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1. Therapists’ defense use impacts their patients’ defensive functioning: a systematic case study

Author

Mariagrazia Di Giuseppe, Katie Aafjes-van Doorn, Vera Békés, Bernard S. Gorman, Karl Stukenberg, and Sherwood Waldron

Subjects
Defense mechanisms, DMRS, psychoanalytic treatment, coping, process-outcome research, Psychology, BF1-990
Abstract

Research into defensive functioning in psychotherapy has thus far focused on patients’ defense use. However, also the defensive functioning of therapists might be significant because of its potential in promoting changes in the patient’s overall defensive functioning by sharing their higher-level understanding of a given situation and letting the patient have the opportunity to learn how to cope more successfully. This exploratory case study is the first to examine therapist’s defense mechanisms and their relationship to changes in the patient’s defensive functioning evaluated at different times throughout psychoanalytic treatment. We assessed the use of defense mechanisms with the Defense Mechanisms Rating Scales in 20 sessions collected at three phases (early, middle and late) of the psychoanalytic treatment. For each session, we identified therapist’s and patient’s defenses, defense levels and overall defensive functioning, with particular attention to the sequence of consecutively activated defenses within the therapeutic dyad. Results showed that the patient’s defensive functioning tended to gradually improve over the course of the treatment, with a slight decrease at the end. Therapists’ overall defensive functioning remained stable throughout the treatment with values in the range of high-neurotic and mature defenses. Assessment of the dyadic interaction between therapist and patient’s use of defenses showed that within-session, the patient tended to use the same individual defenses that the therapist used, which was especially pronounced in the initial phases of the treatment. Towards the end of the treatment, once there was a stable shared knowledge, the patient started to explore using new, higher-level defenses on her own, independent from what defenses the therapist used. Our findings emphasized the analyst’s role in encouraging the development of more effective ways of coping in the patient, confirming previous theoretical and empirical research regarding the improvement of patient’s defensive functioning in psychotherapy. The alterations in these coping strategies, also called high-adaptive defenses, as part of the therapist-patient interaction demonstrate the importance of studying defenses as an excellent process-based outcome measure. The measurement of the degree to which the analyst models and illustrates these superior coping methods to the patient is a prime vehicle for supporting internalization of these skills by the patient.

Published
2024
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2. Source of Information on Intentions to Adopt Protective Behaviours During COVID-19 in China

Author

Jiadong Yu, Bernard S. Gorman, and Carolyn M. Springer

Subjects
Public aspects of medicine, RA1-1270
Abstract

Introduction : COVID-19 spread across China and other countries in a matter of weeks. Yet, it is uncertain how people have responded to protective behaviours in this pandemic. This study aims to evaluate how trust in different types of information sources influences the intention to adopt protective behaviours. Methods : In total, 122 Chinese completed a survey on Qualtrics in March 2021. Data on demographic information, protective behaviours, trust in formal information, trust in informal information, perceived risk, worry and social desirability were collected. Structural equation modelling (SEM) was used to identify associations between these variables. Results : Trust in formal information was significantly associated with perceived risk (β = −.18) and significantly and positively associated with worry (β = .28). Trust in informal information was significantly and positively associated with perceived risk (β = .57). Subsequently, perceived risk was significantly associated with social distancing (β = −.17), and worry was significantly and positively associated with mask wearing (β = .25) and significantly associated with hand washing (β = −.27). Trust in formal information was significantly and positively associated with hand washing (β = .26) while trust in informal information was significantly and positively associated with social distancing and hand washing (β = .26). Perceived risk was significantly and positively associated with worry (β = .32). Conclusion : People who trust in informal information from social media and interpersonal communication would be more likely to adopt mask wearing and hand washing protective behaviours. People who trust in formal information from government-agency source would have a lower perceived risk of COVID-19 and are less likely to adopt social distancing, but people who trust in formal information have a greater worry about contracting COVID-19 and are more likely to wear masks.

