The psychotherapy of schizophrenia: Patient and therapist factors related to continuance.

The influence of pretreatment patient and therapist characteristics on continuance in individual psychotherapy was investigated using a sample of 143 nonchronic schizophrenic patients. Results showed that 1) most of the usual indicators of patient suitability for psychotherapy were not related to continuance; 2) patients with positive symptoms of schizophrenia were most likely to remain in supportive therapy, whereas patients with negative symptoms were more likely to remain in insight-oriented therapy; and 3) all patients were more likely to continue in treatment with therapists who had a strong commitment to a well-defined treatment approach, be it supportive or insight oriented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mediating role of insight for long-term improvements in psychodynamic therapy.

Objective: According to psychoanalytic theory, interpretation of transference leads to increased insight that again leads to improved interpersonal functioning over time. In this study, we performed a full mediational analysis to test whether insight gained during treatment mediates the long-term effects of transference interpretation in dynamic psychotherapy. Method: This study is a randomized clinical trial with a dismantling design. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment with the same therapists but without the use of transference interpretation. Interpersonal functioning and insight were measured pretreatment, posttreatment, and 1 year and 3 years after treatment termination. Results: Contrary to common expectation, patients with a life-long pattern of low quality of object relations and personality disorder pathology profited more from therapy with transference interpretation than from therapy with no transference interpretation. This long-term effect was mediated by an increase in the level of insight during treatment. Conclusions: Insight seems to be a key mechanism of change in dynamic psychotherapy. Our results bridge the gap between clinical theory and empirical research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Family therapy concepts and methods.

Reviews the book, Family therapy concepts and methods by Michael P. Nichols (1984). The wealth of information presented in this book about the field of psychotherapy is one of its major strengths. Eight separate schools of therapy are described, including their historic roots. Substantial reading lists are included with each chapter. The presentations include a developmental perspective and normal functioning by which the contrast of disordered behavior may be highlighted. Major figures, main concepts, and methods are presented in a well-written, easy-to-follow format. This text lends itself most usefully to the integration of individual psychodynamic psychotherapy as it contributes to an understanding of systems practice. The presentation of psychoanalytic developmental theory is the best and most useful I have seen. It is well suited to teaching clinicians. The total impression is that the book offers a presentation of psychotherapy as integrated into systemic practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The formative method for adapting psychotherapy (FMAP): A community-based developmental approach to culturally adapting therapy.

How is psychotherapy culturally adapted for ethnic minorities? Although there has been growing interest in doing so, few therapy adaptation frameworks have been developed. The majority of these frameworks take a top-down theoretical approach to adapting psychotherapy. This article introduces a community-based developmental approach to modifying psychotherapy for ethnic minorities. The formative method for adapting psychotherapy (FMAP) is a bottom-up approach that involves collaborating with consumers to generate and support ideas for therapy adaptation. It involves 5 phases that target developing, testing, and reformulating therapy modifications. These phases include (a) generating knowledge and collaborating with stakeholders, (b) integrating generated information with theory and empirical and clinical knowledge, (c) reviewing the initial culturally adapted clinical intervention with stakeholders and revising the culturally adapted intervention, (d) testing the culturally adapted intervention, and (e) finalizing the culturally adapted intervention. Application of the FMAP is illustrated using examples from a study adapting psychotherapy for Chinese Americans, but it can also be readily applied to modifying therapy for other ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Humanistic analysis in groups.

Presents a personal and professional journey taken by the author during the past 15 yrs aimed at developing a theoretical and clinical framework for integrating the humanistic functioning of the group psychotherapist within a psychodynamic process. Personally, it represents a struggle to become a flexible, creative, giving, authentic, and emotionally alive psychotherapist. This means an ongoing process of working through the emotional issues of the past and present that inhibit appropriate expression within the psychotherapy encounter. To achieve the desired goal professionally, it was necessary to borrow meaningful aspects of 2 approaches to psychotherapy: the active psychoanalysis of S. Ferenczi (1919, 1920) and the humanistic tradition of client-centered psychotherapy, exemplified by C. Rogers (1942, 1951). Humanistic analysis is the attempt to integrate these approaches into a contemporary form of combined therapy in which action, empathy, and responsiveness are compatible with uncovering understanding and the development of insight. A long-term intensive experience with a seriously disturbed individual whose therapy dictated a flexible and creative approach is used to illustrate this approach. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychodynamic and cognitive therapy regarding acute treatment.

