Short-term Individual Psychotherapy Research Articles

The efficacy of short-term individual interpersonal psychotherapy in augmentation with pharmacotherapy in major depressive disorder

Background The high prevalence rates and persistently increasing burden of depression indicate that there are still many unmet needs in the management of depression. Interpersonal psychotherapy (IPT) is one of the main evidence-based psychotherapeutic interventions for depression.Aim To evaluate the efficacy of short-term individual IPT in combination with pharmacotherapy, compared with pharmacotherapy alone, in the treatment of depression and assess its role in improving social functioning.Setting and design This study was conducted in Mansoura University hospitals and was an interventional randomized controlled trial.Patients and methods A total of 40 patients were recruited and randomized into either the interventional group or the control group. The interventional group received IPT in combination with selective serotonin reuptake inhibitor. IPT was in the form of once weekly session for 12 weeks. Patients in the control group received treatment with an selective serotonin reuptake inhibitor with appointments once every 2 weeks. Patients from both groups were assessed by the Montgomery–Asberg Depression Rating Scale and the Social Adjustment Scale Self-Report at the beginning and after 12 weeks.Statistical analysis IBM SPSS Statistics version 20.0 was used for statistical analysis.Results There were highly statistically significant improvements in depressive symptoms and in social functioning between the baseline assessments and after 12 weeks on the used scales in both groups. There was a trend for better improvement in the interventional group (IPT+pharmacotherapy) in depressive symptoms and in overall and specific domains of social functioning when compared with the control group. The interventional group showed statistically significant better improvements in social functioning when compared with the control group.Conclusions Combined IPT and pharmacotherapy shows clear benefits over pharmacotherapy alone, in both alleviating depressive symptoms and improvement of social functioning.

How Pediatric Hospitals Must Adapt to the Adolescent Mental Health Crisis.

How Pediatric Hospitals Must Adapt to the Adolescent Mental Health Crisis.

Dynamics of clinical and psychological indicators of patients with anxiety neurotic disorders in the treatment of short-term individual analytical-catarrhal psychotherapy

Modern development of psychotherapy involves conceptual integration of methods that allows to increase efciency and provide quality personalized treatment for patients with neurotic disorders, taking into account specifc impact targets. Te article describes the application of short-term individual analyticalcathartic therapy, combining various techniques of dynamic approach. Clinical and individual psychological characteristics of patients with disturbing neurotic disorders in the dynamics reflecting the result of the applied therapy were studied. Positive changes in the severity of symptoms, the intensity of psychological defenses, the range of constructive coping mechanisms used, self-esteem and interpersonal relationships are shown. Predictors of successful application of this model of psychotherapy are singled out.

EPA-1021 - Peculiarities of emotional damages in patients with anxiety disorders

The aim of the study the development of a comprehensive system ofpsychotherapy and psychocorrection of anxiety disorders of neurotic case, based on the study of their clinical structure and peculiarities of emotional damages. Methodologies Clinical and psychological investigation, included the scales of anxiety and uneasiness CH.D. Spielberger, Eysenck Personality Questionnaire (EPQ), The Hamilton Rating Scale for Depression (HRSD), The studyof accentuation of personality by K.Leonhard. Scope and contributing research 100 patients with diagnostic categories: F41.0 - Panic disorder(episodic paroxysmal anxiety, F41.1-Generalized anxiety disorder, F41.2-mixedanxiety-depressive disorder who are on the examination and treatment at the psychiatric unit. A control group included 40 patients. We performed the explorationof the peculiarities of clinical anxietyand patterns of therapeutic effect, based on the influence of short-term groupand individual psychotherapy in the treatment of anxiety disorders, andevaluation the effectiveness of its reconition. The development of the methodology of applying a short-term group and individual psychotherapy in the treatmentof anxiety disorders based on combination relaxation, hypnosis, cognitive-behavioral teqniques in combination on with short-term group therapy. In fact, this is a new realmodel psychotherapy based on integrative principles. The higt efficacy was shown in 82% patients, compared with 54% efficacy in control group patients. We will offer a new comprehensive methodology in the treatment of anxiety disorders of neuroticcase that will improve the therapeutic efficacy of the treatment process, reduce the time of treatment, reduce the period of drug therapy

Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial

ObjectiveThere are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome (FMS). We conducted a randomized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy (ASTPP) versus primary care management (TAU). The study focused on FMS patients with psychiatric comorbidity. MethodsForty-six female patients with FMS and an International Classification of Diseases, 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting. Participants were randomized to receive either ASTPP (25 sessions, 1 session/week) or TAU (4 consultations/6 months). Outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Disability Index, the Symptom Checklist 27 and the health-related quality of life. Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up. ResultsBoth treatments were effective in reducing the FIQ total score (ES=0.56 and ES=0.75, respectively). Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU. ConclusionsA high-standard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms.

