Psychotherapy Outcome Studies Research Articles

Interpretation viewed through the lens of attachment informed couple psychotherapy

Historically, the mutative power of psychoanalysis has been attributed to interpret- ing transference. The site of transformational change has been located in the patient–analyst relationship; the medium for bringing it about has been language: psychoanalysis as the "talking cure". There is much wrong with this formulation, not least for therapists whose "patient" is the adult couple— itself constituting a powerful site for past conflicts to find a home. Moreover, psychoanalysts of all persuasions accept that fundamental assumptions about relationships are formed at an unconscious level before experience can be symbolised through language. Attachment theory has laid the foundations for theoretical and therapeutic developments that highlight the mutative potential of relationships in which both parties are involved in the mutual process of creating something new. This transformational capacity is not the preserve of any one therapeutic approach, but belongs in the realm of what have been described as the "non-specific" factors that have accounted for change identified in many psychotherapy outcome studies. This article will consider the "mood music" of psychotherapy, suggesting that interpretation can be viewed as an act of love, stemming from, as much as resulting in, change.

Systemic Individual Therapy: Therapeutic Change from the Perspective of Clients and Therapists

ABSTRACT Therapeutic change is a well-studied construct in psychotherapy process and outcome studies, providing the basis for how psychotherapy practices are effective in individuals wellbeing. The current study explores the experiences of therapists and clients regarding how therapeutic change is experienced in systemic individual therapy. 12 therapists (1 men, 11 women) and 12 clients (2 men, 10 women) were recruited as participants from two training centers. Both therapists’ and clients’ experiences are investigated with semi-structured interviews using thematic analysis (TA). Results revealed three main themes for clients: “Sense-making the Problems Through Relational Awareness”, “Acceptance in Relationships”, and “Manifesting the Differentiated Self in Relationship.” Regarding therapists’ perspective, the results yielded three main themes: “Going Beyond One-to-one Relationship in Therapy”, “Increasing Relational Awareness”, “Shift in Clients’ Attitudes Towards Boundaries with Significant Others.”. The themes were discussed in the context of the systems theory literature, limitations, strengths, future research directions, and clinical implications.

Changes in dreams - the development of a dream-transformation scale in psychoanalyses with chronically depressed, early traumatized patients

ABSTRACT As is well known, dreams are still seen as via regia to the unconscious by many psychodynamic and psychoanalytic clinicians and researchers. Therefore, this article reports on decades of efforts to understand changes in manifest dreams in psychodynamic therapies as indicators for relevant, sustaining transformations in the inner object world of patients and to use them in comparative psychotherapy outcome studies. An empirical psychotherapy study by Leuzinger-Bohleber has described the following changes in manifest dream during successful psychoanalyses: reduction of nightmares, widening of the affective spectrum, increase of successful problemsolving, fewer observer dreams and more mature object relations. These transformations are illustrated in a detailed case report of a chronically depressed, early traumatized patient of the LAC Depression Study. In the next section the results of a systematic focused literature review aiming to identify suitable instruments for the study of dreams are presented. Finally, we discuss which conclusions can be drawn for the development of a dream transformation scale capturing changes in manifest dreams in psychodynamic therapies with depressive patients. Such a scale would be an important methodological addition for future comparative psychotherapy outcome studies, since it takes into account dreams, as a genuinely psychoanalytic criterion for psychic transformations.

Why Don't You Take This to a Friend? A Question Psychotherapists Should Ask More Often.

Why Don't You Take This to a Friend? A Question Psychotherapists Should Ask More Often.

More than one way home - Student raters' impressions of interventions and group processes in mentalisation based group psychotherapy and group analytic psychotherapy.

