Psychotherapeutic Context Research Articles

The Transtheoretical Model of Change and Recovery from a Suicidal Episode

Objective The Transtheoretical Model of Change (TTM) is an established model outlining five stages of change within a psychotherapeutic context: pre-contemplation, contemplation, preparation, action, and maintenance. Research shows that these models benefit patients and clinicians by enhancing their understanding of complex processes and identifying optimal therapeutic support for individuals at specific times. This study aimed to apply the TTM to personal recovery following a suicidal episode. Method A meta-synthesis was conducted on qualitative studies that outlined distinct phases or stages of recovery from a suicidal episode. The identified recovery stages were mapped onto corresponding TTM stages. Results Recovery processes followed a pattern aligning with TTM stages, but the action, maintenance, and termination stages were not clearly distinguished in the context of personal recovery. A three-stage model was proposed instead: (1) precontemplation, where recovery is not seen as possible or meaningful; (2) contemplation, during which there is growing awareness and consideration of the possibility of recovery and change; and (3) active growth, which is characterized by ongoing progress and engagement in at least one personal recovery process. Conclusions The proposed three-stage model condenses the later TTM stages and may better reflect personal recovery from a suicidal episode. Applying the model in clinical settings could help with case conceptualization and inform recovery approaches to an individual's current stage. Future research should evaluate the benefits of incorporating stages of change into suicide-focused recovery interventions to develop more effective interventions.

Drawn Stories Technique: Method and Concluding TherapeuticTurn

Summary The developmental age is often characterized by problems of somatization of psychological problems and conflicts: Anorexia, enuresis, encopresis and persistent constipation. The Drawn-Story (DS) technique presented in this article was developed to enhance and support the narrative-dialogic relationship in the psychodiagnostic and psychotherapeutic context – initially primarily for work with children of developmental age, but later also for other patient groups. It is a projective drawing technique that was developed by Giancarlo Trombini in the 1970s based on his training in Gestalt psychology and psychoanalysis at the University of Bologna and has since been further developed by him, Elena Trombini and their colleagues and also used in other fields of application. This article uses an early case history of DS to explore central aspects of this technique in greater depth. It also explores the question of whether the Concluding Therapeutic Turn observed in therapies with adults can also be observed in developmental age therapy according to the criterion of reconciliation of time perspectives.

How Can We Study Change Processes in Psychotherapy While Addressing Its Interactive Nature

Does the empathy or personality of psychotherapists influence the way they do therapy? Is the therapeutic relationship the key to success? Questions such as these are commonly shared in Change Process Research (CPR) and outcome studies. However, these statements, posed in descriptive cross-sectional terms, often imply the use of strategies grounded in causal-linear explanatory models. The present study offers an alternative tool to measure elements of psychotherapy in dynamic, interactive, and interdependent terms. With nine observational categories defined under analytical-behavioral lens, the Acoveo System is an instrument designed to detect the potential functions of verbal exchanges that take place in the psychotherapeutic context from any theoretical orientation. A guide to its application is provided, and its usefulness is elaborated on two of the pivotal common factors in change process research: empathy and therapeutic alliance.

“Angry at the Wrong Thing:” Queering Ketamine Assisted Psychotherapy for Clients Experiencing Body Image and Eating Distress

ABSTRACT Unlike classic serotonergic psychedelics, whose psychoactive shifts are recognized as having therapeutic value, ketamine’s perceptual effects are often overshadowed by its rapid antidepressant properties. However, within a ketamine assisted psychotherapeutic (KAP) context, ketamine’s distinct anxiolytic and dissociative features can cocreate a safe setting for client-directed psycho-spiritual exploration, including around body image and feeding disturbances. Eating disorders affect approximately 9% of Americans, and present a significant concern for LGBTQ2SIA+ community. This paper outlines a KAP framework, for further study, that is foundationally queer and grounded in postcolonial and intersectional feminist theories. This paper introduces societal body dysphoria, as a tool for clinicians to recontextualize how unrealistic ideals, identified as a societal distortion rooted in white supremacy, are individually internalized and collectively enforced through self-policing, with the belief that adherence will yield access to power and resources. Within this framework, a case report presents an example of how KAP can facilitate the deconstruction of societal constructs and alleviate distress.

Promoting Spiritual Coping of Family Caregivers of an Adult Relative with Severe Mental Illness: Development and Test of a Nursing Intervention.