Cognitive–behavioral therapy (CBT) and psychodynamic psychotherapy either in their pure forms or possibly synthesized as a form of eclectic therapy appear to be the 2 most commonly utilized forms of psychotherapy, both having levels of empirical support. As the majority of outpatient therapy in America appears to be very brief, 1 reasonable assumption is that treatment is often sought for resolution of acute episodes. A relevant question for practice and clinical training is what are the potential implications with brief psychodynamic and cognitive therapy for this type of treatment? This brief commentary will address the following: (a) the current general differential empirical status of each approach; (b) distinctions between acute treatment and traditional brief therapy and current common treatment patterns; and (c) the general clinical mechanisms for change for each approach and their potential implications regarding acute treatment and clinical supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing treatment progress of individual patients using expected treatment response models.

The dosage model provides a normative estimate of the overall pattern of patient improvement in psychotherapy. The phase model further specifies patterns of change in the domains of subjective well-being, symptom remediation, and functioning. The expected treatment response (ETR) approach uses patient characteristics to predict an expected path of progress for each patient. With repeated measures of mental health status, the treatment progress of an individual patient can be assessed against the patients ETR to support decisions that would enhance the quality of a clinical service while it is being delivered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison": Correction to Nietzel et al.

Reports an error in "Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison" by Michael T. Nietzel, Robert L. Russell, Kelly A. Hemmings and Monica L. Gretter (Journal of Consulting and Clinical Psychology, 1987[Apr], Vol 55[2], 156-161). The data presented in Table 2 were incorrect because a row and a column were inadvertently omitted. The corrected Table 2 appears in the erratum. (The following abstract of the original article appeared in record 1987-28817-001.) This study used meta-analysis to study the clinical significance of psychotherapy for symptoms of unipolar depression. The following questions were addressed: How similar is the posttherapy adjustment of depressed adults to that of nondepressed adults? Is this adjustment maintained at follow-up? What dimensions of treatment, therapists, or design are associated with clinical significance? Using the Beck Depression Inventory (BDI), we calculated composite BDI norms from 28 published studies. Sixty effect sizes (from 31 outcome studies utilizing the BDI) were calculated. The results indicated that psychotherapy produces outcomes that have moderate clinical significance and that are well-maintained at follow-up, that individual therapy is associated with greater clinical significance than group treatment, and that type of therapy is not related to improvement. Alternative approaches for operationalizing clinical significance as the return of individuals to normal levels of functioning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.

Although the subject has been debated and examined for more than 3 decades, it is still not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive-behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment, problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that 1 of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d = 0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments; d = -0.13). The drop-out rate was significantly higher in cognitive-behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Reactance as a Predictor of Outcome in the Treatment of Chronic Depression.

This study examined whether reactance would negatively influence treatment outcome in 347 patients diagnosed with chronic forms of depression and treated at 9 sites with either Nefazodone, cognitive-behavioral analysis system of psychotherapy (CBASP), or combination therapy. Contrary to our hypotheses, reactance positively predicted treatment outcome in CBASP on 2 of 4 scales. These effects were independent of the therapeutic alliance, which also positively predicted outcome. Reactance did not predict outcome in the groups receiving medication alone or in combination with CBASP. The findings suggest that reactance may be an asset in psychotherapy among chronically depressed individuals and that reactant patients can benefit from directive psychotherapy when therapists flexibly respond to perturbations in the therapeutic relationship. Results support the importance of Aptitude × Treatment interactions in psychotherapy outcome. The direction and significance of such interactions may vary with different forms of psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women in psychotherapy: Their life circumstances and treatment needs.

Explored how certain social cultural conditions influence women's treatment needs by assessing the primary presenting problem and mental health functioning of 379 women (aged 18–61 yrs) who sought psychotherapy. Life circumstances (LC) groups were formed based on age (life stage), marital status, family composition/living arrangements, and employment status. Comparisons of the reasons for treatment and level of mental health functioning at presentation were made between the full sample and each LC group as well as between LC groups. Results indicate that clinically relevant differences in treatment needs exist among women patients in different LCs. 34% of the women indicated distress, anxiety, depression, or anger as their primary reason for seeking therapy. The most vulnerable women were single-parent women and women who lacked the major life roles of spouse, worker, or student. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence process research in family therapy: A rationale and some practical guidelines.

Suggests that treatment adherence research has recently established a permanent niche in psychotherapy outcome research as a means for testing whether interventions have been implemented as intended. Advanced-level adherence methods allow investigators to move beyond treatment integrity questions regarding model fidelity and toward treatment process questions regarding therapeutic technique and intervention dosage. Though still in the developmental stage, treatment adherence process procedures appear to be congruent with the methods, goals, and theoretical framework that characterize contemporary psychotherapy process research. Because adherence process research is virtually absent from the family therapy research literature, practical guidelines are presented for conducting observational-based adherence research on family therapy models, using the example of Multidimensional Family Therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Behavioral Approach to the Case of Ms.S.

