Dyadic Psychotherapy Research Articles

Effects of Dyadic Psychotherapy and Self- Monitoring Strategy on Marriage Anxiety among Young Married Couples in Ibadan Baptist Conference

Sustaining a cordial relationship among married couples is a necessity for the marriage to fulfill its purpose. However, marriage anxiety often exerts force on married couples resulting in undesired behaviours. Evidences have shown that young married couples experience marriage anxiety which may lead to conflicts, separation, divorce, suicide and homicide. Previous studies had focused majorly on factors leading to marital anxiety with very few interventions to address the problem. This study, therefore, employed dyadic psychotherapy and self-monitoring strategy as interventions to reduce marriage anxiety among the participants. Ninety-four participants were selected in Ibadan Baptist Conference. Taylor Manifest Anxiety Scale ( 16r="> 0.89) was used as screening instrument while the main instrument for post test was Hamilton Anxiety Scale ( 16r="> 0.86). The experiment lasted eight weeks. Seven null hypotheses were tested at 0.05 level of significance. Analysis of Covariance (ANCOVA) and Scheffee post hoc test were used as tools of Analysis. The results show that there was a significant main effect of treatment on marriage anxiety (F2.83=60.292; P<0.05, ?2=0.592). Dyadic psychotherapy and self-monitoring strategy were effective in reducing marriage anxiety. Thus, this paper recommended the effective management of marriage anxiety, the strategy involved as well as skills to reduce the marriage anxiety for married couples and professionals in the field of counselling to note in order to effectively treat marital anxiety among couples.

Beyond the outcomes: generic change indicators in a video-feedback intervention with a depressed mother and her baby: a single case study.

Child and dyadic psychotherapy have been scarcely investigated from the psychotherapy process research perspective. Thus, content and mechanisms related to therapeutic change have been overlooked by research. This study aimed at testing the applicability of the generic change indicators (GCI) model to identify moments of change in the parent during dyadic interventions, as well as to explore, describe and illustrate the therapeutic process through a brief mentalization-informed intervention with a depressive mother and her baby, using video-feedback as its main strategy, which has ample evidence about its effectiveness. We conducted a single case qualitative study using the GCI model. The mother’s ongoing change was determined by identifying episodes of change (EC) and moments of change (MC). Each MC was then labelled with one of the 19 GCIs. GCIs were observed from the intervention’s start. GCI’s hierarchical levels were increasing over the intervention, in association with the video-feedback situation. Our findings suggest that the GCI model is feasible to observe and understand dyadic interventions, contributing to the growing body of evidence supporting psychotherapists’ training and supervision.

Assessing therapist and clinician competency in parent-infant psychotherapy: The REARING coding system (RCS) for the group attachment based intervention (GABI).

The development of fidelity and quality measures for the dissemination of evidence-based practices is an often-neglected, vital step in the implementation of psychological interventions, especially within parent-infant mental health. The current study aims to address this gap by developing a competency-based measure for clinicians delivering the Group Attachment Based Intervention (GABI). GABI is an intervention aimed at supporting family preservation in parents who have experienced disparities across multiple systems of care. After observing over 100 hours of clinical video, the research team, comprised of clinicians and academic researchers, developed a competency coding system to measure clinician efficacy titled the REARING coding system (RCS). This paper outlines the development and structure of the measure, including a detailed discussion of the model of therapeutic action (i.e., REARING: reflective functioning, emotional attunement, affect regulation, reticence, intergenerational transmission of attachment, nurturance, and group therapy context), as well as provides a clinical case study to illustrate the utility, flexibility, and depth of the measure. The case study details a family session consisting of a mother, father, and two children (one infant, one toddler), and how RCS can be used in supervision to foster clinical competency and effectiveness in the GABI model. RCS seeks to address the dissemination gap in Evidence Based Practices (EBPs) by contributing to the limited number of existing fidelity and competency measures in infant mental health and psychodynamic dyadic psychotherapy. RCS is an important tool for monitoring clinical competency in the dissemination of GABI and gives supervisors the ability to provide fidelity-focused supervisions.