The Development of a Measure To Assess Putative Mechanisms of Change in the Treatment of Borderline Personality Disorder

1325 PARIS, J., ZELKOWITZ, P., GUZDER, J., JOSEPH, S., & FELDMAN, R. (1999). Neuropsychological factors associated with borderline pathology in children. Journal of the American Academy of Child & Adolescent Psychiatry 38:770–774. PIPER, W.B., HASSAN, F.A.A., JOYCE, A.S., & MCCALLUM, M. (1991). Transference interpretations, therapeutic alliance, and outcome in short-term individual psychotherapy. Archives of General Psychiatry 48:946–953. WESTEN, D., NOVOTNY, C.M., & THOMPSON-BRENNER, H. (2004). The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin 130:631–663. ——— & SHEDLER, J. (1999). Revising and assessing Axis II: II. Toward an empirically based and clinically useful classification of personality disorders. American Journal of Psychiatry 156:273–285.

Men, women, and their outcome in psychotherapy

Abstract This article presents a discussion of the author's research on differences in psychotherapy outcome between men and women. Two studies are highlighted. The first concerned differential responses of men and women to interpretive and supportive models of short-term individual psychotherapy. This study found that men benefited more in interpretive therapy than supportive therapy. Conversely, women benefited more from supportive therapy than interpretive therapy. The second study concerned differential responses of men and women to interpretive and supportive models of short-term group psychotherapy and also examined possible mediators of differential response. The study found that women, compared with men, had superior responses in both types of group therapy. The generally poor response of men could be attributed, in part, to their lower levels of commitment to the groups and their lower levels of compatibility with the other (primarily female) group members. The article concludes with thoughts abo...

Quality of Object Relations as a Moderator of the Relationship Between Pattern of Alliance and Outcome in Short-Term Individual Psychotherapy

In this study, we investigated the personality variable quality of object relations (QOR) as a moderator of the relationship between the pattern of the therapeutic alliance and treatment outcome in two forms (interpretive, supportive) of short-term individual psychotherapy. In a sample of 72 psychiatric outpatients who completed interpretive therapy, QOR emerged as a moderator for the outcome factor general symptomatology and dysfunction. For high-QOR patients, an increasing level of alliance was directly related to benefit, whereas for low-QOR patients, a decreasing level of alliance was directly related to benefit. An explanation for these findings emphasized the importance of patients repeating their typical pattern of maladaptive interpersonal behavior in the therapy sessions in the context of the therapist working with the transference. In a sample of 72 psychiatric outpatients who completed supportive therapy, QOR did not emerge as a moderator. These findings in combination with evidence from previous studies suggest that QOR should be investigated as a moderator variable in future studies of short-term psychotherapy.

Using DSM axis II information to predict outcome in short-term individual psychotherapy.

The present study considered three methods of using DSM Axis II information to examine the effect of personality disorder on outcome in two forms of short-term, individual psychotherapy (interpretive and supportive). The first method involved examining whether the presence of any personality disorder influenced treatment outcome. The second method involved examining the effect of the number of personality disorders on outcome. The third involved examining outcome for specific personality disorders. The study found that a diagnosis of any personality disorder did not influence the outcome of therapy. In contrast, the number of personality disorders was significantly related to outcome at post-therapy and at 12-month follow-up. The findings indicated that a greater number of personality disorders was associated with less favorable outcome across both forms of therapy. This supports the notion that personality pathology is more severe when it involves a greater number of personality disorders. In an exploratory set of analyses, the study also found some evidence of differences in outcome for specific personality disorders.

