Psychotherapy For Patients Research Articles

The Experience of Psychotherapy in Greek Women with Breast Cancer: An Interpretative Phenomenological Study

Βreast cancer is amongst the most frequently occurring types of cancer amongst women worldwide. The present qualitative study explored experiences of long-term psychotherapy among women with breast cancer attending psychodynamic psychotherapy at an outpatient service specializing at providing psychotherapeutic interventions for cancer patients, in Greece. The sample was purposeful and comprised of six women who participated in individual interviews, consisting of questions framed in an open way to explore their lived experiences in the context of therapy. The research data was analyzed using Interpretative Phenomenological Analysis and produced five group experiential themes (superordinate themes) namely 1) the experience of breast cancer 2) psychosomatic aspects of cancer 3) psychotherapy as a process of self-awareness and growth 4) the process of change and 5) the therapist-client relationship. Participant women seemed to experience psychotherapy as a positive, even though challenging journey, that integrated past, present and future promoting post-illness and post-recovery well-being, and allowing for the exploration of different needs that surpass the event of the disease itself. Given the complex experiences and different needs of women with cancer, it seems important for further qualitative research to explore the experiences of patients in psychotherapy in different cultural contexts, and taking into account different theoretical orientations in order to offer appropriate therapeutic interventions.

Embitterment and Aggression in Psychotherapy Patients

Embitterment is an emotion which is known to everybody. Embitterment results in suffering for the afflicted person and the environment, including dysfunctional behavior and aggressive phantasies. This should be recognized in psychotherapy. There is a lack of respective data. The present study examines the rate and correlation of embitterment and aggression in psychotherapy patients. The study was done in an outpatient behavior therapy clinic. Patients filled in the PTED scale (Post-Traumatic Embitterment Disorder self-rating scale), the K-FAF (brief questionnaire to assess aggression factors), and the SCL-90-S (Symptom Checklist-90-Standard). Sociodemographic data were taken from the routine database of the clinic. A total of 118 patients, with a mean age of 38 years (SD=13.3 years, R=18-76 years), agreed to participate in the study. The mean score of the PTED scale was M=1.8 (SD=0.81; R=0-3.38). A cut-off-value of M≥2.5, which indicates clinically relevant embitterment was found in 22% of patients. The mean sum score of the aggressiveness scale (total) was 30.25 (SD=17.94). There were 23.7% of patients with a cut-off≥18.37 in reactive aggression and 54.2% with a cut-off≥14.8 in explosive aggression. Significant correlations were found between the PTED scale and the aggression scale (total) (r=0.422, p<0.001), as well as the subcategories "explosive" (r=0.355, p<0.001) and "reactive" aggression (r=0.425, p<0.001). A comparison of patients with increased embitterment, with increased aggression, with increased combined embitterment/aggression, and with inconspicuous patients showed a significant increase in regard to general mental distress as measured with the SCL-90 (GSI of the SCL-90-S: f(3,71)=4.00, p=0.011) and the rate of unemployment (Fisher-Test p=0.008) in the combined as compared to the inconspicuous group (GSI of the SCL-90-S: f(3,71)=4.00, p=0.011). There were no further significant differences in regard to other sociodemographic variables (age, gender, family status and education). The data show that embitterment and aggression are seen in relevant frequency in psychotherapy patients. They are significantly correlated, as suggested by theory. Therapists should be aware of this problem and intervene adequately.

Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder

Impact of dissociative phenomena on treatment outcome of inpatient psychotherapy of patients with borderline personality disorder Objectives: Although dissociative phenomena belong to the diagnostic criteria of borderline personality disorder (BPD) and are of high clinical relevance, their predictive significance with regard to the treatment outcome has hardly been investigated. Because some therapeutic and experimental studies suggest that dissociation can impede emotional learning and thus adversely affect the response to psychotherapy, we examined this issue in patients with BPD. Methods: In this naturalistic psychotherapy study we assessed 342 patients with BPD at the beginning and end of inpatient dialectical behavioural therapy (DBT) with self-report measures for dissociation (Questionnaire on dissociative symptoms, FDS, as German version of the Dissociative Experiences Scale, DES) as well as general and borderline specific pathology (Brief Symptom Inventory, BSI; Borderline Symptom List, BSL) and quality of life (SF-12). Results: Both the general mental distress (BSI) and the borderline-specific pathology (BSL) as well as the psychosocial quality of life improved less in patients with initially severe dissociative symptoms than in those with less pronounced symptoms; this effect was mainly driven by the subscale derealisation of the Dissociative Experience Scale (DES), and was found particularly in women. Conclusion: Consistent with earlier findings, dissociative phenomena proved to be negative predictors of the therapeutic outcome in BPD women completing inpatient DBT. Whether this also applies to outpatient and other evidence-based treatment approaches for BPD remains to be clarified. Our results indicate the necessity to identify and treat dissociative symptoms as early as possible for a successful psychotherapy.

Stress events and Changes in Dysfunctional Attitudes and Automatic Thoughts Following Recovery from Depression in Inpatient Psychotherapy: Mediation Analyses with Longitudinal Data

BackgroundStressful event exposure, dysfunctional attitudes (DA), negative automatic thoughts (NAT), and declining positive automatic thoughts (PAT) have been associated with depressive relapse/recurrence. Few studies have investigated the course of these variables and their relevance for relapse/recurrence in remitted depression.MethodsFollowing successful inpatient treatment, in 39 remitted depressive patients, stressful events, DA, NAT, PAT, and depressive relapse/recurrence were assessed five times during a 16-month follow-up. Data were analyzed with mixed effect models, and mediation effects were tested.ResultsStressful events after discharge correlated with depressive relapse/recurrence. This association was mainly mediated by a stress-related decline of PAT within four months post discharge. Patients’ DA were relatively stable during the observation period and did not depend on stressful events, indicating DA as a risk trait for depressive relapse/recurrence. Mediation analyses revealed that independent of stress, DA were linked to depressive relapse/recurrence through more NAT.ConclusionOur findings suggest stressful events evoke relapse/recurrence in remitted depression through rapid deterioration of PAT after discharge from inpatient therapy. DA are expressed through NAT which additionally contribute to higher risk of depressive relapse/recurrence. Consequently, maintenance therapy requires techniques to promote the maintenance of PAT, and to effectively restructure DA and NAT.

OXTR-Related Markers in Clinical Depression: a Longitudinal Case\u2013Control Psychotherapy Study

We investigated stability and change of plasma and urinary oxytocin as well as OXTR DNA methylation patterns through psychotherapy. Furthermore, we explored the potential impact of inpatient psychotherapy on oxytocin-related biomarkers and vice versa by differentiating patients who remitted from depression versus non-remitters. Blood and urine samples were taken from 85 premenopausal women (aged 19–52), 43 clinically depressed patients from a psychosomatic inpatient unit, and 42 healthy control subjects matched for age and education at two points of time. Serum and urine oxytocin were measured using standard ELISA, and DNA methylation of the OXTR gene was assessed using bisulfite sequencing at the time of admission (baseline) and at discharge and from controls at matched time points. Oxytocin plasma levels were not associated with depression and were influenced by neither time in healthy controls nor psychotherapy in patients. Non-remitting depressed patients had significantly lower oxytocin urine levels before and after psychotherapy treatment. We found significantly lower exon 1 OTXR methylation in depressed patients over time and these differences were driven by patients remitting due to psychotherapy. A reverse pattern — higher levels of methylation in remitters — was found for exon 2 OXTR DNA methylation. Plasma oxytocin, urinary oxytocin, and OXTR DNA methylation patterns were intrapersonally relatively stable. OXTR-related factors were seemingly unaffected by inpatient psychotherapeutic treatment, but we found significant differences between remitting and non-remitting patients in urinary oxytocin and OXTR DNA methylation. If replicated, this suggests that OXTR-related markers may predict inpatient treatment outcomes of clinically depressed patients.

