salient across clinicians' narratives of protective practices: countering isolation (in professional, personal and spiritual realms); developing mindful self-awareness; consciously expanding perspective to embrace complexity; active optimism; holistic self-care; maintaining clear boundaries; exquisite empathy; professional satisfaction; and creating meaning. Findings confirm and extend previous recommendations for ameliorating VT and underscore the ethical responsibility shared by employers, educators, professional bodies, and individual practitioners to address this serious problem. The novel finding that empathic engagement with traumatized clients appeared to be protective challenges previous conceptualizations of VT and points to exciting new directions for research, theory, training, and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Yazdani, Farzaneh; Harb, Alia; Rassafiani, Mehdi; Nobakht, Laya; Yazdani, Nastaran
Occupational balance is one of the concepts used by occupational therapists with no consensus on its definition. Literature demonstrates different perspectives when this concept is applied in practice and in its link to other concepts such as health and well-being. This study aims to explore how the concept of occupational balance is perceived and practised by occupational therapy practitioners. A qualitative methodology was employed. Fourteen occupational therapists volunteered for the study. Nine occupational therapy practitioners were interviewed individually and five attended a focus group. Thematic analysis was applied to analyze the data. Six themes were identified as follows: (1) occupational balance: what it is; (2) how occupational balance is formed; (3) occupational balance and well-being (4); subjective and objective representations of occupational balance (5); what disrupts/affects occupational balance; and (6) occupational balance/imbalance and occupational therapy practice. Both objective and subjective experiences of occupational balance need to be considered in order to make an informed decision in practice. The right occupational balance for each individual should be based on his/her values but with consideration of the principal of no harm to others.
Dennhag, Inga; Armelius, Bengt-Åke
This effectiveness study explored the outcomes of 187 clients seen by 187 students undergoing baseline training in psychotherapy. Clients reduced their symptoms (SCL-90) and increased their positive self-image (SASB introject) during the therapy. Multiple regression analyses showed no differences between the cognitive and the psychodynamic training approaches and no differences between one and two semesters duration of the therapies. However, 2-3% of variance in end states was accounted for by the interaction between the variables, indicating a moderating effect of duration in the two approaches. Outcomes for clients in the cognitive training approach were significantly better with two semesters than with one semester, while there was no such difference in the psychodynamic approach. Consequences for baseline training are discussed.
Gude, Tore; Hoffart, Asle
The aim was to study whether patients with panic disorder with agoraphobia and co-occurring Cluster C traits would respond differently regarding change in interpersonal problems as part of their personality functioning when receiving two different treatment modalities. Two cohorts of patients were followed through three months' in-patient treatment programs and assessed at follow-up one year after end of treatment. The one cohort comprised 18 patients treated with "treatment as usual" according to psychodynamic principles, the second comprised 24 patients treated in a cognitive agoraphobia and schema-focused therapy program. Patients in the cognitive condition showed greater improvement in interpersonal problems than patients in the treatment as usual condition. Although this quasi-experimental study has serious limitations, the results may indicate that agoraphobic patients with Cluster C traits should be treated in cognitive agoraphobia and schema-focused programs rather than in psychodynamic treatment as usual programs in order to reduce their level of interpersonal problems.
Weck, Florian; Richtberg, Samantha; Esch, Sebastian; Höfling, Volkmar; Stangier, Ulrich
Meta-analyses reveal that homework compliance is associated with a better treatment outcome. However, little is known about the processes that could be responsible for patient compliance with homework. It has been proposed that therapist competence, in particular with respect to reviewing homework, is highly relevant for homework compliance. The present study is a secondary analysis of a randomized controlled trial. Altogether, 54 patients with recurrent depressive disorder (currently in remission) who were treated with maintenance cognitive therapy (MCT), were considered. One videotaped treatment session of each patient was randomly selected and therapist competence (general competence and specific competence in setting and reviewing homework) was assessed by 2 independent raters. Furthermore, both patient and therapist views of the therapeutic alliance were evaluated by questionnaire in this therapy session. Homework compliance (considering quantitative as well as qualitative aspects) in the following session was evaluated by 2 additional raters. These 2 raters were blinded regarding the ratings of the therapeutic competence. In a multilevel path analysis model, a significant association between the therapeutic competence in reviewing homework and homework compliance was detected, while the therapeutic alliance and several patient characteristics were not associated with homework compliance. We found no relationship between homework compliance and treatment outcome. Our results demonstrate that a specific therapeutic competence (i.e., competence in reviewing homework) is associated with patient compliance with homework, and therefore, provides further empirical evidence of the importance of therapist competence in the psychotherapeutic process. Copyright © 2012. Published by Elsevier Ltd.
