Aspects Of Psychotherapy Research Articles

Let's talk: a narrative of mental illness, recovery, and the psychotherapist's personal treatment

This article describes the author's experience in psychotherapy, beginning as a suicidal teenager with a dismal prognosis, through 5 years of hospitalization, including shock treatment that erased most memory before age 20, through an Ivy League education, and successful professional career. Retraumatization triggered by reading her hospital records 40 years later adds a unique perspective, as the author watched, but could not control, a process within herself that she regularly addressed as therapist with her own patients. Healing aspects of relationships with three psychodynamic psychotherapists (two psychiatrists and a social worker), credited with her survival and success, are examined. A dramatic interview with Harold Searles, her psychiatrist's supervisor, and its role in her recovery is considered. Lasting lessons concerning the healing aspects of psychotherapy, the effects of repressed early trauma encountered late in life, the need to counter stigma, and the value of personal psychotherapy are discussed.

Psychotherapy and the Perfect Storm of Change

The author surveys the many forces of change that will have an impact on the practice of psychotherapy in coming years. These include parity, health care reform, federal and state deficits, electronic health records, evidence-based medicine, pay-for-performance, reimbursement issues, and attacks on fee-for-service medicine. Vulnerable aspects of psychotherapy are privacy and confidentiality, individualization and choice of therapy, access to therapy, therapist's choice about participation, denial of coverage based on diagnosis, and sufficient payments to sustain practice. Psychiatric workforce issues may compound the effects. The author identifies some issues calling for vigilance, advocacy, and defense of the key values of psychotherapy and the environment for providing it. (Journal of Psychiatric Practice 2009;15:408-414).

Multiple levels of analysis in psychotherapy research

Psychotherapy research can be thought to involve multiple levels of analysis: client, therapist, and group. The authors argue that such research would benefit from the application of multilevel modeling. They illustrate the use of such a procedure for research studies of individual psychotherapy, group psychotherapy, and rolling group psychotherapy and provide SPSS syntax for all three cases. Psychotherapy is an inherently social process. Individual therapy involves a very complicated interaction between a client and therapist. Group therapy involves relationships between a therapist and each of the clients as well as relationships between clients. It is critical that the analysis of psychotherapy data explicitly recognize these interpersonal aspects of psychotherapy.

“The Difference that Makes a Difference”: What Matters to Lesbians and Gay Men in Psychotherapy

SUMMARY Lesbians and gay men are more likely to use psychotherapy services than are heterosexual men and women, yet little is known of the aspects of psychotherapy that lesbians and gay men find helpful. A postal survey with a community sample of lesbians and gay men in the UK who had used counselling or psychotherapy services examined this issue. Content analysis of the responses that lesbians and gay men (n = 365) gave to a series of open-ended questions on what was helpful or unhelpful in psychotherapy revealed that issues related to sexual identity were important in addition to generic qualities of the therapeutic relationship. Lesbians and gay men also listed friends, family of choice, and family of origin, and complementary or “alternative” therapies as important sources of support aside from psychotherapy. This study has implications for counselling and psychotherapy training, for counsellors and psychotherapists working with lesbians and gay men, and for lesbians and gay men who use psychotherapy.

Gender in psychotherapy: controversies, impacts and healing

Issues related to gender have enormous impact on every facet of human existence and relationship. Psychotherapy could be defined as the co-enquiry into the experience of human existence and relationship, and as such is massively affected by gender difference and the allied and inseparable issue of sexuality. My personal experience has been that gender issues have been central in every aspect of psychotherapy through being a client, in training and in working as a therapist. At times, however, this was unclear and confusing. The territory often went unexplored and unspoken because of taboos and sensitivities. Issues of gender have felt unworkable because they constellate a filter through which all experience passes in a deeply held unconscious and numinous manner, almost too close to bring into focus. Gender is like a blackboard onto which our experience is scored.

Survey of psychotherapy experience and interest among psychiatric specialist registrars

Aims and MethodA postal survey was conducted to determine what proportion of psychiatric specialist registrars working in Scotland (n=119, excluding those specialising in psychotherapy) met the requirements for experience in psychotherapy. Since 2004, this has been a compulsory part of eligibility criteria for the MRCPsych part II examination.ResultsTwo-thirds of those surveyed responded. One-third of respondents met the Royal College of Psychiatrists' requirements for psychotherapy experience. Half the respondents reported competence in at least one modality of psychotherapy. Four-fifths of respondents were interested in gaining further experience and training, two-thirds in developing a special interest and one-quarter in dual training, in at least one modality of College psychotherapy. There was no significant association between adherence to the requirements and self-perceived competence, qualification or the wish to gain further training and experience in psychotherapy.Clinical ImplicationsThe majority of trainees, even those interested in psychotherapy, still fail to meet College requirements. Many trainees would appreciate an opportunity to gain greater depth of psychotherapy experience, in addition to gaining broad experience of various aspects of psychotherapy as required by the College.