Effectivity of Inpatient and Day-clinic Psychosomatic-Psychotherapeutic Treatment

(Partial) inpatient psychotherapy is well implemented in Germany. To better understand efficacy factors and effects, efficacy studies are necessary. This naturalistic study investigates the effectiveness of inpatient and day clinic psychotherapy as well as patient-and disorder-related factors influencing individual symptom improvements. Patients at a psychosomatic-psychotherapeutic university hospital treated from 2015 to 2019 who completed the BSI-18 either at admission and discharge (n=1366) or at admission and three-month catamnesis (n=497) were included in the analysis. Improvements in global symptom severity showed moderate effect sizes. Descriptively, these were larger for day clinic patients than for those receiving treatment as inpatients-especially in the follow-up comparison (immediately after discharge: dinpatient=0.401, dday clinic=0.482; three months after discharge: dinpatient=0.403, dday clinical=0.807). Day hospitalized patients differed significantly from inpatients-slightly in age, employment status, ability to work and initial symptom burden, moderately in the number of mental comorbidities and strongly in their main diagnoses. Socio-demographic factors showed no positive influence on symptom improvement, initial symptom severity a moderate positive influence and the number of mental comorbidities a complex influence. In general, this study confirms the effectiveness of (partial) inpatient psychosomatic therapy. The relevance of day clinic offers is emphasised in the context of cost efficiency and good integration into everyday life, but under consideration of individual treatment indications.

Associations between patient personality, symptomatic change and therapy dropout.

Studies show that 16% to 77% of psychotherapy patients abandon therapy within the first sessions. The aim of this study is to examine how patient personality variables, specifically the patients' structural integration and the personality traits dependency and self-criticism, are associated with symptomatic change and therapy dropout. We analysed data from 96 patients (age: M = 30.56, SD = 11.39; 78.5% women; 44.6% students, 28.3% employees). A hierarchical logistic regression analysis was carried out to determine whether patients' structural integration (assessed via the OPD-SQ) and their level of dependency and self-criticism (DEQ) can predict therapy dropout. In addition, a multiple regression was used to analyse how these variables affect symptomatic change (OQ-45.2 symptom subscale). The interaction of structural integration level and dependency best predicts therapy dropout. For the prediction of symptomatic change, both structural integration and dependency were significant. However, their interaction showed no significant results. The patient's structural integration was associated to both symptomatic change and dropout. Therapists' training should include techniques addressing patients' structural integration and degree of dependency to prevent patient dropout from therapy.

Little Girl, Big Feelings: Online Child Psychotherapy during the COVID-19 Pandemic

ABSTRACT The COVID-19 crisis has provided unique opportunities for the expansion of telepsychotherapy services. To date, the extant literature on telepsychotherapy has not included many strategies for effective telepsychotherapy with youth and families. This paper examines the evolution of a play psychotherapy case conducted fully online amidst the COVID-19 pandemic in 2020. A review of the telepsychotherapy literature is provided and multiple aspects of online psychotherapy are explored within the context of a completed, online psychotherapy treatment with one eight-year-old girl with externalizing symptoms. This case study is the first start-to-finish online case of Regulation Focused Psychotherapy for Children, and to our knowledge one of the few known case studies of a completed, fully online, child psychotherapy case. Clinical vignettes illustrate how the therapist’s interpretation of the child’s defenses within an online modality allowed the child to progress in her ability to tolerate painful emotions. In addition, countertransference reactions of a novice therapist, treating her first psychotherapy patient, are highlighted. This unique case study provides support for the value of an online, play-based treatment for children with behavioral issues and their families.

Compulsively Moral: OCD, Ethics, and the Law.

Compulsively Moral: OCD, Ethics, and the Law.

COVID-19 Related Traumatic Distress in Psychotherapy Patients during the Pandemic: The Role of Attachment, Working Alliance, and Therapeutic Agency.

