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Objective: This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliable symptom increase pre-to-post treatment. Method: An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre–post outcome evaluation of self-reported depression symptoms and qualitative analysis of patients' interviews. In a Randomized Controlled Study on the treatment of Major Depression, three patients showing reliable increase in symptom severity on the BDI-II pre-to-post therapy were selected. An interpretative phenomenological analysis (IPA) was performed on individual interviews conducted pre-, peri- and post-treatment. Results: Cross-case outcome experiences were: (1) uncontrollable complaints; (2) remaining questions and uninternalized insights and (3) persisting interpersonal difficulties. Within-case idiosyncratic differences revealed that the statistical classification of "deterioration" not necessarily corresponds to a "deteriorated experience," nor univocally indicates unwanted therapy effects. Our findings point at the influences of the patient's (lack of) agency in the process, a discrepancy between patients' expectations and the therapy offer, the therapeutic relationship, interpersonal difficulties, and contextual influences. Conclusion: The meaning of symptomatic deterioration should be interpreted within a patient's idiosyncratic context. The multi-faceted nature of deterioration requires further research to rely on multiple perspectives and mixed methods. [ABSTRACT FROM AUTHOR]

This study aims to investigate the conceptual grounds on which subjective rectification and the interweaving of the therapeutic and epistemic demand rely, specifically the assumption that the subject is involved in their own suffering. This perspective presupposes a subject with a certain degree of freedom and choice. Drawing on Freud's choice of neurosis, Lacan's unsoundable decision of being and forced choice and Zupančič's ideas on psychological freedom, we explore the kind of choice involved in psychoanalytic theory and how it can be understood in light of the psychic determination that is central to both Freud's and Lacan's work. We argue that the subject's determination is self-chosen, albeit a forced choice. This allows the subject to take responsibility for what is experienced as a causal necessity. To illustrate this, we provide examples of childhood trauma and discuss how these children have taken responsibility for their position in what happened to them. [ABSTRACT FROM AUTHOR]

Introduction: Different types of psychotherapy are effective for treating major depressive disorder across groups yet show large within-group differences. Patient personality style is considered a potentially useful variable for treatment matching. Objective: This study is the first experimental test of the interaction between therapeutic approach and patients' dependent versus self-critical personality styles. Methods: A pragmatic stratified parallel trial was carried out with 100 adult patients diagnosed with DSM-IV-TR major depressive disorder. They were randomly assigned to short-term (16–20 sessions) cognitive behavioral therapy (CBT) or short-term psychodynamic psychotherapy (STPP). Patients were assessed at baseline, during therapy, post-therapy, and at 3- and 6-month follow-up. Primary outcome is depression severity measured by the Hamilton Rating Scale for Depression posttreatment. Primary analysis was by intention to treat. This trial is registered with the ISRCTN registry (www.isrctn.com), number ISRCTN17130982. Results: The intention-to-treat sample consisted of 100 participants; 40 with self-critical and 60 with dependent personality styles were randomized to either CBT (n = 50) or STPP (n = 50). We observed no interaction effect (−0.34 [−6.14, 5.46]) between therapy and personality style and found no evidence for a difference in effectiveness between the treatments in general in terms of symptom reduction and maintained benefits at 6-month follow-up. Conclusion: We found no evidence that dependent versus self-critical personality styles moderate the relation between treatment and outcome in depression. Research using individual patient data could gain further insight into why specific therapeutic approaches work better for specific patients. [ABSTRACT FROM AUTHOR]

Self-critical perfectionism has been linked to alliance impairments due to patients' distancing attitudes. However, systematic research on therapists' emotional experiencing when working with self-critical patients is scarce. This qualitative study explores how therapists perceive, emotionally experience, and react to self-critical patients' interpersonal dynamics. We studied narrative data from clinical supervisions where psychodynamic psychotherapists discussed self-critical patients (N = 7) within the context of an RCT on Major Depressive Disorder. Consensual Qualitative Research was applied to identify recurrent patterns in the data. As a global impediment to treatment, therapists observed a pattern of non-engagement. Patients' superficial and avoidant way of communicating, hostility or aggressiveness in the alliance, and low or inaccurate treatment expectations emerged as main obstacles to the therapeutic process, evoking negative affect in therapists. More vulnerable aspects of the patient and case formulation emerged as having a mitigating effect on unfavorable therapist reactions. Our findings confirm longstanding clinical and theoretical accounts associating therapeutic work with self-critical patients with negative affect in therapists. Our study suggests that negative responses may be enacted in therapy which can reinforce poor alliance. We discuss the role of supervision in helping therapists to become aware of and manage negative responses, engage in case conceptualization, and advance clinical work. [ABSTRACT FROM AUTHOR]

