Patient-therapist Interaction Research Articles

Therapists' defense use impacts their patients' defensive functioning: a systematic case study.

Research into defensive functioning in psychotherapy has thus far focused on patients' defense use. However, also the defensive functioning of therapists might be significant because of its potential in promoting changes in the patient's overall defensive functioning by sharing their higher-level understanding of a given situation and letting the patient have the opportunity to learn how to cope more successfully. This exploratory case study is the first to examine therapist's defense mechanisms and their relationship to changes in the patient's defensive functioning evaluated at different times throughout psychoanalytic treatment. We assessed the use of defense mechanisms with the Defense Mechanisms Rating Scales in 20 sessions collected at three phases (early, middle and late) of the psychoanalytic treatment. For each session, we identified therapist's and patient's defenses, defense levels and overall defensive functioning, with particular attention to the sequence of consecutively activated defenses within the therapeutic dyad. Results showed that the patient's defensive functioning tended to gradually improve over the course of the treatment, with a slight decrease at the end. Therapists' overall defensive functioning remained stable throughout the treatment with values in the range of high-neurotic and mature defenses. Assessment of the dyadic interaction between therapist and patient's use of defenses showed that within-session, the patient tended to use the same individual defenses that the therapist used, which was especially pronounced in the initial phases of the treatment. Towards the end of the treatment, once there was a stable shared knowledge, the patient started to explore using new, higher-level defenses on her own, independent from what defenses the therapist used. Our findings emphasized the analyst's role in encouraging the development of more effective ways of coping in the patient, confirming previous theoretical and empirical research regarding the improvement of patient's defensive functioning in psychotherapy. The alterations in these coping strategies, also called high-adaptive defenses, as part of the therapist-patient interaction demonstrate the importance of studying defenses as an excellent process-based outcome measure. The measurement of the degree to which the analyst models and illustrates these superior coping methods to the patient is a prime vehicle for supporting internalization of these skills by the patient.

Research on a new cable-driven lower limb rehabilitation robot with bilateral coordination control

In this paper, a new type of cable-driven lower limb rehabilitation robot (CDLLRR) based on bilateral control is proposed. Compared with the traditional rehabilitation robot, it has multiple cooperative remote rehabilitation modes of patient-therapist interaction with better safety, mechanical compliance and adaptability. Firstly, according to the characteristics of gait movement of human lower limbs and the performance requirements of the robot in therapy and rehabilitation, the overall structure, main components and assembly arrangement of the robot are designed in detail. Secondly, in order to ensure that the rehabilitation robot has excellent force transparency and system stability while still maintaining a certain position tracking, according to the performance measurement index based on the introduced bilateral control strategy, this paper proposes an improved PD controller based on Anderson method (IPDAM). Finally, the feasibility of the proposed CDLLRR and the effectiveness of the IPDAM are verified by simulation experiments.

The Future of Psychotherapy Research and Neuroscience: Introducing the 4E/MoBI Approach to the Study of Patient–Therapist Interaction

The integration of neuroscience and psychotherapy research has long been a topic of interest in the field of mental health. A significant challenge in psychotherapy research is understanding the dyadic interaction between patient and therapist. This interaction is complex, emerging from a myriad of multi-level factors such as gestures, verbal communication, mentalization, and environmental influences. This article aims to present a roadmap for the future integration of neuroscience and psychotherapy research, addressing the complexities of human interaction. We introduce the 4E/MoBI approach, a framework that combines theoretical and methodological tools to study the dynamics of the brain, body, and environment in real-world settings. This approach emphasizes the use of physiological systems (e.g., heart and brain), behavioral interactions (e.g., conversations and eye-tracking), and environmental video recordings. Additionally, the scalable experimental design (SED) heuristic is discussed as a method to blend controlled experiments with real-world scenarios, allowing for the parametric testing of neurobehavioral markers. As a practical demonstration of the SED heuristic within the 4E/MoBI framework, a concrete experimental example using the N170 event-related potential (ERP) component is presented. While the N170 ERP component is not posited as the foundational marker in the field, it serves to illustrate the application of hypothesis-driven designs and analyses. The 4E/MoBI approach offers a promising avenue for the integration of neuroscience and psychotherapy research. By addressing existing gaps, such as the physiology and phenomenology of expertise in psychotherapy, this framework can foster a virtuous relationship between the two disciplines, paving the way for more comprehensive and nuanced understandings of therapeutic interactions.

