Beyond brand names of psychotherapy: Identifying empirically supported change processes.

There is considerable debate about which empirical research methods best advance clinical outcomes in psychotherapy. The prevailing tendency has been to test treatment packages using randomized, controlled clinical trials. Recently, focus has shifted to considering how studying the process of change in naturalistic treatments can be a useful complement to controlled trials. Clinicians self-identifying as psychodynamic treated 17 panic disorder patients in naturalistic psychotherapy for an average of 21 sessions. Patients achieved statistically significant reductions in symptoms across all domains. Rates of remission and clinically significant change as well as effect sizes were commensurate with those of empirically supported therapies for panic disorder. Treatment gains were maintained at 6-month follow-up. Intensive analysis of the process of the treatments revealed that integrative elements characterized the treatments: Adherence to cognitive-behavioral process was most characteristic, adherence to interpersonal and psychodynamic process, however, was most predictive of positive outcome. Specific process predictors of outcome were identified using the Psychotherapy Process Q-Set. These findings demonstrate how process research can be used to empirically validate change processes in naturalistic treatments as opposed to treatment packages in controlled trials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring psychotherapy process with the Adolescent Psychotherapy Q-set (APQ): Development and applications for training.

This study presents the initial findings from the development of an adolescent version of the Child Psychotherapy Q-set (CPQ, Schneider, 2003). The CPQ is a psychotherapy process measure that utilizes Q-methodology to define psychotherapy process in an empirical form suitable for quantitative analysis. This new instrument, the Adolescent Psychotherapy Process Q-set (APQ), was developed to be pantheoretical in assessing the process of psychotherapy with adolescents. Panels of "expert" psychodynamic (PD) and cognitive-behavioral (CB) theoreticians and practitioners (N = 22) rated the 100 APQ items, and these ratings were factor analyzed to develop general prototypes of ideally conducted therapy for each respective orientation. Agreement between and amongst the experts was examined; in order to determine the reliability of, and shared variance between, each prototype. Coefficient alpha reliabilities were high for both PD (.93) and CB (.94) orientations. A significant correlation between the factor scores of each prototype (r = .31; p ≤ .01) was found. In a second study, a case example is provided to demonstrate the applications of the APQ and the prototypes in psychotherapy training and supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of Collaborative Problem Solving in Affectively Dysregulated Children With Oppositional-Defiant Disorder: Initial Findings.

Oppositional-defiant disorder (ODD) refers to a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures. Research has shown that children with ODD and comorbid mood disorders may be at particular risk for long-term adverse outcomes, including conduct disorder. In this study, the authors examined the effectiveness of a cognitive-behavioral model of intervention--called collaborative problem solving (CPS)--in comparison with parent training (PT) in 47 affectively dysregulated children with ODD. Results indicate that CPS produced significant improvements across multiple domains of functioning at posttreatment and at 4-month follow-up. These improvements were in all instances equivalent, and in many instances superior, to the improvements produced by PT. Implications of these findings for further research on and treatment selection in children with ODD are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using psychodynamic, cognitive behavioral, and control mastery prototypes to predict change: A new look at an old paradigm for long-term single-case research.

This article illustrates a method of testing models of change in individual long-term psychotherapy cases. A depressed client was treated with 208 sessions of control mastery therapy (CMT), an unmanualized approach that integrates elements of psychodynamic therapy (PDT) and cognitive behavioral therapy (CBT). Panels of experts developed prototypes of ideal PDT, CBT, and CMT process using the Psychotherapy Process Q-set (PQS; J. S. Ablon & E. E. Jones, 1999; E. E. Jones, L. A. Parke, & S. Pulos, 1992; E. E. Jones & S. M. Pulos, 1993). Independent observers rated every 4th session (N = 53) with the PQS. Using correlations between ideal and actual PQS ratings followed by paired t tests, the authors compared adherence to the CMT prototype with adherence to plausible alternative models advocated by the PDT and CBT experts. Bivariate time series analyses determined whether prototype adherence predicted an estimated index of symptom change. Results showed that the therapist's behavior was most consistent with the CMT prototype and that this aspect of the CMT prototype along with particular aspects of the other prototypes influenced estimated symptom change. The results, which replicate and extend earlier findings, support the validity of this approach to studying long-term therapies but also highlight its limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship among patient contemplation, early alliance, and continuation in psychotherapy.

The present study examined the relationship among contemplation stage of readiness to change, formation of an early therapeutic alliance, and psychological distress following the first session of psychotherapy. Significant correlations between the contemplation scores and the therapeutic alliance were found for patients in the contemplation stage. Although contemplation scores were not a factor in return for a second session of psychotherapy, the bond subscale of the alliance inventory did significantly contribute to whether patients returned for therapy. Patient psychological distress was not a significant factor in predicting the early alliance. Results indicate a need for further focus on contemplation with its inherent ambivalence, its relationship to alliance, and continuation in early psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalysis with avoidant personality disorder: A systematic case study.

This case study of process and outcome is based upon data obtained during a 5-year psychoanalysis of an adult male with avoidant personality disorder (AVPD). To date, no known systematic case studies, effectiveness studies, or randomized control trials exist for psychoanalysis in the treatment of AVPD. In this study, self-reported symptoms and observer-rated personality disorder (PD), global functioning, object relations, and psychological health were gathered at intake, after each year of treatment, and at 1-year follow-up. Process data was gathered to determine the extent to which the treatment adhered to prototypes of psychodynamic, cognitive-behavioral, and interpersonal therapy. Results indicated that the patient achieved clinically significant reductions in PD, symptom severity, and relational pathology. Gains were maintained at 1-year follow-up. The treatment significantly adhered to psychodynamic principles throughout, with some use of cognitive-behavioral and interpersonal principles in the third year of treatment. These findings warrant further investigation of psychoanalysis for AVPD and demonstrate the usefulness of assessing multiple domains of patient functioning and treatment process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

'The Elephant Man' as 'self' and 'other': the psycho-social costs of a misdiagnosis

'The Elephant Man's Disease' acquired enormous notoriety through the portrayals of the life of Joseph Merrick, 'The Elephant Man', on American stage, screen and television. These portrayals, inspired by Ashley Montagu's book, The Elephant Man (1971) parleyed the designation of Merrick's condition into a household phrase, a metaphor for the grimmest extreme of ugliness. This paper explores the impact of 'The Elephant Man' as the chief referent and role model for persons who believed they shared the condition of neurofibromatosis 1, a neurological genetic disorder, which was erroneously believed at the time his story was popularized to have affected Joseph Merrick. Data were gathered through interviews with sixty affected individuals and families about their responses to the media representations of 'The Elephant Man'. Informants were recruited from three NF Support Groups and two urban hospital caseloads in Northern California.     

Ideal control mastery technique correlates with change in a single case.

The authors present a study of a 16-session psychotherapy conducted from the perspective of control mastery theory (CMT), a cognitive-psychodynamic-humanistic theory of psychopathology and psychotherapy process. Following every session, measures of the client's in-session affect, the therapist's in-session techniques, therapeutic alliance, and session outcome were obtained. The authors developed a quantitative prototype of ideal CMT technique for this case and determined how closely each session's technique matched the prototype. The closer the therapist's in-session technique was to ideal CMT technique, the better the client's in-session affect and the better the session outcome, Providing ideal CMT technique was associated with better session outcome, even after controlling for the passage of time, in-session affect, and therapeutic alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)