Galvanic skin response as a measure of patient's reaction to therapist's permissiveness.

"Frequency of a patient's galvanic skin response is shown to be inversely related to the judged permissiveness of the therapist during a series of 42 hours of psychotherapy. The GSR is interpreted as a measure of the anxiety of the patient, or his 'mobilization' against any cue threatening punishment by the therapist, such as any cue which the patient has learned to perceive as evidence of low esteem. This anxiety presumably motivates varying subtle forms of resistance and defense against the feared punishment. Several alternative interpretations of the relation between permissiveness and GSR are rejected by various findings." GSR is related to the emotional significance of the patient's speech, as well as to the permissiveness of the therapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interaction rules and strategies in psychotherapy.

To examine the presence of interaction rules and strategies used in therapy, the verbal responses of therapists and clients in 26 actual psychotherapy cases were coded using the Interpersonal Communication Rating Scale (ICRS; S. R. Strong, H. Hills, C. Kilmartin, et al., 1988). The conditional response probabilities of these MRS codes were examined from a rules and strategies perspective according to procedures suggested by S. Duncan (1983). The results supported the presence for rules for both the client and the therapist, and these rules were found to involve complementary interactions. No support was found for the presence of strategies in the interactive behavior of either participant. Finally, there was no relation between the presence of rules and session evaluation. The results are discussed with respect to the definition of rules in counseling and the concept of complementarity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Test of the phase model of psychotherapy in a training clinic.

Recent publications suggest that psychotherapy models generated in outpatient settings do not fully generalize to the training clinic. A possible explanation for these findings is that the nature in which change occurs during psychotherapy may actually differ according to setting. To examine this possibility, the phase model of psychotherapy was tested in an outpatient training clinic. Results partially support the phase model, suggesting that the nature of change during effective psychotherapy within the training clinic setting does not differ from that in other outpatient settings. That is, clients who completed effective courses of treatment in the training clinic environment generally experience an improvement in subjective well-being before evidencing a reduction in symptom distress. Obtaining success in role performances (i.e., work or school) appears to emerge last. Practitioners may enhance treatment outcomes by targeting interventions that are congruent with the phase of the individual client presenting for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating an emotion-focused approach to treatment into psychotherapy integration.

A truly integrative approach to treatment needs to combine methods of working with affect, cognition, and behavior, but established principles of affective change are sorely missing in the literature. Emotion theory and research suggests that emotion awareness, regulation, and transformation are 3 major principles of emotional change. In addition to these principles, 3 general factors that help guide integrative intervention in their use are discussed. Intervention should be guided by the source of the affect involved in the client's distress (amygdala- or prefrontal cortex-generated emotion), the type of affect dysregulation involved (too much or too little emotion), and the type of change process to be used (quick change to improve coping or longer change to restructure character). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance and commitment therapy for smoking cessation: A preliminary study of its effectiveness in comparison with cognitive behavioral therapy.

This controlled preliminary trial determined the feasibility and initial effectiveness of a promising behavioral intervention for smoking: Acceptance and Commitment Therapy (ACT). In a quasi-experimental design, the ACT intervention condition used metaphors and experiential exercises focused on personal values to motivate quitting smoking and enhancing the willingness to experience internal cues to smoke (e.g., urges) and abstinence-related internal distress. The comparison condition was cognitive behavioral therapy (CBT)—the current standard in behavioral intervention for smoking cessation. Each treatment was delivered in seven weekly 90-min sessions in a group format to 81 (43 in ACT; 38 in CBT) adult smokers. Results show that the ACT treatment was as feasible as the CBT treatment. They also demonstrate promising evidence of ACT’s effectiveness: 30.2% intent-to-treat biochemically-supported 30-day point prevalence at twelve month follow-up, compared with 13.2% in the CBT condition (odds ratio = 5.13; p = .02). Replication in a well-powered, randomized, controlled trial is now needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A contextual behavioral approach to the role of emotion in psychotherapy supervision.

As behavior therapy expands to address problems related to private events, appropriate methods of supervision must be developed to train individuals to work with the full range of human experience, using a behavioral model. The authors suggest that therapists’ in-session emotions are an important source of information about the impact of clients’ behavior on others. Contextual behavior therapists may enhance their effectiveness in meeting clients’ needs by attending to the therapist’s own emotional responses. This paper provides a contextual behavioral rationale for including a focus on emotion in supervision, with a four-phase model for shaping early trainees’ ability to use their emotional reactions to facilitate therapy in a coherent manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methods and mechanisms in the efficacy of psychodynamic psychotherapy.