Nonverbal Synchrony in Couple Therapy Linked to Clients' Well-Being and the Therapeutic Alliance.

Nonverbal synchrony between individuals has a robust relation to the positive aspects of relationships. In psychotherapy, where talking is the cure, nonverbal synchrony has been related to a positive outcome of therapy and to a stronger therapeutic alliance between therapist and client in dyadic settings. Only a few studies have focused on nonverbal synchrony in multi-actor therapy conversations. Here, we studied the synchrony of head and body movements in couple therapy, with four participants present (spouses and two therapists). We analyzed more than 2000min of couple therapy videos from 11 couple therapy cases using Motion Energy Analysis and a Surrogate Synchrony (SUSY), a procedure used earlier in dyadic psychotherapy settings. SUSY was calculated for all six dyads per session, leading to synchrony computations for 66 different dyads. Significant synchrony occurred in all 29 analyzed sessions and between the majority of dyads. Complex models were used to determine the relations between nonverbal synchrony and the clients’ well-being and all participants’ evaluations of the therapeutic alliance. The clients’ well-being was related to body synchronies in the sessions. Differences were found between the clients’ and therapists’ alliance evaluations: the clients’ alliance evaluations were related to synchrony between both dyads of opposite gender, whereas the therapists’ alliance evaluations were related to synchrony between dyads of the same gender, but opposite to themselves. With four participants present, our study introduces a new aspect of nonverbal synchrony, since as a dyad synchronizes, the other two participants are observing it. Nonverbal synchrony seems to be as important in couple therapy as in individual psychotherapy, but the presence of multiple participants makes the patterns more complex.

Language and Movement Synchronization in Dyadic Psychotherapeutic Interaction - A Qualitative Review and a Proposal for a Classification.

In individual psychotherapy verbal communication and movement synchronization are closely interrelated. The microanalysis of timing, rhythm and gestalt of movement has established dynamic movement coordination as a systemic property of the dyadic interaction. Movement synchronization supports and enhances the unfolding of linguistic meaning. In order to substantiate the importance of the concept of synchrony for adult psychotherapy we review evidence from developmental psychology and discuss approaches to measure synchrony with particular reference to the naturalistic setting of dyadic psychotherapy. As the concept of synchrony is still ambiguous, and the respective interactional phenomena are ephemeral and fluid, in the current paper we suggest a set of five criteria for the description of synchronization in general terms and eight additional criteria which specifically enable the description of phenomena of movement synchronization. The five general dimensions are: (1) context, (2) modality, (3) resources, (4) entrainment, and (5) time-lag. The eight categories for the description of movement synchrony are: (1) spatial direction, (2) amplitude, (3) sinuosity, (4) duration, (5) event structure, (6) phase, (7) frequency, and (8) content. To understand the process of participatory sense-making and the emergence of meaning in psychotherapy, synchrony research has to cope with the multimodality of the embodied interaction. This requires an integrated perspective of movement and language. A system for the classification of synchrony phenomena may contribute to the linking of variations and patterns of movement with language and linguistic utterances.

Lenses and Mirrors: Reflecting on Dyadic Psychotherapy, Supervision, and Research with Families Involved in the Child Welfare System

ABSTRACT Historically, services for families in the child welfare system have been behaviorally and externally focused, rather than attuning to what is happening on the inside for parents and children. Rarely do families have access to psychodynamic treatment provided by highly trained and well supported therapists. The Building Blocks program was developed at New Alternatives to Children, a child welfare agency, to provide mentalization-based psychodynamic treatment to families with children in foster care or at risk of being removed from the home. This paper presents data from a case of a mother and her infant daughter, observed through three lenses – clinical observation, research and supervision – sharpening our understanding of factors that facilitate trust, healing and attachment within both parent-child and therapeutic relationships. To empirically evaluate the Building Blocks program, families participate in assessments at baseline and after 12 sessions. We observed meaningful changes in this dyad’s verbal and nonverbal behaviors, based on Coding Interactive Behavior System, confirming the clinical observations. Finally, reflective supervision supported positive movement, and the use of video aided therapist mentalization. Integration of clinical training and research can provide a more comprehensive view of clinical work and allow families to be more fully seen and known.