In a study comparing mentalisation-based group therapy (MBT-G) and group analytic psychotherapy (GAP) in a day clinic, both group psychotherapy forms were found to be highly effective. But how did specific interventions and processes in both groups differ? The present article describes student raters impressions. Twelve psychology students listened to 100 audio recordings of 90 minutes group psychotherapy sessions of GAP and MBT-G. Each session was randomly assigned to two student raters, who were asked to write down their impressions. These were analysed. Group conductors in MBT-G used more questions, had short shares of speech, used group dynamics and fostered multiple perspectives on issues discussed. Affect perception was stimulated by asking questions. In PDGT, conductors used more interpretations, confrontations and supportive interventions, and they had longer shared of speech. Handling of affects was based on 'allowing to get infected'. Discussion. It is hypothesized that symptom reduction in both groups occurred via different ways: in GAP the pathic (affective contagion) function of interactions was more relevant, while in MBT-G it was the phatic (contact keeping) function. Results are also discussed in relation to previous findings on group processes and interventions.

Symptom distress and disability: Different sides of the same coin? An investigation of the relationship between symptom distress and disability over time in patients receiving treatment for internalizing disorders.

Most psychotherapy outcome research focuses on symptom reduction as a primary outcome. However, most patients do not seek psychological treatment exclusively for symptom relief, but mainly because they can no longer do what they want to do or used to do. Therefore, besides symptom reduction, also disability in daily functioning should be a focus of psychotherapy outcome research. Yet, until now there is a paucity in research pertaining to the relation between symptom reduction and reduction of disability during psychological treatment. For this reason, the aim of the current study was to examine the relationship between changes in symptom reduction (reduction in general symptom distress) and changes in self-reported disability over a period of two years in patients that receive psychotherapy for mood and anxiety disorders (N = 1182). We found strong correlations between both outcome measures at all measurement points. Furthermore, results demonstrated a decrease in both outcome measures from start to end of treatment with a moderate effect for symptom distress and a small effect for experienced disability. Cross-lagged panel analysis demonstrated that a decrease in symptom distress predicted a subsequent decrease in self-reported disability, and a decrease in self-reported disability equally predicted a subsequent decrease in experienced symptom distress. Our results seem to indicate that both outcome measures are interchangeable in psychotherapy outcome studies for internalizing disorders.

The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda

ObjectivesWe reviewed the evidence regarding the effectiveness of schema therapy for anxiety disorders, obsessive‐compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).MethodsThis systematic review followed the recommendation of the PRISMA guidelines. A database search (PsycINFO, MEDLINE, EMBASE, WEB OF SCIENCE, and Academic Search Ultimate) was conducted to identify eligible studies up until 2 April 2021. The search included the keywords (‘schema therap*’ or ‘schema group therap*’ or ‘schema mode therap*’ or ‘schema focused’ or ‘young’s model’) and (‘anxiety disorder*’ or ‘anxiety‐related disorder*’ or ‘agoraphobia’ or ‘health anxiety’ or ‘phobi*’ or ‘panic disorder’ or ‘obsessive compulsive disorder’ or ‘OCD’ or ‘posttraumatic stress’ or ‘post traumatic stress’ or ‘PTSD’ or ‘hypochondria’ or ‘axis 1’). Included studies were appraised on methodological quality according to the Psychotherapy Outcome study Methodology Rating Form.ResultsWe identified 41 studies that were eligible based on the topic. However, only six (comprising 316 anxiety, OCD, and PTSD patients) could be included despite lenient methodological inclusion/exclusion criteria. Results showed that schema therapy can lead to beneficial effects in disorder‐specific symptoms and early maladaptive schemas. Yet, we also uncovered substantial methodological limitations in most studies.ConclusionsSchema therapy is a promising treatment for anxiety, OCD, and PTSD. Yet, there is a systematic problem in the quality of research despite growing clinical interest and application. We therefore concluded with a research agenda presenting recommendations for future research that will be crucial for building a solid evidence‐base for schema therapy in chronic anxiety, OCD, and PTSD.Practitioner points A systematic review on the effectiveness of schema therapy for anxiety disorders, OCD, and PTSD.Preliminary but limited evidence that schema therapy leads to beneficial effects in disorder‐specific symptoms.Preliminary but limited evidence that schema therapy leads to beneficial effects in early maladaptive schemas in anxiety, OCD, and PTSD.More research of higher methodological quality is needed to provide more conclusive empirical support for the use of schema therapy for anxiety, OCD, and PTSD.

