Adult Psychotherapy Research Articles

Outpatient Psychotherapy for Adults with High-Functioning Autism Spectrum Condition: Utilization, Treatment Satisfaction, and Preferred Modifications

Many adults with autism spectrum condition (ASC) desire outpatient psychotherapy (PT). This study compared reasons for seeking PT, experiences with PT, and modifications preferred with respect to PT of individuals with ASC to non-autistic individuals with depression (MDD). Furthermore, factors predictive for treatment satisfaction were identified in individuals with ASC. A total of 262 adults with ASC without intellectual impairment and 304 non-autistic controls with MDD were surveyed. In this pilot study both groups predominantly sought treatment for depressiveness. A low level of expertise with autism was the main reason for being declined by therapists and a contributing factor to the overall treatment dissatisfaction of patients with ASC. ASC patients desire adjustments such as written communication, and clearly structured sessions.

Psychoanalytic Psychotherapy for Hikikomori Young Adults and Adolescents

A hikikomori is a child, an adolescent or a young adult who voluntarily retreats into his own home for long periods, not showing evident signs of psychological distress or overt mental disorder. This phenomenon was first described in Japan, but several research studies show that it is spreading in many countries around the world. The author hypothesizes that the decision to become a hikikomori is made by the person in an attempt to find a solution to difficulties in relationships with himself and with others. The choice of reclusion rapidly becomes a trap: in this condition the individual is imprisoned in complex functions of the mind which curb and restrict independence and personal autonomy. This is owing to the fact that, with the withdrawal, a pathological personality organization, formed during the years of early infancy, gradually takes control of the internal world, pushing towards anti‐developmental mental states and behaviours. The paper continues with some reflections on individual treatment with psychoanalytic psychotherapy of adolescents and young adults in a state of acute social withdrawal. The reference model used is John Steiner's notion of ‘psychic retreat’. A description of a four‐year treatment completes the paper, allowing for further clinical reflections.

Humor Associated With Positive Outcomes in Individual Psychotherapy.

Considerable anecdotal evidence points to the usefulness of humor in the therapeutic process, but empirical evidence is lacking. The purpose of this study, conducted in Belgium, was to search for an association between humor and therapy outcomes in a population of 110 adult psychotherapy clients who attended at least 10 therapy sessions. Clients and their therapist evaluated the frequency and intensity of humorous events, as well as therapy effectiveness, therapeutic alliance, perceived hope, and pleasure in participating in therapy sessions. A strong positive correlation was observed between humor and therapy effectiveness, from both client (rs=0.40; p<0.001) and therapist perspectives (rs=0.37; p<0.001). The link between humor and therapy effectiveness remained significant in subgroups of clients with more severe illness, although these clients reported less humor in their therapy sessions. Further research is needed to determine whether humor enhances outcomes or whether positive outcomes trigger occurrence of humor.

Specialized psychotherapies for adults with borderline personality disorder: A systematic review and meta-analysis.

Objective:Borderline personality disorder affects up to 2% of the population and is associated with poor functioning, low quality of life and increased mortality. Psychotherapy is the treatment of choice, but it is unclear whether specialized psychotherapies (dialectical behavior therapy, mentalization-based treatment, transference-focused therapy and schema therapy) are more effective than non-specialized approaches (e.g. protocolized psychological treatment, general psychiatric management). The aim of this systematic review is to investigate the effectiveness of these psychotherapies.Methods:PubMed, PsycINFO, CINAHL, EMBASE and CENTRAL were searched from inception to November 2017. Included randomized controlled trials were assessed on risk of bias and outcomes were meta-analyzed. Confidence in the results was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results:A total of 20 studies with 1375 participants were included. Specialized psychotherapies, when compared to treatment as usual or community treatment by experts, were associated with a medium effect based on moderate quality evidence on overall borderline personality disorder severity (standardized mean difference = –0.59 [95% confidence interval: –0.90, –0.28]), and dialectical behavior therapy, when compared to treatment as usual, with a small to medium effect on self-injury (standardized mean difference = –0.40 [95% confidence interval: –0.66, –0.13]). Other effect estimates were often inconclusive, mostly due to imprecision.Conclusion:There is moderate quality evidence that specialized psychotherapies are effective in reducing overall borderline personality disorder severity. However, further research should identify which patient groups profit most of the specialized therapies.

The quality of randomized controlled trials of psychotherapy for eating disorders.

We investigated the quality of randomized controlled trials (RCTs) that included direct comparisons of psychotherapy for adults with an eating disorder (ED). Thirty-five direct comparison RCTs of psychotherapy for adults diagnosed with an ED were rated using the Randomized Controlled Trials Psychotherapy Quality Rating Scale (RCT-PQRS). The mean total RCT-PQRS score (mean=28.26; SD=7.04) was in line with those that were reported for RCTs of psychotherapy for depression and anxiety disorders. Several standards of quality were unfulfilled by over half of the RCTs of treatment for EDs, including therapist supervision while treatment was being provided (62.9% unfulfilled); outcome assessment performed by raters blind to treatment group/condition (54% unfulfilled); and adequate sample size (66% unfulfilled). More recent RCTs were of higher quality, and higher quality was moderately associated with lower effect sizes. To improve the quality of RCTs of psychotherapy of EDs, we recommend that researchers address the quality criteria listed in the RCT-PQRS. Psychotherapy trials should be registered, have a published protocol, and be reported following the Consolidated Standards of Reporting Trials guidelines. Authors should take into account the quality of the research when using that research to inform ED treatment guidelines.