Published
2022
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3. The Difficult Task of Assessing and Interpreting Treatment Deterioration: An Evidence-Based Case Study

Author

Sarah Bloch-Elkouby, Catherine F. Eubanks, Lauren Knopf, Bernard S. Gorman, and J. Christopher Muran

Subjects
deterioration, treatment failure, case study, outcome, process, patient satisfaction, Psychology, BF1-990
Abstract

Objectives: Literature on outcome assessment suggests that 35–40% of patients in randomized control trials terminate treatment with unchanged or higher levels of symptomatology. The goal of the present study was to shed light on this phenomenon and the factors accounting for it using a single case study design that investigates the process and outcome of a treatment conducted within a non-randomized clinical trial comparing a cognitive behavioral and a brief relational treatment.Method: The condition of L., a Caucasian man undergoing cognitive-behavioral therapy in a large metropolitan research program, was classified as deteriorating using the Reliable Change Index for the Inventory of Interpersonal Problems (IIP) and the Symptom Checklist-90 (SCL-90). Therapeutic process and outcome were examined using quantitative and qualitative methods rated by several sources.Results: Analysis showed that the treatment was delivered skillfully, and that despite initial difficulties, a strong alliance eventually developed between the patient and the therapist whose perspectives on the outcome of therapy nevertheless diverged. The patient's satisfaction with treatment was high, and he believed his deterioration was caused by its termination.Discussion: Results suggest that the deterioration was not caused by a negative process or a faulty delivery of the therapy. Several explanations were discussed in the context of the literature.

Published
2019
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4. Deepening the Group Training Experience: Group Cohesion and Supervision Impact in Alliance-Focused Training

Author

Bernard S. Gorman, Adelya A. Urmanche, Mary Minges, Catherine F. Eubanks, and J. Christopher Muran

Subjects
Supervisor, Social Psychology, medicine.medical_treatment, Group conflict, Mean age, Article, Cognitive behavioral therapy, Group cohesiveness, Alliance, Meaningful learning, medicine, Group supervision, Psychology, Applied Psychology, Clinical psychology
Abstract

OBJECTIVE: The aim of the current study is to explore experiences of trainees engaged in alliance-focused training (AFT), a group supervision modality with an explicit focus on awareness of ruptures and implementation of repair strategies. Using Cognitive Behavioral Therapy (CBT) group supervision as a point of comparison, the study examines supervisory alliance, ruptures, group cohesion and safety, and supervision impact. METHOD: Eighty-three trainees (clinical psychology interns, advanced-level psychology externs and psychiatry residents) at a metropolitan medical center in New York City who received supervision in CBT (N = 38) or AFT (N = 45) reported on their group supervision experience. Participants had a mean age of 29.5 (SD = 4.9); 77% were women; 84% of participants identified as White, 7% as Multiethnic, 6% as Hispanic/Latinx, 1% as Black, and 1% as Asian. Participants reported on occurrence of ruptures with their supervisor, supervisory alliance (Working Alliance Inventory-Short), group safety, supervision depth and smoothness (Session Evaluation Questionnaire), and group cohesion (Group Climate Questionnaire). Mixed and general linear models, and correlation analyses were used for analysis. RESULTS: All trainees reported equally low incidence of ruptures with their supervisor alongside high ratings of supervisory alliance. Trainees in AFT reported experiencing less safety, smoothness, and greater intergroup conflict than trainees in CBT supervision; however, they also reported stronger group engagement and a deeper supervision experience. CONCLUSIONS: Results suggest that AFT may provide a rich environment to foster a certain level of discomfort and risk-taking that may facilitate an engaging and meaningful learning experience.

Published
2021

5. How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide

Author

Sarah Bloch-Elkouby, Bernard S. Gorman, Shira Barzilay, Timothy Wilkerson, Igor Galynker, Lauren Lloveras, David B. Schnur, Allison Schuck, Raffaella Calati, Bloch-Elkouby, S, Gorman, B, Lloveras, L, Wilkerson, T, Schuck, A, Barzilay, S, Calati, R, Schnur, D, and Galynker, I

Subjects
Adult, Adolescent, Suicide, risk factors, Suicide, Attempted, Structural equation modeling, Suicidal Ideation, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Risk Factors, medicine, Humans, Narrative, Prospective Studies, longitudinal study, risk factors, suicide, suicidal ideation, suicidal behavior, Suicide Risk, Prospective cohort study, Suicidal ideation, Aged, Life events, Middle Aged, Explained variation, 030227 psychiatry, Psychiatry and Mental health, Clinical Psychology, Suicide, Trait, medicine.symptom, Psychology, 030217 neurology & neurosurgery, Clinical psychology
Abstract

Aim : The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model. Methods : The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18–65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes. Results : The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts. Discussion : The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.