Quantified symptom measurement by self-report questionnaires is part of the 'gold standard' of assessing psychotherapeutic efficacy. In this paper, we report a qualitative case comparison to explore how June and Amy, two patient-participants in a gold standard psychotherapy study, experienced the process of quantitative data collection. The study resembles cognitive interviewing studies conducted in the development of measures, yet advances them by investigating patients' experiences of questionnaire administration in actual psychotherapy. Both cases reported known issues in interpretation of pre-structured item- and response formats, communicative administrator-respondent dynamics, and response shifts. Beyond known scoring problems, the act of questionnaire administration changed their interpretation of experienced symptoms, which facilitated clinical change beyond therapeutic effects. For Amy, this change was associated with improvement, but for June, questionnaire administration facilitated deterioration in experienced symptoms. These findings emphasize that it is both epistemically and ethically vital to consider measurement effects in clinical practice. This study demonstrates the importance of taking a qualitative stance in psychotherapy research, as qualitative research can elaborate the contextual and idiosyncratic nature of questionnaire scores, and highlights that both researchers and clinicians have to be attentive to the meaning of scores as words in participants' clinical stories. [ABSTRACT FROM AUTHOR]

In psychotherapy research, treatment efficacy is commonly studied by means of self-report questionnaires to gain quantitative data on symptom development. The data serve as input for statistical analyses up to the level of evidence-based treatment. We analyzed how a patient in a psychotherapy study experienced the translation of her story into quantitative data by combining a phenomenological qualitative analysis of her therapeutic narrative and a visual analysis of her extensively annotated paper-and-pencil questionnaires. Our findings provide a practical empirical illustration of the nature and impact of known validity issues. Beyond, we found the act of questionnaire administration affected the primary complaint such that it became performative toward the symptoms under study. We discuss the epistemic consequences for the validity of data, and we argue that valid data collection requires qualitative scrutiny of meaning within data and a concept of validity that allows for consideration of performativity of data collection. [ABSTRACT FROM AUTHOR]

Client agency is considered a crucial contributor to good treatment outcome. Recent studies, however, differ strongly in how they conceptualise and investigate agency. The current study explores the nature of client agency in ten clients' pre-treatment interviews. Applying Consensual Qualitative Research, we constructed three overarching categories, subdivided into 14 sub-categories capturing both betweenand within-person differences in agency before therapy. We found that all participants oscillated between the experience of a lack of grip on problems on the one hand and noticing their involvement in the problem and taking action on the other. These results present a dynamic conceptualisation of client agency. This allows us to ask pertinent questions for both future research and clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To assess the outcome of psychotherapeutic treatments, psychotherapy researchers often compare pre- and post-treatment scores on self-report outcome measures. In this paper, the common assumption is challenged that pre-to-post decreasing and increasing outcome scores are indicative of successful and failed therapies, respectively. Method: The outcome of 29 psychotherapeutic treatments was evaluated by means of quantitative analysis of pre- and post-treatment scores on commonly used outcome measures (such as the Symptom Checklist-90-R, the Inventory of Interpersonal Problems, and the General Health Questionnaire-12), as well as through consensual qualitative research. Results: Overall, a moderate to low convergence between qualitative and quantitative evaluations of outcome was observed. Detailed analyses of six cases are presented in which pre-to-post comparisons of outcome measures proved misleading. Conclusions: It is concluded that psychotherapy outcome research might benefit from assessment strategies that are sensitive to the singularities of individual treatments and to the complexity of the phenomenon of therapeutic outcome. Furthermore, classical psychometric evaluations of the validity of outcome measures might be supplemented with less-systematic evaluations that take any contingent source of information on outcome into account. [ABSTRACT FROM AUTHOR]

Keywords: Single Case Archive; psychotherapy outcome; efficacy; failure; publication bias; Einzelfallarchiv; Psychotherapieergebnis; Wirksamkeit; Misserfolg; Publikationsbias; Archivo de caso único; resultado de psicoterapia; eficacia; fracaso; sesgo de publicación; archivio dei "single case"; esito della psicoterapia; efficacia; fallimento; bias di pubblicazione; Archive des Cas Uniques; résultats en psychothérapie; efficacité; échec; biais editorial; ; ; ; ; DE Single Case Archive psychotherapy outcome efficacy failure publication bias EN Einzelfallarchiv Psychotherapieergebnis Wirksamkeit Misserfolg Publikationsbias Archivo de caso único resultado de psicoterapia eficacia fracaso sesgo de publicación archivio dei "single case" esito della psicoterapia efficacia fallimento bias di pubblicazione Archive des Cas Uniques résultats en psychothérapie efficacité échec biais editorial ; ; ; ; 139 155 17 09/14/21 20210601 NES 210601 Introduction Decades of psychotherapy research have focused on investigating treatment efficacy (Lambert, [23]). The lack of failure reports in published psychotherapy case studies: Implications for dis-"illusioning" of research and practice There were nine studies in which the emphasis was on the patient's contribution to the therapy failure, for example, if the patient is diagnosed with a hard to treat condition (e.g. 'Specific Challenges in the Treatment of Psychopathy: A Case Report'; Neergaard & Gullhaugen, [31]). Single case research makes it possible to study the particular circumstances and experience of the patient, examine the whole range of different outcomes (from failure to treatment success), and understand the process of therapy and how change comes about (Gerring, [14]). [Extracted from the article]