Therapeutic expectancy in physiotherapy

ABSTRACT In health sciences, including physical therapy, communication techniques are a critical part of the success in the therapeutic process. Managing the patient’s beliefs, perceptions, and the narrative of their problems, becomes an essential part of the therapeutic process. This is the key to achieving real changes regarding how the patient copes with pain, illness, dysfunction, as well as the ability to develop adequate resources for facing them. We call this “Therapeutic expectancy” a new concept that originates from the well-known Therapeutic alliance and incorporates practices from the field of Motivational interviewing and Strategic dialogue. The Therapeutic expectancy starts from the first interaction with the patient and continues throughout the different stages of the therapeutic process. This article describes the structure of the relationship with the patient and some verbal communication techniques to generate an effective physical therapist-patient interaction, building Therapeutic expectancy, through a “centered on the patient’s narrative” strategy. Expectancy constitutes a desirable goal in any patient and in any pathological condition as it pursues a change in an individual’s perception of their state of health, thereby enhancing the desire for healing and empowerment.

Goal-setting and personalization under the International Classification of Functioning, Disability, and Health framework: Community reintegration program for post-stroke patients.

Body functions and structures, activities, and participation are the core components in the International Classification of Functioning, Disability, and Health (ICF) to identify post-stroke patients' health conditions. The specification of health conditions enhances the outcomes of post-stroke rehabilitation. This study aimed to explore the extent and the processes in an ICF-based post-stroke rehabilitation program (ICF-PSRP) that could enhance patients' community reintegration level. Post-stroke patients who completed the ICF-PSRP participated in intake and pre-discharge individual face-to-face semi-structured interviews. In addition, case therapists were invited to a face-to-face semi-structured group interview. Clinician experts were invited to complete an interview with the same interview contents as case therapists but in an online format. All interview recordings were analyzed with the Framework analysis. Patients' treatment goals were mapped with the ICF Core Set for Stroke. Out of 37 invited post-stroke patients, thirty-three of them completed the interview. Three case therapists and five clinicians completed the interviews. The goals set by the patients and their caregivers showed a broadening of their scope over the course of the program. The changes in scope ranged from the activities to the participation and environmental components. Increases in patient-therapist interactions played an essential role in the goal-setting process, which were integral to personalizing the treatment content. These characteristics were perceived by all parties who contributed to the program outcomes. The application of ICF's principles and core components offers a useful framework for enhancing post-stroke patients' community reintegration level. Future studies should explore the way in which patient-therapist interaction, exposure to environmental factors, and personalized interventions maximize the benefits of applying this framework to the community integration of post-stroke patients.

Patient-Therapist Cooperative Hand Telerehabilitation through a Novel Framework Involving the Virtual Glove System.

Telerehabilitation is important for post-stroke or post-surgery rehabilitation because the tasks it uses are reproducible. When combined with assistive technologies, such as robots, virtual reality, tracking systems, or a combination of them, it can also allow the recording of a patient's progression and rehabilitation monitoring, along with an objective evaluation. In this paper, we present the structure, from actors and functionalities to software and hardware views, of a novel framework that allows cooperation between patients and therapists. The system uses a computer-vision-based system named virtual glove for real-time hand tracking (40 fps), which is translated into a light and precise system. The novelty of this work lies in the fact that it gives the therapist quantitative, not only qualitative, information about the hand's mobility, for every hand joint separately, while at the same time providing control of the result of the rehabilitation by also quantitatively monitoring the progress of the hand mobility. Finally, it also offers a strategy for patient-therapist interaction and therapist-therapist data sharing.

Learning Post-Stroke Gait Training Strategies by Modeling Patient-Therapist Interaction.

For safe and effective robot-aided gait training, it is essential to incorporate the knowledge and expertise of physical therapists. Toward this goal, we directly learn from physical therapists' demonstrations of manual gait assistance in stroke rehabilitation. Lower-limb kinematics of patients and assistive force applied by therapists to the patient's leg are measured using a wearable sensing system which includes a custom-made force sensing array. The collected data is then used to characterize a therapist's strategies in response to unique gait behaviors found within a patient's gait. Preliminary analysis shows that knee extension and weight-shifting are the most important features that shape a therapist's assistance strategies. These key features are then integrated into a virtual impedance model to predict the therapist's assistive torque. This model benefits from a goal-directed attractor and representative features that allow intuitive characterization and estimation of a therapist's assistance strategies. The resulting model is able to accurately capture high-level therapist behaviors over the course of a full training session (r2=0.92, RMSE=0.23Nm) while still explaining some of the more nuanced behaviors contained in individual strides (r2=0.53, RMSE=0.61Nm). This work provides a new approach to control wearable robotics in the sense of directly encoding the decision-making process of physical therapists into a safe human-robot interaction framework for gait rehabilitation.