This article provides a behavioral formulation and treatment plan for the case of Ms. S (see record 2005-02680-005). Given the complexity of Ms. S and the status of current research, interventions proposed emphasize empirically supported principles of change over any specific protocol. This particular behavioral approach incorporates aspects of dialectical behavior therapy and functional analytic psychotherapy in addition to more traditional behavior therapy. The utility of the therapeutic relationship in this approach is described (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching time-limited dynamic psychotherapy for post-traumatic stress disorder and pathological grief.

The authors' experience with a model of time-limited dynamic therapy for posttraumatic stress disorder (PTSD) and pathological grief has evolved over more than a decade of work that preceded formal manuals delineating treatment principles. Their accumulated experiences in training using this model suggests that a minimum of 2 yrs training in psychodynamics and psychopathology, supervised long-term dynamic psychotherapy experience, and some familiarity with brief therapy approaches is essential prerequisite knowledge. Because training needs to be sequential, they suggest the use of previous cases illustrating nuances of techniques with different personality styles, different levels of adaptive functioning, and implications of each of these factors for conducting treatment. They suggest liberal use of previously recorded cases in the context of ongoing tracking of adherence to a manual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The technique of psychotherapy.

Review the book "The technique of psychotherapy," by Lewis R. Wolberg (see record 1954-08774-000). This is not the case with The Technique of Psychotherapy. It provides one of the most remarkably comprehensive discussions of specifically what to do in psychotherapy that is currently available. The range and specificity of the topics covered is truly astounding. The topics covered deal with almost every conceivable question that the beginning therapist might ask an expert. This book is remarkable not only in the comprehensiveness of its coverage of specific aspects of therapy but also in the flexibility and freedom of dogmatism of the writer. Wolberg's position appears to be best described as eclectic-psychoanalytic. Wolberg has something good to find in all varieties of psychotherapy. Insight therapy, catharsis, re-education, environmental manipulation, support, reassurance, hypnosis, dream interpretation, free association, and persuasion all have their place for different kinds of therapy and for different kinds of cases. It will be useful in teaching psychotherapy and as a reference for those who practice psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Engagement in psychological treatment for functional neurological symptoms--Barriers and solutions.

This naturalistic study explores how many patients with functional neurological symptoms referred for specialist psychotherapy engage with and complete treatment, and whether routinely recorded demographic or clinical features predict engagement. Of 77 consecutive patients referred, 14.3% were considered unsuitable for therapy and excluded from between group comparisons, 23.4% did not attend any appointments, 20.8% unilaterally discontinued therapy, and 41.6% completed treatment. 66.6% of patients starting therapy completed. Older patients were more likely to engage in or complete therapy (p = .05). There were no significant differences between groups in terms of specific functional symptoms, comorbidity, predisposing, precipitating and perpetuating, or social factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Third-party payment and the outcome of psychotherapy.

Theorists have long debated whether the efficacy of psychotherapy is enhanced when clients are required to pay for their treatment. The aim of the present experiment was to assess this issue in a naturally occurring clinical setting. Clients in the study were individuals who had sought psychotherapy from a low-cost treatment center. One group of clients paid the fees normally charged by the treatment center, whereas another randomly selected group did not pay because a grant was used to cover the cost of their therapy. Results failed to reveal any reliable difference in the outcomes of clients who had paid for treatment and those whose treatment had been subsidized. These findings suggest that the effectiveness of psychotherapy is not impaired when someone other than the client pays for the therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metamorphosis in psychotherapy: End of the systems era.

Discusses the reorganization of psychotherapy from a group of dominant schools of thought into a more generalized approach to treatment. It is noted that outcome studies found that all therapies seem to work, with only negligible differences between them. Self-criticism of the 3 major therapy systems (psychoanalysis, behavior therapy, and cognitive therapy) is outlined. Formal responses to the decline of psychotherapy systems include eclecticism, nonspecific therapies, pluralism, microinvestigation of therapy sessions, and therapy manuals that make therapies portable and transferrable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Supportive therapy for borderline patients—A psychodynamic approach.

Reviews the book, Supportive therapy for borderline patients—A psychodynamic approach by Lawrence H. Rockland (see record 1992-97952-000). In this book, the author addresses the supportive psychotherapy of clients with Borderline Personality Disorder (BPD). While there is an abundant literature on expressive and psychoanalytic treatments for the borderline client there is very little on supportive approaches in the psychotherapy literature. Rockland offers a guide to the therapist who, after careful assessment and treatment planning, decides that a primarily supportive psychotherapy is most appropriate for his/her client, either initially or throughout the treatment. Using a practical, how-to format, Rockland applies the principles of Psychodynamically Oriented Supportive Therapy (POST)—an approach that he formulated (Rockland, 1989)—to clients with BPD. This text will assist clinicians in conceptualizing interventions that are often already part of their "supportive" repertoire but are applied in an unorganized and unsystematic fashion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)