Using an inductive qualitative analysis approach, for each case, the patient's idiosyncratic experience was extracted relating to (dis)satisfied experiences about the therapist, therapy, the therapy process, the role of therapy and potential influencing factors (outside of therapy). Keywords: outcome; patient experiences; psychotherapy; therapy effect; Ergebnis; Patientenerfahrungen; Psychotherapie; Therapieeffekt; resultado; experiencias del paciente; psicoterapia; efecto terapéutico; esito; esperienze del paziente; effetto della terapia; résultat; experiences du patient; psychothérapie; effet de la thérapie; ; ; ; EN outcome patient experiences psychotherapy therapy effect DE Ergebnis Patientenerfahrungen Psychotherapie Therapieeffekt ES resultado experiencias del paciente psicoterapia efecto terapéutico IT esito esperienze del paziente effetto della terapia FR résultat experiences du patient psychothérapie effet de la thérapie EL 156 176 21 09/14/21 20210601 NES 210601 Introduction Psychotherapy outcome research is the primary source of evidence to conclude on the efficacy of treatments (McLeod, [36]; Wampold & Imel, [53]). When "good outcome" does not correspond to "good therapy": Reflections on discrepancies between outcome scores and patients' therapy satisfaction Nonetheless, it seems that the intricate relationship between therapy and outcome is widely recognized in the case of patient deterioration or treatment failure (Lambert, [27]; Lampropoulos, [28]), while it is given a lot less attention in the situation of treatment success. [Extracted from the article]

In this theory-building case study, we investigate Blatt's two-polarity model of personality development according to which psychopathology is a consequence of an unbalance between the two developmental lines of interpersonal relatedness and self-definition. Anaclitic psychopathology, such as schizophrenia, histrionic, dependent, and borderline personality disorders, is associated with an excessive and rigid emphasis on interpersonal relatedness. In this theory-building case study, we examine whether this model can be extended to dissociative identity disorder (DID). The patient is a 23-year old Caucasian man who suffers from periodic episodes of dissociation. Consensual qualitative research for case studies is used to quantitatively and qualitatively describe the interplay between symptomatic and interpersonal evolutions throughout 41 sessions of supportive-expressive psychoanalytic psychotherapy. In line with the two-polarity model of personality development, close associations between symptoms of dissociation and dependent interpersonal dynamics were observed. Psychoanalytic interventions focusing on elaboration of the subjective meanings of (past and anticipated) dissociations, and on working through core interpersonal conflicts, are followed by transformations in the patient's interpersonal stances and subjective well-being. No new dissociative episodes were reported during the follow-up assessment three and a half years after the completion of treatment. This case study demonstrates that DID is a form of anaclitic psychopathology as it is associated with a predominant tendency to interpersonal relatedness. [ABSTRACT FROM AUTHOR]

Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre–post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research. [ABSTRACT FROM AUTHOR]

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as "dangerous," "a matter of lifestyle," "a unique story and experience," and "socially situated." We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts. [ABSTRACT FROM AUTHOR]

Background: Mental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems.Method: In total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N = 7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes.Results: The theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential.Conclusion: Facilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems. [ABSTRACT FROM AUTHOR]

Although Blatt's two-polarity model of depression has suggested that patients' interpersonal styles may shape countertransference phenomena in psychotherapy, empirical research on this topic has remained scarce. This article provides an in-depth study of countertransference processes in clinical work with dependent (anaclitic) depressed patients using a qualitative methodology. Thematic analysis of narrative material of psychodynamic therapists discussing patient cases during supervision (n = 7) resulted in four recurrent themes: "empathy, compassion, and support," "anxiety, feeling overwhelmed, and protection," "frustration, irritation, and confrontation," and "inadequacy, incompetence, and fatalism." We found that these countertransference processes mainly revolved around perceived adaptive and maladaptive aspects of patients' relational functioning. Regarding clinical practice, our study suggests that therapists can use countertransference to determine in which position they are maneuvered by patients, although we caution against the exclusive use of subjectively informed data as a benchmark in the diagnostic and treatment process. We conclude that further in-depth research on countertransference and personality styles is needed to identify pitfalls in the treatment of depression. [ABSTRACT FROM AUTHOR]