In the face of a pandemic: adapting a mentalization-focused treatment that promotes attachment with birth parents and young children in foster care

ABSTRACT The central focus of the Building Blocks Program is to increase the mentalizing capacity of high-risk birth mothers whose young children under the age of five have been placed in foster care. In Building Blocks, therapists are trained to provide dyadic psychotherapy with a birth mother and her child during court-mandated supervised visits, with the aim of reducing cycles of trauma, abuse and neglect, and facilitating a more secure attachment. The program is psychoanalytically informed, grounded in theories of attachment, mentalization and reflective functioning. On March 14, 2020, due to the rapidly spreading coronavirus, it became clear that the birth parents could no longer safely visit with their children in person. In addition, court hearings that might have allowed the retention of parental rights were postponed, leaving many parents devastated. In this paper, we first describe how we adapted the Building Blocks approach during the pandemic. Second, two case examples are presented that highlight the pre-pandemic work of Building Blocks, as well as the innovative and creative ways the treatment model was adapted when it became unsafe to conduct dyadic therapy at the clinic. Using virtual video platforms, the Building Blocks Program has applied the model of ‘Nested Mentalization,’ providing support and scaffolding for the therapists, parents and children.

The Effect of Early Dyadic Psychotherapy for Mothers Suffering From PPD on Oxytocin Level and on Childrens' Emotional Development

The Effect of Early Dyadic Psychotherapy for Mothers Suffering From PPD on Oxytocin Level and on Childrens' Emotional Development

Physiological synchrony in psychotherapy sessions

Objective: In this proof-of-principle study, a convenience sample of 55 dyadic psychotherapy sessions conducted by one therapist was analyzed. This study aimed at exploring physiological synchrony in naturalistic psychotherapy sessions and the association of such synchrony with self-report ratings. Methods: The electrocardiograms and respiration behavior of both therapist and client were monitored simultaneously. Four clients were included, and session outcome was documented by session reports in two clients. From electrocardiograms, heart rate and heart rate variability were derived in consecutive 15-second intervals throughout sessions. Entire sessions (average duration, 51 min) were assessed for physiological synchrony of therapist’s and client’s respiration, electrocardiogram, heart rate, and heart rate variability. Two methods of synchrony computation were applied to the time series: windowed cross-correlation and correlation of local slopes (concordance). Both methods included surrogate controls using segment-wise shuffling. Results: Significant synchrony of three measures, but not of electrocardiograms, was present in this dataset. In regression models, we found associations between synchronies and alliance ratings, and further self-report variables. Conclusions: Results support the existence of physiological synchrony in this collection of psychotherapy sessions, which speaks for the sympathetic and parasympathetic coupling between this therapist and her clients and its link with ratings of the therapy process. The feasibility of deriving signatures of synchrony of physiological signals with the described methodology was corroborated. The findings now await generalization by further research.

The Joint Painting Procedure: Parents and children creating shared space

The Joint Painting Procedure (JPP) is an art-based assessment and clinical intervention that evaluates and focuses on implicit aspects in parent–child relationships in middle childhood. The JPP has been utilized in parent–child art psychotherapy and various other clinical settings over the past 15 years and involves the parent and child painting together on the same sheet of paper using gouache or tempera paints. The JPP enables multi-dimensional expression and representation of implicit qualities of the relationship that cannot be expressed verbally. Sharing the same space and creating together enables transformational processes such as fostering mutual recognition, encouraging reflective function and creating mutual regulation. The JPP offers the painting dyad a meaningful non-verbal intersubjective experience, as well as ways of looking at various aspects of their relationship. The JPP and its clinical aspects are being examined and validated through rigorous research. Keywords: Dyadic art psychotherapy, art-based assessment, mutual recognition, mentalization

A pilot, exploratory report on dyadic interpersonal psychotherapy for perinatal depression.