The alliance construct in psychotherapies: from evolution to revolution in theory and research

The alliance construct in psychotherapies: from evolution to revolution in theory and research

Child and Adolescent Psychodynamic Therapy: Using Q-Methodology in Process Research

ABSTRACT Psychotherapy for children and adolescents has been shown to be generally effective in treating a wide variety of psychological problems. In spite of this success, the field has been slow to identify the key therapeutic processes responsible for changes in psychiatric symptoms, emotional well-being, social relationships, and school functioning observed across theoretically different treatment models. The child and adolescent psychodynamic psychotherapy literature lags far behind the adult literature in assessing the change processes associated with the successful treatment of children and adolescents. This article reviews the rapidly growing literature engaged in the pursuit of articulating the change processes associated with successful treatment outcomes for children and adolescents. Two classes of change processes are reviewed: interaction structures (i.e., patterns of reciprocal therapist-patient interaction) and adherence to “brand-name” treatment models (e.g., child psychodynamic therapy). Researchers have used children’s psychiatric diagnoses most commonly as moderators of significant process-outcome associations. This article will explore the contributions of the Child Psychotherapy Q-Set (CPQ) and Adolescent Psychotherapy Q-Set (APQ) to this field of study, while also reviewing some of the data analytic strategies used. Finally, an outline of the future directions of child and adolescent psychodynamic psychotherapy process research using the CPQ and APQ is suggested.

The acceptability of cognitive behaviour therapy in Indonesian community health care

Abstract Cognitive behaviour therapy (CBT) is considered to be the most empirically supported treatment in the Western world. However, many authors emphasize the need for cultural adaptations of CBT for patients in a non-Western context. Before considering such adaptations, it is important to investigate the reasons and the degree to which this type of treatment should be adapted. One important factor is the acceptability of CBT by local health care consumers in non-Western countries, for which there is only very limited empirical evidence. This explorative study aimed to investigate the acceptability of CBT’s principles and specific interventions in Indonesia. Lectures and video clips were developed, demonstrating various mainstream CBT principles and procedures. These were presented to 32 out-patients and mental health volunteers from various Indonesian community health centres (Puskesmas), who were asked to rate to what extent they considered the presented materials to be acceptable in accordance with their personal, family, cultural and religious values. Acceptance in all four value domains was rated as very high for the general features of CBT, as well as for the content of the video clips. There were no significant differences in acceptability between the value domains. The presented study suggests that mainstream CBT applications, which are slightly culturally adapted in terms of language, therapist–patient interaction and presentation, might resonate well with consumers in community health centres in Indonesia. Key learning aims (1) Adapting CBT to non-Western patients should be based on empirical evidence. (2) The potential need for adaptation of CBT might depend on the acceptability of unadapted CBT. (3) Acceptability is assumed to be related to patients’ values.

Mobile Diary App Versus Paper-Based Diary Cards for Patients With Borderline Personality Disorder: Economic Evaluation.

BackgroundThe cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown.ObjectiveThis study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility.MethodsThis study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app.ResultsA total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054; SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization <5 and <5; general practice −1.32; SE 3.68 and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worried about potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction of the new technology but pointed at innovation potential from digital database registrations.ConclusionsThis study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness.Trial RegistrationClinicalTrials.gov NCT03191565; http://clinicaltrials.gov/ct2/show/NCT03191565International Registered Report Identifier (IRRID)RR2-10.2196/17737

Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy.

Research suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16–18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work–in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature.

Managing Countertransference in the Treatment of Personality Disorders.

The clinical and technical difficulties presented by patients with personality disorders are well documented. This article focuses on the challenges faced by therapists when managing their emotional reactions, that is, their countertransferences, to patients with personality disorders. While leaving room for therapists' unique and idiosyncratic countertransferences to the patient with personality pathology, Kernberg emphasized the role of a more general form of countertransference, one reflective largely of the patient's conflicts and defenses, in the treatments of personality disordered individuals. Here, the nature of the patient's internal and external functioning can be seen to lead to similar reactions among different therapists, opening the possibility of utilizing countertransference to better understand the patient's difficulties. In transference-focused psychotherapy (TFP), countertransferences arising in the patient-therapist interaction are first identified and contained by the therapist and then utilized to clarify and explore how the patient's internal object relations are being enacted in the clinical process. This article describes this process and how TFP therapists work with their countertransference to help illuminate the patient's split representational world, paving the way for interpretation and integration.