Mol, Mayke; Dozeman, Els; van Schaik, Digna J. F.; Vis, Christiaan P. C. D.; Riper, Heleen; Smit, Jan H.
Background Internet-based Cognitive Behavioural Therapy (iCBT) for the treatment of depressive disorders is innovative and promising. Various studies have demonstrated large effect sizes up to 2.27, but implementation in routine practice lags behind. Mental health therapists play a significant role in the uptake of internet-based interventions. Therefore, it is interesting to study factors that influence the therapists in whether they apply internet-based therapy or not. This study, as part o...
Heinz eBoeker; André eRichter; Holger eHimmighoffen; Jutta eErnst; Laura eBohleber; Elena eHofmann; Johannes eVetter; Georg eNorthoff
The paper focuses on the essentials of psychoanalytic process and change and the question of how the neural correlates and mechanisms of psychodynamic psychotherapy can be investigated. The psychoanalytic approach aims at enabling the patient to “remember, repeat, and work through” concerning explicit memory. Moreover, the relationship between analyst and patient establishes a new affective configuration which enables a reconstruction of the implicit memory. If psychic change can be achieved ...
The therapist is a neglected and poorly understood variable in pediatric rehabilitation. Much more attention has been paid to the role of intervention on client change than the role of therapist-related variables. This article synthesizes what is known in the adult and child mental health literature about the role of the therapist, and integrates this with work in pediatric rehabilitation. The article reviews the mental health literature on the therapist as a random variable associated with client outcomes (role of the therapist alone) and the role of three other therapist-related constructs: the therapist-client relationship (therapist and client), treatment implementation (therapist and intervention), and therapy process (therapist, client, and intervention considered holistically). Implications for clinical practice in pediatric rehabilitation include recognition of change as a multi-determined phenomenon involving common therapist-related factors, the therapist's role in creating facilitative conditions for change (through supportive relationships, positive expectancies, and mastery and learning experiences), and the importance of training in collaborative partnership skills. A contextual approach to therapeutic change is advocated, in which psychosocial factors and mechanisms are acknowledged, the therapist is seen as crucial, and the intervention process is seen as the context or vehicle through which changes occur.
Almlov, J.; Carlbring, P.; Kallqvist, K.; Paxling, B.; Cuijpers, P.; Andersson, G.
Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method:
Owen, Jesse; Imel, Zac; Adelson, Jill; Rodolfa, Emil
In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who…
Strunk, Daniel R.; Brotman, Melissa A.; DeRubeis, Robert J.; Hollon, Steven D.
Objective: The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address…
Kramer, Ueli; de Roten, Yves; Beretta, Veronique; Michel, Luc; Despland, Jean-Nicolas
Patients and therapists have somewhat divergent perspectives of alliance. Usually in psychotherapy research, the focus is on the patient's view of alliance, predicting parts of outcome. This study questions this hypothesis by applying the shape-of-change procedure to patient's and therapist's view of alliance-building processes in dynamic…
Roebroeck, M.E.; Dekker, J.; Oostendorp, R.A.B.
Background and purpose: the purpose of this study were to describe the use of ultrasound by Dutch physical therapists and to address the question of whether this use is what would be considered correct. Subjects and methods: physical therapists in the Dutch primary health care system gathered data
Baker, Vicki D.; Cohen, Nicki
The purpose of this study was to describe the university vocal training and vocal health of music educators and music therapists. The participants (N = 426), music educators (n = 351) and music therapists (n = 75), completed a survey addressing demographics, vocal training, voice usage, and vocal health. Both groups reported singing at least 50%…
... COMMISSION 10 CFR Part 26 Petition for Rulemaking Submitted by the California Association of Marriage and... Riemersma, on behalf of the California Association of Marriage and Family Therapists (the petitioner... the Code of Federal Regulations (10 CFR) 26.187(b) to add marriage and family therapists as substance...