Statistical mechanics is the field of physics focusing on the prediction of the behavior of a given system by means of statistical properties of ensembles of its microscopic elements. The authors examined the possibility of applying such an approach to psychotherapy research with the aim of investigating (a) the possibility of predicting good and poor outcomes of psychotherapy on the sole basis of the correlation pattern among their descriptors and (b) the analogies and differences between the processes of good- and poor-outcome cases. This work extends the results reported in a previous paper and is based on higher-order statistics stemming from a complex network approach. Four good-outcome and four poor-outcome brief psychotherapies were recorded, and transcripts of the sessions were coded according to Mergenthaler's Therapeutic Cycle Model (TCM), i.e., in terms of abstract language, positive emotional language, and negative emotional language. The relative frequencies of the three vocabularies in each word-block of 150 words were investigated and compared in order to understand similarities and peculiarities between poor-outcome and good-outcome cases. Network analyses were performed by means of a cluster analysis over the sequence of TCM categories. The network analyses revealed that the linguistic patterns of the four good-outcome and four poor-outcome cases were grounded on a very similar dynamic process substantially dependent on the relative frequency of the states in which the transition started and ended ("random-walk-like behavior", adjusted R 2 = 0.729, p < 0.001). Furthermore, the psychotherapy processes revealed statistically significant changes in the relative occurrence of visited states between the beginning and the end of therapy, thus pointing to the non-stationarity of the analyzed processes. The present study showed not only how to quantitatively describe psychotherapy as a network, but also found out the main principles on which its evolution is based. The mind, from a linguistic perspective, seems to work-through psychotherapy sessions by passing from the most adjacent states and the most occurring ones. This finding can represent a fertile ground to rethink pivotal clinical concepts such as the timing of an interpretation or a comment, the clinical issue to address within a given session, and the general task of a psychotherapist: from someone who delivers a given technique toward a consultant promoting the flexibility of the clinical field and, thus, of the patient's mind. [ABSTRACT FROM AUTHOR]

The conversational actions of reformulating and mirroring constitute some of the core intervention techniques of psychotherapy. The purpose of the present study was to investigate the way in which therapists in cognitive-behavioral (CBT) and psychodynamic therapy (PDT) use reformulating and mirroring strategies to return patients' prior talk and how their differential usage can be viewed in light of the respective manualized recommendations. A mixed methods approach was applied using qualitative data that derived from a RCT. The data collection consisted of 200 excerpts assembled from both treatment conditions. The method of Conversation Analysis was used to determine the practices that accomplished instances of reformulating and mirroring, and to examine their distinct implications for subsequent talk. The quantitative analysis revealed that cognitive-behavioral therapists are significantly more likely to use reformulations, which is in harmony with what is suggested in CBT's treatment manuals. Psychodynamic therapists' frequent use of transformative formulations is, by contrast, unexpected in regard to the suggestions of the treatment protocol, as these interventions steer toward topical closure. Compared to the CBT condition, psychodynamic therapists were still significantly more likely to rely on mirroring strategies, which are in line with PDT's theoretical preference. Our findings raise the question whether alleged differences in treatment styles, as they are imposed by RCT methodology, are actually tangible in manual-guided clinical practice. [ABSTRACT FROM AUTHOR]

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision. [ABSTRACT FROM AUTHOR]

We performed a case comparison study to investigate the nature of interpersonal patterns in childhood trauma and the process of change therein. We analyzed three matching cases of childhood trauma that followed a psychodynamic treatment via a mixed-methods design. We found that (1) the core tendency to avoid negative reactions from others through passive behaviors emerged in all three cases, both in childhood and adulthood, (2) core interpersonal patterns transpired in the interaction between patient and therapist and thereby affected the therapeutic relationship, and (3) change ensued when a repetition of core interpersonal patterns was avoided and a new relational experience occurred. The accumulated findings across cases further resulted in several clinical implications and recommendations, such as the importance of the assessment of patients' (covert) conditions, responsiveness, supervision and facilitating patients' agency, and provided several avenues for further research. [ABSTRACT FROM AUTHOR]

Complex trauma is a much-debated construct and research findings are dispersed due to, for example, the lack of conceptual clarity about the core features constituting complex trauma and its sequalae. Recently, there has been a vast expansion of research studies on interpersonal features, which is fundamental in understanding complex trauma. The aim of this article is to provide a comprehensive overview of the literature with regard to this dimension. We found that trauma research stresses the importance of interpersonal features on three major levels. First, complex trauma is an umbrella term encompassing prolonged and repeated harmful events that typically occur in the interpersonal sphere. A second line of research focuses on the interpersonal difficulties associated with complex trauma, which can be broadly divided into two related categories: behavioral disruptions and distorted interpersonal schemata. Third, researchers address the importance of interpersonal difficulties in the treatment of complex trauma, especially the formation of the therapeutic alliance. Our literature review reveals that these three research areas are interconnected through the concept of core interpersonal schemata. We proclaim that further research should aim at a deeper understanding of the nature of these interpersonal schemata, the ways they develop, and the processes through which they can change. [ABSTRACT FROM AUTHOR]

The application of time limits (i.e. restricting the amount of sessions before the beginning of psychotherapy) has become ingrained in psychotherapy research and in the context of managed care, mostly due to pragmatic and economic reasons. However, little is know on how this technique interferes with the psychotherapeutic process. Although several theorists have considered the possible advantages and drawbacks of the technique, research explaining these mechanisms is scattered. By conducting this review, we strived to answer two questions: (1) Does a time limit alter the psychotherapeutic process? And (2) In what way? In doing so, this study aspires to grant more insight into the mechanisms of time limited psychotherapy and aimes to contribute to a first understanding of the dynamics of a time restricted therapy process. We searched for articles in the databases of Web of Science and Pubmed. Our review identified 28 studies that provide empirical grounds to explain processes involved when applying a time limit to psychotherapy. Qualitative research suggests that a time limit exerts pressure on the therapy process and creates an expectancy effect, which can have both positive and negative consequences. Additionally, time limits can be associated to therapists taking on a more directive role in therapy. Results show that a time limit is anything but a neutral intervention; it is a technique that complexly interacts with therapy processes on multiple grounds. Further research is vital to determine which environment is appropriate for its application. [ABSTRACT FROM AUTHOR]