Facial-affective communication and verbal relational offers during ruptures and resolution strategies: A single case study

Research on the therapeutic relationship has underscored its central role for the therapeutic change process, indicating the relevance of determining the specific elements and mechanisms involved in its configuration (Knobloch-Fedders, Elkin, &amp; Kiesler, 2014). Research on ruptures of the therapeutic relationship has yielded particular contributions to better understanding the interpersonal negotiation process involved in the patient-therapist interaction. Although previous studies have contributed to the objective characterization and the exhaustive description of ruptures, more research is needed to further specify markers that allow a better understanding about how patterns of affective regulation between patient and therapist are involved and contribute to the emergence of these events and the attempts at reparation. The aim of this study is to characterize patient’s and therapist’s facial-affective behavior associated to verbal relational offers (RO) during rupture (R) and resolution strategy (RS) events in a brief psychodynamic therapy. Facial-affective behavior was determined using the Facial Action Coding System (FACS), ROs were derived from the content analysis of session transcripts, and R and RS were determined using the 3RS. Nested analyses were carried to establish associations between variables. Results indicate characteristic patient-therapist facial-verbal regulatory patterns for both rupture and resolution strategy events. These findings underscore the value of combining multiple approaches to allow an access to observable indicators of dyadic affect regulatory processes that can contribute to better understand and be attentive to the oscillations of the therapeutic relationship.

”Open” and ”closed” therapies

Abstract As a longitudinal process, psychotherapy is geared to facilitate a positive change in the patients. Starting from the classical psychoanalytical tradition, a fundamental aim in many types of psychotherapy is to increase the clients’ contact with their problematic emotions and parts of the self, and increase their self-reflexive abilities. As the interaction in psychotherapy aims towards a change, it is evident that it is not only the patient’s inner experience that changes during the process of psychotherapy, but also the relationship between the participants develops over time. In this paper, we propose a way to describe the global dynamics of the therapist-patient interaction, by making a distinction between what we call open and closed therapies. This perspective emerged from our work with a set of data coming from five dyads of psychodynamic psychotherapy. We consider how much variety there is in the interactional moves of the participants, that is, in the possible relations between two turns at talk. We call therapies with sequential variation as “open therapies” and those with rather stable sequential patterns as “closed therapies”. We propose that the variety on sequential relations links to the phasic organization that is common to all psychotherapeutic processes (in that they have beginning, middle and end) and to the change in the internal world of the patient.

Patient Satisfaction Measurement by MedRisk Instrument

Background: The importance of evaluating the user’s perspective when dealing with the quality of health services has been a constant and the user’s role as protagonist of this system has a direct impact on improving service. Thus, it is essential to know how users evaluate the care provided to rethink professional practices or intervene in the form of organization of services, to its improvement. Objectives: Assess the degree of patient satisfaction through MedRisk Instrument and identify the item that has the greatest impact on overall satisfaction. Methods/Design: The users of a university clinic of physical therapy, in rheumatology and pediatrics sectors, were asked about their degree of satisfaction, using MedRisk instrument. Results: Forty-six users completed the questionnaire. The 2 global measures means were 4,86 and 4,86 in rheumatology sector; and 4,76 and 4,84 in pediatrics sector. The specific items that had higher level of satisfaction and the highest correlation with overall satisfaction were items 6, 7, 8 and 11. Conclusion: The university physiotherapy clinic was assessed with a high degree of satisfaction to its users and items related to the therapist-patient interaction have more influence on overall satisfaction. Thus demonstrating that the MedRisk instrument is effective, functional and wide applicability.

Eurythmy therapy versus slow movement fitness in the treatment of fatigue in metastatic breast cancer patients: study protocol for a randomized controlled trial