Published
2020

6. Be yourself: Authenticity as a long-term mating strategy

Author

Sanya Masroor, Benjamin Warach, Bernard S. Gorman, Peter K. Jonason, Kirby L. Goldin, Nixza Lebron, and Lawrence Josephs

Subjects
media_common.quotation_subject, 050109 social psychology, Mindset, Playing hard to get, 050105 experimental psychology, Attachment theory, Narcissism, medicine, Personality, 0501 psychology and cognitive sciences, Mating, General Psychology, media_common, Emotional intelligence, 05 social sciences, Assortative mating, Authenticity, Dark Triad, Dating, Priming (media), medicine.symptom, Psychology, Social psychology
Abstract

We hypothesize that “being yourself” is the dating strategy of individuals that have successful long-term relationships. Study 1 examined the relationships between authenticity and personality variables that predict relationship outcome. Study 2 employed a two-part acts nomination design to enumerate “being yourself” while dating and to examine personality correlates of “being yourself”. Study 3 explored whether individuals being themselves are attractive and if being yourself results in assortative mating with authentic individuals. Study 4 determined the effect of “be yourself” mindset priming on “be yourself” dating behavior. Study 1 found that authenticity is associated with emotional intelligence and positive relational outcomes. Study 2 found that “being yourself” dating behavior is associated with authenticity, secure attachment, and low narcissism. Study 3 found that “be yourself” dating behavior is attractive and facilitates assortative mating with authentic individuals. Study 4 found that rejection sensitive individuals are more likely to engage in “be yourself” dating behavior when made to feel safe to be themselves. “Be yourself” is the dating strategy that authentic individuals use to facilitate successful long-term relationships.

Published
2019

7. Preliminary data about the validation of a self-report for the assessment of interpersonal guilt. The Interpersonal Guilt Rating Scales-15s (IGRS-15s)

Author

George Silberschatz, Filippo Faccini, Nino Dazzi, Marshall Bush, Emma De Luca, Francesco Gazzillo, and Bernard S. Gorman

Subjects
Adult, Male, Psychometrics, media_common.quotation_subject, 050109 social psychology, Interpersonal communication, 050108 psychoanalysis, Rating scale, Surveys and Questionnaires, Control-Mastery Theory (CMT), IGRS-15s, assessment, factor analysis, interpersonal guilt, Humans, Personality, Interpersonal Relations, 0501 psychology and cognitive sciences, Reliability (statistics), media_common, Psychiatric Status Rating Scales, 05 social sciences, Discriminant validity, Reproducibility of Results, Construct validity, General Medicine, Confirmatory factor analysis, Italy, Scale (social sciences), Guilt, Female, Self Report, Psychology, Clinical psychology
Abstract

The aim of this article is to present validation data about a self-report rating scale for the assessment of interpersonal guilt according to Control-Mastery Theory (CMT; Silbershatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986), the Interpersonal Guilt Rating Scale-15s (IGRS-15s). In order to perform the validation of this tool in an Italian sample we have collected a sample of 645 nonclinical subjects. They had to complete the IGRS-15s, the Scale for the Measurement of the Impending Punishment (SMIP; Caprara et al., 1990), the Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor et al., 1997), the Psychological General Well-Being Index (PGWBI; Dupuy, 1984), and the Affective Neuroscience Personality Scales (ANPS; Davis, Panksepp, & Normansell, 2003), together with an ad-hoc questionnaire for collecting demographic data, the Socio-Demographical Schedule. We have performed a confirmatory factor analysis to verify if the four-factor solution based on CMT and replicated in previous research (Gazzillo et al., 2017) was confirmed. Then, we checked the retest reliability of IGRS-15s after four weeks in a random subsample of 54 subjects. In order to assess its concurrent and discriminant validity, we calculated the correlations between IGRS-15s assessment and SMIP and IGQ-67. Finally, to test its construct validity, we assessed the relationships between the IGRS-15s and the affective systems using the ANPS and the wellbeing assessed with the PGWBI. The data collected support the retest reliability and the concurrent and discriminant validity of the measure, and we have collected preliminary data about its construct validity. Examples of the possible clinical and research applications of this tool are discussed.