Measuring belongingness: Validation and invariance of the general belongingness scale in Spanish adults

According to Baumeister and Leary (1995) belongingness is an important characteristic of psychological functionality and central to human need. The experience of achieved belongingness is a positive feeling of security and comfort that is the result of feeling part of a community, in personal life, at the workplace, or in any other social contexts. In addition, belongingness is an important predictor of well-being. This study presents the Spanish adaptation of the General Belongingness Scale GBS (Malone et al. 2012), with a test of four different confirmatory models, including bifactor and methods effects model. A sample of 240 Spanish adults replied to the Spanish version of the GBS, the satisfaction with life scale and a short form of the Big Five dimensions. The Spanish version showed best fit with a model representing a one-factor structure and a method factor, associated with reversed-worded items. GBS showed strong invariance by gender; no gender differences in general belongingness were observed. Validity evidences, i.e. correlations with well-being and the Big Five dimensions, were similar to the results with the original English version. We conclude that our results warrant the use of the Spanish version of the General Belongingness Scale in further studies with this construct. Future studies should also assess test-retest reliability and include additional measures for establishing construct and predictive validity: Since belongingness is associated with well-being and other positive outcomes and thwarted belongingness a risk factor for suicidal behavior, belongingness could also be used with clinical samples and psychotherapy outcome studies in order to measure therapeutic change.

Patient‐reported reasons for discontinuing psychotherapy in a low‐cost psychoanalytic community clinic

AbstractUsing data from an outcome study of adult individual psychoanalytic psychotherapy, conducted in a low‐cost Australian clinic, a mixed‐methods approach was employed to investigate patient discontinuation. This paper addresses the qualitative component of the discontinuation study, which explored patients’ reasons for leaving the clinic service upon assessment or in treatment proper. Of 205 patients commencing clinic contact, 41% discontinued during or shortly after the four‐week assessment period, while 40.5% of patients beginning psychotherapy withdrew before reaching the two‐year treatment limit. Across these two groups, former patients were interviewed about their therapy experience and decision to discontinue. Thematic analysis of 20 interview transcripts generated five descriptive categories of discomfort or dissatisfaction prompting discontinuation: clinic factors, therapist factors, patient factors, therapist–patient relationship factors and therapy factors. Findings suggest that experience of the clinic setting itself, together with negative patient perceptions of therapists and therapist interactional style, weres significant influences and that dissatisfaction with the psychotherapy process and outcome was more relevant than problematic patient factors in treatment withdrawal. A number of patients, mainly late discontinuers, reported positive experiences of psychotherapy and significant treatment gains. Implications of the findings, with specific emphasis on psychoanalytic treatment settings, are discussed.

Regulation focused psychotherapy for children in clinical practice: Case vignettes from psychotherapy outcome studies.

There is a need for empirically informed play therapy approaches for children with oppositional and disruptive behaviors. Regulation-focused psychotherapy for children (RFP-C) is a manualized intervention rooted in the longstanding tradition of nondirective, psychodynamic play therapy. It builds on

Supportive Psychotherapy: Giving Cinderella Her Due

Supportive Psychotherapy: Giving Cinderella Her Due

Psychological interventions for epilepsy: How good are trialists at assessing their implementation fidelity, what are the barriers, and what are journals doing to encourage it? A mixed methods study