Severe mental illness disrupts daily functioning, burdening family caregivers, who often adopt spiritual coping strategies. With comprehensive skills, mental health nurses can promote well-being and mental health. The aim is to develop and test the nursing intervention "promoting spiritual coping" in the family caregivers of home-dwelling people with mental illness. This study was conducted in two distinct stages. Initially, the intervention was developed according to the first phase of the Framework for Developing and Evaluating Complex Interventions. Secondly, the intervention protocol was tested in a mixed-method pilot study. An intervention protocol was developed and tested on ten family caregivers. The intervention comprised three sessions, and before-and-after assessments were conducted. Significant improvements were observed in the outcomes, with caregivers expressing that discussing spirituality and religiosity benefited them. This intervention prioritized the therapeutic relationship of the nurses and family caregivers. The intervention "promoting spiritual coping" was created and evaluated as a suitable approach for mental health nurses to use in a psychotherapeutic context with family caregivers of individuals with mental illness.

A social inference model of idealization and devaluation.

People often form polarized beliefs, imbuing objects (e.g., themselves or others) with unambiguously positive or negative qualities. In clinical settings, this is referred to as dichotomous thinking or "splitting" and is a feature of several psychiatric disorders. Here, we introduce a Bayesian model of splitting that parameterizes a tendency to rigidly categorize objects as either entirely "Bad" or "Good," rather than to flexibly learn dispositions along a continuous scale. Distinct from the previous descriptive theories, the model makes quantitative predictions about how dichotomous beliefs emerge and are updated in light of new information. Specifically, the model addresses how splitting is context-dependent, yet exhibits stability across time. A key model feature is that phases of devaluation and/or idealization are consolidated by rationally attributing counter-evidence to external factors. For example, when another person is idealized, their less-than-perfect behavior is attributed to unfavorable external circumstances. However, sufficient counter-evidence can trigger switches of polarity, producing bistable dynamics. We show that the model can be fitted to empirical data, to measure individual susceptibility to relational instability. For example, we find that a latent categorical belief that others are "Good" accounts for less changeable, and more certain, character impressions of benevolent as opposed to malevolent others among healthy participants. By comparison, character impressions made by participants with borderline personality disorder reveal significantly higher and more symmetric splitting. The generative framework proposed invites applications for modeling oscillatory relational and affective dynamics in psychotherapeutic contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and testing of a questionnaire on the expectations and experiences with wearing face masks in inpatient and day hospitals.

The Covid-19 pandemic made wearing of face masks mandatory in the psychotherapeutic context. Against this background, the present study aimed to compare the expectations of patients undergoing day-hospital or inpatient treatment regarding wearing a mask in psychotherapy before the start of therapy with the final experience after the end of therapy. The study also investigated the extent to which expectations and experiences were influenced by other factors such as socio-demographic characteristics, patients' general attitudes towards wearing a mask, duration of treatment, or mental health diagnoses. Patients' expectations and experiences were recorded using two versions of a self-developed questionnaire: the pre-version, which was administered before the start of therapy and recorded expectations, and the post-version, which was administered after the end of therapy and recorded the final experiences. An exploratory factor analysis was conducted for the questionnaire's pre- and post-version. T-tests for paired samples were calculated to compare the patients' expectations regarding the extracted factors with the final experiences. Bivariate correlations were calculated to explore the association of other potential factors with expectations and experiences. The exploratory factor analysis revealed a three-factor structure: communication barriers, self-confidence, and infection protection. The communication barriers expected by the patients before the start of the therapy turned out to be significantly higher than ultimately experienced after the therapy. Higher age correlated significantly negatively with expectations and experiences, with less self-confidence expected and experienced in therapy with a mask by older patients. There was a significant positive correlation between the expectations and the duration of treatment. Patients' general attitudes correlated significantly with their expectations and experiences. Based on the results, wearing a mask does not appear to negatively impact the success of psychotherapy from the patient's perspective. However, patient-specific characteristics also appear to play a role in this context.

Rediscovering Interpersonal Punctuation.