Change in psychotherapy, dynamics of change, psychotherapy process, psychotherapy process-outcome research, dynamic systems, precursors of change The specific theme of this Research Topic is a pivotal and pressing question in psychotherapy research: What are the processes that promote change in psychotherapy and what are their precursors? Keywords: change in psychotherapy; precursors of change; dynamics of change; psychotherapy process; psychotherapy process-outcome research; dynamic systems EN change in psychotherapy precursors of change dynamics of change psychotherapy process psychotherapy process-outcome research dynamic systems 1 3 3 09/16/21 20210913 NES 210913 It is really a great pleasure for us to introduce this Research Topic focused on the dynamics of change in psychotherapy. [Extracted from the article]

Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores that indicate no reliable change in depression symptoms with a qualitative inquiry of patients' perspectives. Methods: The study took place in the context of a Randomised Controlled Trial evaluating time-limited psychodynamic and cognitive behavioral therapy for major depression. A mixed methods study was conducted including patients' pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients' interviews. Findings: From the patients' perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength, and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients' resistance and impossibility and the context as a source of distress. "No change" in outcome scores therefore seems to involve a "partial change" when considering the patients' perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed. [ABSTRACT FROM AUTHOR]

In psychotherapy research, "validity" is canonically understood as the capacity of a test to measure what is purported to measure. However, we argue that this psychometric understanding of validity prohibits working researchers from considering the validity of their research. Psychotherapy researchers often use measures with a different epistemic goal than test developers intended, for example when a depression symptom measure is used to indicate "treatment success" (cf. outcome measurement for evidence-based treatment). However, the validity of a measure does not cover the validity of its use as operationalization of another target concept within a research procedure, nor the validity of its function toward an epistemic goal. In this paper, we discuss the importance of considering validity of the epistemic process beyond the validity of measures per se , based on an empirical case example from our psychotherapy study ("SCS", Cornelis et al., 2017). We discuss why the psychometric understanding of validity is insufficient in covering epistemic validity, and we evaluate to what extent the available terminology regarding validity of research is sufficient for working researchers to accurately consider the validity of their overall epistemic process. As psychotherapy research is meant to offer a sound evidence-base for clinical practice, we argue that it is vital that psychotherapy researchers are able to discuss the validity of the epistemic choices made to serve the clinical goal. [ABSTRACT FROM AUTHOR]

Background Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). Objectives To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. Methods Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups. Results Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner. Conclusions The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, they have received limited research attention. This trial aims at investigating the interaction between therapeutic approach (pre-structured versus explorative) and the personality style of patients (dependent versus self-critical), which is considered a core underlying dimension of depressive pathology.Methods/design: This study is a pragmatic stratified (dependent and self-critical patients) parallel trial with equal randomization (allocation 1:1) conducted in Flanders, Belgium. One hundred and four patients will be recruited and randomized to either 16-20 sessions of cognitive behavioral therapy for depression (pre-structured approach) or 16-20 sessions of short-term psychodynamic psychotherapy for depression (explorative approach) conducted by trained psychotherapists in private practices. The primary outcome is the severity of depression as measured by the Hamilton Rating Scale for Depression at completion of therapy. Secondary outcome measures include self-reported depressive and other symptoms, interpersonal functioning, idiosyncratic complaints, and the presence of the diagnosis of depression. Additional measures include biological measures, narrative material (sessions, interviews), and health care costs.Discussion: This trial presents the test of an often-described, yet hardly investigated interaction between important personality dimensions and therapeutic approach in the treatment of depression. Results could inform therapists on how to match psychotherapeutic treatments to specific personality characteristics of their patients.Trial Registration: Isrctn.com, ISRCTN17130982 . Registered on 2 February 2015. [ABSTRACT FROM AUTHOR]

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Background: GPs' subjectivity is an intrinsic instrument in their daily work. By offering GPs a platform to present and discuss difficult interactions with patients, Balint group work be might provide them an opportunity to explore and articulate aspects of their subjectivity. In order to get a more profound understanding of what participation in a Balint group can offer, we focused on the process of change that can be observed during Balint group meetings. To that end, this study scrutinized two Balint group case discussions on a micro-level. Method: Two cases were selected from a larger data set of 68 audio-taped case discussions in four Balint groups. In order to shed light on the type of change that characterizes the presenter's narrative, we used Lacan's theoretical distinction between imaginary and symbolic modes of relating to the other. Results: In both case discussions, the GPs presenting the case initially appeared to be stuck in a fixed image of a situation, referred to as 'imaginary relating to the other.' Through a range of interactions with the group, the presenters were encouraged to explore different subject positions, which allowed them to broaden their initial image of the situation and to discover other issues at stake. This was referred to as a more symbolic way of relating to the other. Conclusion: This study throws light on the type of change Balint group participation allows for and on the way this might be achieved. We conclude that Balint group work is potentially beneficial to the participating GPs as well as to the relationship with their patients. [ABSTRACT FROM AUTHOR]