Perinatal depression is a major public health burden impacting both mothers and their offspring. The purpose of this study was to develop and test the acceptability and feasibility of a novel psychotherapeutic intervention that integrates an evidence-based intervention for depression, interpersonal psychotherapy (IPT), with postpartum dyadic psychotherapy focused on emotional development in the context of the mother-infant relationship. Nine women between 12 and 30weeks gestation with Edinburgh Depression Scale (EDS) scores >12 were entered into treatment. Three out of nine women dropped out of the study after initiating treatment (one lost to follow-up antepartum; two lost to follow-up postpartum). Seven out of eight women (87%) reported clinically significant improvements in EDS scores from baseline to 37-39weeks gestation, and all women had clinically significant improvements at 12months postpartum. A small randomized controlled trial is underway to further examine the feasibility and acceptability of the intervention.

Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial.

An integrated approach addressing maternal depression and associated mother-infant relationship dysfunction may improve outcomes. This study tested Perinatal Dyadic Psychotherapy (PDP), a dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression and improve aspects of the mother-infant relationship related to child development. Women recruited from hospital postpartum units were screened using a three-stage process. Forty-two depressed first-time mothers and their 6-week-old infants were enrolled and randomized to receive the PDP intervention or usual care plus depression monitoring by phone. The intervention consisted of eight home-based, nurse-delivered mother-infant sessions consisting of (a) supportive, relationship-based, mother-infant psychotherapy, and (b) a developmentally based infant-oriented component focused on promoting positive mother-infant interactions. Data collected at baseline, post-intervention, and three-month follow-up included measures of maternal depression, anxiety, maternal self-esteem, parenting stress, and mother-infant interaction. Depression and anxiety symptoms and diagnoses decreased significantly, and maternal self-esteem increased significantly across the study time frame with no between-group differences. There were no significant differences between groups on parenting stress or mother-infant interaction at post-intervention and follow-up. No participants developed onset of postpartum depression during the course of the study. PDP holds potential for treating depression in the context of the mother-infant relationship; however, usual care plus depression monitoring showed equal benefit. Further research is needed to explore using low-intensity interventions as a first step in a stepped care approach and to determine what subset of at-risk or depressed postpartum mothers might benefit most from the PDP intervention.

Perinatal dyadic psychotherapy: design, implementation, and acceptability.

Maternal postpartum depression (PPD) and mother-infant relationship dysfunction have reciprocal effects on each other and thus an integrated approach that addresses both problems simultaneously may lead to improved outcomes. This study aimed to determine the feasibility, acceptability, and preliminary efficacy of a new intervention, Perinatal Dyadic Psychotherapy (PDP), for the early treatment of maternal PPD. PDP is designed to promote maternal mental health and facilitate optimal mother-infant relationships via (a) a supportive, relationship-based, mother-infant psychotherapeutic component, and (b) a developmentally based infant-oriented component focused on promoting positive mother-infant interactions. This paper describes the pilot use of PDP with six acutely depressed postpartum women. Nurses delivered the intervention over eight home visits. Results indicate that PDP is a feasible, acceptable, and safe intervention with this population. All participants achieved remission of depression with significant reduction of depression and anxiety symptoms, suggesting that PDP is a promising treatment for PPD.

Dyadic Psychotherapy with Infants and Young Children

This article briefly reviews the historical and empiric foundations of dyadic psychotherapy, highlighting the evolution of the central tenet that very young children exist in a relational context. The target of therapeutic intervention must therefore be the caregiver-child relationship. General features of dyadic psychotherapy are discussed, as well as aspects that are unique to the treatment of very young children. An overview of the goals and intervention modalities of Child-Parent Psychotherapy is provided as an example of an evidence-based dyadic intervention that incorporates theoretical principles and techniques of psychodynamic psychotherapy.

