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It is well established that there is a fundamental need to develop a robust therapeutic alliance to achieve positive outcomes in psychotherapy. However, little is known as to how this applies to psychotherapies which reduce suicidal experiences. The current narrative review summarizes the literature which investigates the relationship between the therapeutic alliance in psychotherapy and a range of suicidal experiences prior to, during and following psychotherapy. Systematic searches of MEDLINE, PsycINFO, Web of Science, EMBASE and British Nursing Index were conducted. The search returned 6472 studies, of which 19 studies were eligible for the present review. Findings failed to demonstrate a clear link between suicidal experiences prior to or during psychotherapy and the subsequent development and maintenance of the therapeutic alliance during psychotherapy. However, a robust therapeutic alliance reported early on in psychotherapy was related to a subsequent reduction in suicidal ideation and attempts. Study heterogeneity, varied sample sizes and inconsistent reporting may limit the generalizability of review findings. Several recommendations are made for future psychotherapy research studies. Training and supervision of therapists should not only highlight the importance of developing and maintaining the therapeutic alliance in psychotherapy when working with people with suicidal experiences but also attune to client perceptions of relationships and concerns about discussing suicidal experiences during therapy. [ABSTRACT FROM AUTHOR]

The examination of nonverbal synchrony has become a promising line of psychotherapy research. Although several studies have found between‐dyad associations between nonverbal synchrony and multidimensional outcomes, the findings remain heterogeneous, and within‐dyad effects remain to be investigated. The present study examines within and between effects of nonverbal synchrony on mastery, resource activation, problem actuation, and motivational clarification (Grawe's general mechanisms of change). Four‐hundred and twenty‐three videotaped sessions of 175 patients were analysed using motion energy analysis (MEA), providing values to quantify nonverbal synchrony in the patient–therapist dyad. Grawe's general mechanisms of change in psychotherapy were rated using the Inventory of Therapeutic Interventions and Skills (ITIS). On average, patient–therapist nonverbal synchrony was greater than chance. Hierarchical linear modelling revealed that nonverbal synchrony was significantly associated with higher mastery and less resource activation on the within‐dyad level. Nonverbal synchrony was not associated with problem actuation or motivational clarification, and in general, no associations were found on the between‐dyad level. The results demonstrate the importance of disentangling within and between effects of nonverbal synchrony and provide initial evidence that nonverbal synchrony is tied to the specific therapeutic strategies observed in psychotherapy sessions. [ABSTRACT FROM AUTHOR]

Empirical research has explored different dimensions of the therapy process and their associations, often showing bidirectional links: for example, metacognition may be favoured by a positive alliance with the clinician; on the other hand, metacognitive difficulties may be an obstacle for the alliance. However, little is still known about the overall relationship between multiple dimensions during the psychotherapy process. The aim of this study is to further explore the in‐session interaction of therapeutic process variables, focusing on patient metacognition, therapeutic alliance, technical intervention, therapist expertise, and patient functioning. Participants included 45 patients involved in a psychodynamic weekly treatment in two clinical centres. Therapists were both in‐training and experienced clinicians. Four instruments were applied on four psychotherapy sessions (178 verbatim transcripts): Metacognition Assessment Scale‐Revised (MAS‐R) assessing metacognition, Collaborative Interaction Scale (CIS) assessing therapeutic alliance, Psychodynamic Intervention Rating Scale (PIRS) assessing therapist technical interventions, and Shedler–Westen Assessment Procedure (SWAP)‐200 assessing patient functioning. Sequential analyses revealed that specific therapist interventions co‐occurred with three different levels of therapeutic alliance: a first one characterized by positive collaboration, the second one by neutral collaboration, and the third one by ruptures. Moreover, and critically, the patient metacognition, patient functioning, and therapist expertise were found to exert different effects in the three alliance levels. These findings suggest the existence of a specific interdependence between the variables involved in the research. These results further indicate that the therapist expertise is a key element in the therapeutic process, as it can drastically affect the in‐session interactive dynamic. [ABSTRACT FROM AUTHOR]

Reduced self-esteem is a core symptom of depression, but few studies have investigated within-treatment change of self-esteem as a predictor of long-term outcome in depression. This study investigated change in self-esteem during 8 weeks of multimodal, psychodynamically oriented psychotherapy for 40 depressed patients and tested whether it would predict outcome 6 months after termination. Data was drawn from a randomized clinical pilot trial on day-clinic versus inpatient psychotherapy for depression. Findings supported the association between change in self-esteem and follow-up depression severity, even when controlling for within-treatment symptom change. Change in self-esteem was not related to overall symptoms and interpersonal problems at follow-up. Thus, change in self-esteem may be an important variable in preventing relapse for depression. Key Practitioner Message Self-esteem is related to depressive symptoms and interpersonal problems., Improvement of self-esteem during psychotherapy correlates with improvements of symptoms and interpersonal problems., Change of self-esteem during psychotherapy predicts depressive symptoms 6 months after termination of therapy., When treating depressed patients, psychotherapists should work towards an improvement of self-esteem in order to prevent relapse. [ABSTRACT FROM AUTHOR]

There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI-D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty-eight women with a DSM-IV diagnosis of major depression or dysthymia were allocated to a 10-session IPPI-D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI-D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate psychosocial correlates of comorbid psychopathology. Data were collected from a total of 90 female inpatients with anorexia nervosa (AN). Higher levels of general psychopathology were detected in depression, interpersonal sensitivity, obsessive-compulsive and anxiety subscales of the Symptom Checklist (SCL)-90. Regression analysis also revealed that higher levels of psychopathology across SCL-90 subscales in AN patients are significantly associated with an earlier age of onset of the condition, higher levels of anorectic psychopathology as measured by Eating Disorders Examination, lower self-esteem as measured by Multidimensional Self-Esteem Inventory and social support levels as measured by Quality of Social Network and Social Support Questionnaire. Considering the high levels of general psychopathology in people with AN, routine clinical practice should aim for a comprehensive assessment of such. Given the strong association between psychosocial factors such as self-esteem, social support and general psychopathology, psychological therapies could play an important role in facilitating emotional recovery. Copyright © 2010 John Wiley & Sons, Ltd. • Levels of depressive and anxiety psychopathology are elevated in people with Anorexia Nervosa. • Routine clinical practice should involve a comprehensive assessment of general psychopathology in people with Anorexia Nervosa. • Psychological interventions targeting self-esteem and interpersonal difficulties may be useful in the treatment of general pathology in people with Anorexia Nervosa. [ABSTRACT FROM AUTHOR]

The impact of DSM-III-R personality pathology on the Axis I therapy process was studied in 70 outpatients who received cognitive and/or behavioural therapy for an Axis I anxiety disorder. The Axis I therapy process was evaluated by the therapist. DSM-III-R personality pathology was assessed first by an independent rater using a semi-structured interview (Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II)) and second by the therapist in the course of treatment. Results showed poor diagnostic agreement between SCID- and therapist-derived personality pathology. SCID-derived personality pathology was only weakly related to a dysfunctional Axis I therapy process, as reported by the therapist. Therapist-derived personality pathology, on the contrary, was strongly related to a dysfunctional Axis I therapy process, as reported by the therapist. Possibly, therapists erroneously attributed Axis I therapy failure to assumed personality pathology. This is the first study on the impact of personality pathology, as assessed by an independent semi-structured interview, on the process of cognitive-behavioural therapy for Axis I anxiety disorders. The findings are consistent with studies that show no negative impact of personality pathology, as assessed by independent semi-structured interviews, on therapy outcome of Axis I anxiety disorders. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]