Therapy processes and outcomes of psychological interventions for women diagnosed with gynecological cancers: A test of the generic process model of psychotherapy.

Objective: Little attention has been paid to the role of nonspecific therapy processes in the efficacy of psychological interventions for individuals diagnosed with cancer. The goal of the current study was to examine the three constructs from the generic model of psychotherapy (GMP): therapeutic alliance, therapeutic realizations, and therapeutic openness/involvement in the treatment outcome of women with gynecological cancers attending either a 7-session supportive counseling intervention or a coping and communication skills intervention. Method: Two hundred and three women completed measures of alliance, realizations, and openness after Intervention Sessions 2, 3, and 6, as well as measures of depressive symptoms after these sessions and 6 months after the pre-intervention assessment (posttreatment). Results: Consistent with the GMP, in early sessions, therapeutic bond predicted openness in terms of positive affect experienced during sessions, and both aspects of openness (positive and negative affect), in turn, predicted more therapeutic realizations. Therapeutic realizations predicted perceptions of greater session progress, and greater therapeutic bond predicted more therapeutic realizations. When early session GMP variables were used to predict later GMP processes and outcomes and posttreatment outcomes, early therapeutic bond predicted later session therapeutic realizations directly and indirectly via emotional arousal, emotional arousal predicted session progress, session progress predicted lower postsession depressive symptoms, and depressive symptoms as rated after Session 6 predicted depressive symptoms 3 months posttreatment. However, a number of additional associations among GMP processes were found. Conclusions: Our results suggest that therapy processes played a role in predicting both short- and long-term treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Universal session-level change processes in an early session of psychotherapy: Path models.

The authors used structural equation modeling to investigate universal change processes identified in the generic model of psychotherapy (GMP). Three path models of increasing complexity were examined in Study 1 in dynamic therapy. The best fitting model from Study 1 was replicated in Study 2 for participants receiving either cognitive or interpersonal therapy. Findings provided support for the universality of the GMP constructs in different types of therapy. Positive influences for therapeutic bond, openness, and realizations were observed, as was a surprising negative impact for one aspect of bond. Discussion highlights a complex conception of the therapy relationship that underscores the importance of investigating the multiple functions that the therapy relationship might serve in different psychotherapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing a model of change in the experiential treatment of depression.

In this study, we measured emotional processing and the alliance across 3 phases of therapy (beginning, working, and termination) for 74 clients who each received brief experiential psychotherapy for depression. Using path analysis, we proposed and tested a model of relationships between these 2 processes across phases of therapy and how these processes relate to predict improvement in the domains of depressive and general symptoms, self-esteem, and interpersonal problems after experiential treatment. Both therapy processes significantly increased across phases of therapy. Controlling for both client processes at the beginning of therapy, working phase emotional processing was found to directly and best predict reductions in depressive and general symptoms, and it could directly predict gains in self-esteem. Within working and termination phases of therapy, the alliance significantly contributed to emotional processing and indirectly contributed to outcome. Surprisingly, beginning therapy alliance (measured after Session 1) also directly predicted all outcomes. Furthermore, only clients’ beginning therapy process predicted reductions in interpersonal problems. Therefore, although the proposed theory of change was supported, clients’ beginning therapy processes may constrain clients’ success in experiential treatment and in particular their outcomes in some problem domains related to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Therapeutic Process As a Predictor of Change in Patients' Important Relationships During Time-Limited Dynamic Psychotherapy.

Components of the therapeutic process have been shown to be moderately strong predictors of change in patients' global interpersonal functioning during therapy. The authors sought to extend this research by examining how the therapeutic process in time-limited dynamic psychotherapy related to change in patients' perceptions of a specific relationship as rated by the Structural Analysis of Social Behavior. Results showed that ratings of therapist warmth at Session 3 predicted increased warmth and decreased hostility in patient behavior at posttreatment. Therapist warmth at Session 16 was predictive of a decrease in submissive behavior by patients toward their significant other. The importance of the association between the therapeutic process and patients' important interpersonal relationships is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of therapist adherence and competence on patient outcome in brief dynamic therapy.

