Time-limited Psychotherapy Research Articles

Facets of Structure and Adaptation: A Qualitative Study of Time-limited Psychotherapy with Children Experiencing Difficult Family Situations

We present here a qualitative study of nine time-limited therapies with children. Time-limited psychotherapy with children is a structured therapeutic method, where the objectives and contents are individual for each child. The number of hours for the therapy is contracted together with the child and the parents. The goal of the therapy is formulated as a shared focus based on the needs of the individual child. The focus is expressed metaphorically and is decided upon together with the child and parents before the therapy is commenced. The therapist's task is to connect the material that the child brings in to the sessions to the agreed focus. The study showed that a clear framework gave the children and the families the necessary security during the therapy process. Attunement to the children's experiences within this framework invited the children to communicate their experiences. Parents, teachers and therapists reported in all cases a positive change after the therapies had been concluded.

Time-limited psychodynamic psychotherapy and venlaxafine among acutely suicidal bordeline patients

Time-limited psychodynamic psychotherapy and venlaxafine among acutely suicidal bordeline patients

Chapter 5. Time-Limited Dynamic Psychotherapy and God Image

SUMMARY Time-Limited Dynamic Psychotherapy (TLDP) is an empirically supported treatment that can be used to conceptualize and address God image difficulties. This article provides an introduction to TLDP and outlines how the God image develops and can be modified through this method of psychotherapy. A case study is also provided to practically illustrate the TLDP process, treatment plan, and technique.

Chapter 12. God Image Psychotherapy

SUMMARY This chapter compares the seven different God image therapy approaches outlined in Part II of this book. These approaches include: attachment therapy, existential-integrative psychotherapy, neuroscientific therapy, rational emotive behavior therapy, time-limited dynamic psychotherapy, liberal protestant pastoral psychotherapy and theistic psychotherapy. First, similarities and differences are explored. Next, God image psychotherapy integration is discussed. General psychotherapy integration models are reviewed and applied to the different God image approaches. Finally, the chapter closes with a table that compares each orientation across the following categories: background and assumptions, God image development, God image difficulties, God image change, strengths and weaknesses.

Time-Limited Dynamic Psychotherapy and God Image

Time-Limited Dynamic Psychotherapy (TLDP) is an empirically supported treatment that can be used to conceptualize and address God image difficulties. This article provides an introduction to TLDP and outlines how the God image develops and can be modified through this method of psychotherapy. A case study is also provided to practically illustrate the TLDP process, treatment plan, and technique.

New Developments in Cognitive-Behavioural Therapy for Mood Disorders

Cognitive-behavioural therapy (CBT) for depression is an empirically validated, time-limited psychotherapy that leverages awareness of mood-linked changes in cognition and phenomenology to teach patients suffering from depression effective means to regulate affect and reduce symptoms. Its current standing as a front-line treatment for mood disorders can be traced to changes in the scientific study of psychotherapy outcomes that began over 30 years ago. was one of the first psychotherapies for depression to be evaluated against contrast conditions such as antidepressant pharmacotherapy. When the results of these trials indicated a rough parity in clinical outcomes,1-3 the efficacy of psychological treatment for depression could no longer be dismissed. In the same vein, the publication of Cognitive Therapy for Depression4 represented one of the first attempts to detail step-by-step therapy procedures for conceptualizing depression as the product of biased mental representation as well as behavioural and cognitive strategies designed to address this. The expansion of treatments for anxiety, eating, and substance use disorders was premised on the same combination of compelling clinical evidence and the explication of technique. Well over a quarter of a century later, it might be tempting to conclude that the treatment of mood disorders within a cognitive-behavioural frame is a project largely completed-yet challenges do remain. This issue's In Review section provides a view of the field that is both prospective and retrospective. It strives to look beyond the modal applications of in mood disorders to highlight areas of potential future investigation and application. The section's pair of articles speak to the ever-expanding role of in mood disorders. Kuyken et al5 report the most up-to-date conceptualizations of unipolar depression in the context of the cognitive model. In particular, they emphasize the diathesis-stress approach and multilevel schematic models to illuminate the intersection between biological vulnerability and psychopathology. Their writing also touches on some exciting new lines of evidence exploring the active ingredient in CBT and predictors of outcome. We are now beginning to collect evidence from neuroimaging studies to illustrate brain changes associated with effective CBT. These kinds of studies are at the vanguard of psychotherapy research. In particular, Goldapple et al6 have used functional imaging studies to demonstrate a different pattern of response in the brain when is compared with paroxetine in the context of unipolar depression. Brain images of depression patients treated with paroxetine showed increased brain activity in the lateral cortices and suppression of limbic circuits in both the hippocampus and the subgenual cingulate, Area 25. In the same study, treatment response was associated with significant increases in hippocampal and dorsal cingulate activity and decreased activity in the dorsal, ventral, and medial frontal cortex. These opposite changes with (relative to medication) in predominantly cortical brain regions, such as the medial frontal and dorsal cingulate, have been postulated to reflect regions primarily associated with attention, self-references, and reappraisal-areas specifically targeted by this form of psychotherapy. Characterization of adaptive and maladaptive functional interactions among these pathways is a critical step toward future development of evidenced-based algorithms that will optimize the diagnosis and treatment of individual patients suffering from depression. Further work by Siegle et al7 with fMRI has shown that patients whose sustained reactivity to emotional stimuli was low in the subgenual cingulated cortex and high in the amygdala displayed the strongest improvement with CBT. These novel lines of research are beginning to narrow the gap between brain and mind, informing not only an integrated depression network model but also clinical choices for treatment suitability and prognosis. …