The term punctuation in psychotherapy refers to narrative decisions about when a problem started and who should be held accountable for it. The concept was once a staple of family and systems therapies, but it has largely fallen into disuse. Its near disappearance coincided with the declining interest in those therapeutic approaches rather than as the result of direct attacks on the concept's validity or usefulness. In other words, punctuation seems to have been neglected rather than deliberately abandoned or supplanted. The authors argue for the continuing value of punctuation and its introduction to a new generation of clinicians. They also discuss several theoretical issues that were not well explored during the heyday of punctuation's popularity. Finally, the authors explore and illustrate the practical utility of punctuation in psychotherapeutic contexts.

Applying the Self-Determined Learning Model of Instruction to the Psychotherapeutic Context for People with Intellectual/Developmental Disabilities

Applying the Self-Determined Learning Model of Instruction to the Psychotherapeutic Context for People with Intellectual/Developmental Disabilities

Personal Projects Analysis as an idiographic approach in psychotherapy: an exploratory study.

Client feedback research is a new but encouraging area that recognizes the importance of engaging patients in offered treatments and the relevance of the relationship between therapist and client. This study aimed to explore clients' experiences of goal-oriented work using Personal Projects Analysis (PPA). PPA was applied to 5 participants of a psychodrama group after their consent and in agreement with the ethics and deontology research university committee. Their progress was evaluated with Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM; 4 moments) and subjective well-being measures. Findings show how personal projects may be informative about clients' difficulties and change processes. All outcomes on CORE-OM went below clinical cut-off points, and all these changes are reliable and clinically significant. PPA offers a consistent way to implement the goals approach in a psychotherapeutic context successfully. Nevertheless, some adjustments need to be implemented in the goal-oriented work using PPA.

Psychotherapy as Ethics

Talk of matters ethical is, in the psychotherapeutic context, typically relegated to therapy’s preconditions and setting, i.e., to its ‘frame’. What goes on within that frame, i.e., therapeutic action itself, gets theorised in psychological rather than ethical terms. An explanation for this is the frequent therapeutic imperative to extirpate self-directed moralising. Moralising, however, constitutes but a phoney pretender to the ethical life. A true ethical sensibility instead shows itself in such moments of life as involve our offering humane recognition to one another and to ourselves. Being offered such recognition not only allows a patient to internalise it as a remoralising dignity or healthy pride. It also enables the patient to know herself by animating within herself a range of virtue concepts—courage, probity, repentance, etc.—which can then function as regulative ideals for a well-functioning psyche. Inchoate anxiety now takes shape as intelligible guilt. Repentance and the repair of damaged relationships now replace blame’s repression or projection. Conscience now becomes a motor for therapeutic change. In such ways, ethical concern constitutes not merely the frame but the living flesh of the therapeutic project.

Allegory Analysis from M. Theresa - A Case Study.

In the following article, I will briefly introduce the method of Allegory Analysis (AA) (Guenther, 2020, 2021, in press) and then outline it in its application to the case study of. The goal of this article is to introduce AA and illustrate it using the particularly illustrative case of Theresa. It will be shown how AA can be a new psychotherapeutic method in the therapist's toolbox, with which the human psyche in its individual uniqueness can be understood in the clinical context through creative means. Allegories of patients are defined here as complex linguistic constructs of multiple metaphors and as expressions of complex affective perception and experience. In order to understand a human psyche through its allegories, AA proceeds in four steps: (1) picking up and describing the allegories, (2) summarizing them into a so-called allegory poem, (3) interpreting the allegories on the part of the therapist, and (4) participatory interpretation of the allegories with the patient. The present case of Theresa illustrates the application of the AA method in an outpatient psychotherapeutic context and shows how through AA. In Theresa's case, the client was found to be ideologically guided by values such as autonomy, freedom, honesty, sustainability, charity, and connectedness. Her psychosis represented an autopoietic self-healing attempt to recover these values, which had been inaccessible to her in the antecedent process. The AA showed that Theresa believes that crises in the market economy, interpersonal coexistence, and climate change are at a critical point that threatens the existence of the world and thus her psychological stability. Moreover, in Theresa's allegories, it is evident that she had managed to use her values and beliefs autopoietically to stabilize her crisis through her coping strategy: externalization through poetic-allegorical language.