Anxiety is found to play an important role in the severity complaint of tinnitus patients. However, when investigating anxiety in tinnitus patients, most studies make use of verbal reports of affect (e.g., self-report questionnaires and/or interviews). These methods reflect conscious appraisals of anxiety, but do not map underlying processing mechanisms. Nonetheless, such mechanisms, like the automatic processing of affective information, are important as they modulate emotional experience and emotion-related behaviour. Research showed that highly anxious people process threatening information (e.g., fearful and angry faces) faster than non-anxious people. Therefore, this study investigates whether tinnitus patients process affective stimuli (happy, sad, fearful, and angry faces) in the same way as highly anxious people do. Our sample consisted out of 67 consecutive tinnitus patients. Relationships between tinnitus severity, pitch, loudness, hearing loss, and the automatic processing of affective information were explored. Results indicate that especially in severely distressed tinnitus patients, the severity complaint is highly related to the automatic processing of fearful ( r = 0.37, p < 0.05), angry ( r = 0.44, p < 0.00) and happy ( r = −0.44, p < 0.00) faces, and these relationships became even stronger after controlling for hearing loss. Furthermore, in contrast with findings on the relation between audiological characteristics (pitch and loudness) and conscious report of anxiety, we did find that the audiological characteristic, loudness, tends to be in some degree related to the automatic processing of fearful faces ( r = 0.25, p = 0.08). We conclude that tinnitus is an anxiety-related problem on an automatic processing level. [ABSTRACT FROM AUTHOR]

Tinnitus has been defined as a phantom auditory perception. Research indicates the necessity to make a distinction between the physical symptom and the subjective severity of the tinnitus symptom, since especially the latter seems to vary among patients. The relationship between tinnitus severity and psychological variables has been well established. Anxiety is considered to be an important variable for understanding the differences in the subjective tinnitus severity. Although many studies confirm the relationship between anxiety and tinnitus severity, most studies do not take the possibility of shared method variance and content overlap between questionnaires into account. Furthermore, anxiety is a broad concept and contains both a cognitive and somatic dimension. Research including both dimensions of anxiety in tinnitus population is rare. According to us two conditions must be fulfilled before theorization on the relation is useful: (1) the presence of clinically relevant cognitive and/or somatic anxiety, (2) evidence of a substantial or 'real' relationship. In our sample, almost 60% reported more than average cognitive anxiety and 40.8% reported clinical relevant somatic anxiety. After controlling for content overlap between the questionnaires used, the relation between tinnitus severity and cognitive and somatic anxiety remains significant. Two hypothetical models concerning this relationship that deserve future research attention are described. [ABSTRACT FROM AUTHOR]

This study investigated the psychometric properties of the 20-item Toronto Alexithymia Scale (TAS-20) in an adolescent sample (N=406, ages 12 to 17). This is rarely done even though the TAS-20 is used in adolescent research. Five published factor models were tested. For good fitting models, a second-order model with alexithymia as a higher-order factor and metric invariance across sex and age groups was tested. Confirmatory factor analyses showed that the original three-factor model and a four-factor model provided acceptable fit. Both models were invariant across sex, but not across age. Second-order models did not provide good fit. Reliability was good for the "Difficulty identifying feelings" subscale and acceptable for the "Difficulty describing feelings" subscale, but not for the "Externally oriented thinking" subscale. Measuring alexithymia with the TAS-20 in adolescents thus seems problematic, especially in younger age groups. [ABSTRACT FROM AUTHOR]

This study examines the reliability and convergent validity of 2 versions of the Social Cognition and Object Relations Scale (SCORS), one for use with Thematic Apperception Test narratives (SCORS–TAT; Westen, 1990) and one for use with clinical interview data (SCORS–CDI; Westen, Barends, Leigh, Mendel, & Silbert, 1990). Four SCORS dimensions were evaluated. Data were collected in a psychiatric sample (N = 74). Results show that although interrater reliability was good for all dimensions, internal consistency was low, especially for the affective dimensions. Structural equation modeling, in which a model with 2 factors (i.e., SCORS–TAT and SCORS–CDI) and 4 dimensions each was tested, indicated low convergence between corresponding dimensions of SCORS–TAT and SCORS–CDI. Correlational analyses suggested that this was due to a strong method factor. Regression analyses, however, revealed that the presence of a personality disorder operated as a moderator for convergence between corresponding cognitive-structural dimensions. [ABSTRACT FROM PUBLISHER]