It Takes More Than Training To Become a Psychotherapist

It Takes More Than Training To Become a Psychotherapist

Increasingly Informed Consent: Discussing Distinct Aspects of Psychotherapy at Different Points in Time

Psychologists are ethically obligated to obtain informed consent to psychotherapy "as early as is feasible" (American Psychological Association, 2002, p. 1072). However, the range of topics to be addressed includes both information that may be immediately and uniformly applicable to most clients via policy or rule, as well as information that is not immediately presentable because it varies widely across clients or emerges over time. In this study, licensed psychologists were surveyed regarding the earliest feasible point at which they could provide information regarding specific aspects of psychotherapy. Results indicate that, although psychologists believe that they are capable of presenting some information, such as payment and confidentiality policies, at the outset, they believe that a discussion of more substantive issues, such as psychotherapy duration, goals, orientation, and activities, can take place only after some therapy has transpired. Implications are discussed regarding the process and event models of informed consent.

Issues of Divine Healing in Psychotherapy

Despite Biblical and empirical support for divine healing, there are several barriers to accepting it as an aspect of psychotherapy for many professionals and religious people. Two of the major barriers to the acceptance of divine healing are professional ideologies and theories. These professional stances likely play a critical role in the disinterest in religion and spiritual experiences reported by the majority of professionals that conduct psychotherapy. Another barrier is the divergent theologies regarding spiritual experiences such as divine healing. Many persons of theistic faith subscribe to theologies that often impede experiences of healing by the Holy Spirit. Finally, the scientific method is often used to address questions about spiritual experiences that are more likely conundrums. However, belief in divine healing ultimately is based on faith.

Dr. Andreasen Replies

Back to table of contents Previous article Next article Letter to the EditorFull AccessDr. Andreasen RepliesNANCY C. ANDREASEN, M.D., Ph.D., NANCY C. ANDREASENSearch for more papers by this author, M.D., Ph.D., Iowa City, IowaPublished Online:1 Sep 2004https://doi.org/10.1176/appi.ajp.161.9.1725AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail I am glad that Dr. Kandler enjoyed Dr. Gabbard’s essay on Freud, and I concur with his point about the importance of maintaining balance in the Journal, including adequate coverage of psychotherapy. It is for this reason that we include Clinical Case Conferences in many issues. Quite often, these are presentations of case histories, together with discussions by experts. In addition, the book review section contains quite a large number of reviews of books on various aspects of psychotherapy and psychoanalysis. Finally, we do try to have a reasonable number of data-based articles on this topic. This issue contains several excellent articles on the topic, which we are pleased to publish, including a Clinical Case Conference concerned with psychotherapy. The following is a sampling of other articles on this topic from recent issues:Spinelli MG, Endicott J: Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry 2003; 160:555–562Leichsenring F, Leibing E: The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003; 160:1223–1232Wilhelm S, Deckersbach T, Coffey BJ, Bohne A, Peterson AL, Baer L: Habit reversal versus supportive psychotherapy for Tourette’s disorder: a randomized controlled trial. Am J Psychiatry 2003; 160:1175–1177Horvitz-Lennon M, Normand S-L T, Frank RG, Goldman HH: “Usual care” for major depression in the 1990s: characteristics and expert-estimated outcomes. Am J Psychiatry 2003; 160:720–726Svartberg M, Stiles TC, Seltzer MH: Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Am J Psychiatry 2004; 161:810–817We are always eager to publish high-quality articles of this type.Reprints are not available; however, Letters to the Editor can be downloaded at http://ajp.psychiatryonline.org. FiguresReferencesCited byDetailsCited ByBehavior and Social Issues, Vol. 15, No. 2 Volume 161Issue 9 September 2004Pages 1725-1725 Metrics PDF download History Published online 1 September 2004 Published in print 1 September 2004

Handbook of Cultural Psychiatry

Handbook of Cultural Psychiatry

Real relationship: The "something more" of psychotherapy.