Tłumaczenie dzieci i dla dzieci w obecnej sytuacji migracyjnej w Polsce

Interpreting of Children and for Children in the Actual Migration Situation in Poland The paper describes the actual scene of public service interpreting and translation in Poland since the beginning of the war in Ukraine and the influx of a vast number of Ukrainian refugees into Poland. In particular it is focused on the role played by volunteer interpreters and translators who offer linguistic and cultural assistance to Ukrainian children in medical and psychotherapeutic contexts. It also deals with the activities of non-governmental organizations offering linguistic and translational support for immigrants in Poland.

How can psychotherapists improve their practice with service users from minoritised ethnicities? An application of the Declarative-Procedural-Reflective (DPR) model of clinical skill development

Abstract Many white psychotherapists may lack the skills required to work effectively with service users from minoritised ethnicities. This article proposes that the nature of this skills deficit can be understood through applying the Declarative-Procedural-Reflective (DPR) model of therapist skill development. The DPR model has been used in a range of psychotherapeutic contexts, and it provides a systematic account of how therapists from all modalities develop and can improve their skills. Adapting this model to white therapists’ skills in working with service users from minoritised ethnicities allows the identification of specific areas of skills deficit, and therefore clear recommendations as to how to address those deficits. The application of the DPR model to this context suggests that there are clear areas of skills deficit in terms of knowledge base, the practical skills of carrying out therapy, and the ability of therapists to reflect on their work with service users from minoritised ethnicities. I conclude by making a number of suggestions as to how those deficits could be addressed, both by individual therapists and at a systemic level. Key learning aims (1) To explore why some white psychotherapists find it more difficult to work effectively with service users from minoritised ethnicities. (2) To conceptualise difficulties in working with service users from minoritised ethnicities as an issue of clinical skill, knowledge and attitude development, where therapists’ skills can be improved if specific deficits are appropriately addressed. (3) To use the structure of the DPR model to better understand how deficits in therapists’ skills, knowledge and reflective ability may have an impact on their work with service users from minoritised ethnicities. This allows the identification of specific areas of deficit, and therefore clear recommendations as to how to address those deficits. (4) This is primarily addressed at CBT therapists, but the points raised in this article apply to all schools of therapy.

Socioeconomic status and the therapeutic alliance: An empirical investigation using structural equation modeling.

The purpose of the study was to investigate the associations between client socioeconomic status and the therapeutic alliance. Data on socioeconomic status and different aspects of the therapeutic alliance were obtained from participants currently or recently in psychotherapy and analyzed using structural equation modeling. The results provided support for a structural equation model where socioeconomic status was positively related to the therapeutic alliance. The study also found that the associations between socioeconomic status and therapeutic alliance was significantly stronger among clients who had received psychodynamic therapy compared to those who had received cognitive behavior therapy. The results are discussed in relation to research suggesting that clients of lower socioeconomic status are estranged from the psychotherapeutic context, reflecting experiences among the clients both of not being understood and as inferior in relation to their therapist, as well as possible perceptions that such client are less suitable for psychotherapy.

Religious diversity and well-being in positive psychology: implications for clinical practice

ABSTRACT Positive psychology, as a subdiscipline oriented to promoting human well-being, has grown significantly as a field over the past thirty years. To date, clinical applications in positive psychology have tended to advance more generalized, universal understandings of what constitutes well-being. We assert in this article that greater attention ought to be paid to more particular understandings of well-being, especially those emerging from religious traditions. We summarize visions of well-being from four different religious traditions, while highlighting possibilities for integrating understandings of these with clinical approaches in psychotherapeutic contexts. For each religious tradition, we also describe case examples to elucidate therapeutic possibilities when working with clients from diverse religious contexts. The article concludes with an extended discussion concerning points of divergence among religious traditions’ conceptions of well-being, along with commentary on the merits and practical demands of integrating universal and particular understandings of well-being in positive psychology interventions.

Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review.

