Individual Psychotherapist Research Articles

Case of psychological consultation and observation an adolescent with dissociative dysmnesia

IntroductionCases of memory loss are rare phenomena. We present a case-study of common psychological and psychotherapy observation 14,5 years old girl with dissociative dysmnesia during 2 years. Teenager grew up in a small town near Moscow, her parents were divorced. A girl and her elder brother stay with mother. One day in New Year Holiday in January she had come to take out the trash and did not return home. When mother and her friends had found girl on the other side of town, she did not remember anything about her life and family. Goal: description the case of long observing adolescent with dissociative dysmnesiaObjectivesGirl age 14,5 y.o.MethodsPsychodiagnostics, Psychotherapy.ResultsFirst period (1 months later initial episode) mother provided mane consultations to understand what has happened with daughter and what is illness. Psychiatrist made a diagnosis - dissociative dysmnesia, neurologists did not find any disturbances. Psychological diagnostics showed small gaps in knowledge, pronounced violations of autobiographical memory, decreased activity, and mood. Unusual results were obtained in projective drawing. She got to know her family and friends again, started an account on Internet, shares her stories. These 2 years she worked with individual psychotherapist with positive changes. In September 2020 she went to school, not yet caught up with program. She masters the guitar, continues to play in the theater studio, and makes plans for future.ConclusionsAfter 2 year observation and work autobiographical memory has not restored. Girl’s personality hasn’t changed, according to the family. Her mood and communication look better.DisclosureNo significant relationships.

Burnout as an ethical issue in psychotherapy.

Recent studies highlight a range of factors that place psychotherapists at risk of burnout. The aim of this study was to investigate the ethics issues linked to burnout among psychotherapists and to describe potentially effective ways of reducing vulnerability and preventing collateral damage. A purposive critical review of the literature was conducted to inform a narrative analysis. Differing burnout presentations elicit a wide range of ethics issues. High rates of burnout in the sector suggest systemic factors and the need for an ethics review of standard workplace practice. Burnout costs employers and taxpayers billions of dollars annually in heightened presenteeism and absenteeism. At a personal level, burnout has been linked to poorer physical and mental health outcomes for psychotherapists. Burnout has also been shown to interfere with clinical effectiveness and even contribute to misconduct. Hence, the ethical impact of burnout extends to our duty of care to clients and responsibilities to employers. A range of occupational and personal variables have been identified as vulnerability factors. A new 5-P model of prevention is proposed, which combines systemic and individually tailored responses as a means of offering the greatest potential for effective prevention, identification, and remediation. In addition to the significant economic impact and the impact on personal well-being, burnout in psychotherapists has the potential to directly and indirectly affect client care and standards of professional practice. Attending to the ethical risks associated with burnout is a priority for the profession, for service managers, and for each individual psychotherapist. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Therapist effects on outcome and alliance in inpatient psychotherapy: The contribution of patients' symptom severity.

Therapists differ in their effectiveness regarding their patients' symptomatic improvement as well as their therapeutic alliances, but little is known about influencing factors. The current study aimed to investigate therapist effects on outcome and alliance in inpatient psychotherapy and to estimate the influence of patient severity on the magnitude of therapist effects in this specific setting. We examined differences between individual psychotherapists in their patients' early alliance and outcome at discharge in a psychotherapy setting of a psychiatric hospital. The sample included 33 therapists and 3,051 patients, and minimum caseload was 30 patients. Outcome was measured as patient-rated symptoms and interpersonal problems as well as therapist-rated impairment. Similarly, alliance was assessed from the patients' and the therapists' perspective. First, we estimated the amount of variance that was owing to therapists for patients with average symptom severity. Next, we examined whether the therapist effect was influenced by initial patient severity. Therapist effects on patient-rated symptomatic outcome and alliance were not significantly different from zero. Therapist differences were considerably larger for therapist-rated measures. Patient severity did not significantly influence the therapist effect for patient-rated outcome or alliance. However, there was a u-shaped association for therapist-rated severity and the therapist effect in therapist-rated alliance. Here, therapist differences were larger for patients with either very low or very high initial severity. The magnitude of the therapist outcome effect was smaller in inpatient therapy compared with outpatient settings. (PsycINFO Database Record

On the importance of the therapist in psychotherapy: A summary of current research

The American Psychological Association's Presidential Task Force on Evidence-Based Practice articulates a decision-making process based on the integration of the best available research, clinical expertise, and patient characteristics. The treatment method, the individual psychotherapist, the treatment relationship, and the patient are all vital contributors to successful psychotherapy. Several studies have shown that the variation in treatment effect among psychotherapists using the same method is greater than the variation in treatment effect among different methods. This outcome pleads for a comprehensive psychotherapist-related “g-factor” of psychotherapy. In terms of decision-making for health-care institutions and clinical practices, it would seem wise not to separate the psychotherapist, the patient, or the relationship from the method as there seem to be extensive effects relative to the interaction among these parameters. Parallel to a growing knowledge of evidence-based methods, there is still a decisive lack of scientific knowledge about these interactions.