Although it often operates silently, the personal relationship is a part of everything that transpires between therapist and client. Following the psychoanalyst Ralph Greenson's (1967) early lead, the term Real Relationship is used to capture this personal aspect of psychotherapy. It is divided into two elements, realism and genuineness; and both these elements are further divided into magnitude and valence aspects. Research on the real relationship is almost nonexistent, and to an important extent this is due to the lack of a reliable, valid, and convenient measure. The author is involved in a research project aimed at developing such measures from both the client and therapist perspective. Examples of items are provided.

Therapeutic goals in psychological medicine--state of research and development of a standardized self-rating instrument

From the patient's as well as from the therapist's point of view goals of therapy undoubtedly play an important role in all fields of psychological medicine (psychiatry, psychotherapy, psychosomatic medicine). On the other hand, there is a substantial lack of systematic i.e. empirical studies on this issue. Giving an overview on the available scientific literature we start by characterising therapeutic goals as a secondary psychological construction. Therapeutic goals and their multiple associations and different aspects of psychotherapy are discussed. However, a variety of definitions of therapeutic goals, often influenced by the therapeutic orientation of the authors, make it difficult to integrate concepts and to compare findings. Hence, we focus on those results which were found in relation to general concepts, i.e. beyond specific theoretical approaches. Furthermore, we discuss the pros and cons of individual measures of therapeutic goals compared with standardised self-rating instruments. Finally, we underline the lack of studies on therapeutic goals in the psychiatric sphere and report on some results of our own pilot study on the Personal Goals Questionnaire in psychiatric inpatients.

Aspects of psychotherapy with adults with attention deficit disorder.

The process of psychotherapy with individuals with Attention Deficit Disorder who may require this form of intervention (in addition to medication and psychoeducation) is described. Salient features of therapy specific to these patients, such as the subjective effects of medication, characteristic defensive operations, and reconciliation with the past, are emphasized.

Medical necessity and psychotherapy.

Managed care and, specifically, the need to conform to medical necessity requirements have had a dramatic effect on medical and psychiatric practice, especially on psychotherapy. The author describes the progression of the concept of medical necessity from a simple accounting of services reimbursable by insurance companies to an ambiguous term without definitional consensus. He describes its relationship to the medical model and discusses the incongruity between medical necessity and certain aspects of psychotherapy. He proposes a broader concept--health necessity--based on an evaluation on the merits of the advantages, disadvantages, and costs of medical and psychiatric services.

Reflections on Contemporary Psychotherapy Practice, Research, and Training

We do not lack for criticism about psychotherapy practice, research, and training. Admittedly, there is much there that needs to change. But, thus far, what have we done right? What are some of the positive, affirming, constructive strides that have been made with regard to therapy practice, research, and training? In this paper, those questions are addressed. Ten broad-based themes about some aspects of psychotherapy are presented and discussed; while by no means exhaustive, each is considered to be quite robust and clearly reflective of some of the truly constructive facets now evident in the field.

Methodological Problems in Identifying Efficacious Psychotherapies

National discussions of health-care delivery systems have renewed the effort to identify empirically validated psychotherapies. Although the logic of efficacy studies in psychotherapy, which are used to empirically establish the efficacy of psychotherapy, is relatively simple, the validity of inferences from these studies are ambiguous and the focus on outcome obscures other important aspects of psychotherapy. Problems related to (a) common versus specific confounds, (b) difficulties in disproving the uniform efficacy supposition, and (c) hazards in standardizing treatments are discussed. These problems make developing criteria for establishing empirically validated treatments difficult; a currently proposed set of criteria for proving treatment efficacy is critiqued.Die in den USA geführte Diskussion über das System der Gesundheitsversorgung hat zur Erneuerung von Bemühungen beigetragen, empirisch validierte Psychotherapien zu identifzieren. Obwohl die Logik von Effektivitätsstudien in der Psychotherapie, die dazu benutzt werden, die Effektivität von Behandlungen empirisch abzusichern, relativ emfach ist, ist die Validität von Schilussfolgerungen, die aus diesen Studien abgeleitet werden, durchaus zwiespältig. Die ausschliessliche Betrachtung des Therapieergebnisses beispielsweise verschleiert andere wichtige Aspekte der Psychotherapie. Wesentliche Probleme, die in diesem Beitrag diskutiert werden, beziehen sich auf (a) Konfundierungen allgemeiner vs. spezifischer Effekte, (b) Schwierigkeiten, die uniforme Annahme der Effektivität zu widerlegen und (c) die Gefahren standardisierter Behandlungen. Diese Probleme machen es schwierig, Kriterien fur empirisch validierte Behandlungen festzulegen. Die gegenwärtig vorgeschlagenen Kriterien zum Nachweis der Effektivität einer Behandlung werden kritisiert. (Wampold)Les discussions nationales du système de distribution des soins de santé ont ravivé les efforts concernant l'identification des psychothérapies validées empiriquement. Bien que la logique des études sur l'efficacité des psychothérapies soit relativement simple, la validité des inférences de ces études est ambiguë. De plus, le fait de se focaliser sur les résultats occulte d'autres aspects importants de la psychothérapie. Nous discutons dans cet article des problèmes relatifs:aux confusions communes versus spécifiquesaux difficultés dans la réfutation de l'efficacité uniforme supposéeet au hasard dans la standardisation des traitements.Ces problèmes nous poussent à développer des critères afin d'établir les difficultés de traitement validé empiriquement; nous discutons un ensemble de critères pour mettre à l'épreuve l'efficacité des traitements. (Wampold)