Adapting interpersonal psychotherapy for borderline personality disorder

Background: Among the important characteristics of borderline personality disorder (BPD) are interpersonal difficulties and depressive symptoms. Interpersonal psychotherapy (IPT), one of the best tested time-limited psychotherapies for certain DSM-IV Axis I disorders, has demonstrated efficacy in improving psychosocial functioning and in treating major depressive disorder.Aims: This paper describes the rationale for testing IPT as a treatment for patients with BPD, the adaptation of standard IPT for such patients, and the commencement of an open, pilot study of initial tolerance and feasibility.Method: The authors developed a treatment manual adapting IPT to BPD. Changes from standard IPT included: (i) conceptualization, and (ii) chronicity of the disorder, (iii) difficulties in forming and maintaining the treatment alliance, (iv) length of treatment, (v) suicide risk, (vi) termination, and (vii) choice of subjects within the BPD spectrum of diagnosis.Results: The manual is being tested in an open, eight-month trial. Early results of the intervention are discussed.Conclusions: IPT may provide an alternative to existing treatments for patients with BPD who have interpersonal difficulties.Declaration of interest: This work was supported by a grant from the National Alliance for Research on Schizophrenia and Depression (NARSAD). The lead author has published books on IPT with American Psychiatric Press, Basic Books, Franco Angeli, and Editions Médecine & Hygiène Société.

Recent non-medication trials of interpersonal psychotherapy for depression

Interpersonal psychotherapy (IPT) is a time-limited treatment described in a manual and tested in numerous clinical trials, with and without medication. Four recent clinical trials are reviewed in situations where medication as a first-line treatment for depression was not feasible (pregnancy, post partum, adolescence and in a developing country). The results show the efficacy of 12-16 wk of IPT compared to treatment as usual or no treatment in reducing depressive symptoms. The therapists providing the treatment included psychiatrists, psychologists, social workers as well as non-mental-health workers. We do not know if these patients might have done even better with medication, but each study showed a significant remission of symptoms of patients in IPT compared to controls. The use of efficacious, time-limited psychotherapy, which can be administered by non-medical personnel can be economical. An obstacle to providing evidence-based psychotherapies is the paucity of practitioners trained in them. Until the gap between training in psychotherapy and the research evidence in psychotherapy is bridged in training programmes, it will be difficult to provide patients with these treatments.

An Open Pilot Study of Interpersonal Psychotherapy for Panic Disorder (IPT-PD)

Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat depression. It has yet to be studied systematically for treatment of panic disorder. We modified IPT for the treatment of panic disorder and tested this treatment in an open clinical trial with 12 patients seeking treatment of DSM-IV panic disorder. Patients were assessed before during and after treatment. At completion of treatment, nine patients (75%) were independently categorized as responders (i.e., rated as much improved or very much improved on the Clinical Global Impression-Change Scale). Substantial improvement was found for panic symptoms, associated anxiety and depressive symptoms, and physical and emotional well-being. Degree of change in this sample approximated that obtained in studies using established treatments such as cognitive behavioral therapy. Results, though preliminary, suggest that IPT may have efficacy as a primary treatment of panic disorder. Further study is warranted.

