Varieties of transference patterns in psychotherapy

This investigation explored the nature of transference of interpersonal patterns in patients' psychotherapy narratives. The relation between interpersonal patterns with significant others in a patient's life and the pattern with the therapist early in treatment was examined. Cluster analysis was used to categorize similar relationships for each of 35 patients. Many patients revealed multiple interpersonal themes in their relationship narratives. Furthermore, these interpersonal themes correlated significantly with the interpersonal pattern extracted from narratives told about the therapist for many of the patients who discussed the therapeutic relationship during therapy. However, the interpersonal pattern evident in the relationship with the therapist was not necessarily the most pervasive pattern exhibited in the narratives about significant others.     

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)     

Short-term psychotherapy for perinatal loss.

Suggests that psychotherapy with victims of perinatal loss provides an opportunity to facilitate the mourning process as well as further resolution of long-standing conflicts in pregnancy and its tragic aftermath. Two cases illustrate psychotherapy for recent perinatal loss and for unresolved grief. While a psychodynamic orientation is used, it is argued that interpersonal resources and family styles of coping are important factors in the outcome of perinatal bereavement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical dilemmas in contemporary psychotherapy: The search for clinical wisdom.

Examines the concept of the clinical dilemma in the contemporary practice of psychotherapy. The notion of "dilemma management" by the psychotherapist is viewed as a ubiquitous phenomenon in the psychotherapeutic process. Dilemmas in a range of areas of clinical practice are discussed. These include (1) differing treatment modalities, such as insight-oriented psychotherapy, behavior therapy, marital and family therapy, and group therapy; (2) systemic issues such as spousal codependency and family homeostasis; (3) transference and countertransference; (4) therapeutic neutrality and management of the therapeutic boundary; and (5) psychological assessment and psychiatric diagnosis. Finally, observations are made about the interpersonal process of dilemma management in psychotherapy that models for patients an effective way of approaching the pervasive conflicts and dilemmas in their own lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in the perception of interpersonal relationships in successfully treated adolescent delinquent boys.

Successful psychotherapy with adolescent delinquent boys revealed significant improvement in the perception of interpersonal relationships on thematic stories to pictures selected to measure 3 areas of personality functioning (self-image, control of aggression, and attitude toward authority). People in the stories were seen as having more highly differentiated roles and relationships. These changes were highly correlated with improved academic performance (revealed on achievement tests) and improvement in overt behavior (reduction in antisocial behavior and better employment history). The results are consistent with many views regarding the nature of personality change in psychotherapy and strongly indicate that improvement in the perception of interpersonal relationships is associated with higher levels of overall performance and integration. Exactly how these changes are brought about during psychotherapy still remains to be explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Appraisal, coping, health status, and psychological symptoms.

Examined the relation between personality factors (mastery and interpersonal trust), primary appraisal (the stakes a person has in a stressful encounter), secondary appraisal (options for coping), 8 forms of problem- and emotion-focused coping, and somatic health status and psychological symptoms among 75 married couples (aged 26–54 yrs). Measures included the Hopkins Symptom Checklist, Rosenberg Self-Esteem Scale, and items from the Rotter Trust Scale. It was assumed that appraisal and coping processes should be characterized by a moderate degree of stability across stressful encounters for them to have an effect on somatic health status and psychological symptoms. These processes were assessed in 5 stressful situations that Ss experienced in their day-to-day lives. Certain processes (e.g., secondary appraisal) were highly variable, whereas others (e.g., emotion-focused forms of coping) were moderately stable. Mastery and interpersonal trust, primary appraisal, and coping variables (aggregated over 5 occasions) explained a significant amount of the variance in psychological symptoms but not somatic health status. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in positive quality of life over the course of psychotherapy.

The objective of this study was to examine patients' reports of positive quality of life over the course of multiple forms of psychotherapy and disorders. Data from 5 studies using a common assessment battery were pooled to evaluate the magnitude of change in positive quality of life and explore the relation of change in positive quality of life to change in symptoms and how these relations vary by disorder. Positive quality of life was measured at intake, termination, and during 2 posttreatment visits 6 and 12 months following termination. Results revealed that positive quality of life improved moderately over the course of psychotherapy and was sustained through follow-up. Levels of positive quality of life and the degree of change in positive quality of life varied considerably by disorder. There were also moderately sized correlations between changes in positive quality of life and changes in symptomatic response and interpersonal functioning from intake to termination. Implications of the findings for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resolving interpersonal conflicts: An analysis of stylistic consistency.