BackgroundCancer-related fatigue (CRF) is the most taxing symptom for many breast cancer patients during and after therapy. In patients with metastatic disease, the prevalence of CRF exceeds 75%. Currently, there is no gold standard for the treatment of CRF. Physical activity can reduce CRF and is recommended during and after cancer treatment, but may be too burdensome for patients with metastatic breast cancer. The aim of this study is to assess the effect on fatigue of eurythmy therapy (ERYT) compared to slow movement fitness (CoordiFit) in metastatic breast cancer patients.MethodsThe ERYT/CoordiFit study is a randomized controlled, open-label, two-arm, multi-center Swiss clinical trial. A sample of 196 patients presenting with CRF will be recruited by oncologists from the departments of clinical oncology at each local study site. All participants will be randomly allocated to the intervention or control group in a 1:1 ratio. The control group is an active control intervention (CoordiFit) in order to control for potential non-intended effects such as therapist-patient interaction and participation in a program. Both ERYT and CoordiFit exercises are easy to learn, and the training sessions will follow the same frequency and duration schedule, i.e., 13 standardized therapy sessions of 45 min (once a week for 6 weeks and then once every second week) during the total intervention period of 20 weeks. The primary endpoint of the study is the change from baseline over the whole intervention period (i.e., including measurements at baseline, weeks 8, 14, and 20) in the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) subscale score.DiscussionThis study is the first-known randomized clinical trial assessing eurythmy therapy in the treatment of fatigue in metastatic breast cancer patients. Given the distress that fatigue causes patients, it is important to validate treatment options. If eurythmy therapy proves beneficial in CRF as part of this randomized controlled clinical trial, the study may be very impactful with implications not only for metastatic breast cancer patients but also for other cancer patients, health care personnel, scientists, and funding and regulatory bodies.Trial registrationThe ERYT/CoordiFit trial was registered at the US National Institutes of Health (ClinicalTrials.gov) on July 18, 2019, #NCT04024267, and in the portal for human research in Switzerland on December 3, 2019, #SNCTP000003525.

Active Ingredients and Mechanisms of Change in Motivational Interviewing for Medication Adherence. A Mixed Methods Study of Patient-Therapist Interaction in Patients With Schizophrenia.

BackgroundTrials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms.MethodsFirst, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk.ResultsWe found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change.ConclusionsMechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.

Psychotherapy of Dependent Personality Disorder: The Relationship of Patient–Therapist Interactions to Outcome

Objective So far, only a few studies have focused on psychotherapy for Dependent Personality Disorder (DPD). DPD is marked by a repetitive pattern of efforts aiming at maintaining close relationships, which may present as a lack of assertiveness and as a difficulty in making routine decisions. The present study aims at exploring processes of change taking place during the working phase of a clarification-oriented psychotherapy (COP) by focusing on the in-session patient–therapist interaction, as it changes during treatment and their links with treatment outcome. Methods: N = 74 patients with DPD were recruited in a naturalistic setting; they underwent long-term COP. Sessions 15, 20 and 25 were video- or audio-recorded and analyzed using the Process-Content-Relationship Scale, an observer-rated instrument that measures the quality of the interaction processes from patient’s and therapist’s perspectives. Therapy outcomes were assessed with the Personality Inventory – Dependency Subscale, Beck Depression Inventory, Inventory of Interpersonal Problems and Self-efficacy Scale at intake and discharge of therapy. Three-level Hierarchical Linear Modeling was applied to test the hypotheses. Results: Improvement in interaction processes was observed in all patient’s and therapist’s variables over the sessions 15, 20, 25. Overall, this increase in quality of interaction process was unrelated with outcome, but decrease in dependency traits was predicted by increase in therapist’s quality of relationship offer, understanding of content and directivity over the course of the working phase of COP. Conclusions: Studying interaction processes in DPD provides an initial understanding of differential roles of potential mechanisms of change in effective treatment.

Gazing Back, Playing Forward: Contemporary Psychoanalytic Musings on the Relational Essence of Hypnotherapeutic Action

To build bridges between hypnosis and contemporary psychoanalysis, this article addresses how hypnosis, when used in psychotherapy, facilitates curative action through its relational essence. The author’s extensive experience with hypnosis, psychotherapy, and psychoanalysis orient the narrative toward the unconscious patient–therapist interaction, with particular attention paid to the ethics of the inherent hypnotic seduction. Whether used primarily in relief-oriented ways or geared toward more transformative therapeutic aims, powerful unconscious factors are in play for both patient and therapist and are explicated to illustrate the interactive and frequently unformulated, intersubjective factors that facilitate effective, psychotherapeutic hypnosis. Consequently, therapists attuned to such intersubjective dynamics can make use of their own internal mental activities to understand a patient’s current state of mind and level of developmental functioning, and thereby subsequently formulate mutative interventions. For instance, because hypnotizability reflects the ability to play in imaginative space, the regression promoted in hypnotherapy may activate both an illusion of omnipotence and its optimal disillusionment through the relational context. This requires going beyond more traditional, procedural ways of bifurcating hypnotic interventions as being either direct or indirect and instead further distinguish hypnotic interventions in accordance with their maternal and paternal relational dimensions. Arguably, then, the skillful hypnotherapist needs to maintain a coupling interplay between the maternal, maximally receptive and the paternal, more active modes of functioning within hypnotic play space.