Morokoff, Patricia J.; LoPiccolo, Joseph
Compared a four-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. Both programs were effective in producing female orgasm and in improving satisfaction with the sexual relationship and, for women in MTC treatment, happiness in…
Trautt, Gregory M.; And Others
The therapist with similar attitudes was seen as more qualified, higher in interpersonal attraction, and more likeable. Subjects were more willing to recommend or seek therapy from these therapists. Significant interaction indicated that male subjects were more affected by the degree of attitude similarity. (Author)
Kellems, Ian S.; Hill, Clara E.; Crook-Lyon, Rachel E.; Freitas, Gary
University counseling center therapists (N = 220) completed an Internet survey about religion/spirituality in therapy, with 200 of these therapists describing therapy with a recent client whose issues involved religion/spirituality. Common client religion/spirituality issues were questioning one's childhood religion, exploring…
Greeson, Johanna K. P.; Guo, Shenyang; Barth, Richard P.; Hurley, Sarah; Sisson, Jocelyn
Objective: This study examines the influence of therapist and youth characteristics on post-discharge outcomes from intensive in-home therapy. Method: Data for 1,416 youth and 412 therapists were obtained from a behavioral health services provider. The Huber-White method was used to account for nested data; ordered logistic regression was employed…
Barkaia, Ana; Stokes, Trevor F.; Mikiashvili, Tamar
This study examined the effects of intercontinental telehealth coaching on the mastery of therapists' skills and improvements in verbalizations by children with autism, testing whether telehealth can be a solution for underserved communities in developing countries such as Georgia-Sakartvelo in Eastern Europe. Three therapists delivering and three…
Drolet, Marie-Josée; Désormeaux-Moreau, Marjorie
Recently, there has been increasing interest in the values of occupational therapy and the values held by occupational therapists. A wide range of values has been reported in the literature. Furthermore, despite the fact that values are an important part of professional identity, empirical studies have demonstrated that several occupational therapists possess an ambiguous professional identity. This study was undertaken to explore the values of Canadian occupational therapists, specifically French-speaking occupational therapists in Quebec. Semi-structured interviews were conducted with 26 occupational therapists. Their narratives were subject to hermeneutic analysis, a method of textual analysis common in philosophical research. A total of 16 values were identified in the discourses of the occupational therapists interviewed: autonomy; human dignity; occupational participation; social justice and equity; professionalism; holism; partnership, environment, or ecological approach; quality of life; solicitude; honesty; integrity; health; creativity; professional autonomy; effectiveness; and spirituality. The results of this study are, in general, consistent with those reported in the few other empirical studies that have documented the values perceptions of occupational therapists. Finally, the explanation of the values of occupational therapists may reinforce their professional identity and favour best, or at least desirable, professional practices related to ethics and culture.
Weaver, P L; Varvaro, F F; Connors, R; Regan-Kubinski, M J
Recent literature pertinent to adult survivors suggests that childhood sexual abuse is a serious problem, and that disclosure is on the rise. The aftereffects of childhood sexual abuse can cause dysfunction in various aspects of the survivor's physical and mental health. Understanding the traumagenic dynamics of childhood sexual abuse and its aftereffects provides direction for the nurse therapist during both the client's disclosure and intervention planning. This knowledge assists the therapist in promoting mental health and healing, as well as providing comfort for the therapist. The nurse therapist's reactions to the client's disclosure can affect the way the client feels about disclosure and the therapeutic relationship. If a negative message is conveyed to the survivor at the time of disclosure, the feelings of betrayal, stigmatization, and powerlessness that the survivor experienced as a child will be replicated. This can damage the therapeutic relationship and delay the healing process. When disclosure is received and acted upon in a sensitive, therapeutic manner, the survivor is empowered and can enter with the nurse therapist into an effective therapeutic alliance. Nurse therapists should gain awareness of the types of emotional responses that can be engendered in the health professional during disclosure. Awareness of these emotional reactions can lead to the identification of coping strategies useful to both the therapist and the adult survivor. Coping strategies useful to the therapist include maintaining adequate boundaries, understanding oneself and one's responses to sexual-abuse issues, utilizing ongoing consultation or supervision, and preventing burnout.(ABSTRACT TRUNCATED AT 250 WORDS)
Van Deusen, Julia
Seeks to determine if attitudes of occupational therapists toward theory development are related to their level of education or to their length of professional experience. Data collected from 38 therapists indicated that both longevity of practice as well as level of education were associated with high priorities for theory development. (Author/CT)
Explores which therapist-patient gender matches facilitate most patient growth and avoid detriment to female patients with eating disorders. Distills relevant variables from literature on eating disorders, adolescence, transference and countertransference, and psychotherapy to suggest guidelines for effective matches. Sees therapist and patient…