Following the trail of the focus in time-limited psychotherapy.

Studied 47 short-term psychotherapy cases (aged 18–33 yrs) from a college counseling center that followed the evolution of the focus from the patient's presenting problem, through the formulation of the focus during the consultation, to the stated focus at termination. Findings suggest that the presenting complaint was not the same as the consultation or the termination focus and that the consultation focus was not the same as the termination focus. The longer the time-limited therapy progressed, the more likely it was that the focus was revised between the time of the initial consultation and termination. Clinical examples of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring adherence in time-limited dynamic psychotherapy.

Reports the development of the Vanderbilt Therapeutic Strategies Scale (VTSS), a measure of adherence to the tenets of time limited dynamic psychotherapy (TDLP). The VTSS comprises 2 subscales, 1 intended to assess the extent to which therapist's in-session behaviors are consistent with the approach outlined in the TDLP manual and the other rating the presence and quality of general psychodynamic techniques. Results from 64 patients (aged 24–64 yrs) and 16 therapists (aged 27–48 yrs) suggest the VTSS subscales have acceptable psychometric properties and provide good discriminant validity between pre- and post-training conditions. VTSS ratings were also compared with ratings of the therapist's contribution to the therapy process and ratings of "overall competence" made by the therapists' supervisors. The relationship between technical adherence, competence, interpersonal manner, and therapeutic skill is examined and discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Initial client expectancies in time-limited counseling.

Assessed the effects of (a) whether counseling was time-limited (12 sessions), (b) the interaction of time limits with the chronicity of the client's problem, and (c) the rationale given for time limits (time limits effective/appropriate vs a long waiting list) on the initial expectancies of clients. 80 female college students were asked to place themselves into the role of a client they saw interacting with a counselor on film. Pre- and postfilm written material manipulated the independent variables. Results show that Ss in the chronic (vs acute) problem condition had the most negative expectancies for the counseling relationship and outcome when the counseling was time-limited (vs unlimited). While the rationale for time limits did not affect the primary dependent variables, post hoc analyses of Ss' essay responses indicated that the waiting-list rationale stimulated more negative expectancies than the time-limits-effective/appropriate rationale. Contrary to predictions, time did not affect Ss' expectancies for client activity and responsibility and for counselor activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic focusing in time-limited group psychotherapy.

The degree to which treatment outcome is related to therapeutic focusing, leader skill, and positive aspects of the therapeutic relationship was examined in time-limited group psychotherapy. Measures tapping each of these domains were assessed at Sessions 3, 8, and 14 in 15-week therapy groups led by 4 expert professional group therapists and 4 "natural-helper" nonprofessionals. Significant differences were found on process measures for both the leader skill condition and time factors. In addition, both the quality of the therapeutic relationship and the degree of therapeutic focusing independently predicted client improvement. Specifically, the results indicate that therapist focusing occurs differentially and is only predictive of improvement in professional groups, whereas a positive therapeutic relationship is only predictive of early positive improvement in nonprofessional groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of cognitive behavior therapies: A quantitative review of the research evidence.

Assessed the effectiveness of cognitive behavior therapies in a review of 48 studies of adolescents and adults that compared cognitive behavioral therapy with some form of control group. Analyses indicated that cognitive behavior therapies were superior to no treatment; however, there was no firm evidence that these therapies were superior to other psychotherapies. Analyses failed to find cognitive behavior therapies emphasizing behavioral techniques to be more effective than primarily cognitive approaches. Also, the efficacy of cognitive behavior therapies appeared relatively uniform across diagnostic categories and equally effective when administered in a group or individual format. There was no evidence that sex or age of patient, experience of therapist or even duration of therapy were related to treatment effects. (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The time-limited influence of sentential context of function word identification.

Sentential context effects on the identification of the Dutch function words te (to) and de (the) were examined. In Experiment 1, listeners labeled words on a [te]–[de] continuum more often as to when the context was to biased (Ik probeer [?e] schieten [I try to/the shoot]) than when it was de biased (Ik probeer [?e] schoenen [I try to/the shoes]). The effect was weaker in slower responses. In Experiment 2, disambiguation began later, in the second word after [?e]. There was a weak context effect only in the slower responses. In Experiments 3 and 4, disambiguation occurred on the word before [?e]: There was no context effect when one set of sentences was used, but there was an effect (larger in the faster responses) when more sentences were used. Syntactic processing affects word identification only within a limited time frame. It appears to do so not by influencing lexical access processes through feedback but, instead, by biasing decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observations on the training of therapists in time-limited dynamic psychotherapy.

Suggests that "manualized training" is most effective at increasing adherence to the technical procedures characterizing the treatment under scrutiny. There is minimal evidence that other skills associated with therapeutic competence are acquired or enhanced to the extent found with technical adherence. Drawing on findings from a study of manual-guided training of therapists in the techniques of brief therapy (H. H. Strupp and J. L. Binder, 1984), the author offers recommendations for improving therapy training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internalization of interpersonal process in time-limited dynamic psychotherapy.