The early months of the COVID-19 pandemic have been a challenging time for many psychotherapy patients. To understand why certain patients were more resilient, we examined the role of patients’ attachment anxiety and attachment avoidance, as well as collaborative therapy experiences (perceived working alliance and therapeutic agency) in their online sessions on their COVID-related traumatic distress over a three-month period. A total of 466 patients in online psychotherapy completed a survey during the first weeks of the pandemic, and 121 of those completed a follow-up survey three months later. Lower distress at follow-up was predicted by patients’ lower attachment anxiety and higher therapeutic agency in their online sessions after controlling for baseline distress and time of survey completion. Higher working alliance predicted less distress at follow-up only for patients with high attachment anxiety. For patients with low attachment avoidance (i.e., more securely attached), higher therapeutic agency predicted less distress. These findings suggest that patients’ attachment anxiety and therapeutic agency may play significant roles also in online therapy during COVID-19 in patient’s experienced traumatic distress, and that working alliance and therapeutic agency may be differentially important for patients with different levels of attachment anxiety and avoidance.

Emotional experience and change in psychodynamic inpatient psychotherapy

Emotional experience and change in psychodynamic inpatient psychotherapy Objectives: The subject of the present study is the recording of emotional experience and its change through inpatient psychodynamic psychotherapy, taking into account the factors of age, gender, and traumatic experiences in childhood and adolescence. Methods: The following standardized instruments were used on the clinical sample of 971 patients (413 inpatient, 558 day clinic patients) at the beginning and at the end of the treatment: Questionnaire for the Assessment of Emotional Experience and Emotion Regulation (EER), Childhood-Trauma-Questionnaire (CTQ), Inventory of Interpersonal Problems (IIP), Helping Alliance Questionnaire (HAQ), Symptom-Check-List (SCL-90-R). Results: The mean duration of treatment was 66.8 days (SD = 14.1; range 30-96). Younger patients and polytraumatized patients showed a higher expression of negative emotions. At the end of treatment, the whole group of patients showed a change in emotional experience, especially a strong decrease in passive-negative emotions and a decrease in psychological distress. Age represented a significant factor influencing emotional change. Discussion: The results underline the importance of emotional change as a prerequisite for treatment success and confirm the effectiveness of inpatient psychodynamic treatment. A further differentiation of the patients with regard to their emotional responsiveness seems to make sense with regard to the suitability of the therapeutic offers.

Revisiting Boarding School Syndrome: The Anatomy of Psychological Traumas and Sexual Abuse

The ABC‐D of Boarding School Syndrome clarifies the anatomy of the series of psychological traumas and sexual abuses that contribute to what, in 2011, I first classified as Boarding School Syndrome. The premise is that going to boarding school at a young age may inflict emotional injuries with lasting psychological consequences. The purpose here, ten years on, is to elucidate more fully aspects of the trauma embedded in the earlier writings and in the book Boarding School Syndrome. Research over the intervening years has led to developing an understanding of this enduring harm as presented in adult psychotherapy patients. The initials ABC‐D refer to the elements that constitute the multiple traumas suffered by the children: abandonment, bereavement, captivity and as a result, for some, disassociation. As a consequence, children may be vulnerable to sexual advances from paedophile adults, school bullies and the confusing, sexually charged, solace found in dormitories with other children. The accumulation of these events may have the long‐term effect of distorting intimate relationships and adult sexuality.

Predictors for successful psychotherapy: Does migration status matter?