Psychotherapy for eating disorders: A meta-analysis of direct comparisons

Objective: We conducted a meta-analysis of randomized controlled trials (RCTs) of bona fide psychotherapy for adults with eating disorders (EDs). Method: Thirty-five RCTs with 54 direct comparisons were included. The majority of RCTs included participants with bulimia nervosa and/or binge-ED, while only two RCTs included participants with anorexia nervosa, and three RCTs included participants with an ED not otherwise specified. Results: There was a clear advantage of bona fide psychotherapy over wait-list controls. Bona fide psychotherapy was superior to non-bona fide treatment; however, the majority of results were not stable. There were no significant differences between bona fide cognitive–behavioral therapy (CBT) and bona fide non-CBT, with the exception of bona fide CBT resulting in greater reductions in ED psychopathology assessed by the ED Examination, which primarily assesses maintenance factors according to the CBT model. Conclusions: Generally, the results indicate that any bona fide psychotherapy will be equally effective. While the number of trials remains modest, we hope that as more research becomes available, treatment guidelines can be updated, and more evidence-based treatment options will be available for treating EDs.

Unwanted Side Effects in Children and Youth Psychotherapy - Introduction and Recommendations

Psychotherapy in children and adolescents is effective, but unwanted effects can occur. Until now, psychotherapy research has neglected this important topic, although children and youths are in need of special protection. Unwanted effects caused by therapy are not systematically investigated and a corresponding conceptualization is missing. The aim of this article is to investigate whether the current classifications of unwanted effects of psychotherapy in adults are applicable to children and adolescents and to identify distinctive features. Furthermore, the adaptation of the Inventory for the Assessment of Negative Effects of Psychotherapy for children and adolescents (Children-INEP) is presented. Finally, steps for the information and prevention of unwanted, and negative effects of psychotherapy in children and adolescents are pointed out.

Psychological therapies for treatment-resistant depression in adults.

Psychological therapies for treatment-resistant depression in adults.

Patienthood meets parenthood: Widening the lens of adult psychotherapy.

Patienthood meets parenthood: Widening the lens of adult psychotherapy.

Journal Digest

Journal Digest

Advances in Psychotherapy for Depressed Older Adults.

We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings. Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.

The relationship between clients' depression etiological beliefs and psychotherapy orientation preferences, expectations, and credibility beliefs.

The purpose of this study was to examine the relationship between clients' etiological beliefs for depression and treatment preferences, credibility beliefs, and outcome expectations for five different depression treatments-behavioral activation, cognitive therapy, interpersonal psychotherapy, pharmacotherapy, and psychodynamic psychotherapy. Adult psychotherapy clients (N = 98) were asked to complete an online survey that included the Reasons for Depression Questionnaire, a brief description of each of the five treatment options, and credibility, expectancy, and preference questions for each option. On average, the participating clients rated pharmacotherapy as significantly less credible, having a lower likelihood of success, and being less preferred than the four types of psychotherapy. In general, interpersonal psychotherapy was also rated more negatively than the other types of psychotherapy. However, these findings depended somewhat on whether the participating client was personally experiencing depression. Credibility beliefs, outcome expectations, and preferences for pharmacotherapy were positively associated with biological beliefs for depression; however, the other hypothesized relationships between etiological beliefs and treatment attitudes were not supported. Although the study is limited based on the specific sample and treatment descriptions that were used, the results may still have implications for psychotherapy research, training, and practice. (PsycINFO Database Record

A randomised controlled trial of three psychological treatments for anorexia nervosa

There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy. A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25-40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment. Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up. The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) http://www.anzctr.org.au/.

Research evidence and the provision of long-term and open-ended psychotherapy and counselling in Germany

At first, a description of the recent situation and the historical development of long-term psychotherapy in Germany is presented. Public health services pay for a certain amount of sessions depending on the therapy method. In 1967, psychotherapy became a standard insurance achievement. This was supported by the convincing results of a comparative psychotherapy outcome study. In 1999, the law for psychotherapists was established allowing two professions (physicians and psychologists) to get payed for psychotherapy for adults. As scientific evidence had to be proven for the different methods to be acknowledged, the Methods Paper of the Scientific Advisory Board was published as a guideline for empirical studies.Secondly, we want to answer the question: How was it possible to establish this system? We report the research that facilitated the German reimbursement situation.Thirdly, we describe how the system for psychotherapy was sustained. The necessity of evidence-based investigations enhanced several psychotherapy studies. We present recent and ongoing German psychotherapy studies, three of them are tailored for specific diseases and three of them are practice-oriented studies; all of them support the sustained benefits of long-term psychotherapy.We advocate that research efforts were necessary to implement the contemporary reimbursement system of the German health insurance system.