The Cost of Therapy Services Provided by a Day Psychotherapy Unit

The sole clinical evaluation of a therapeutic approach is not enough anymore; cost-effectiveness studies are also necessary. The findings of several studies agree that community-based care services and psychotherapy reduce the cost of mental health consumers. However, much of the ‘psychiatric reform’ process throughout Europe is not based on knowledge of cost and effectiveness of various interventions. On the contrary, it seems that several myths concerning the cost of psychotherapy still have an impact on the choices of clinicians. The aim of the present study is to measure psychotherapy’s financial cost both for the patient and for the providing organization; in our case the latter is the Open Psychotherapy Centre: an autonomous, self-sufficient and non-profit psychotherapy day centre, which is not financially supported by any other organization inside or outside of Greece. The results confirm the operational viability of such unit and the observance of the constitution’s principles (i.e. good working conditions, practising psychotherapy on a daily basis especially for the seriously disturbed patients and the fact that psychotherapy may be accessible to all patients regardless of their diagnosis or economic status), the low cost of psychotherapy for the patient and the providing organization, especially that of group psychotherapy (group analysis and therapeutic community) compared to dyadic psychotherapy.

Negative Treatment Effects in Dyadic Psychotherapy: A Focus on Prevention and Intervention Strategies

Therapy holds the potential to harm as well as help. This paper highlights approaches that may help prevent or decrease the incidence of negative effects in psychotherapy. These approaches include supervision, peer consultation, ongoing assessment of the therapeutic process, therapist-client matching, and referrals and transfers. We hope that this paper will serve as a stimulus for clinicians, psychotherapy researchers, and educators to put forth collabo-rative effort into identifying variables directly associated with adverse treat- ment outcomes and determining appropriate prevention and intervention strategies.

Temporal interaction of process variables in psychotherapy

A sample of 91 courses of dyadic psychotherapy using different treatment modalities was analyzed in order to study session-by-session dynamics. The process data consisted of therapist and patient session reports and therapy outcome was evaluated by pre-post questionnaires and direct measures of change. After data reduction by principal component analysis, linear time series models of the resulting factors were computed to describe the prototypical dynamical patterns of the sample and of the modality subsamples (cognitive-behavioral, client-centered, schema-theoretical psychotherapy). It was found that the factor of Patient's Sense of Self-Efficacy/Morale governed the observed dynamics of the sample, whereas the therapeutic bond factors did have less impact on the dynamics. The dynamical patterns of client-centered therapies differed from other modalities. The dynamics-outcome findings showed that direct measures of change were associated with a specific process pattern in which the patient's sense of self-efficacy was supported by other process variables.

Highlights of the 1999 Institute on Psychiatric Services

Highlights of the 1999 Institute on Psychiatric Services

Does managed care permit appropriate use of psychotherapy?

The author reviews the history of the development of managed care, the restrictions it has placed on psychiatric treatments, including psychotherapy, and the concerns it has raised about access to and quality of care. He discusses research studies documenting that psychotherapy is a fundamental component of psychiatric treatment and that it must be included in all health plans and organized systems of care. Several false beliefs about the use and cost of psychotherapy are considered, such as that dyadic psychotherapy is based on abreaction, a technique that Freud abandoned, and that costs for psychotherapy will skyrocket if it becomes universally accessible. Research has indicated that inappropriate limitations on psychotherapy in prepaid settings lead to poor mental health outcomes. The author emphasizes that cost-based constraints on established psychiatric treatments are not acceptable until carefully constructed scientific outcome studies demonstrate that the use of such constraints does not lead to adverse consequences.

A note on deep-seated social values and countertransference in mothernfant dyadic psychotherapy.

A note on deep-seated social values and countertransference in mothernfant dyadic psychotherapy.