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler summarized a large body of research that shows psychodynamic therapy to have a substantial effect size, comparable to that for many empirically supported treatments. This is an important finding, in part refuting the concerns raised by Bornstein (2001, 2002) regarding the future of psychodynamic approaches had there been no substantial changes in how practitioners and researchers approached the science to demonstrate efficacy. Further, Shedler showed that the efficacy of psychoanalytic psychotherapy is due to therapeutic methods commonly employed in cognitive behavior therapy (CBT), one of the most frequently cited empirically supported approaches for a wide range of psychological conditions. From a methodological perspective, there are some important limitations to the claim of psychodynamic psychotherapy’s comparable efficacy to other empirically supported approaches. (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)     

The efficacy of psychodynamic psychotherapy.

Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist immediacy in brief psychotherapy: Case study II.

Immediacy was examined in a 17-session case of brief therapy with a bright, articulate, inner-city, African American female client seeing an interpersonally oriented, White, male therapist. The main types of therapist immediacy were reinforcing the client for in-session behavior, inviting the client to collaborate, inquiring about client reactions to therapy, and reminding the client that it was okay to disagree with him. An in-depth qualitative examination of the seven most extensive/salient immediacy events revealed that therapist immediacy enabled the therapist and client to negotiate the relationship, helped the client express her immediate feelings to the therapist, helped the client open up to deeper exploration of concerns, and provided the client with a corrective relational experience. Implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples psychotherapy: A psychodynamic model.

Psychoanalytic assumptions and goals need not be viewed or approached from a purely individual analytic perspective. Families and especially marriages offer a unique opportunity for systems-oriented intervention to add therapeutic depth by addressing psychodynamic interactions in vivo. Doing so requires integration in therapy, as well as in theory, of the manner in which individual psychodynamics manifest in primary interpersonal systems. A model is presented which aims at translating and instilling a useful degree of analytic insight in members of marital or family systems. Insight into transferential distortions and behavior is facilitated by introducing the metaphor of unconscious "hopes" and "expectations" in the interactive contexts of conjoint and individual sessions. It is suggested that such an expansion of systems-oriented approaches is a crucial step in adding depth and durability to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helpful and hindering events in psychotherapy: A practice research network study.

This paper presents the findings of a psychotherapy process study conducted within the Pennsylvania Psychological Association Practice Research Network (PPA-PRN). The investigation was the product of a long-term collaborative effort, both in terms of the study design and implementation, between experienced clinicians of various theoretical orientations and full-time psychotherapy researchers. Based on a relatively large sample of clients seen in independent practice settings, close to 1,500 therapeutic events (described by clients and therapists as being particularly helpful or hindering) were collected. These events were coded by three independent observers using a therapy content analysis system. Among the findings, both clients and therapists perceived the fostering of self-awareness as being particularly helpful. The results also point to the importance of paying careful attention to the therapeutic alliance and other significant interpersonal relationships. The merits and difficulties of conducting scientifically rigorous and clinically relevant studies in naturalistic contexts are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist immediacy in brief psychotherapy: Case study I.

The authors examined immediacy (i.e., discussions about the here-and-now therapeutic relationship) in a 12-session case of individual interpersonal psychotherapy. Therapist immediacy during immediacy events most often focused on parallels between external relationships and the therapy relationship, encouraging expression of immediate feelings, processing termination, therapist expressing disappointment/sadness/hurt and inquiring about the client's reactions. Client involvement was slightly higher before and after than during immediacy events. On the positive side, therapist immediacy seemed to help the client express her immediate feelings about the therapist more openly, feel closer to the therapist, and become less defended. On the negative side, the client felt somewhat awkward and pressured when the therapist used immediacy. Limitations and implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model for teaching psychotherapy theory through an integrative structure.