Published
2018

8. A Functional Analysis of Two Transdiagnostic, Emotion-Focused Interventions on Nonsuicidal Self-Injury

Author

Kate H. Bentley, David H. Barlow, Bernard S. Gorman, Shannon Sauer-Zavala, and Matthew K. Nock

Subjects
Adult, Male, 050103 clinical psychology, Psychotherapist, Adolescent, medicine.medical_treatment, Emotions, Psychological intervention, Poison control, Single-subject design, Anxiety, Article, Cognitive reappraisal, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine, Humans, 0501 psychology and cognitive sciences, Borderline personality disorder, Depression, 05 social sciences, medicine.disease, Dialectical behavior therapy, 030227 psychiatry, Psychiatry and Mental health, Clinical Psychology, Multiple baseline design, Treatment Outcome, Female, Self Report, medicine.symptom, Psychology, Self-Injurious Behavior, Clinical psychology
Abstract

OBJECTIVE Nonsuicidal self-injury (NSSI) is prevalent and associated with clinically significant consequences. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the critical components for NSSI treatment remain largely unknown. The aim of this study was to examine the specific effects of mindful emotion awareness training and cognitive reappraisal, 2 transdiagnostic treatment strategies that purportedly address the functional processes thought to maintain self-injurious behavior, on NSSI urges and acts. METHOD Using a counterbalanced, combined series (multiple baseline and data-driven phase change) aggregated single-case experimental design, the unique and combined impact of these 2 4-week interventions was evaluated among 10 diagnostically heterogeneous self-injuring adults. Ecological momentary assessment was used to provide daily ratings of NSSI urges and acts during all study phases. RESULTS Eight of 10 participants demonstrated clinically meaningful reductions in NSSI; 6 participants responded to 1 intervention alone, whereas 2 participants responded after the addition of the alternative intervention. Group analyses indicated statistically significant overall effects of study phase on NSSI, with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in self-reported levels of anxiety and depression, and large improvements in mindful emotion awareness and cognitive reappraisal skills. CONCLUSIONS Findings suggest that brief mindful emotion awareness and cognitive reappraisal interventions can lead to reductions in NSSI urges and acts. Transdiagnostic, emotion-focused therapeutic strategies delivered in time-limited formats may serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals. (PsycINFO Database Record

Published
2017

9. Design and Analysis of Single-Case Research

Author

Ronald D. Franklin, David B. Allison, Bernard S. Gorman, Ronald D. Franklin, David B. Allison, and Bernard S. Gorman

Subjects
Psychology--Research--Methodology, Case method, Psychometrics
Abstract

This book focuses on one important aspect of psychological research -- the intensive study of people measured one or more at a time. Some important historical material is detailed in several chapters making a strong connection to previous material in psychology. Several contributors present important details on classical and novel methods to study behavior over time, and they do so in the context of appropriate statistical methods. This appropriately reflects the growing interest in examining dynamic behaviors by objective measurement. Key experimental design principles are expertly stated, reflecting the growing interest in studying the individual course of development for invariants in behaviors, including some unusual constructs such as cycles and punctuated equilibria. This book also deals with practical contemporary problems in psychology and documents the increased possibility of using clinical research tools. Taken as a whole, this volume is filled with interesting historical points, informative mathematical and statistical analyses, and practical methods. It is the only book addressing the issues of meta-analysis, cyclicity, and confounds to visual inspection of single subject data that considers ways in which statistical software can aid in overcoming these constraints.

Published
2014

10. Hierarchical linear models for the development of growth curves: an example with body mass index in overweight/obese adults.

Author

Moonseong Heo, Myles S. Faith, John W. Mott, Bernard S. Gorman, and David T. Redden

Abstract

When data are available on multiple individuals measured at multiple time points that may vary in number or inter-measurement interval, hierarchical linear models (HLM) may be an ideal option. The present paper offers an applied tutorial on the use of HLM for developing growth curves depicting natural changes over time. We illustrate these methods with an example of body mass index (BMI; kg/m2) among overweight and obese adults. We modelled among-person variation in BMI growth curves as a function of subjects' baseline characteristics. Specifically, growth curves were modelled with two-level observations, where the first level was each time point of measurement within each individual and the second level was each individual. Four longitudinal databases with measured weight and height met the inclusion criteria and were pooled for analysis: the Framingham Heart Study (FHS); the Multiple Risk Factor Intervention Trial (MRFIT); the National Health and Nutritional Examination Survey I (NHANES-I) and its follow-up study; and the Tecumseh Mortality Follow-up Study (TMFS). Results indicated that significant quadratic patterns of the BMI growth trajectory depend primarily upon a combination of age and baseline BMI. Specifically, BMI tends to increase with time for younger people with relatively moderate obesity (25 BMI <30) but decrease for older people regardless of degree of obesity. The gradients of these changes are inversely related to baseline BMI and do not substantially depend on gender. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Published
2003
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