In three experiments, we examined people's consistency in their styles of resolving interpersonal conflicts. In Experiment 1, 40 Yale undergraduates described recent significant interpersonal conflicts with a same-sex peer, an opposite-sex peer, and a parent, and their methods of resolving these conflicts. They then rated the extent to which each of seven styles of conflict resolution characterized their actual and ideal styles of conflict resolution. In Experiment 2, 40 Yale summer school subjects again described and rated their own methods for resolving recent significant interpersonal conflicts with a parent, a teacher, a roommate, and a romantic partner. They also rated styles of conflict resolution for hypothetical conflicts involving these same significant others. In Experiment 3, 40 Yale undergraduates rated actual and ideal styles of conflict resolution as they pertained to both sides of two real conflicts: one regarding a contract dispute between Yale University and Local 34, the union for clerical and technical workers, and the other between the United States and the Soviet Union over arms negotiations. Strong consistencies in styles of conflict resolution were observed within individuals across various interpersonal conflicts, and at the same time widespread differences were observed across individuals in preferred styles of conflict resolution. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Once upon a time there was a schizophrenic

A series of 4 schizophrenic patients is described. In 2 it was unequivocally shown that acute outbreaks of "positive" symptoms were expressions of intrapsychic conflicts and in 1, the result of a therapist's error. In the first case, when the conflict was resolved, symptoms disappeared. 2 other cases were in the chronic phase. In both, long-term dynamically oriented psychotherapy resulted in reappearance of "lost" cognitive and affective functions. Thus, "negative" symptoms (so-called post-psychotic defects) are amenable to psychotherapy and potentially reversible. Concern is expressed about the exclusive biological approach to the understanding and treatment of schizophrenia.     

Social problem solving and depressive symptoms over time: A randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy.

Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy (Kocsis et al., 2009). Method: Participants with chronic depression (n = 491) received cognitive-behavioral analysis system of psychotherapy (CBASP; McCullough, 2000), which emphasizes interpersonal problem solving, plus medication; brief supportive psychotherapy (BSP) plus medication; or medication alone for 12 weeks. Results: CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. Conclusions: It does not appear that improved social problem solving is a mechanism that uniquely distinguishes CBASP from other treatment approaches. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpersonal psychotherapy with men who experience gender role conflict.

Although research on men's gender role conflict reveals that it adversely affects men's psychological health and interpersonal relationships, psychotherapists typically underuse knowledge of masculine gender roles in psychological assessment and treatment. Interpersonal psychotherapy is proposed as a useful framework for working with men whose rigid enactment of traditional male gender roles leads to intrapersonal and interpersonal conflict (i.e., gender role conflict). Thus, this article integrates knowledge of male gender role conflict and interpersonal psychotherapy to examine issues that men who experience gender role conflict bring to their important interpersonal relationships and the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lester Bernard Luborsky (1920–2009).

The field of psychotherapy research has lost one of its founding fathers. Lester Bernard Luborsky, born in Philadelphia on May 15, 1920, to Meyer and Celia Luborsky, immigrants from Eastern Europe, died on October 22, 2009. Lester Luborsky is best known as one of the pioneers of empirical research on psychodynamic psychotherapy. Indeed, he operationalized many of its concepts. His core conflictual relationship theme (CCRT) method was a breakthrough in the formalization of clinical psychodynamic concepts (Luborsky & Crits-Christoph, 1998, Understanding Transference: The Core Conflictual Relationship Theme Method, APA Books). Until the end of his life, Lester was a strong believer that psychotherapy is effective and that different psychotherapies are equally effective (a belief known as the “dodo bird verdict”). On the basis of a qualitative review of about a hundred comparative treatment studies, Luborsky, Singer, and Luborsky (1975, Archives of General Psychiatry, 32, 995–1008) first concluded that all psychotherapies were equally effective. Lester’s early contribution to psychosomatic research attempted to delineate the onset conditions for the appearance of both psychological and somatic symptoms. Using his symptom-context method, he compared the content of clients’ narratives preceding the appearance of symptoms in psychotherapy to sections of a psychotherapy session preceding a randomly selected control event. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Victim and perpetrator accounts of interpersonal conflict: Autobiographical narratives about anger.