From the Treatment of a Compulsive Spitter: A Psychoanalytical Approach to Profound Disability

Every practicing psychotherapist will have ample experience of patients expressing rage and hatred during the course of a session. In virtually all cases, patients emit their fury in a verbal form. But what happens when an angry, traumatized patient lacks the capacity to spit out nasty words and, instead, spits saliva? While most adult psychotherapy patients have developed a well-internalized ability to keep their bodily fluids contained inside their bodies (with the possible exception of tears), severely and profoundly learned disabled patients can drool, vomit, urinate, defecate, ejaculate, and spit in the midst of a psychotherapy session. In view of this little-discussed, yet not infrequent, clinical phenomenon, how can a psychotherapist function when under attack from the patient and his or her actual bodily fluids? In order to explore this aspect of disability psychotherapy, the author will discuss an eight-year treatment with a psychotic, brain-damaged psychogeriatric patient who spat compulsively in an aggressive manner. The author will describe the way in which he endeavoured to use classical psychoanalytical approaches in order to create an environment of safety in which the patient could begin to experience greater mental containment as well as bodily containment, and eventually arrive at a state in which her spittle could be transformed into feelings and even rudimentary words.

A systematic review of the effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.

Psychothérapie inspirée de la théorie de l’attachement : une perspective basée sur la théorie de l’évolution des systèmes de motivation

A type of adult psychotherapy entirely based on the study of the attachment system seems unlikely. A type of psychotherapy informed by attachment theory and research, but also able to consider aspects of human relatedness different from attachment, on the contrary, is a possibility at hand. To be congruent with Bowlby's approach to the study of attachment, however, such an attachment informed psychotherapy must conceive the various other components of human relatedness as evolved systems to be identified with an ethological approach. This paper dwells first on the roots in Bowlby's thinking of a study of the interactions between the attachment system and other evolved systems that control various key aspects of human relatedness. Then, it outlines a type of attachment informed psychotherapy that is emerging in the treatment of adult mental disorders rooted in infant attachment disorganization and complex childhood trauma.

Effect of psychotherapy for depression on quality of life: meta-analysis

Several meta-analyses have shown that psychotherapy is effective for reducing depressive symptom severity. However, the impact on quality of life (QoL) is as yet unknown. To investigate the effectiveness of psychotherapy for depression on global QoL and on the mental health and physical health components of QoL. We conducted a meta-analysis of 44 randomised clinical trials comparing psychotherapy for adults experiencing clinical depression or elevated depressive symptoms with a control group. We used subgroup analyses to explore the influence of various study characteristics on the effectiveness of treatment. We detected a small to moderate effect size (Hedges' g = 0.33, 95% CI 0.24-0.42) for global QoL, a moderate effect size for the mental health component (g = 0.42, 95% CI 0.33-0.51) and, after removing an outlier, a small but statistically significant effect size for the physical health component (g = 0.16, 95% CI 0.05-0.27). Multivariate meta-regression analyses showed that the effect size of depressive symptoms was significantly related to the effect size of the mental health component of QoL. The effect size of depressive symptoms was not related to global QoL or the physical health component. Psychotherapy for depression has a positive impact on the QoL of patients with depression. Improvements in QoL are not fully explained by improvements in depressive symptom severity.

Diagnosis and Therapeutic Interventions in Autism Spectrum Disorders in Adulthood

Autism spectrum disorders (ASD) are characterized by disturbed social interaction and communication as well as stereotyped or repetitive behaviors and interests. Although adults with ASD often acquire complex compensatory strategies that help them master social situations in a rule-based fashion, they still show impairments in intuitive processing of social signals and especially nonverbal communication in complex everyday situations. This constitutes a particular challenge for the psychotherapy of ASD. Psychotherapists are required to explicitly inform and act as an agent of the non-autistic world to enable patients to acquire the ability to take different perspectives. The overall aim of cognitive behavioral therapy interventions addressing ASD in adulthood is to extend the patients' behavioral repertoire to improve their quality of life. Thus, besides psychoeducation on ASD and its frequently associated comorbidities, psychotherapy for adults with ASD should focus on the training and development of social-communicative skills. Furthermore, dealing with stress in everyday situations is an important aspect of psychotherapy of these patients.

Changes in Romantic Competence and Career Adaptability Among Emerging Adults in Psychotherapy

While studies indicate that a growing number of emerging adults have difficulty meeting developmental challenges and, as a consequence, experience distress, the extent to which psychotherapy can help emerging adult clients cope with developmental tasks remains unexplored. This study examined the extent to which two core developmental capabilities of emerging adults—romantic competence and career adaptability—change during psychotherapy and the association between these changes and symptom change. Forty-six clients aged 21–31 (26 females; 56%) completed outcome measures and interviews regarding their romantic competence and career adaptability at the beginning and the end of psychodynamic psychotherapy. The mean duration of treatment was 26 sessions ( SD = 6.88). Findings indicated that romantic competence and career adaptability increased significantly throughout treatment while symptoms decreased. Change in romantic competence was associated with change in symptoms. The findings suggest that therapy could be helpful in the pursuit of the core developmental tasks; and that improvement in romantic competence is associated with symptom relief.