Intergenerational work as an adjunct to psychoanalysis and psychotherapy

Psychotherapy and psychoanalysis are opportunities for individuals to repair faulty aspects of their development that have resulted in symptoms or other difficulties in living. Although transference is the major therapeutic tool in this work, it is not the only one. The potential resources for healing that exist in family relationships is great, especially as these relationships go on long after therapy has ended. We are all living longer; families of three and four generations are no longer uncommon. There are many adult patients who have one or both parents alive and well. Intergenerational work can be a useful adjunct where there is no severe narcissistic pathology or psychosis in either patient or parent. It is especially helpful in cases where there is severe resistance and insight is not effective in promoting change. "By focusing constantly on the patient's transference distortions and ignoring reality elements we undermine self-esteem and make him feel he is always wrong, sick or crazy" (Greenson, 1978b,p. 434). The addition of intergenerational work in the course of psychoanalysis/psychotherapy can shorten the time of therapy and be another tool for dealing with resistance. This work has theoretical implications for the modification of the place that transference has in psychoanalytic therapy. By placing greater emphasis on the patient's real relationships in influencing intrapsychic change we pave the way to exciting clinical and theoretical possibilities.     

A meta-analysis of psychotherapy dropout.

A meta-analysis was conducted of 125 studies on psychotherapy dropout. Mean dropout rate was 46.86%. Dropout rate was unrelated to most of the variables that were examined but differed significantly as a function of definition of dropout. Lower dropout rates occurred when dropout was defined by termination because of failure to attend a scheduled session than by either therapist judgment or number of sessions attended. Significant effect sizes were observed for 3 client demographic variables: racial status, education, and income. Dropout rates increased for African-American (and other minority), less-educated, and lower income groups. Recommendations for future psychotherapy dropout research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Goal attainment scaling as an adjunct to counseling.

T. J. Kiresuk and R. E. Sherman (see record 1970-04099-001) have proposed a method of evaluating programs and counseling that combines theoretical approaches that may be beneficial to the counseling process itself. The present study hypothesized that counseling with these Goal Attainment Scaling evaluation procedures would improve the conduct of counseling. The Personal Orientation Inventory, Nowicki and Strickland Children's Locus of Control Scale, a consumer satisfaction questionnaire, and behavioral measures were used to assess outcome of counseling for 20 13-17 yr olds with adjustment problems. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A guide to violating an injunction in psychotherapy: On seeing acquaintances as patients.

After a review of the prohibition against seeing acquaintances in therapy and the frequency with which the prohibition is violated, reasons favoring the injunction are presented. These include loss of the previous relationship, complication of transference and countertransference, and stimulation of therapist grandiosity. Guidelines are offered to offset the difficulties in seeing acquaintances as patients. The problem of seeing acquaintances in therapy is discussed in terms of the profession as a whole and the need for research, training, and a more articulated code of ethics. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal exchange structure of brief psychodynamic-interpersonal and cognitive-behavioral psychotherapy.

A verbal exchange is a set of 2 people's co-occurring speech-act categories that accomplish some subtask within an interpersonal encounter. Factor analysis of verbal response mode (speech act) frequencies in 1,630 segments (each approximately 10 to 12 min) drawn from the brief psychodynamic-interpersonal or cognitive-behavioral treatment of 39 mainly depressed clients identified 6 exchanges in each treatment—4 that were the same in both treatments (Revealing, Storytelling, Explaining, and Inquiring) and 2 that distinguished each treatment (Exploring and Interpreting in psychodynamic–interpersonal treatment; Prescribing and Reframing in cognitive–behavioral treatment). The exchanges showed distinctive temporal patterns across segments of sessions and across sessions of each time-limited treatment. The verbal exchange is a midsize concept that links atomistic verbal codes with clinical or theoretical concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy.

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderate intensity exercise as an adjunct to standard smoking cessation treatment for women: A pilot study.

Previous randomized controlled trials have not supported moderate intensity exercise as an efficacious adjunct to smoking cessation treatments for women; however, compliance with exercise programs in these studies has been poor. The purpose of this pilot study was to estimate the effects of moderate intensity exercise on smoking cessation outcomes under optimal conditions for exercise program compliance. Sixty previously sedentary, healthy, female smokers were randomized to an 8-week program consisting of brief baseline smoking cessation counseling and the nicotine patch plus either 150 min/week of moderate intensity exercise or contact control. Participants attended a median of 86.4% and 95.5% of prescribed exercise/control sessions, respectively. There was a moderate, though statistically nonsignificant, effect of exercise at post-treatment for objectively verified 7-day point prevalence abstinence (48.3% vs. 23.3%; OR = 3.07, 95% CI: 0.89–11.07) and prolonged abstinence (34.5% vs. 20.0%; OR = 2.11, 95% CI: 0.56–8.32). Effects were attenuated when controlling for potential confounders, and after a 1-month, no-treatment period. The findings provide a preliminary indication that, given adequate compliance, moderate intensity exercise may enhance short-term smoking cessation outcomes for women; however, a larger trial is warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: A controlled comparison.

Evaluated the effectiveness of group cognitive-behavioral treatment (CBT) and group interpersonal psychotherapy (IPT) for binge eating. 56 women with nonpurging bulimia were randomly assigned to 1 of 3 groups: CBT, IPT, or a wait-list control (WLC). Treatment was administered in small groups that met for 16 weekly sessions. At posttreatment, both group CBT and group IPT treatment conditions showed significant improvement in reducing binge eating, whereas the WLC condition did not. Binge eating remained significantly below baseline levels for both treatment conditions at 6-mo and 1-yr follow-ups. These data support the central role of both eating behavior and interpersonal factors in the understanding and treatment of bulimia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis.

Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent with the values and worldviews of ethnic and racial minority groups (e.g., D. W. Sue, Arredondo, & McDavis, 1992). Culturally adapted psychotherapy has been reported in a previous meta-analysis as more effective for ethnic and racial minorities than a set of heterogeneous control conditions (Griner & Smith, 2006), but the relative efficacy of culturally adapted psychotherapy versus unadapted, bona fide psychotherapy remains unestablished. Furthermore, one particular form of adaptation involving the explanation of illness—known in an anthropological context as the illness myth of universal healing practices (Frank & Frank, 1993)—may be responsible for the differences in outcomes between adapted and unadapted treatments for ethnic and racial minority clients. The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of psychological functioning. Adaptation of the illness myth was the sole moderator of superior outcomes via culturally adapted psychotherapy (d = 0.21). Implications of myth adaptation in culturally adapted psychotherapy for future research, training, and practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Meditation as an adjunct to a happiness enhancement program

Arginine vasopressin (AVP) plays an important role in the control of a gonadal hormone-dependent communicative behavior in the Syrian hamster (Mesocricetus auratus) called flank marking. Previous studies have shown that gonadal hormones alter the amount of flank marking stimulated by the microinjection of AVP into the medial preoptic area-anterior hypothalamus (MPOA-AH). The purpose of the present study was to determine if testicular hormones alter the amount of flank marking stimulated by the microinjection of AVP into two other sites involved in the control of flank marking, the lateral septum-bed nucleus of the stria terminalis (LS-BNST) and the central gray. The data of the present study indicate that testicular hormones may influence the amount of AVP-stimulated marking in the central gray and LS-BNST; however, these effects are subtle and appear to occur primarily at high concentrations of AVP. When taken together with previous studies, these data indicate that gonadal hormones have greater effects on AVP-stimulated marking in the MPOA-AH than in the LS-BNST or central gray.     

Effectiveness of psychotherapy with children and adolescents: A meta-analysis for clinicians.

How effective is psychotherapy with children and adolescents? The question was addressed by meta-analysis of 108 well-designed outcome studies with 4–18-year-old participants. Across various outcome measures, the average treated youngster was better adjusted after treatment than 79% of those not treated. Therapy proved more effective for children than for adolescents, particularly when the therapists were paraprofessionals (e.g., parents, teachers) or graduate students. Professionals (with doctor"s or master"s degrees) were especially effective in treating overcontrolled problems (e.g., phobias, shyness) but were not more effective than other therapists in treating undercontrolled problems (e.g., aggression, impulsivity). Behavioral treatments proved more effective than nonbehavioral treatments regardless of client age, therapist experience, or treated problem. Overall, the findings revealed significant, durable effects of treatment that differed somewhat with client age and treatment method but were reliably greater than zero for most groups, most problems, and most methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of group psychotherapy for older adult clients: A meta-analysis.

This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects.

Relapse and recurrence following response to acute-phase treatment for major depressive disorder (MDD) are prevalent and costly. In a meta-analysis of 28 studies including 1,880 adults, the authors reviewed the world's published literature on cognitive-behavioral therapies (CT) aimed at preventing relapse-recurrence in MDD. Results indicate that after discontinuation of acute-phase treatment, many responders to CT relapse-recur (29% within 1 year and 54% within 2 years). These rates appear comparable to those associated with other depression-specific psychotherapies but lower than those associated with pharmacotherapy. Among acute-phase treatment responders, continuation-phase CT reduced relapse-recurrence compared with assessment only at the end of continuation treatment (21% reduction) and at follow-up (29% reduction). Continuation-phase CT also reduced relapse-recurrence compared with other active continuation treatments at the end of continuation treatment (12% reduction) and at follow-up (14% reduction). The authors discuss implications for research and patient care and suggest directions, with methodological refinements, for future studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promise-of-treatment as an opening strategy for psychotherapy.

Contends that withholding of explicit, formal treatment until after S's completion of experimental and information-gathering ordeals is an opening tactic for psychotherapy that potentiates both a course and a conclusion for the therapeutic process. The benefits of the promise-of-treatment strategy include removal of "failure" from the initial process, ability to assess and intensify client motivation, and possible eliciting of the placebo effect. Clients may be asked to delay treatment until the best one is formulated. Covertly therapeutic tasks (e.g., testing conventional cures, attempting personal solutions, rehearsing symptoms, reframing, slowly developing insight, pretending to be cured, pretending to be sick, spontaneously changing, gathering information) allow the client to do something different and to make a change for the better. Case examples of a 40-yr-old female binge eater, a 20-yr-old male with a sleep disorder, and a 15-yr-old compulsive face scratcher are presented to illustrate the promise-of-treatment strategy. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multicenter trial of fluoxetine as an adjunct to behavioral smoking cessation treatment.

The authors evaluated the efficacy of fluoxetine hydrochloride (Prozac; Eli Lilly and Company, Indianapolis, IN) as an adjunct to behavioral treatment for smoking cessation. Sixteen sites randomized 989 smokers to 3 dose conditions: 10 weeks of placebo, 30 mg, or 60 mg fluoxetine per day. Smokers received 9 sessions of individualized cognitive-behavioral therapy, and biologically verified 7-day self-reported abstinence follow-ups were conducted at 1, 3, and 6 months posttreatment. Analyses assuming missing data counted as smoking observed no treatment difference in outcomes. Pattern-mixture analysis that estimates treatment effects in the presence of missing data observed enhanced quit rates associated with both the 60-mg and 30-mg doses. Results support a modest, short-term effect of fluoxetine on smoking cessation and consideration of alternative models for handling missing data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)