Ss furnished autobiographical accounts of being angered (victim narratives) and of angering someone else (perpetrator narratives). The provoking behavior was generally portrayed by the perpetrator as meaningful and comprehensible, whereas the victim tended to depict it as arbitrary, gratuitous, or incomprehensible. Victim accounts portrayed the incident in a long-term context that carried lasting implications, especially of continuing harm, loss, and grievance. Perpetrator accounts tended to cast the incident as a closed, isolated incident that did not have lasting implications. Several findings fit a hypothesis that interpersonal conflicts may arise when a victim initially stifles anger and then finally responds to an accumulated series of provocations, whereas the perpetrator perceives only the single incident and regards the angry response as an unjustified overreaction. Victim and perpetrator roles are associated with different subjective interpretations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression.

The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Interpersonal psychotherapy of depression.

Reviews the book, Interpersonal psychotherapy of depression by Gerald L. Klerman, Myrna M. Weissman, Bruce J. Rounsaville, and Eve S. Chevron (1984). The authors state their intention to "describe the theoretical and empirical basis for interpersonal psychotherapy of depression," and also "offer a guide to the planning and conduct of the therapy." They do both, and waste no words. The book is organized into three parts. In the first part, the authors present an overview of the theory of the interpersonal approach of the use of interpersonal psychotherapy for depression, objectively offer both favorable and unfavorable findings from completed studies, and outline several studies in progress. The chapters in Part Two clarify how one conducts interpersonal therapy of depression. Part Three addresses the combination of psychotherapy with pharmacotherapy and the professional requirements of the therapist. This book is clearly written, well referenced, and easily understood by beginners who might not have the perspective, as well as by busy veterans who want to learn something new without plowing through mountains of theory and data. It would be useful for students in training, and extremely valuable to the legions of relatively inexperienced front-line mental health center therapists who are required to use time-limited approaches with depressed patients, often without having much structure for what they are doing. More experienced therapists who treat ambulatory depressed patients will add to their clinical skills and enjoy the process. The authors have turned their manual into a useful book that competes most favorably with other texts on short-term approaches to therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repetitive relationship themes in waking narratives and dreams.

The aims of the study were to see whether the core conflictual relationship theme (CCRT) measure can be reliably applied to dreams and to evaluate the degree to which the main components of the CCRT are present in both dreams and waking narratives in psychotherapy. For 13 psychoanalytic cases, the reliability of the CCRT was found to be good. Dreams and narratives were found to contain significant degrees of similarity in their CCRT components and a similar and high level of negativity in both dreams and waking narratives. The results support the concept of a central relationship pattern that can be expressed in common in both waking narratives and dreams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intimidades: confianza, gender, and hierarchy in the construction of Latino-Latina therapeutic relationships

The intimate nature of psychotherapy requires psychotherapists be educated to deal with the sexualization of the sharing of intimate feelings and interpersonal closeness. Latino cultures have relatively rigid sex role expectations and norms that privilege men at the expense of women. Experiences of emotional intimacy threaten this Latino cultural discourse of boundaries between men and women and may lead to impasses in therapy and enactments of pathogenic aspects of machismo and marianismo in the therapeutic relationship. Clinical vignettes illustrating the embeddedness of such gender discourses within therapeutic conversations between a Latino therapist and his Latina clients are presented, with discussion of how an intersubjective--relational approach can be used to deconstruct oppressive machista metaphors and cultural narratives and then aid in the coconstruction of reparative narratives within a context of intergender mutuality.     

Client attachment style and the psychotherapist's interpersonal stance.

Attachment style is proposed as an important client variable that psychotherapists may need to assess in order to tailor their interpersonal stance in psychotherapy. The authors draw on J. Bowlby's (1969, 1973, 1978) attachment theory and describe the therapeutic implications of 3 adult attachment styles: Anxious/Ambivalent, Avoidant, and Secure. Results are summarized from a psychotherapy research program, including the finding that attachment style was related to symptomatology and to therapists' perceptions of the therapeutic alliance. Case illustrations of clients displaying the 3 types of attachment style are presented to illustrate how therapists can productively alter their interpersonal stance to enhance treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal complementarity and the therapeutic alliance: A study of relationship in psychotherapy.

Examined the relationship between the therapeutic alliance and interpersonal complementarity during the early stage of psychotherapy. 36 pairs of patients (aged 18–57 yrs) and therapists from 14 outpatient settings recorded their perceptions of their therapeutic alliance, using a working alliance inventory, and rated each other's therapy behaviors on the Checklist of Interpersonal Transactions. There were positive associations between patient–therapist interpersonal complementarity and both patients' and therapists' perceptions of the alliance. The more extreme/abnormal the patient's interpersonal behavior, the more both patient and therapist perceived a less positive working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)