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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]

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]

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]

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]

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]

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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]

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]