The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders.

This study examined the relationship of early alliance ruptures and their resolution to process and outcome in a sample of 128 patients randomly assigned to 1 of 3 time-limited psychotherapies for personality disorders: cognitive–behavioral therapy, brief relational therapy, or short-term dynamic psychotherapy. Rupture intensity and resolution were assessed by patient- and therapist-report after each of the first 6 sessions. Results indicated that lower rupture intensity and higher rupture resolution were associated with better ratings of the alliance and session quality. Lower rupture intensity also predicted good outcome on measures of interpersonal functioning, while higher rupture resolution predicted better retention. Patients reported fewer ruptures than did therapists. In addition, fewer ruptures were reported in cognitive–behavioral therapy than in the other treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

基于矩阵重构的DOA阵元位置误差校正方法

针对阵元位置误差引起阵列流型出现一定的偏差和扰动,从而导致多重信号分类(MU-SIC)算法估计波达方向(DOA)性能下降的问题,本文在Toeplitz预处理算法的基础上,提出了一种基于矩阵重构的阵元误差校正算法.所提算法首先对有阵列位置误差的协方差矩阵进行预处理,恢复理想情况下协方差矩阵的Toeplitz结构,然后利用核范数优化算法构造凸优化函数,对处理后的协方差矩阵进行降噪,同时保证信号和噪声子空间的正确划分,最后利用MUSIC算法进行DOA估计.计算机仿真和实验分析表明,所提算法有效改善了存在阵元位置误差时MUSIC算法的角度分辨能力,而且减少了由快拍数不足带来的影响,提高了估计精度.     

Evaluating an alliance-focused treatment for personality disorders.

This paper presents a study with the aim of evaluating the relative efficacy of an alliance-focused treatment, brief relational therapy, in comparison to a short-term dynamic therapy and a cognitive-behavioral therapy on a sample of highly comorbid personality disordered patients. Results indicated that the three treatments were equally effective on standard statistical analyses of change, including those conducted on repeated measures and residual gain scores. Some significant differences were indicated regarding clinically significant change and reliable change, favoring the brief relational and cognitive-behavioral models. There was also a significant difference regarding dropout rates, favoring brief relational therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repairing alliance ruptures.

In this article, we review the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture-repair episodes and treatment outcome (r = .24, z = 3.06, 95% CI [.09, .39], p = .002, k = 3, N = 148). The second meta-analysis reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles (prepost r = .65, z = 5.56, 95% CI [.46, .78], p k = 8, N = 376). Both meta-analyses provided promising evidence regarding the relevance of alliance rupture-repair processes to therapeutic outcome. The limitations of the research reviewed are discussed as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Patient pretreatment interpersonal problems and therapeutic alliance in short-term cognitive therapy.

The growing consensus regarding the importance of interpersonal process in psychotherapy, as well as of interpersonal factors in self-definition, has underscored the relevance of examining patient interpersonal functioning as it relates to the development of the therapeutic alliance. This study examined the relationship of patient pretreatment interpersonal functioning, as measured by the Inventory of Interpersonal Problems and the Millon Clinical Multiaxial Inventory (MCMI), to the therapeutic alliance, as measured early in treatment by a patient self-report version of the Working Alliance Inventory. On the basis of an interpersonal circumplex interpretation, the results generally indicated that friendly-submissive interpersonal problems were positively related to the development of aspects of the alliance and that hostile-dominant problems were negatively related to the development of aspects of the alliance early in short-term cognitive therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking in-session change to overall outcome in short-term cognitive therapy.

Validated suboutcome measures that represent intermediate links between more molecular in-session changes and ultimate outcome. The present study involved the collection of pre- and postsession ratings from 53 patients in a 20-session protocol of cognitive therapy, which yielded anxiety shift, depression shift, cognitive shift, optimism shift, and therapeutic alliance. From a series of regression analyses of repeated measures with a generalized estimating equations approach, results regarding the predictive relationship of these variables to a number of patient and therapist-rated outcome criterion variables indicated that change in cognition and quality of the therapeutic alliance were the strongest predictors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment: Can some interpersonalists be more different than alike? Implications for method in practice and research.