The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. 29 depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression, Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step toward disentangling the alliance/improvement cycle in family therapy.

The authors focused on 2 unique aspects of the alliance in conjoint therapy: feeling safe in the therapeutic context with other family members and the family's shared sense of purpose about treatment (i.e., productive within-family collaboration). Low-income, multiproblem families were seen in a community clinic by therapists with varying theoretical orientations and a wide range of experience. Alliance-related behavior was assessed using the System for Observing Family Therapy Alliances (M. L. Friedlander, V. Escudero, & L. Heatherington, 2006). The significant mediated model showed that parent safety contributed to productive family collaboration in the 1st session, which, in turn, predicted global improvement rated after Session 3. Given the heterogeneous sample of clients, therapists, and therapy approaches, findings support the ecological validity of the alliance in family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Influence of Therapist Adherence and Competence on Client Reprocessing of Child Abuse Memories.

This study follows previous research examining change processes in emotion-focused therapy for adult survivors of child abuse (N = 37). Therapist (n = 10) adherence to intervention principles and competence with an imaginal confrontation (IC) intervention were examined in the context of relationship skills. The Therapist Facilitating Scale assessed competence with IC. Therapists differed in technical (but not relationship) skills; relationship skills and IC competence (but not adherence) improved over therapy. Therapist competence predicted better client processes during IC. Relationship skills independently contributed to abuse resolution; the potency of IC (Competence x Frequency of Implementation) independently contributed to reduced interpersonal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural analysis of social behavior as a common metric for programmatic psychopathology and psychotherapy research.

This article describes the use of the Structural Analysis of Social Behavior (SASB; L. Benjamin, 1974) as applied to programmatic psychodynamic-interpersonal psychotherapy research. SASB fosters cumulative, theory-driven research by permitting problem-treatment-outcome (PTO) congruence—the conceptualization and measurement of patients' problems, treatment processes, and outcome in a common metric. In this explication of the principle of PTO congruence, the following are discussed: a general model of interpersonal psychopathology and etiology, SASB-based assessment devices for measuring early history and formulating presenting problems, empirical studies of interpersonal process in therapy, the relationship between manual-guided training and interpersonal process, and the assessment of outcome. A generic interpersonal model of psychotherapy is proposed that theoretically links all of these elements. Finally, the use of these SASB-based models for cross-theory integrative research from a common-factors approach is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of the psychotherapy relationship in long- versus short-term therapy.

Examined participant perceptions of therapy by comparing long- with short-term therapy dyads. 30 therapy dyads from 3 large midwestern community mental health centers were included. Therapists and clients (20–49 yrs old) completed the Therapy Session Report 4 times and the Survey of Interpersonal Values twice immediately following scheduled therapy sessions. Results indicate that therapists and clients in long-term therapy dyads were more phenomenologically congruent in their feelings toward psychotherapy and each other and in their perceptions of therapeutic goals and processes than were therapists and clients in short-term therapy dyads. Often these perceptions were shared at the very outset of therapy. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceleration of changes in session impact during contrasting time-limited psychotherapies.

Following the suggestion that therapeutic change is accelerated in time-limited psychotherapy, this study investigated the across-session patterns of session impact in the treatments of 117 depressed clients who were randomly allocated to 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) therapy. After each session, all clients completed the Session Evaluation Questionnaire and 75 of the clients completed the Session Impacts Scale. Session ratings indicated that sessions were perceived increasingly positively on most impact dimensions (e.g., session depth and smoothness, relationship with the therapist, feelings of understanding and problem solving, postsession positive mood) as treatment progressed. Early in treatment, PI therapy sessions were less smooth (i.e., more tense and uncomfortable) and less focused on problem solving, but PI sessions changed more rapidly than CB sessions on these dimensions, so that later in treatment, sessions of both treatments were equivalently positive. In both treatments, the trend toward more positive sessions was more rapid (i.e., the across-session slope was steeper) in 8-session treatments than in 16 session treatments. Such accelerated changes in session impact may reflect the suggested acceleration … (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of causal attributions in dynamic self-regulation and goal processes.