Brief Psychodynamic Psychotherapy With Young Children

Specific techniques for brief dynamic psychotherapy are now well established for adults ( Davanloo, 1978 Davanloo H Evaluation and criteria for selection of patients for short-term dynamic psychotherapy. Psychother Psychosom. 1978; 29: 307-308 Crossref PubMed Scopus (5) Google Scholar , Mann, 1973 Mann J Time-Limited Psychotherapy. Harvard University Press, Cambridge, MA1973 Google Scholar , Piper et al., 1990 Piper WE Azim HF McCallum M Joyce AS Patient suitability and outcome in short-term individual psychotherapy. J Consult Clin Psychol. 1990; 58: 475-481 Crossref PubMed Scopus (0) Google Scholar , Sifneos, 1987 Sifneos PE Short-Term Dynamic Psychotherapy. Plenum Medical Book Company, New York1987 Crossref Google Scholar ). These approaches are typically characterized by a single dynamic focus, selection of highly motivated, nonpsychotic patients with high-quality object relations and a limited number of sessions established at the outset of treatment. Brief psychodynamic therapy models that use a fixed number of sessions have also been adapted for use with selected child patients ( Dulcan, 1984 Dulcan MK Brief psychotherapy with children and their families: the state of the art. J Am Acad Child Psychiatry. 1984; 23: 544-551 Abstract Full Text PDF PubMed Scopus (14) Google Scholar ). Based on work with adults, some approaches have included the idea of a “focal issue” and the use of a contemporary understanding of a “corrective emotional experience” ( Proskauer, 1969 Proskauer S Some technical issues in time-limited psychotherapy with children. J Am Acad Child Psychiatry. 1969; 8: 154-169 Abstract Full Text PDF PubMed Scopus (17) Google Scholar , Proskauer, 1971 Proskauer S Focused time-limited therapy with children. J Am Acad Child Psychiatry. 1971; 10: 619-639 Abstract Full Text PDF PubMed Scopus (16) Google Scholar ), while others have emphasized concomitant work with the family by a single therapist ( Lester, 1968 Lester EP Brief psychotherapies in child psychiatry. Can J Psychiatry. 1968; 13: 301-309 Google Scholar , MacKay, 1967 MacKay J The use of brief psychotherapy with children. Can J Psychiatry. 1967; 12: 269-278 Google Scholar , Turecki, 1982 Turecki S Elective brief psychotherapy with children. Am J Psychother. 1982; 36: 479-488 PubMed Google Scholar ). This report describes a further extension of the use of these models of short-term dynamic psychotherapy that is applicable to children between ages 3 and 7 years. While still relying on a fixed number of sessions, there is a lessened emphasis on time and more on the expectation of “being ready” to terminate treatment, reflecting young children's cognitive limitations regarding concepts of time.

Follow-up findings for interpretive and supportive forms of psychotherapy and patient personality variables.

Follow-up findings at 6 and 12 months are reported for a clinical trial that investigated the efficacy of interpretive and supportive forms of short-term individual psychotherapy and the interaction of each form with the patient's quality of object relations (QOR) and psychological mindedness (PM). Patients in both forms maintained their posttherapy improvements at 6- and 12-month follow-up assessments. They did not differ significantly from each other. At 6 and 12 months, there was evidence for a direct relation between QOR and favorable outcome. At 12 months, there was also evidence for an interaction effect, which indicated a direct relation between QOR and favorable outcome for interpretive therapy and almost no relation for supportive therapy. Thus, QOR continued to be an important predictor of outcome at 6 and 12 months, with some evidence for persistence of an interaction effect. In contrast, no follow-up effects were found for PM.

Pattern of alliance and outcome in short-term individual psychotherapy.

Pattern of alliance and outcome in short-term individual psychotherapy.

Task Analysis of “Working” Responses to Dynamic Interpretation in Short-Term Individual Psychotherapy

Results of the preliminary stages of a task analysis of “working” interpretation episodes from brief dynamic psychotherapy are described. A database of interpretation episodes (N = 1081) drawn from 60 completed therapy cases was the source for the study sample. Each episode was characterized by a dynamic interpretation, reliably coded according to a therapist intervention rating system. A conceptual model of a “working” response to interpretation was specified. The model was first evaluated against 10 episodes selected to reflect a working response by the patient. The analysis identified additional patient and therapist operations and greatly increased the complexity of the model. The revised model was then refined through the review of another 10 work episodes. The final model was applied to 10 episodes in which the patient had clearly evidenced a “nonwork” response, allowing for a diagnosis of deviations from a working interpretive process. Implications, limitations, and verification research directions...

Understanding the relationship between transference interpretation and outcome in the context of other variables.

Transference interpretation has traditionally been regarded as a powerful distinguishing feature of dynamically oriented psychotherapy. The failure of early studies to demonstrate its impact on outcome may, in part, have been due to limitations in methodology and conceptual models. A recently completed clinical trial of short-term individual psychotherapy has provided evidence of associations between two aspects of transference interpretation and outcome. The two aspects were concentration (frequency expressed as a proportion of interventions) and correspondence (congruence with a patient formulation). The nature of the associations varied as a function of the patient characteristic known as quality of object relations. Also important was the therapeutic alliance. When the variables were considered together in a multivariate model and their relationships examined by means of multiple regression, substantial amounts of outcome variance were accounted for. The evidence from previous and recent studies suggests that technique can have an important impact on outcome in short-term individual psychotherapy. It also indicates that the impact of technique should be viewed in relation to patient and relationship variables.