IntroductionPsychological interventions hold promise for the epilepsy population and continue to be trialed to determine their efficacy. Such interventions present opportunities for variance in delivery. Therefore, to accurately interpret a trial's estimate of effect, information on implementation fidelity (IF) is required. We present a novel 3-part study. Part 1 systematically rated trials for the extent to which they reported assessing whether the intervention was delivered as intended (adherence) and with what sort of skill (competence). Part 2 identified barriers to reporting and assessing on fidelity perceived by trialists. Part 3 determined what journals publishing epilepsy trials are doing to support IFs reporting. MethodsArticles for 50 randomized controlled trials (RCTs)/quasi-RCTs of psychological interventions identified by Cochrane searches were rated using the Psychotherapy Outcome Study Methodology Rating Form's fidelity items. The 45 corresponding authors for the 50 trials were invited to complete the ‘Barriers to Treatment Integrity Implementation Survey’. ‘Instructions to Authors’ for the 17 journals publishing the trials were reviewed for endorsement of popular reporting guidelines which refer to fidelity (Consolidated Standards of Reporting Trials (CONSORT) statement or Journal Article Reporting Standards [JARS]) and asked how they enforced compliance. ResultsPart 1: 15 (30%) trials reported assessing for adherence, but only 2 (4.3%) gave the result. Four (8.5%) reported assessing for competence, 1 (2.1%) gave the result. Part 2: 22 trialists – mostly chief investigators – responded. They identified ‘lack of theory and specific guidelines on treatment integrity procedures’, ‘time, cost, and labor demands’, and ‘lack of editorial requirement’ as “strong barriers”. Part 3: Most (15, 88.2%) journals endorsed CONSORT or JARS, but only 5 enforced compliance. ConclusionsMost trials of psychological interventions for epilepsy are not reported in a transparent way when it comes to IF. The barriers' trialists identify for this do not appear insurmountable. Addressing them could ultimately help the field to better understand how best to support the population with epilepsy.

An Unfortunate Comparison of Apples to Oranges: Comment on Jensma (2016)

In reporting the findings of her outcome study of Along-side's intensive outpatient psychotherapy (IOP) program for Christian missionaries and clergy, Jensma (2016) offered an unfortunate “apples-to-oranges” comparison to my outcome data on Link Care's IOP, which resulted in a largely erroneous discussion section. In this comment, I briefly describe the nature of the problematic comparison and provide some additional analyses of my earlier outcome research to highlight my concerns. I close with the assertion that extant data can only support the conclusion that Alongside and Link Care IOP programs both appear to be beneficial to participants and equivalently so at three month follow up.

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.

Interactional synchrony and negative symptoms: An outcome study of body-oriented psychotherapy for schizophrenia

Objective: We sought to assess the efficacy of a manualized body-oriented psychotherapy (BPT) intervention for schizophrenia, by focusing on improvement of negative symptoms and on changes in interactional synchrony. We also explored aspects of a phenomenological theory of schizophrenia, which states that negative symptoms should be understood within an encompassing disturbance of subjectivity and intersubjectivity. Method: Sixteen persons with schizophrenia participated in 10 weeks of BPT. General psychiatric symptomatology and negative symptoms were assessed before and after therapy. Interactional synchrony was assessed via cross-correlations of movements between patient and interviewer in interviews conducted before and after therapy. Results: Psychiatric symptomatology and negative symptoms significantly improved with a medium effect size. We also demonstrated a significant increase in interactional synchrony with a strong effect size. Post hoc analyses showed a significant increase only with open-ended interviews conducted by the same interviewer. Furthermore, we explored the correlation between negative symptoms and interactional synchrony, finding a large inverse relationship. Conclusions: BPT for schizophrenia may effectively reduce patients’ negative symptoms and psychiatric symptomatology. Moreover, it may yield some recovery of pre-reflective social relations. Further evidence of the specific relation between negative symptoms and interactional synchrony would support a phenomenologically informed holistic view of schizophrenia.