Objective. In this study, the authors investigated whether tinnitus severity is a problem related to depression. If so, the following 2 conditions should be fulfilled:first, there should be evidence for the presence of moderate to severe depressive symptomatology in a substantial group of tinnitus patients; second, there should be evidence of a substantial relationship between depressive symptoms and tinnitus severity.Study Design. Cross-sectional.Setting. Ear, Nose, and Throat (ENT) Department of the Ghent University Hospital.Subjects and Methods. In total, 136 consecutive help-seeking tinnitus patients were seen by a psychologist, an audiologist, and an ENT specialist. All patients filled in the Beck Depression Inventory II (BDI-II) and the Tinnitus Handicap Inventory (THI) and underwent psychoacoustic measurement.Results. Mean scores indicate the presence of no or minimal depressive symptoms. There was a positive correlation (P < .01) between the BDI-II and the THI. No correlations were found between psychoacoustic measures and the self-report questionnaires. Linear regression analysis was performed to examine the predictive role of the 3 components of depression (cognitive, somatic, and affective) in tinnitus severity. Results show that only the somatic depression subscale of the BDI-II significantly predicted tinnitus severity, which can be explained because of content overlap between the BDI-II and the THI.Conclusion. Tinnitus does not appear to be a problem related to depression. The authors did not find a substantial group of tinnitus patients with moderate to severe depressive symptoms. The relation between depressive symptoms and tinnitus severity seems to be an artifact of content overlap between the BDI-II and the THI. [ABSTRACT FROM AUTHOR]

In this study, the authors compared the respective contribution of an individual's subjective response and the frequency of exposure to critical incidents to the development of symptoms of posttraumatic stress disorder (PTSD) in a sample of 136 nurses and ambulance personnel working in military facilities. They found no relationship between the frequency of encountered critical incidents and the occurrence of PTSD symptoms. The subjective response to a stressor contributed to the development of PTSD symptoms and was most strongly associated with intrusion, partial eta squared =.23, and hyperarousal symptoms, partial eta squared =.16. Stressors that elicited the most intense affects within this population were those involving children and those where workers encountered limitations in supplies and resources. [ABSTRACT FROM AUTHOR]

The Personal Style Inventory–II (Robins, Ladd, Welkowitz, Blaney, Diaz, & Kutcher, 1994) was connstructed to assess sociotropy and autonomy; two personality dimensions associated with increased susceptibility to depression. In the present study, the authors used a confirmatory factor analysisi to evaluate the fir of the theoretical model of the Personal Style Invetory–II in a heterogeneous clinical sample (N = 266) and in a student sample (N = 799); construct validity was evaluated by correlating the Personal Style Inventory–II with the scales of the Inventory of Interpersonal Problems–64 and the Symptom Checklist–90–R. Poor fit of the original Personal Style Inventory–II model was observed in both samples. Yet, after progressive elimination of 18 items, a good fit was obtained in the clinical sample and replicated in the student sample. This brief version demonstrated better construct validity than the long version, especially in a depressed clinical saple; sociotropy was associated with nonasserive, overly accomodating, and self–sacrificing interpersonal behaviour, depressive symptoms, phobic complaints, and anxiety and somantic symptoms; autonomy was associated with cold and vindictive interpersonal behaviour, obsessive–compulsive symptoms, and aggressive urges. In contrast to the long version, scores on the shortened version showed the predicted sex differences. [ABSTRACT FROM AUTHOR]

In this study, we evaluated the reliability and validity of the Dutch version of the Observer Alexithymia Scale (OAS; Haviland, Warren, & Riggs, 2000) while addressing shortcomings of earlier research. Internal consistency and test-retest reliability were found to be adequate, whereas interrater reliability was insufficient. The original five-factor model (Distant, Uninsightful, Somatizing, Humorless, Rigid) with item parcels showed excellent fit, indicating adequate translation. Alternative models were tested to overcome problems with the parcel method, and all showed poor fit. OAS total scores correlated .23 with the 20-item Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994; Bagby, Taylor, & Parker, 1994) and .50 with the Toronto Structured Interview for Alexithymia (Bagby, Taylor, Parker, & Dickens, 2006). These problematic results on validity compromise the use of the OAS as an alexithymia measure. [ABSTRACT FROM AUTHOR]

Construct validity of the 20-item Toronto Alexithymia Scale (TAS- 20) was investigated by analyzing natural language use. It was hypothesized that the TAS-20 should be related to a lower use of emotion words and fewer references to social processes. 32 clinical interviews with mental health outpatients were analyzed with four categories of the computerized Linguistic Inquiry and Word Count dictionary: positive emotions, negative emotions, references to others, and communication words. The Difficulty Identifying Feelings subscale was positively related to negative emotion words, the Difficulty Describing Feelings subscale showed no relevant associations, and the Externally Oriented Thinking subscale was related to reduced use of positive emotion words and social process words. It is concluded that in this sample, the Externally Oriented Thinking subscale provides the best operationalization of the alexithymia construct. [ABSTRACT FROM AUTHOR]