BackgroundWe investigated, if migration status, and additional sociodemographic and clinical factors, are associated with somatization and depressiveness at admission and with remission after inpatient psychotherapy.MethodsMultiple linear and binary logistic regression analyses were used to identify predictors for severity of somatoform and depressive symptoms at admission of inpatient psychotherapy (T0), and for remission after inpatient psychotherapy (T1). We tested the association between symptoms concerning somatization (PHQ-15: Patient-Health-Questionnaire Somatization Module) and depression (PHQ-9: Patient-Health-Questionnaire Depression Module) and several sociodemographic and clinical factors in 263 patients at admission. For remission after treatment, we additionally included severity of symptoms at admission, number of diagnoses and duration of treatment in the regression models. Remission after treatment was defined as response plus a post value of less than 10 points in the respective questionnaire. Clinical relevance was interpreted using effect sizes (regression coefficients, Odds Ratio (OR)) and Confidence Intervals (CI).FindingsSignificant and clinically relevant predictors for high symptom severity at T0 were lower education (β = -0.13, p = 0.04), pretreatment(s) (β = 0.205, p = 0.002) and migration status (β = 0.139, p = 0.023) for somatization, and potential clinically relevant predictors (|β|>0.1) for depression were living alone (β = -0.116, p = 0.083), pretreatment(s) (β = 0.118, p = 0.071) and migration status (β = 0.113, p = 0.069). At T1 patients with pretreatment(s) (OR = 0.284 [95% CI: 0.144, 0.560], p<0.001) and multiple diagnoses (OR = 0.678 [95% CI: 0.472, 0.973], p = 0.035) were significantly and clinically relevant less likely to show a remission of depressive symptoms. In addition, a potentially clinically meaningful effect of migration status on remission of depressive symptoms (OR = 0.562 [95% CI: 0.264, 1.198], p = 0.136) cannot be ruled out. For somatoform symptoms pretreatment(s) (OR = 0.403, [95% CI: 0.156, 1.041], p = 0.061) and education (OR = 1.603, [95% CI: 0.670, 3.839], p = 0.289) may be regarded as clinically relevant predictors for remission.ConclusionThe results of our study suggest that migration status has a clinically relevant influence on severity of somatoform and depressive symptoms at admission. Clinical relevance of migration status can also be assumed regarding the remission of depression. Migration status and further factors affecting the effectiveness of the treatment should be analyzed in future research among larger samples with sufficient power to replicate these findings.

Development and psychometric properties of the Therapeutic Relationship Assessment Scale-Nurse.

WHAT IS KNOWN ON THE SUBJECT?: The literature shows a clear relationship between a good therapeutic relationship (TR) and the efficacy of nursing interventions. For the implementation of nursing psychotherapeutic interventions, the initial establishment of a good TR is essential. Several instruments assess the relationship established between the therapist and the patient in psychotherapy. However, no tool has been found to assess the quality of the TR established between the nurse and the patient. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study allowed the development and evaluation of the psychometric properties of a scale to assess the TR between the nurse and the patient in a sample of mental health nurses. The developed scale (Therapeutic Relationship Assessment Scale-Nurse) has psychometric properties that attest its reliability (internal consistency and test-retest) and construct validity as an instrument to assess the quality of the TR established between the nurse and the patient from the nurse's perspective. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: As the TR is crucial for providing nursing care and, in particular, for implementing nursing psychotherapeutic interventions, the scale developed is a valid tool to assess the quality of the TR established between the nurse and the patient in the perspective of the mental health nurse. The use of instruments to assess the quality of the nurse-patient TR facilitates the identification of the relationship's gaps, which can serve as a basis for improving the relationship itself and the nursing care provision. ABSTRACT: Introduction The therapeutic relationship (TR) is essential to providing psychiatric and mental health nursing care. Nevertheless, no assessment tools exclusive for assessing nursing TR were found in the literature. Aim To describe and evaluate the psychometric properties (reliability and construct validity) of a scale that allows assessing the quality of TR established between the nurse and the patient. Method A survey method was adopted, using a convenience sample of 356 mental health nurses. Internal consistency was assessed by Cronbach's alpha and Omega index. Results A total of 221 mental health nurses participated in the study (response rate=62.08%). The scale's final structure has 25 items. Cronbach's alpha was 0.93, ranging from 0.78 to 0.88 for each of the factors. The cumulative variance explained in a four-factor structure was 71.12%. Discussion The Therapeutic Relationship Assessment Scale (TRAS)-Nurse presents good psychometric properties. In the light of Benner's theory, it can be an useful tool for novice nurses to better understand what aspects they should pay attention to for establishing a successful TR. Implications for Practice Mental health nurses can use the TRAS-Nurse, thus having a scale available that allows them to self-assess the quality of TR they establish with their patients.