Terminally ill patients may experience existential distress, depression, or anxiety, limiting quality of life in the final stage. Existing psychotherapeutic or pharmacological interventions have (time) limited efficacy. Psychedelic treatment may be a safe and effective alternative treatment option. Systematically review studies on psychedelic treatment with and without psychotherapy for existential distress, depression, and anxiety in terminally ill patients. Medline, PsycINFO, and Embase were searched for original-data studies on the treatment of depression, anxiety, and existential distress with classical or a-typical psychedelics in patients with a terminal illness, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 1850 records were screened, and 33 articles were included in this review: 14 studies on classical psychedelics (DPT, LSD, and psilocybin) and 19 studies on atypical psychedelics (MDMA and ketamine). Results of early pre-post studies are promising but have serious methodological flaws. Recent (controlled) trials with LSD, psilocybin, ketamine, and MDMA are of higher methodological quality and indicate positive effects on existential and spiritual well-being, quality of life, acceptance, and reduction of anxiety and depression with few adverse and no serious adverse effects. Both classical and a-typical psychedelics are promising treatment options in patients with terminal illness. To draw final conclusions on effectiveness and safety of psychedelics, we need larger high-quality studies for classical psychedelics and MDMA. Ketamine studies should pay more attention to existential dimensions of well-being and the psychotherapeutic context of the treatment.

Use of Automated Thematic Annotations for Small Data Sets in a Psychotherapeutic Context: Systematic Review of Machine Learning Algorithms.

BackgroundA growing body of literature has detailed the use of qualitative analyses to measure the therapeutic processes and intrinsic effectiveness of psychotherapies, which yield small databases. Nonetheless, these approaches have several limitations and machine learning algorithms are needed.ObjectiveThe objective of this study is to conduct a systematic review of the use of machine learning for automated text classification for small data sets in the fields of psychiatry, psychology, and social sciences. This review will identify available algorithms and assess if automated classification of textual entities is comparable to the classification done by human evaluators.MethodsA systematic search was performed in the electronic databases of Medline, Web of Science, PsycNet (PsycINFO), and Google Scholar from their inception dates to 2021. The fields of psychiatry, psychology, and social sciences were selected as they include a vast array of textual entities in the domain of mental health that can be reviewed. Additional records identified through cross-referencing were used to find other studies.ResultsThis literature search identified 5442 articles that were eligible for our study after the removal of duplicates. Following abstract screening, 114 full articles were assessed in their entirety, of which 107 were excluded. The remaining 7 studies were analyzed. Classification algorithms such as naive Bayes, decision tree, and support vector machine classifiers were identified. Support vector machine is the most used algorithm and best performing as per the identified articles. Prediction classification scores for the identified algorithms ranged from 53%-91% for the classification of textual entities in 4-7 categories. In addition, 3 of the 7 studies reported an interjudge agreement statistic; these were consistent with agreement statistics for text classification done by human evaluators.ConclusionsA systematic review of available machine learning algorithms for automated text classification for small data sets in several fields (psychiatry, psychology, and social sciences) was conducted. We compared automated classification with classification done by human evaluators. Our results show that it is possible to automatically classify textual entities of a transcript based solely on small databases. Future studies are nevertheless needed to assess whether such algorithms can be implemented in the context of psychotherapies.

Interpretation of affects: Spinozist approach to the issue of human emotionality

Abstract This paper deals with the possibilities of using the ethical considerations of Baruch Spinoza in a psychotherapeutic context. I begin the interpretation by defining the basic features of Spinoza’s ethics and their connection with the whole of his philosophical system. The core of the study is the interpretation of Spinoza’s theory of affectivity and especially his concept of the transformation of passive affects into active, and what role philosophical knowledge plays in this transformation. The third part of the study then tries to show how selected points of Spinoza’s introduced ideas can be useful for psychotherapeutic work. As much as the connection between philosophical ethics and psychotherapy seems obvious to many non-experts, most professionals on both sides are vehemently opposed to it. I believe that Spinoza’s thinking is an example of how the boundaries of these disciplines can be meaningfully bridged.

SUJEITO E O OUTRO NO TRATAMENTO DA TOXICOMANIA

Esse artigo é resultado de uma pesquisa bibliográfica, realizada com o objetivo de investigar as contribuições da psicoterapia voltada às pessoas que buscam a ressignificação da sua relação com a droga. Como resultado da pesquisa, evidenciou-se que é possível, a partir da queixa clínica e do desejo manifesto do sujeito diante à busca pelo tratamento da toxicomania, contribuir com intervenções que possibilitem a produção de novas subjetivações, ressignificando o papel do objeto droga através do processo de fala e das elaborações fomentadas no âmbito psicoterapêutico, onde se estabelece uma outra noção de sujeito. Conclui-se que as intervenções psicológicas e o setting estabelecido favorecem a ampliação do manejo do sofrimento, possibilitando ao sujeito em tratamento, o rearranjo de suas ações em suas formas de existências.