New directions and resources in group psychotherapy: introduction to the issue

Establishing an evidence-based practice (EBP) is a central byproduct of the ever-increasing emphasis on accountability in mental health services. Though much has been written and developed for individual psychotherapists who wish to develop EBPs, there are far fewer resources for group psychotherapists. This article introduces a series of articles designed to provide EBPs and resources for group psychotherapists. We discuss how therapists can develop and apply the following aspects of EBPs: research-supported treatments (RSTs), practice guidelines, practice-based evidence, and multicultural competence.

INFLUENCES OF PATIENTS’ AND THERAPISTS’ INTERPERSONAL PROBLEMS AND THERAPEUTIC ALLIANCE ON OUTCOME IN PSYCHOTHERAPY

The aim of this study was to investigate the importance of therapists’ and patients’ interpersonal problems as well as the impact of the therapeutic alliance on symptomatic outcome in psychotherapy. Of interest were direct effects of interpersonal problems, represented through the dimensions of affiliation and control, as well as possible interaction effects between patient and therapist variables on outcome. Further hypotheses referred to therapist differences in the predictive impact of the therapeutic alliance for outcome. Outcome ratings of 1,513 psychotherapy inpatients treated by 31 psychodynamically oriented individual psychotherapists were studied. Therapists’ and patients’ interpersonal dispositions were assessed with the Inventory of Interpersonal Problems, and patients answered standardized outcome measures before and after therapy and retrospectively evaluated the therapeutic alliance at discharge. The results indicate that dominant patients profited better from their therapy and that therapists’ interpersonal disposition did not have a direct influence on outcome. The influence of the therapeutic alliance on outcome varied among the therapists. The general positive effect of therapeutic alliance on outcome was stronger for less affiliative therapists. Limitations of the study and implications of the results are discussed.

Ethical Issues in RecordKeeping in Group Psychotherapy

This article discusses numerous ethical issues regarding the keeping of records in group psychotherapy, those activities that have to do with the creating, retaining, storing, releasing, and disposing of them. A central dilemma for the group therapist is whether to keep records separately for each individual group member or to keep one record for the group as a whole. Confidentiality of records, patient access, and release of information tend to be more complex issues for group psychotherapists than for individual psychotherapists. Although notes written about the entire group may capture important themes, such notes can compromise the privacy and confidentiality of individual group members. An individual record for each patient is recommended.

Zur Bedeutung der Einzeltherapeuten für das Therapieergebnis in der stationären Psychotherapie - eine Pilotstudie

How much does the individual psychotherapist influence therapy outcome in a multimodal inpatient setting with several therapeutic relationships and the additional influence of group processes. We studied the outcome of n = 293 psychotherapy inpatients (mean treatment duration: 11 weeks) who were treated in an integrated inpatient concept by 9 mostly psychodynamically oriented psychotherapists (professional experience 0.5 to 7 yrs, 13 to 56 patients per therapist). Patients had an extensive evaluation of process and outcome variables (e. g. SCL 90R, IIP, Global outcome rating, Helping Alliance Questionnaire - HAQ). Differences in outcome between patients of different therapists were calculated. Patients assigned to the participating therapists did not differ in their basic clinical characteristics, except in the clinical severity rating carried out by therapists themselves. Outcome in the SCL90R - GSI residual score and global rating differed significantly between the therapists (d (SCL-pooled SD) = 0.43 to 1.10, explained variance: 10 %). The same holds true for the therapeutic alliance (HAQ, explained variance: 45 %). Assessment of therapeutic relationship shows good correlation between patients and therapists, outcome assessment does not. Therapists differed in the degree of matching between their own and their patients' evaluations. We found significant therapist differences in outcome and alliance. Despite the multifaceted inpatient setting the individual therapist is an important determinant of therapeutic success.

The Future of Psychotherapy: Visions and Recommendations

Using a roundtable discussion format, the editor and new members of the editorial board for the Journal of Contemporary Psychotherapy exchange ideas about how they envision the future of psychotherapy, anticipate likely positive and negative outcomes, identify key issues to be confronted today in order to maximize future success, and clarify the role of the individual psychotherapist in protecting psychotherapy as a viable field of study and practice. The discussion closes with recommendations for the next generation of psychotherapists and general conclusions about the future of psychotherapy.

Eliciting children's thinking in families and family therapy.

In this article, I introduce a way of talking between a therapist and children, which aims to be more adaptive to the family therapy context than the modes of communication with children often reported by individual psychotherapists. Although the recent increase in articles concerned with the role of children in family therapy is welcomed, I suggest that the common recommendation of the use of "play" and nonverbal methods of communication with young children can at times introduce its own constraints on a child's thinking. A method of engagement in "dialectical" conversations with children is described, and illustrated with verbatim case examples. It is argued that this offers one route to a discourse commonly used between children, and one that acknowledges their capacity to think.

The effects of the individual psychotherapist and implications for future research.