Two kinds of sudden gains in brief psychotherapy

Objective Sudden gains (SGs) are known to predispose to good outcome in psychotherapy, especially in brief treatment. However, some SGs may be illusory, in the sense that they arise from measurement error in the context of gradual change. We examined change before, during, and after SGs that were either true or illusory. Method In a sample of 1,867 university students treated with brief psychotherapy, we simulated session data as gradually changing score sequences, identified artifactual SGs therein, and utilized the simulated data to categorize actual participant SGs as either illusory or true. Results During treatment, participants with illusory SGs (N = 42) improved as much as did participants with true SGs (N = 67). Moreover, late in treatment participants with SGs and their matched controls improved at similar rates. True SGs were preceded by more distress and were larger than illusory SGs. Among participants with true SGs, very large SGs were more likely to reverse later in treatment. Conclusions Relatively small SGs may reflect measurement error. When brief psychotherapy patients deteriorate early in treatment but then suddenly experience substantial improvement, little further change is to be expected.

Patterns of Psychologists' Interprofessional Collaboration Across Clinical Practice Settings.

Healthcare increasingly emphasizes collaborative treatment by multidisciplinary teams. This is the first research focusing on psychologists' participation in team-based care, the mix of professionals with whom psychologists collaborate, and how these collaborations vary across practice settings. Data are from 1607 respondents participating in the American Psychological Association Center for Workforce Studies' 2015 on-line Survey of Psychology Health Service Providers. Practice settings differed markedly in systemic organizational support for interprofessional collaboration and in psychologists' participation in collaborative activities. Psychologists in individual private practice reported least support for and least occurrence of interprofessional collaboration. Psychologists' collaboration with non-behavioral health professionals, such as non-psychiatrist physicians and nurses, was more frequent in general hospitals and VA medical centers. Across settings, greater contact with another health profession was generally associated with psychologists being more confident about working with that profession. However, for work with psychiatrists, that association was attenuated. A collaborative practice model is presented for psychotherapy patients also treated by physicians or other professionals who manage a patient's psychotropic medication.

Negative Emotion Differentiation Predicts Psychotherapy Outcome: Preliminary Findings.

Emotion differentiation (ED), the extent to which same-valenced emotions are experienced as distinct, is considered a valuable ability in various contexts owing to the essential affect-related information it provides. This information can help individuals understand and regulate their emotional and motivational states. In this study, we sought to examine the extent to which ED can be beneficial in psychotherapy context and specifically for predicting treatment response. Thirty-two prospective patients with mood and anxiety disorders completed four daily assessments of negative and positive emotions for 30 days before receiving cognitive-behavioral treatment. Depression, stress, and anxiety symptoms severity were assessed pre- and post-treatment using self-reports and clinical interviews. We conducted a series of hierarchical regression models in which symptoms change scores were predicted by ED while adjusting for the mean and variability. We found that negative ED was associated with greater self-reported treatment response (except for anxiety) when negative emotional variability (EV) was included in the models. Probing negative ED and EV’s interactive effects suggested that negative ED was associated with greater treatment response (except for anxiety) for individuals with lower EV levels. Results were obtained while controlling for mean negative affect. Our findings suggest that negative ED can benefit psychotherapy patients whose negative emotions are relatively less variable. We discuss the meaning of suppression and interactive effects between affect dynamics and consider possible clinical implications.

Sparks of psychotherapeutic change: How therapists understand moments of meetings’ contribution to change in psychotherapy

Moments of Meeting (MoM) in psychotherapy are understood as shared moments between patients and therapists that allow a mutual implicit understanding about their relationship and create a new state of intersubjectivity that reconfigures the patient’s procedural knowledge of “being with others.” Despite ample theoretical and clinical descriptions of this phenomenon, little is known, from an empirical standpoint, about these kinds of moments in therapy. Objective : This study describes therapists’ experience of moments of meeting with their patients in psychotherapy, and how these moments relate to the patient’s change process. Method 13 in-depth interviews conducted with therapists from different theoretical backgrounds were analyzed using Grounded Theory. Results Four categories were established: (1) Characteristics of moments of meeting, (2) Triggers of moments of meeting (3) Enabling conditions, and (4) Main effects of moments of meeting. A conceptual model was developed around an axial phenomenon that provides understanding on how moments of meeting contribute to the change process in psychotherapy, through the construction of shared relational knowing. Discussion : The value of moments of meeting for the therapeutic process is discussed and reflected upon, as well as their effect on changes regarding implicit relational knowing.