The Clinical Conduct of Interpersonal Psychotherapy

Interpersonal psychotherapy (IPT) is a well-researched psychotherapy that has only recently begun to spread into clinical use. A manual-based, diagnosis-targeted, time-limited treatment, IPT has demonstrated efficacy as a treatment for mood and eating disorders and shows promise for other disorders. This article focuses on clinical aspects of IPT rather than its supporting empirical research base. It describes basic principles of IPT and of time-limited psychotherapies in general.

‘Coming out’ with Alzheimer's disease: Changes in awareness during a psychotherapy group for people with dementia

This paper forms part of the second phase of a project looking at those changes that occurred for participants during a series of time-limited psychotherapy groups for people with dementia. Using the Assimilation of Problematic Experiences Scale (APES), the accounts of one participant (Robert) are analyzed across the course of the group. Robert moves from a position in which he wards off awareness that he has dementia of the Alzheimer's type, to being able to joke about having brain changes that are symptomatic of the illness. This change in his discourse about Alzheimer's disease was accompanied by an increase in Robert's levels of affect. However, reflecting on the changes that had occurred for him, Robert commented that before he came to the group he had been frightened, thinking that ‘I’m going crazy … what am I going to be like in another five years?’. For Robert, coming to the group had meant that this fear had been replaced by the knowledge that he was not alone. In the light of the move towards early diagnosis, the importance of this model of change in awareness as a means of increasing understanding of the process of emotional development is discussed. ‘… but I think that a lot of people who I have met who have come out about Alzheimer's were quite shocked because I said that. It did help, it may not have helped others, but I suppose that it helps overcome a feeling of being different.’ Janet, session six.

Patient progress during two time-limited psychotherapies as measured by the Rutgers psychotherapy progress scale

Abstract The authors tracked patient progress in two cases of time-limited psychotherapy using the Rutgers Psychotherapy Progress Scale (RPPS; Spillman, 1991), which assesses in-session progress in psychodynamic therapy on six different dimensions. Two judges rated the transcripts of two female patients who were selected from the Jerusalem Short-Term Project (Shefler, Dasberg, & Ben Shakhar, 1995). The patients were treated by the same therapist, one with a successful outcome and the other with an unsuccessful outcome. Results showed that the patients differed in three dimensions on the global ratings: collaboration, clarity and vividness of speech, and emergence of significant material. The patient with the successful outcome became rapidly involved in treatment, and her RPPS scores continued to increase significantly throughout treatment. The patient with the unsuccessful outcome did not engage rapidly in treatment, and her RPPS scores dropped in the middle phase of therapy and picked up only toward ter...

Intermittent Psychotherapy

This paper details a model of intermittent psychotherapy defined as a sequence of time-limited psychotherapies over an extended period of time. The model emphasizes the importance of relationship, careful assessment of short-and long-term client needs, focused work in successive stages, attention to termination while maintaining connection, and planned follow-up contact. To support the intermittent model, a new conceptualization of termination is offered, allowing for maintenance of client-clinician connection. Selection and exclusion criteria are discussed, as are necessary skills for the treating clinician. A case example illustrates application of the intermittent model. A careful review of the pertinent research literature on time-limited therapies is included.

Psicoterapias breves psicodinâmicas: características da produção científica nacional e estrangeira (1980/2003)

Apresenta o levantamento de algumas características formais da produção científica para saber quem, onde e o que tem sido indexado nas bases de dados eletrônicas, sob os verbetes: "psicoterapias breves psicodinâmicas" e "psicoterapias psicodinâmicas de tempo limitado". As produções estrangeira e nacional foram cotejadas e críticas apresentadas. A amostra de 534 resumos (1980 a 2003), publicados em bases nacionais e internacionais, indicou que a produção estrangeira foi quantitativamente superior quanto ao número de referências, periódicos científicos e autores. No entanto, a nacional equipara-se em aspectos tais como: média de referência por autor, predomínio de autoria única e adoção de psicoterapias integrativas, em que influências de outras abordagens, que não a psicodinâmica, são identificadas. Nas duas realidades predominaram, ainda, publicações sobre psicoterapias individuais de adultos, veiculadas por periódicos psiquiátricos. Espera-se que com a expansão das bases de dados da psicologia, esta última característica venha a se reverter, ao menos no Brasil.