A dynamic model of self-regulation and goal process was tested with student survey responses and exam scores over successive performance episodes. A model of goal processes related to performance within episodes was developed and supported in both instances. The locus and stability dimensions of causal attributions were examined as moderators of how self-regulation and goal processes develop over time in a between-episode model. Results of the between-episode model showed stability attributions as moderating goal achievement–self-efficacy change relations following both episodes, whereas the locus attributions moderated the goal achievement–satisfaction relationship only after the first exam. Findings were discussed in terms of the evolution of goal processes over time and the use of attributional framing interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value and use of interpretation in play therapy.

Irrespective of the therapist's theoretical orientation, interpretation can be a very powerful tool within play therapy, supporting the essential change processes delimited by S. Shirk and R. Russell (1996). However, several issues often interfere with play therapists' optimal use of interpretation. One is the sense of conflict many child-centered therapists experience because they view interpretation as overly directive and inconsistent with their desire to follow the child's lead and pace in session. Second, the lack of a well-organized, stepwise model of interpretation formulation and delivery makes it difficult for therapists to be consistent in its use. Third, the absence of a solid understanding of how interpretation supports the therapy process reduces therapists' tendency to use this highly flexible technique. This article attempts to provide a model of interpretation that addresses each of these issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CONSCOM: An OO Construction Scheduling and Change Management System

In a companion paper, an object-oriented (OO) information model was presented for construction scheduling, cost optimization, and change order management (CONSCOM), based on the creation of a domain-specific development framework. The framework architecture is developed using generic software design elements, called patterns, which provide effective low-level solutions for creating, organizing, and maintaining objects. The OO model has been implemented in a prototype software system for management of construction projects, called CONSCOM, using the Microsoft Foundation Class library in Visual C++. CONSCOM is particularly suitable for highway construction change order management. It can be used by the owner as an intelligent decision support system in schedule reviews, progress monitoring, and cost-time trade-off analysis for change order approval. The OO information model for construction scheduling cost management can be integrated into a concurrent engineering model for the architecture, engineering, and construction industry.     

One and the same pathogenetic process for cognitive therapy and experiential dynamic therapy?

Cognitive therapy and experiential dynamic therapy show quite many similarities but they diverge in their initial approach to the patient (aiming respectively at cognitions and at emotions) and in their assumptions about core pathogenetic processes. According to cognitive therapy patients suffer because of a negative unrealistic inner representation of self and world, whereas for experiential dynamic therapy problems arise from conflictual experience and expression of healthy feelings and needs. A synthetic model of the pathogenetic core process, embracing both a conflict about healthy needs and emotions, and a negative self-image, is outlined and discussed. In particular, the model's congruence with new knowledge emerging from infant and attachment research, emotion theory, and cognitive neurosciences is illustrated. Assuming an identity of their basic pathogenetic theory, the two therapies can be thought of as two initially different approaches, the one focusing more on cognitions, the other on emotions, but converging toward the change of a common pathogenetic core. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reproductive toxicity testing of pharmaceutical compounds to support the inclusion of women in clinical trials

1. Researchers have identified five stages of change and the 10 experiential and behavioral processes most effective in helping people move from one stage to the next. This model is referred to as "transtheoretical" because it encompasses many theories of behavior change. 2. Each stage of change tends to be characterized by the use of specific processes. Experiential strategies are used most frequently by individuals in the contemplation and preparation stages of change. Behavioral processes are used most frequently by individuals in the action and maintenance stages. 3. The transtheoretical model assists providers in developing interventions targeted not only for employees who are prepared to take action, but also for the majority of the population who are not yet intending to change their behavior, or for those who are only considering a lifestyle change. 4. Using this information, the occupational health nurse can design specific interventions targeted to an individual's current stage of change, with the potential to accelerate the employee's progress toward increasing the adoption and maintenance of the desired behavior.