[Correction Notice: An erratum for this article was reported in Vol 31(3) of Psychotherapy: Theory, Research, Practice, Training (see record 2009-17141-002). This article contained, as Figure 1, an SASB model. The authorship and copyrights for the model were not acknowledged. The following acknowledgement should have been included: "Adapted from Benjamin (1984). Principles of Prediction using Structural Analysis of Social Behavior (SASB). In R. A. Zucker, J. Aronoff, and A. J. Rabin (Eds.), Personality and the Prediction of Behavior (pp. 121- 174). New York: Academic." An apology is offered to the author, Dr. Lorna Smith Benjamin. The particular version used in the article was developed in collaboration with Clinton W. McLemore.] Investigated the internalization of positive aspects of therapist–patient (TP) interactions among 70 patients and their 16 therapists who participated in a 5-yr study (H. H. Strupp et al, unpublished) of time-limited dynamic psychotherapy. Patients sought help for anxiety, depression, or other problems with a clear interpersonal component and qualified for an Axis I or Axis II diagnosis on the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III). Instruments included the Structural Analysis of Social Behavior and outcome measures of depression, anxiety, and psychological functioning. Patients' intrapsychic functioning became more similar to interpersonal activity in the TP relationship over the course of psychotherapy. Intrapsychic movement toward interpersonal activity in the TP relationship was associated with positive outcome on measures of depression, anxiety, and on independent clinician ratings of patient psychological functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The working alliance within time-limited therapy: A case analysis.

The working alliance across stages of time-limited psychodynamic treatment was investigated using an intensive case-analysis approach. Two White, male clients in their 20s were treated by the same therapist with process data obtained from the perspectives of client, therapist, and independent judge. As predicted, clients' perceptions of the working alliance increased, dropped, and then increased over the course of treatment. The implications of these results for a stage-process model of time-limited treatment and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of time-limited counseling on client change.

24 college-student clients seeking help from a counseling center for emotional or personal-social problems were randomly assigned to 1 of 2 treatment conditions: time-limited or undetermined-time counseling. Pre- and postcounseling measures were obtained relating to client status and problems. These included the Personal Orientation Inventory and Strupp's therapist questionnaire. Findings indicate significant improvement in terms of self-acceptance and increased independence as well as on various other self-report statements for clients in the time-limited group over a period of 8 wks. In addition, assessment by clients and the 15 counselors of improvement in both groups was significantly related. Implications of findings in terms of use of time-limited counseling in a time-limited environment, e.g., college counseling centers, are discussed. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insight and symptom reduction in time-limited psychoanalytic counseling.

The contention that client insight "causes" symptom reduction was examined for 12 clients who completed 20 sessions of psychotherapy. Clients rated target complaints before each counseling session and completed the Important Events Questionnaire (IEQ; A. L. Cummings, J. Martin, E. T. Hallberg, & A. G. Slemon, 1992) after each counseling session. Counselors rated target complaints for their clients after each session. Three judges rated the IEQs using the Insight Rating Scale (IRS; R. W. Morgan, L. Luborsky, P. Crits-Christoph, H. Curtis, & J. Solomon, 1982). Validity of the IRS was established by examining the relationship between IRS ratings, counselor-judged insight, and counts of client insight statements. Regression analyses showed that clients had significant linear increases in insight and significant linear decreases in target complaint distress across the 20 counseling sessions. Time-series analyses showed that increases in insight led reductions in target complaints. These results support the importance of insight for symptom reduction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transference, insight, and the course of time-limited therapy.

This study examined (a) the interactive role of therapist-rated transference and insight (in first session and first quarter of treatment) in predicting the outcome of time-limited therapy and (b) the course of therapist-rated transference and insight in more and less successful cases. The sample consisted of 33 completed cases. Although neither transference nor insight alone predicted outcome, the interaction of transference and emotional insight was significantly related to both client- and therapist-rated outcome. The course of negative transference and overall amount of transference differentiated more successful from less successful cases. In more successful cases, transference increased during the first three quarters of treatment and then declined, whereas in less successful cases, transference continued to increase throughout treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating the effectiveness of family therapies: An integrative review and analysis.

A number of previous reviews of studies evaluating the effectiveness of family therapy have varied in their conclusions. This review is the first attempt at an integrated statistical analysis of family therapy effectiveness research. Family therapy was found to have positive effects compared with both no-treatment and alternative treatment controls, as measured by family interactions and behavior ratings. Follow-up data demonstrated that family therapy continued to show positive effects over time, but the effects were diminished and more variable than at posttreatment assessment. Future research should concentrate on comparative outcome studies with specific populations and with both legitimate alternative treatments and placebo controls. In addition, researchers need to describe in greater detail the family therapy procedures that are used. Outcome measures should represent multiple vantage points and should include measures of family interactions, preferably using both self-report and observational methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in clients' attachment styles over the course of time-limited dynamic psychotherapy.