Psychogenic Erectile Dysfunction: Comparative Study of Three Therapeutic Approaches

We admistered the International Index of Erectile Function (IIEF; Rosen et al., 1997) questionnaire to 30 patients with psychogenic erectile dysfunction (ED) at baseline, immediately after treatment, and 3 months after treatment. We randomized patients into three groups: group I, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months and 50 mg sildenafil citrate orally on demand; group II, who had an intake of 50 mg sildenafl citrate orally on demand for 6 months only; and group III, who had weekly sessions of time-limited theme-based group psychotherapy for 6 months. We analyzed data (15-item IIEF) for each group at three times during the study and compared by the data using analysis of variance (ANOVA), followed by the Bonferroni multiple comparison test. We used Cochran's Q-test for analysis between baseline and posttreatment stages of patients with remission of symptoms (EF equal to or higher than 26 points). Group III had a mean score higher than group II, with the difference being statistically significant (immediately after treatment, p = 0.033; at 3 months after treatment, p = 0.049; p < 0.05). All three therapeutic alternatives resulted in an improvement of erectile function domain score. However, significant differences from baseline were observed in groups I (p = 0.0009) and III (p = 0.0002) but not in group II (p = 0.135). The psychotherapy groups, I and III, had significantly higher scores compared with group II, in which patients were exclusively treated with sildenafil citrate. These findings suggest that time-limited theme-based group psychotherapy is an effective treatment for psychogenic ED.

A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders

Interpersonal psychotherapy (IPT) is a time-limited psychotherapy for major depression. The aim of this study is to summarize findings from controlled trials of the efficacy of IPT in the treatment of depressive spectrum disorders (DSD) using a meta-analytic approach. Studies of randomized clinical trials of IPT efficacy were located by searching all available data bases from 1974 to 2002. The searches employed the following MeSH categories: Depression/ Depressive Disorder; Interpersonal therapy; Outcome/Adverse Effects/Efficacy; in the identified studies. The efficacy outcomes were: remission; clinical improvement; the difference in depressive symptoms between the two arms of the trial at endpoint, and no recurrence. Drop out rates were used as an index of treatment acceptability. Thirteen studies fulfilled inclusion criteria and four meta-analyses were performed. IPT was superior in efficacy to placebo in nine studies (Weight Mean Difference (WMD) - 3.57 [-5.9, -1.16]). The combination of IPT and medication did not show an adjunctive effect compared to medication alone for acute treatment (RR 0.78 [0.30, 2.04]), for maintenance treatment (RR 1.01 [0.81, 1.25]), or for prophylactic treatment (RR 0.70 [0.30, 1.65]). IPT was significantly better than CBT (WMD -2.16 [-4.16,-0.15]). The efficacy of IPT proved to be superior to placebo, similar to medication and did not increase when combined with medication. Overall, IPT was more efficacious than CBT. Current evidence indicates that IPT is an efficacious psychotherapy for DSD and may be superior to some other manualized psychotherapies.

Patient Factors Predicting Dropout from Supportive-Expressive Psychotherapy for Patients with Personality Disorders

In this prospective study of psychiatric outpatients with personality disorders, the authors examined patient factors that predicted dropout from supportive-expressive (SE) psychotherapy. Eighty patients were randomized to 40 sessions of time-limited SE psychotherapy. The dropout rate was 35%; 50% of dropouts terminated psychotherapy before Session 7, and 10% were nonengagers. A model including age, type of Axis II cluster, total amount of interpersonal distress, and degree of focus on 1 particular type of interpersonal problem predicted 71% of the completers and 50% of the dropouts. The prediction model was more accurate for men than women. The findings regarding age and type of Axis II cluster are consistent with those of prior studies. The findings for total amount of interpersonal distress and degree of focus on 1 particular type of interpersonal problem are in accordance with key concepts in interpersonal theory and research. Thus, patients' manner of relating to others is associated with dropout. Researchers are encouraged to examine the association between interpersonal factors and dropout in greater depth.

Depression, IV: STAR*D Treatment Trial for Depression

Depression, IV: STAR*D Treatment Trial for Depression

A Case Study of Occupationally Focused Brief Dynamic Therapy Using Mann's Model of Central Conflict

For most people who work, social and occupational competence is inherent to a sense of well-being and support. When occupational competence is questioned by themselves or others, patients may present to clinicians with complaints of dysfunction in the work setting. For these patients, addressing work issues with immediacy and brevity may quickly resolve difficulties, preventing further escalation. Mann's model of time-limited brief psychodynamic therapy may prove to be a useful tool in addressing these issues. The author reviews the current literature regarding occupational dysfunction combined with literature supporting the usefulness of Mann's model of time-limited brief dynamic psychotherapy. A case is discussed demonstrating the integration of Mann's model into a current occupational theme, elucidating the central conflict as it pertains to the occupational setting.