This article discusses a model for teaching psychotherapy theory through an integrative structure from the start of graduate students' training. This model articulates an ordering structure for the reputed 400+ so-called "theories" of psychotherapy. The rationale for such a structure highlights one dimension among several--that is, the recognition that a vast majority of mental health practitioners describe their orientation as eclectic or integrative. Professionals in training are encouraged to use this structure as an organizing principle to create the underpinnings for future professional development. The structure informs all aspects of a graduate-level course, including its syllabus, the textbooks selected, the reader, learning objectives, and tools for learning outcome assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Women changing therapy: New assessments, values and strategies in feminist therapy.

Reviews the book, Women changing therapy: New assessments, values and strategies in feminist therapy edited by Joan Hamerman Robbins and Rachel Josefowitz Siegel (1985). The assertion has been made that women in general, and feminist therapists in particular, have impacted on the theory, research, and practice of psychotherapy. Women Changing Therapy is a compilation of articles designed to provide evidence for this assertion. The book grew out of the participation of a number of female therapists in the Women's Institutes of the American Orthopsychiatric Association and its breadth of topic areas addresses a wide range of issues in psychotherapy. The twenty articles are loosely arranged in three thematical areas: Women's Issues: New Assessments, Valuing Our Selves, and New Strategies in Feminist Therapy. This volume is a patchwork of sorts which attempts to detail the effect women have had on the psychotherapeutic process. While it is uneven in places, its blending and contrasting sets it up as a good reference piece and/or volume for the uninitiated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Wish and overgeneralization model for psychotherapy integration.

This article introduces a clinical Wish and Overgeneralization (W&O) Model for dynamic, cognitive and narrative procedures, supported by a metasynthetic study linking cognitive overgeneralization and psychodynamic transference and determining it to be the antithesis of wish – a Luborsky (1988a) transference component. The model emphasizes symptoms and patient core themes: The therapist interprets the conflict between wish and overgeneralization, indicating how it confirms the overgeneralization and sabotages the wish. He helps the patient identify unique outcomes (White & Epston, 1990) for formulation of positive self-statements (Meichenbaum, 1994, 1985, 1977) and proposes an alternative narrative based on a coherent experience. This integrative therapy thus combines insight-oriented and coping strategies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

FACT: The Utility of an Integration of Functional Analytic Psychotherapy and Acceptance and Commitment Therapy to Alleviate Human Suffering.

Functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT) are 2 contemporary behavioral therapies designed to address complex clinical problems. The 2 therapies are described, and areas of convergence and divergence are discussed. A new psychotherapy integrating the 2-functional-analytic acceptance and commitment therapy (FACT)-is defined. It is argued that FACT enhances the utility of FAP or ACT alone by expanding the target of therapy to include both interpersonal and intrapersonal client behaviors. In addition, the authors posit that the intervention technologies used in FAP and ACT enhance one another. The authors also address the following topics: populations for whom FACT would be most beneficial, supervision and training issues, current empirical research on FACT, and FACT's applicability and generalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applications of the psychotherapy phase model to clinically significant deterioration.

While previous research on deterioration has focused on identifying individuals at risk for negative outcomes, little is known about the nature or pattern by which deterioration occurs. The problem of deterioration is especially salient in training clinics; a setting in which higher deterioration rates have been reported. Two studies were designed to test the applicability of the phase model to deterioration in a training clinic and to replicate the model with a training clinic referral-base sample. In Study 1, the course of therapy was monitored for 135 clients. For the 38 clients who deteriorated during therapy, a model where increased symptoms (demediation) reliably preceded both decreased functioning (dehabilitation) and decreased well-being (demoralization) was found. In Study 2, the same three phases were prospectively monitored for 914 undergraduate students on a weekly basis throughout a single semester. For the 158 individuals who deteriorated during this time, a model where demediation reliably preceded dehabilitation, which preceded demoralization was found. These results have clinical implications for the use of tailored intervention strategies focusing on the deterioration phases. (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)     

Reinforcement and nonreinforcement in Rogerian psychotherapy.

Excerpts from tape recordings of a single, long-term, successful therapy case handled by Rogers were analyzed to evaluate the adequacy of the client-centered view that empathy, warmth, and directiveness are offered throughout therapy in a manner not contingent upon the patient's behavior. Findings indicate that the therapists respond in a significantly differential way to 5 of the 9 patient behavior classes studied. Concomitantly, significant increases in the emission rates of 4 of the 5 behavior classes were noted throughout therapy. Findings thus indicated significant reinforcement effects in the client-centered therapy. (34 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)