This study utilized a theory-specific measure to examine client relational change over the course of time-limited dynamic psychotherapy in 84 Ss (aged 26–64 yrs). Specifically, this study examined change and stability in clients' attachment style. Categorical and dimensional ratings attachment styles were obtained. Pretreatment and posttreatment measures of attachment styles were then examined in association with Global Assessment Scale (GAS) scores and symptoms. Results show that at posttreatment, a significant number of clients were evaluated as having changed from an insecure to a secure attachment style. Additionally, the sample as a whole demonstrated significant changes toward increased secure attachment. Significant relationships were also found among changes in attachment style, GAS scores, and symptom levels. Implications for psychodynamic/interpersonal psychotherapy research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose–effect relations in time-limited psychotherapy for depression.

Criteria for reliable and clinically significant improvement were applied to standard and individually tailored outcome measures data from 212 depressed clients who had been randomly assigned to receive either 8 or 16 sessions of time-limited psychotherapy. The data were used to address 2 questions: (a) Is the dose-effect curve for psychological symptoms negatively accelerated? and (b) is there a differential rate of response for acute, chronic, and characterological/interpersonal components of depression? The results supported the differential rate of response of different components of depression and suggested qualifications to the acute, chronic, and characterological/interpersonal components and evidence that both supported and qualified previous suggestions that the dose effect curve is negatively accelerated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of dropping out in time-limited, interpretive individual psychotherapy.

Predictors of dropping out were investigated for patients who participated in time-limited, interpretive individual psychotherapy in a randomized clinical trial. A sample of 22 dropouts was compared with a sample of 22 matched completers on pretherapy and therapy process variables. A modified Vanderbilt Psychotherapy Process Scale was used to assess patient hostility and patient and therapist exploration and focus on transference. Pretherapy predictors, which included demographic, diagnostic, and initial disturbance outcome variables, did not significantly differentiate the two groups. Therapeutic alliance, dynamic and supportive work, patient exploration, and focus on transference significantly differentiated dropouts from completers. For dropouts, there was a weaker alliance, less work, less exploration, and greater focus on transference. Examination of the last session of dropouts revealed a nonproductive pattern characterized by resistance and transference interpretation. Implications and limitations associated with the study are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case study of the process and outcome of time-limited counseling.

12 sessions of personal, insight-oriented counseling were conducted by a female psychologist with a female undergraduate with a dominating, melodramatic communication style. The client's presenting problems were difficulties with her boyfriend and family, anxiety, and headaches. The counselor's style was interpretive, confrontive, and experiential within the context of a safe, supportive, therapeutic atmosphere. Process measures indicated that the client increased amount of experiencing and insight and decreased amount of time spent describing her problems both within and across sessions. Mechanisms of change seemed to be interpretations, direct feedback, gestalt exercises, and discussion of the counselor–client relationship, following the establishment of rapport and support. Client's scores on the Hopkins Symptom Checklist and Tennessee Self-Concept Scale showed that treatment had resulted in an improvement that was maintained at 2 mo, but the client had relapsed at a 7-mo follow-up. Process analyses suggested that relapse occurred because counseling was too brief, not allowing enough time for the client to incorporate changes. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of patient and therapist evaluations of time-limited psychotherapy.

Obtained empirical data regarding the degree of congruence between therapists' and patients' evaluations of brief psychotherapy on a session-by-session basis and posttreatment and compared these data with predictions derived from J. Mann's (1973) model of the process of brief psychotherapy. 28 17–34 yr old students who were seen in brief psychotherapy (6–22 sessions) by 6 university mental health staff served as Ss. Patients and therapists completed an evaluative questionnaire at the conclusion of each session and at 1–4 wks posttreatment. Sessions were treated as falling into the early, middle or final phase of treatment by dividing the total number of sessions into equal thirds. Without exception, patients' evaluations were higher than those of therapists, both session-by-session and posttreatment. Therapists gave evidence of appreciating this discrepancy but underestimated its magnitude. Results are viewed as largely consistent with predictions derived from Mann's model of brief psychotherapy and as lending support to the model's validity. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The validity of importance.

Studied the usefulness of weighting by importance when combining measures of satisfaction with job aspects into a measure of overall satisfaction. Results with 380 clerical workers question the validity of the information that is used for importance weighting. It is concluded that the model of cognitive behavior that relates the importance of job aspects to the evaluation of overall job attitude should be revised. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior.

16 therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant–observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways. (PsycINFO Database Record (c) 2010 APA, all rights reserved)