Double-Blinding and Bias in Medication and Cognitive-Behavioral Therapy Trials for Major Depressive Disorder

While double-blinding is a crucial aspect of study design in an interventional clinical trial of medication for a disorder with subjective endpoints such as major depressive disorder, psychotherapy clinical trials, particularly cognitive-behavioral therapy trials, cannot be double-blinded. This paper highlights the evidence-based medicine problem of double-blinding in the outcome research of a psychotherapy and opines that psychotherapy clinical trials should be called, “partially-controlled clinical data” because they are not double-blinded. The implications for practice are, 1. For practitioners to be clear with patients the level of rigor to which interventions have been studied, 2. For authors of psychotherapy outcome studies to be clear that the problem in the inability to blind a psychotherapy trial severely restricts the validity of any conclusions that can be drawn, and 3. To petition National Health Insurance plans to use caution in approving interventions studied without double-blinded confirmatory trials as they may lead patients to avoid other treatments shown to be effective in double-blinded trials.

Double-Blinding and Bias in Medication and Cognitive-Behavioral Therapy Trials for Major Depressive Disorder

While double-blinding is a crucial aspect of study design in an interventional clinical trial of medication for a disorder with subjective endpoints such as major depressive disorder, psychotherapy clinical trials, particularly cognitive-behavioral therapy trials, cannot be double-blinded. This paper highlights the evidence-based medicine problem of double-blinding in the outcome research of a psychotherapy and opines that psychotherapy clinical trials should be called, "partially-controlled clinical data" because they are not double-blinded. The implications for practice are, 1. For practitioners to be clear with patients the level of rigor to which interventions have been studied, 2. For authors of psychotherapy outcome studies to be clear that the problem in the inability to blind a psychotherapy trial severely restricts the validity of any conclusions that can be drawn, and 3. To petition National Health Insurance plans to use caution in approving interventions studied without double-blinded confirmatory trials as they may lead patients to avoid other treatments shown to be effective in double-blinded trials.

How to assess the quality of psychotherapy outcome studies: A systematic review of quality assessment criteria

Objective: Although it is widely accepted that the quality of a study may affect its results, there is no agreed specific standard for assessing the quality of psychotherapy outcome studies. This study aims to review the existing variety of relevant quality assessment criteria. Method: We identified relevant quality measures based on a systematic literature search. To determine the specific relevance of the available quality criteria, we consulted experts in the field of psychotherapy outcome research. Results: Nineteen different measures providing 185 different quality criteria were included. Four measures specifically focused psychotherapy studies, none of these were designed for studies without a control group. Experts did judge 20% of the items as “absolutely indispensable.” Conclusions: Quality criteria that are exclusively related to the context of psychotherapy research are rare. Further research is required to examine the empirical relation between specific quality criteria and study results.

Simple methods for enhancing patient outcome in routine care: Measuring, monitoring, and feedback

While highly effective, psychotherapy outcome studies suggest 5?14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically track client mental health functioning over the course of treatment and adjust treatment through the use of problem-solving tools are described. We summarize meta-analyses of the effects of a feedback system indicating that the number of psychotherapy patients who deteriorate can be cut in half. We conclude with a series of practice implications, including that clinicians seriously consider making formal methods of collecting client feedback a routine part of their daily practice.

Treatment preference among suicidal and self-injuring women with borderline personality disorder and PTSD.

This study examined treatment preferences among suicidal and self-injuring women with borderline personality disorder (BPD) and PTSD. Women (N = 42, M(age) = 34) with BPD, PTSD and recent intentional self-injury were evaluated upon entry into a psychotherapy outcome study. The majority preferred a combined dialectical behavior therapy (DBT) and prolonged exposure (PE) treatment (73.8%), followed by DBT alone (26.2%), and PE alone (0%). Women who preferred the combined treatment were more likely to report a desire to obtain relief from PTSD and to receive specific DBT and PE treatment components as reasons underlying this preference. Few women (21.4%) reported concerns about PE, but those who did were more likely to prefer DBT alone. More severe PTSD re-experiencing symptoms, a childhood index trauma, and less reduction in positive affect after a trauma interview predicted a preference for the combined treatment. These results may help to inform treatment for these complex patients.