Childhood depression: Work in progress

This paper presents preliminary findings from two children who were offered time-limited individual psychotherapy in London as part of a three-centre, ERC BIOMED funded prospective outcome study on childhood depression. The study was co-ordinated from London, the other centres being Athens and Helsinki. The comparative design of the study is described, as well as the research instruments used. The children were offered 30 sessions of manualized individual psychoanalytic psychotherapy, which were tape-recorded; parents were offered 15 sessions of parallel parent work. Both children showed substantial improvement on the instruments used to assess depression, including a marked sleeper effect on follow-up; their mothers' attitude towards them became less enmeshed and critical. A preliminary qualitative analysis suggests that the Childhood Depression Inventory, one of the instruments used, selects a population of depressed young people who are characterized by particularly salient existential anxiety. Cet article présente les résultats préliminaires des psychothérapies individuelles à durée déterminée proposées à deux enfants londoniens; cette prise en charge fait partie d'un projet de recherche sur les résultats potentiels des traitements de la dépression chez l'enfant. Financé par le Centre pour l'éducation et la Recherche - Biomed, il se déroule dans trois centres: la coordination globale s'effectue à Londres, tandis que les deux autres centres se trouvent à Athènes et à Helsinki. Le schéma comparatif est décrit dans cet article, ainsi que les instruments de recherche employés. On propose aux enfants trente séances de psychothérapie psychanalytique individuelle; les thérapeutes s'inspirent des consignes d'un manuel standardisé et les séances sont enregistrées sur support magnétique. En parallèle, quinze séances sont proposées aux parents des enfants concernés. Les progrès faits par chacun des enfants sont considérables, comme en témoignent les résultats obtenus aux tests employés pour mesurer la dépression. On constate par ailleurs un "effet dormant" certain - le suivi de contrôle montre la persistance de ces progrès même aprés la fin du traitement. Parallèlement, les mères se sentant moins enchevêtrées, leur attitude envers leur enfant devient moins négative. L'analyse qualitative préliminaire laisse penser qu'un des instruments employés, l'Inventaire de Dépression chez l'Enfant, fait ressortir un échantillon de jeunes dépressifs caractérisés par des angoisses existentielles particulièrement vives. Questo articolo presenta i risultati preliminari della terapia individuale a tempo definito di due bambini a Londra all'interno di un lavoro di ricerca sulla depressione infantile finanziato dal ERC BIOMED in tre centri. IL lavoro e' stato coordinato da Londra e gli altri due centri sono Atene e Helsinki. Nell'articolo si descrive il programma comparativo del lavoro e gli strumenti di ricerca usati. Ai bambini si offrirono 30 sedute di psicoterapia infantile individuale registrate mentre ai genitori furono offerte 15 sedute di lavoro con i genitori in parallelo. In entrambi i casi per i bambini ci fu un miglioramento sostanziale rivelato dagli strumenti utilizzati per individuare la depressione, compreso un notevole effetto sleeper ad un controllo successivo; l'atteggiamento delle madri verso di loro divenne meno critico e piu' libero. Un'analisi quantitativa preliminare sembra suggerire che il Childhood Depression Inventory, uno degli strumenti usati, selezioni la popolazione giovanile depressa caratterizzata da una notevole ansia esistenziale. Dieser Artikel präsentiert vorläufige Ergebnisse von zwei Kindern, denen zeitlich begrenzte individuelle Psychotherapie in London als Teil einer prospektiven Ergebnisstudie über Kindheitsdepression, die ERC BIOMED finanziert und an drei Zentren durchgeführt wird, angeboten wurde. Die Studie wird von London koordiniert und die anderen Zentren sind Athen und Helsinki. Es werden das vergleichende Design der Studie wie auch die Forschungsinstrumente, die benutzt werden, beschrieben. Den Kindern wurden 30 Stunden individueller psychoanalytischer Psychotherapie gemäss eines Manuals angeboten, die auf Band aufgenommen wurden; den Eltern wurden 15 Stunden paralleller Elternarbeit angeboten. Beide Kinder zeigten wesentliche Verbesserungen bei den Instrumenten, die benutzt wurden, um Depression zu messen, einschliesslich einer markanten 'sleeper' Wirkung bei follow-up: die Haltung ihrer Müter zu ihnen war weniger verworren und kritisch. Eine vorläufige qualitative Analyse schlägt vor, dass das Childhood Depression Inventory, eines der Instrumente, die benutzt wurden, eine Population von depressiven jungen Leuten selektiert, die durch besonders hervorstechende existentielle Angst charakterisiert waren.