Psychiatry Residency Programs: Trends in Psychotherapy Supervision

The evolving dominance of psychobiologic over psychodynamic theoretical influences on education and practice presents new challenges for psychiatry. This article features selected data from the 1989 American Association of Directors of Psychiatric Residency Training annual survey (n = 215) that describe current teaching activities related to psychodynamic psychiatry, mainly psychotherapy. Results are based on a 50 percent return rate (107/215 questionnaires). Responses confirm the emergence of psychobiological (48%) over psychodynamic (40%) departmental orientations and report that the psychodynamic orientation has maintained strength as a secondary emphasis. Residents generally gain experience in a range of psychotherapy theories and modalities, including psychodynamic, cognitive, behavioral, individual, couples, family, and group therapies. Training in brief and short-term individual psychodynamic psychotherapy predominates, however. Use of video- and audiotaping in supervision is limited. Full-time faculty provide the bulk of psychotherapy instruction. This is carried out in both individual and group sessions, which are organized primarily around case reviews. Supervision-related problems include faculty availability, skill diversity, competence, theoretical flexibility, and attitudes, as well as program structure and standards.

Transference Interpretations, Therapeutic Alliance, and Outcome in Short-term Individual Psychotherapy

Relationships between the proportion of transference interpretations provided by therapists and both therapeutic alliance and therapy outcome were investigated for a sample of 64 patients who had received approximately 20 sessions of short-term individual psychotherapy within a controlled, clinical trial investigation. Inverse relationships were found between the proportion of transference interpretations and both therapeutic alliance and favorable therapy outcome for patients with a history of high quality of object relations. An examination of individual sessions revealed evidence that was consistent with two different, but not mutually exclusive, causal explanations. The first concerned the negative effects of high proportions of transference interpretations; the second concerned the reaction of the therapist to the presence of a weak therapeutic alliance. While the evidence from our study was correlational, it was sufficiently strong to warrant alerting clinicians to the possibility of negative treatment effects when high levels of transference interpretations are used with certain types of patients receiving short-term individual psychotherapy.

Quality of Object Relations versus Interpersonal Functioning as Predictors of Therapeutic Alliance and Psychotherapy Outcome

The purpose of the study was to compare an interview measure of quality of object relations to questionnaire and interview measures of recent interpersonal functioning with respect to the prediction of therapeutic alliance and psychotherapy outcome. The sample consisted of 64 patients who had received approximately 20 sessions of short-term individual psychotherapy within a controlled, clinical-trial investigation. Ratings of therapeutic alliance were provided independently by the patient and the therapist after each session. Outcome measures, which were provided by three sources (patient, therapist, and independent assessor), covered the areas of interpersonal functioning, psychiatric symptomatology, self-esteem, and life satisfaction. Quality of object relations, which characterizes the patient's lifelong pattern of relationships, was the best predictor. It was significantly related to patient-rated and therapist-rated therapeutic alliance and to patient improvement of both general symptomatology and specific target problems. The study also replicated previous studies that have reported significant relationships between therapeutic alliance and therapy outcome. The advantages of pretherapy predictors of therapy outcome, such as quality of object relations, are discussed.

Patient suitability and outcome in short-term individual psychotherapy.

Patient suitability and outcome in short-term individual psychotherapy.

Patient suitability and outcome in short-term individual psychotherapy.

The effects of short-term (time-limited), dynamically oriented individual therapy and the patient characteristic quality of object relations (QOR) were studied in a controlled clinical trial involving 8 experienced therapists and 144 psychiatric outpatients. A comprehensive set of outcome scores was monitored at 5-month intervals including a follow-up assessment. A strong treatment effect that was maintained at follow-up was found. The effect was evident in terms of statistical significance, effect size, and clinical significance. Evidence for an additive effect of the combination of treatment and QOR was also found. The best results were attained by high QOR therapy patients, and the worst results were attained by low QOR control patients. The results were suggestive of an optimal match between type of patient and type of therapy.

Relationships between the object focus of therapist interpretations and outcome in short-term individual psychotherapy.

The relationships between the object (person) focus of therapist interpretations and outcome were examined for 21 patients who received short-term individual psychotherapy. Percentages of single objects and linked objects, e.g. therapist-parent link, were derived from an analysis of the therapy sessions. Patients, therapists and an independent assessor provided pre-therapy, post-therapy and six-month follow-up outcome scores. Contrary to other reports in the literature little evidence was found to support the hypothesis of a direct linear relationship between object focus and favourable outcome. Several explanations for the findings are discussed.