This study presents an empirical test of Coyne, Thompson, and Whiffen's statement that the Depressive Experiences Questionnaire does not measure the psychoanalytic constructs it is supposed to measure. Convergence was evaluated between the Depressive Experiences Questionnaire's Dependency and Self-criticism scales and clinicians' ratings on hysterical/anaclytic and obsessional! introjective personality styles in a sex-balanced sample of 56 Flemish outpatients. In line with expectations from Blatt's research paradigm, convergence was observed between the Dependency scale and ratings on hysterical/anaclitic style in the full sample as well as female and male samples separately; convergence between the Self-criticism scale and ratings on obsessional/introjective style was only observed for men. This study yielded no evidence for divergence of the Depressive Experiences Questionnaire and Blatt's psychoanalytic theory. Research is needed to evaluate the sex-specific validity of these subscales. [ABSTRACT FROM AUTHOR]

The present study examined symptom-specificity in depression, testing the hypothesis that affective, cognitive, and somatic dimensions in depressive symptoms, as measured with the Beck Depression Inventory-II, cohere, respectively, with the use of affective-, cognitive-, and somatic-related words in natural language, as measured with the Linguistic Inquiry and Word Count. Based on questionnaire and interview data from 32 mental health outpatients, analyses indicate scores for affective depressive symptoms correlate significantly with affective word use, cognitive depressive symptoms are related to cognitively oriented word use combined with affective word use, and the presence of somatic depressive symptoms correlates significantly with words referring to physical states and functions. These results indicate that different facets of depression have specific correlates and that natural word use serves as a psychological marker. From a psychometric point of view, this study substantiates the concurrent validity of the Linguistic Inquiry and Word Count (LIWC2001) categories under study and the Beck Depression Inventory-IT subscales for affective, cognitive, and somatic symptoms. [ABSTRACT FROM AUTHOR]

The article provides an overview of a study presented at the Sixth Annual Poster Session of the American Psychoanalytic Association in which researchers focus on Sidney Blatt's theory on the subtypes of depression. They examine whether there is evidence to prefer a categorical distinction between latent clusters of patients with substantially divergent scores on the dependency and self-criticism subscales of depression over the assumption that the depressed patients in the study is homogenous, varying only in the degree of dependency and self-criticism.

The article discusses a study on various characteristics that indicate anaclitic and introjective psychopathology through the Personal Style Inventory-II (PSI). The study revealed that anaclitic perfectionism/self criticism (PF/SC) was motivated by the desire to lessen the distance to the other or to attract the other. The authors cited the characteristics that reflect anaclitic psychopathology which include concern on what others think, dependency and pleasing others. Also noted are the traits that underlie introjective psychopathology.

The present study examines whether the experience of a critical incident (CI) is associated with higher burnout scores; whether strong social support is associated with reduced burnout scores; and whether social support moderates the relationship between a CI and burnout scores. Security guards (n = 530) filled out the Maslach Burnout Inventory, the Self-Rating Inventory for Post-traumatic Stress Disorder and the Social Support List. The experience of a CI was reported by 41.1 per cent of the participants, which explained a significant amount of variance in the participants' burnout scores. Everyday emotional support and social companionship were negatively related to burnout. Emotional support with problems showed a positive association with burnout. The authors suggest that the first two forms of social support may function as buffers, whereas the latter could have an aggravating effect on burnout complaints. No significant interaction effects between social support and CI were present. This indicates that, in the present study, social support did not have a moderating effect on the relationship between a CI and burnout. Relations between social support and burnout are discussed, as are limitations of this study and suggestions for further research. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In both clinical and nonclinical samples, the Depressive Experiences Questionnaire is scored with a program that computes factor scores by using means, standard deviations, and item-loadings of a student sample. The underlying assumption of the use of this program in clinical samples is that factor scores computed on the basis of the student factor solution arc similar to factor scores computed on the basis of a clinical factor solution. Consequently, both series of scores should lead up to the same conclusions when studying associations with theoretically related variables. This assumption has not been tested although the questionnaire has been used in research for almost 30 years. In the present paper an alternative scoring program was constructed, based on the factor solution of a clinical sample (N = 400) to assess whether scores of this clinical scoring program are associated in the same way with different types of depressive symptoms and interpersonal problems as the scores of the original (student-based) program. Analysis gave results inconsistent with the assumption and did not support the use of the student-based scoring program in the clinical sample. Further, results suggest that standards for assessing factorial similarity used in confirmatory factor analysis might be too lenient. [ABSTRACT FROM AUTHOR]

This study examines whether alexithymia relates to specific interpersonal problems, based on data collected in a sample of mental health outpatients (N = 404) and a student sample (N = 157). Linear regression analysis, in which the effects of group, gender, and age were controlled, indicated that two interpersonal problems were significantly and reliably related to alexithymia: cold/distant and nonassertive social functioning. The theoretical relevance of the results for attachment and psychoanalytic theory is indicated, as well as implications of the findings for clinical practice. © 2006 Wiley Periodicals, Inc. J Clin Psychol 63: 109–117, 2007. [ABSTRACT FROM AUTHOR]

No abstract available Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

No abstract available [ABSTRACT FROM AUTHOR]