Interactions with Standardized Patients to Evaluate Students’ Psychotherapy-Competencies

Abstract. The use of standardized patients (SPs) in the training of prospective practitioners is a well-established didactic tool in medical schools. Only recently have simulations of patients in psychotherapy been introduced into the training of psychologists. By integrating psychotherapy training into university-level master’s programs, German law now requires licensing exams for psychotherapists (i. e., Approbationsprüfung) to include an assessment of therapeutic competencies in simulated interactions with SPs. Yet, it has not been examined whether these simulations are useful for a reliable assessment of competencies in psychotherapy trainees. Also, we need to develop standardized instruments to evaluate competencies in entry-level psychotherapists. As part of a university course, we trained master’s-level students from three cohorts in clinical interviewing techniques (course title: Klinisch-psychologische Gesprächsführung). We analyzed videotaped 20-min sequences of N = 104 students while they interviewed one of N = 38 trained SPs. The students’ task was to interview the SP, conduct a brief case history, and use the interviewing skills they had learned in class. Two independent raters evaluated their psychotherapeutic competencies with an adapted version of the German Cognitive Therapy Scale (CTS). Raters evaluated students’ performance on two subscales and the total score with satisfactory interrater agreement (intraclass correlations). In general, students performed well in the interviews: They structured the sessions sufficiently, and their global psychotherapeutic competencies were satisfactory. However, the psychotherapeutic competencies of master’s students fell short of the benchmark derived from experienced psychotherapists. This pilot study provides first evidence that simulated interviews with SPs may be a reliable tool in the assessment of practical competencies in psychotherapy trainees at an early stage of their training. Moreover, we found that the CTS, which has demonstrated validity to quantify competencies of psychotherapists, is applicable and reliable in this training context as well. In sum, this suggests that simulated interviews with SPs may be useful for evaluating psychotherapeutic competencies of psychotherapy trainees.

Interpersonal clusters in a depressed outpatient sample

Abstract Background Prior research suggests that DSM diagnostic classification alone does not provide a full clinical picture for psychotherapy patients. Interpersonal problems are a promising area of research to aid in understanding patient experience and functioning, as well as build upon our existing understanding of psychotherapy treatment processes and outcomes. Methods 71 outpatients were enrolled in individual psychodynamic psychotherapy and received a DSM-IV diagnosis of a depressive spectrum disorder. Each patient's current major depressive episode symptoms, global assessment of functioning (GAF) score, and interpersonal functioning were assessed pre-treatment. Hierarchical cluster analysis was used to investigate whether interpersonal “types” could be identified. Results Hierarchical cluster analysis produced a 3-cluster solution that indicated 3 distinct interpersonal subtypes: 1) Non-assertive; 2) Socially Avoidant; and 3) Overly Nurturant. The subtypes did not significantly differ in terms of depressive diagnosis, global symptomatology, current major depressive episode symptoms, or GAF score. However, the Socially Avoidant cluster demonstrated significantly more male patients than the Non-assertive or Overly Nurturant clusters (p = .014). Limitations The current study utilizes a small sample size (N = 71), which limits statistical power. Findings must be interpreted with caution. Additionally, DSM-IV diagnostic classifications were used. Conclusions This study suggests the existence of three interpersonal profiles in depressive disorders: non-assertive, socially avoidant, and overly nurturant. These presentations, independent of quantitative levels of distress, imply that DSM-V classifications are insufficient to understand a patient's clinical presentation. It may be important to assess a patient's interpersonal functioning early in order to improve psychotherapy process and depression outcomes.