What Goes on in a Psychotherapist's Mind?

Processes in the minds of psychotherapists in general, and the process of forming hypotheses about their patients in particular are largely neglected aspects of psychotherapy. Of course, there are prescriptive concepts, and there is some research related to how therapists succeed or fail working with such prescriptive concepts. However, these concepts are not based on a comprehensive empirical insight of how therapist information processing normally takes place, nor are they descriptive. Furthermore, training approaches are not systematically derived or empirically validated. This article argues for greater attention to be given to this aspect of psychotherapy. Difficulties leading to the present situation as well as proposals for research and training are also presented.Die Frage, was in Psychotherapeuten generell vorgeht, speziell aber Untersuchungen des Prozesses der Hypothesenbildung über Patienten gehören zu den vernachlässigten Aspekten innerhalb der Psychotherapie. Zwar gibt es einige präskriptive Konzepte und Untersuchungen dazu, wie erfolgreich Therapeuten mit solchen Konzepten arbeiten; diese Konzepte basieren aber nicht wirklich auf umfassenden, empirisch gestützten Einsichten darüber, wie die Informationsverarbeitung von Therapeuten normalerweise vonstatten geht. Dazu kommt, dass Ausbildungskonzepte weder auf derartige Fragestellungen ausgerichtet noch empirisch validiert sind. Dieser Beitrag plädiert dafür, diesem Aspekt der Psychotherapie künftig mehr Aufmerksamkeit zu schenken. Dabei werden sowohl die Schwierigkeiten, die zur gegenwärtigen Situation beigetragen haben als auch Vorschläge für die künftige Forschung und Weiterbildung diskutiert.Les processus dans I'esprit des psychothérapeutes en général, et le processus de formulation d'hypthèses sur leurs patients en particulier sont des aspects largement négligés de lay psychothérapie. Bien sûr, ce sont des concepts consacrés par l'usage, et il existe des recherches relatant comment les thérapeutes réussissent ou échouent en travaillant avec de tels concepts. Cependant, ces concepts ne sont basés ni sur un aperçu de compréhension empirique, à savoir comment le procédé d'information du thérapeute se met normalement en place, ni sur un usage. En outre, les approches d'entraînement n'en découlent pas systématiquement ou ne sont validées empiriquement. Cet article plaide en faveur d'une plus grande attention à donner à cet aspect de la psychothérapie. Les difficultés conduisant à la situation présente ainsi que des propositions de recherche et d'entraînement sont aussi présentées.

Integrated Psychodynamic Psychotherapy with Children

Integrated psychodynamic psychotherapy with children attempts to prescribe a specific psychotherapy for a child at a specific developmental level with a specific psychiatric syndrome. To this end, any and all accepted means of treatment are integrated in the treatment approach. The use of nonpsychodynamic modalities does not minimize the psychodynamic modality, but, in most instances, enhances the psychodynamic inquiry. The interpersonal and experiential aspects of psychotherapy are emphasized. Specific aspects of technique such as the use of play, the nature of insight, transference, and counter transference are considered.

Operational diagnostic approaches in the assessment of defense mechanisms.

A model for the operationalization of empirical research of defense mechanisms is presented. Measures for operationalized defense diagnoses are discussed against the background of a cognitive model of different coding of information channels (linguistic and perceptual coding). Studies for the operationalized diagnoses in the clinical assessment of defense mechanism are discussed for the identification of the defense mechanism, reliability of rating procedures, and the prognostic aspects in psychotherapy and psychosomatics. The regulation of defense on different levels of a hierarchy of complex systems of variables is demonstrated with paradigmatic results.