A body of research concerning psychotherapy outcome is reviewed with the intent of establishing the importance of the individual psychotherapist to treatment process and outcome. Although particular therapy techniques have not been shown to be especially important in therapy process and outcome, they have been the focus of most research and training for the past two decades. In the past, extensive study of the individual therapist was difficult, but the rising trend of managed health care organizations has created opportunities to conduct research on this topic. Hypothetical outcome data for individual clinicians are presented in graphical form. An attempt is made to show how patient typing can be used to adjust outcome by case-mix methods. Suggestions for future research are made.

When the Individual Psychotherapist is a Group Analyst

The purpose of this paper is to initiate discussion of the particular contribution group analysts make when treating patients in individual therapy. The author describes what group analysts have learnt in the course of their training and clinical practice and can bring to individual psychotherapy.

The therapist evaluation inventory: Evidence for an unidimensional scale

The internal structure of the Therapist Evaluation Inventory (TEI) was investigated with data gathered from therapy sessions conducted by 16 individual psychotherapists with 292 psychiatrically disturbed adolescent inpatients. A principal components analysis (Varimax rotation) indicated a single dimension that accounted for 70.39% of scale variance. The findings did not corroborate a factor structure consistent with the a priori scales of the TEI.

Impact of Therapist's personal Family System on Clinical Work

The impact of the personal life of a therapist on his or her clinical work has received decreasing emphasis in the field of family therapy in the 1980s because of the increasing emphasis on short-term therapy and psychopharmacology. The authors believe that relationship experiences in one's own family arc the basic training ground for the development of an effective family and/or individual psychotherapist. This paper presents three major areas of importance to a therapist's use of sell; his or her basic level of operational autonomy, management of personal and clinical reactivity and personal enrichment- from family experience and therapist's own family (TOF) work.

Issues in concurrent psychotherapy-remediation

There are a large number of multiply handicapped children who are in need of both psychotherapy and academic remediation. The learning disabled, for example, often have problems that extend beyond the classroom and on into the playground or home (Berger, Yule, and Rutter, 1975; Johnson and Mykelbust, 1967), while many emotionally disturbed children have difficulty functioning on academic tasks (Eisenberg, 1975). For children in both of these groups, as well as for those uniquely unfortunate youngsters who present as primarily learning disabled and primarily emotionally disturbed, the provision of appropriate treatments for their particular combination of problems is a vital issue to educators and psychotherapists alike. Often, when such resources are available, the multiply handicapped child is treated for each of his or her two problems by an individual remediation specialist and an individual psychotherapist. In such cases, it is vital that each professional be aware of the unique problems and possibilities that the other's work imposes on the efforts of the first. Through such awareness, it becomes more likely that the child's vicious cycle of academic failure and emotional pain will be transformed into a benign synergy of positive change and development. The goal of this paper is to address the psychotherapy-remediation interaction from the perspective of a psychotherapist. The paper is directed toward both special education teachers and psychotherapists who may be involved in concurrent individual treatment. Its aim is to make these professionals more aware of the variables at work in this multi-modal approach, so that its pitfalls can be avoided and its strengths can more likely be harnessed to the child's advantage. Following a brief review of some of the literature in this field will be a discussion of practical issues in concurrent treatment. Included among these practical issues are: understanding and dealing with the child's feelings or confusion about the concurrent treatments; understanding resistances to either treatment; the nature of the child's dual relationship

Problems in the psychotherapy of children with histories of incest.

Therapists must be cognizant of the meaning of the patients' presentation and the extreme need for therapeutic safety. The therapists must be keenly aware of the deprivation issues for these patients and not be seduced by the sexual "red herring." At the same time, the therapist must be careful that his own discomfort does not make him run away from the sexual material. Thus the therapist must strike a difficult balance between the two. The therapist must avoid allying with the child solely as a victim, an alliance which would hinder an understanding of the child's motivation and subsequent guilt, and thus foster further difficulties. The therapist must work through his own outrage that a child has been molested so that he may avoid blame seeking. By attending to these issues, the individual psychotherapist will pass the patients' "test" and take the first step in helping patients and their families in forming a therapeutic working alliance.

Dissolution of a peer supervision group of individual psychotherapists.

Dissolution of a peer supervision group of individual psychotherapists.

Two Families: The Origins of a Therapeutic Crisis

The treatment by individual and family therapy of a hospitalized young woman is presented as it reflects the historical and current family dynamics of the patient and her individual psychotherapist. The contribution of these factors to a therapeutic crisis is discussed.

Observations in treatment of patients with psychosomatic disorders using subshock insulin in a group setting.

A program is described that has proved useful in practice. It is based on the operation of a psychiatric team. It is designed to give maximum treatment to a group of psychosomatic cases so disabled by their anxiety that they could not relate themselves in a therapeutic situation. The program involves the use of subshock insulin as an adjunctive therapy helpful in allaying anxiety, improving the patient's well-being, and making him more accessible to psychotherapy. The subshock insulin treatment moreover serves as the agent around which a homogeneous group of patients can be formed. The observers note the therapeutic value of the structure, i.e., a homogeneous group within a heterogeneous group. A general tendency toward the remission of symptoms is pointed out. The observation is made that there should be a trained correlator-observer in programs for treating patients in a large therapeutic milieu, for the individual psychotherapist is often not aware of his patient's actions-in-living.