The paper provides a commentary on two qualitative case studies of therapist use of immediacy in two brief interpersonal psychotherapies involving two senior White male clinicians and two young female patients with diverse identities (Hill et al., 2008; see record 2008-13167-001; Kaspar, Hill, & Kivlighan, 2008; see record 2008-13167-002). The commentary proposes an alternative interpersonal model by which the data collected could be examined. The model suggests that therapist and patient interact in a complex process of power and affection toward mutual recognition, which is further shaped by their respective gender and cultural identities. Several implications for the study of the psychotherapeutic situation based on this interpersonal model are presented, including using observer-based measures that can assess power plays and therapist immediate awareness, as well as another qualitative strategy that would capture the richness of clinical process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal change in brief supportive psychotherapy

The pathogenesis, treatment, and outcomes of type 1 and type 2 diabetes differ. Current surveys derive population-based estimates of diabetes prevalence by type using limited clinical information and applying classification rules developed in white populations. How well these rules perform when deriving similar estimates in African American populations is unknown. For this study, data were collected on a group of African Americans with diabetes who enrolled at the Diabetes Unit of Grady Memorial Hospital in Atlanta, Georgia, from April 16, 1991, to November 1, 1996. The data were used to develop some simple classification rules for African Americans based on a classification tree and a logistic regression model. Sensitivities and specificities, in which fasting C-peptide was used as the gold standard, were determined for these rules and for two current rules developed in mostly white, non-Hispanic populations. Rules that yielded precise (minimum variance unbiased) estimates of the prevalence of type 1 diabetes were preferred. The authors found that a rule based on the logistic regression model was best for estimating type 1 prevalences ranging from 1% to 17%. They concluded that simple classification rules can be used to estimate prevalence of diabetes by type in African American populations and that the optimal rule differs somewhat from the current rules.     

带L形横撑的大跨CFST桁式拱桥稳定性分析

为研究新型L形横撑在大跨度钢管混凝土(CFST)桁式拱桥稳定中的有效性,以合江三桥为工程背景,采用数值计算和理论分析相结合的方式对其受力性能和稳定性进行比较分析,并利用正交试验和方差分析方法对L形横撑在大跨度CFST桁式拱桥稳定中的显著性进行了检验。结果表明：①对于L形拓扑横撑类型,当K形斜撑设置在主拱肋上弦且靠近拱脚一侧时,主拱的稳定性最好;②与常用的K形、X形和米字形横撑相比,L形横撑对主拱最大轴力、最大面内弯矩、最大面外弯矩、最大应力和竖向变形的影响均较小,仅对主拱水平变形有一定影响;③当各参数在合理的取值范围内时,使用L形横撑代替常用的K形、X形或米字形横撑,不会显著降低大跨度CFST桁式拱桥的分支点和极值点稳定性,工程师在该类拱桥的稳定设计中可以放心选用。     

Evaluating alliance-focused intervention for potential treatment failures: A feasibility study and descriptive analysis.

This article describes a pilot study evaluating the feasibility of an approach developed to test the efficacy of a therapeutic intervention (brief relational therapy) for patients with whom it is difficult to establish a therapeutic alliance. In the first phase of the study, 60 patients were randomly assigned to either short-term dynamic therapy (STDP) or short-term cognitive therapy (CBT), and their progress in the first eight sessions of treatment was monitored. On the basis of a number of empirically derived criteria, 18 potential treatment failures were identified. In the second phase of the study, these identified patients were offered the option of being reassigned to another treatment. The 10 patients who agreed to switch treatments were reassigned either to the alliance-focused treatment, referred to as brief relational therapy (BRT), or a control condition. For patients coming from CBT, the control condition was STDP. For patients coming from STDP, the control condition was CBT. The results provide preliminary evidence supporting the potential value of BRT as an intervention that is useful in the context of alliance ruptures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)