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Research indicates that combination of psychotherapy and antidepressant medication (ADM) provides cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi‐experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12‐week psychotherapeutic inpatient treatment programme. We compared outcomes through treatment and follow‐up of patients who continued medication with those who discontinued. We also tested possible moderator effects of initial depression severity on change between the groups. Based on prior research, we hypothesized that combination treatment would yield better results (i.e., more reduction in depression). Patients (N = 112) were referred from general practitioners or local secondary health care. Outcome was measured by Beck Depression Inventory‐II (BDI‐II), and comparisons were carried out using multilevel modelling. Although 35 patients discontinued ADM during treatment, 77 continued. Both continuers and discontinuers had a significant treatment effect that was maintained at 1‐year follow‐up. There was no difference in outcome between continuers and discontinuers of ADM. Patients with severe depression had significantly more symptom improvement than patients with moderate depression, but depression severity did not affect outcomes across continuers and discontinuers of ADM differently. The results could indicate that patients had developed resistance and/or tolerance to the prophylactic effects of medication and that ADM did not contribute to the reduction of depressive symptoms. The findings may also indicate that psychotherapy alone in some instances can be a viable alternative to continued combined treatment. Clinicians should carefully assess benefits of patients' ongoing use of antidepressant medication when entering psychotherapy. [ABSTRACT FROM AUTHOR]

Objective: To better understand how therapists facilitate client goal attainment in therapy, we analyzed therapists' future‐oriented actions in good outcome cases in which clients recorded high ratings on goal items in the Working Alliance Inventory‐Short Revised. Method: We selected clients who were within the clinical range (OQ‐45.2) at pretreatment, demonstrated reliable change at the end of treatment, and recorded high WAI client goals scores early in treatment. Qualitative analyses of transcripts of the initial three sessions and client posttreatment interviews were integrated into a combined analysis to identify themes across the two separate sets of findings. Results: Therapist future‐oriented activity included: (1) Picking up explicit and implicit intentions; (2) using linguistic devices, such as meta‐communication, action language, and hedging; (3) using evocative interventions; and (4) nudging the client into practicing change. Core finding: Therapists aligned with clients' directionality in a forward‐driven, gradually evolving process. Conclusion: Conceptual and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Patients are expected to participate in the hospital discharge process, assume self‐management after discharge and communicate relevant information to their general practitioner; however, patients report that they are not being sufficiently empowered to take on these responsibilities. The aim of this study was to explore and understand the discharge process with a focus on medicines communication, from the patient perspective. Methods: Patients were included at a hospital ward, observed during health‐care personnel encounters on the day of discharge and interviewed 1‐2 weeks after discharge. A process analysis was performed, and a content analysis combined data from observations and data from patient interviews focusing on medicines communication in the discharge process. Results: A total of 9 patients were observed on the day of discharge, equalling 67.5 hours of observations. The analysis resulted in the following themes: (a) the observed discharge process; (b) patient initiatives; and (c) the patient role. The medicines communication in the discharge process appeared unstructured. Various patient preferences and needs were revealed. The elements of the best practice structured discharge conversation were observed; however, some patients did not have a discharge conversation at all. Conclusions: The study contributes to a broader understanding of the discharge process, how patients experience it, including their role. It is evident that the discharge process is not always tailored to meet the patients' needs. More focus on early patient involvement and communication, in order to better prepare patients for self‐management of their medications, is important for their health outcomes. [ABSTRACT FROM AUTHOR]

Objective There are reasons to suggest that the therapist effect lies at the intersection between psychotherapists' professional and personal functioning. The current study investigated if and how the interplay between therapists' ( n = 70) professional self-reports (e.g., of their difficulties in practice in the form of 'professional self-doubt' and coping strategies when faced with difficulties) and presumably more global, personal self-concepts, not restricted to the professional treatment setting (i.e., the level of self-affiliation measured by the Structural Analysis of Social Behaviour (SASB) Intrex, Benjamin, ), relate to patient ( n = 255) outcome in public outpatient care. Method Multilevel growth curve analyses were performed on patient interpersonal and symptomatic distress rated at pre-, post- and three times during follow-up to examine whether change in patient outcome was influenced by the interaction between their therapists' level of 'professional self-doubt' and self-affiliation as well as between their therapists' use of coping when faced with difficulties, and the interaction between type of coping strategies and self-affiliation. Results A significant interaction between therapist 'professional self-doubt' (PSD) and self-affiliation on change in interpersonal distress was observed. Therapists who reported higher PSD seemed to evoke more change if they also had a self-affiliative introject. Therapists' use of coping strategies also affected therapeutic outcome, but therapists' self-affiliation was not a moderator in the interplay between therapist coping and patient outcome. Conclusion A tentative take-home message from this study could be: 'Love yourself as a person, doubt yourself as a therapist'. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages The findings of this study suggest that the nature of therapists' self-concepts as a person and as a therapist influences their patients' change in psychotherapy., These self-concept states are presumably communicated through the therapists' in-session behaviour., The study noted that a combination of self-doubt as a therapist with a high degree of self-affiliation as a person is particularly fruitful, while the combination of little professional self-doubt and much positive self-affiliation is not., This finding, reflected in the study title, 'Love yourself as a person, doubt yourself as a therapist', indicates that exaggerated self-confidence does not create a healthy therapeutic attitude., Therapist way of coping with difficulties in practice seems to influence patient outcome., Constructive coping characterized by dealing actively with a clinical problem, in terms of exercising reflexive control, seeking consultation and problem-solving together with the patient seems to help patients while coping by avoiding the problem, withdrawing from therapeutic engagement or acting out one's frustrations in the therapeutic relationship is associated with less patient change. [ABSTRACT FROM AUTHOR]

Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore the development of the working alliance (using the Working Alliance Inventory), rated by both patients and therapists as a function of therapist in-session experiences. The therapist experiences were gathered by means of the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005). Data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (Havik et al., 1995) were used. Multilevel growth curve analyses of alliance scores from Sessions 3, 12, 20 and 40 showed that the therapist factors predicted working alliance levels or growths differently, depending on whether the alliance was rated by patients or by therapists. For example, it emerged that therapists' negative reactions to patients and their in-session anxiety affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of flow (Csikszentmihalyi, 1990) during sessions impacted only the therapist-rated alliance. The patterns observed in this study imply that therapists should be particularly aware that their negative experiences of therapy are noticed by, and seem to influence, their clients when they evaluate the working alliance through the course of treatment. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The findings of this study suggest that the working alliance is influenced by therapists' self-reported practice experiences, which presumably are communicated through the therapists' in-session behaviours., The study found a notable divergence between practice experiences that influenced the therapists and those that influenced the patients when evaluating the working alliance., Specifically, practitioners' self-reported difficulties in practice, such as their negative reactions to patients and their in-session anxiety, affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of 'flow' during sessions impacted only the therapist-rated alliance., Practitioners should note that patient alliance ratings were more likely to be influenced by therapists' negative practice experiences than by positive ones., The divergence in the patient and therapist viewpoints has potential implications for therapist training and supervision and everyday self-reflection. [ABSTRACT FROM AUTHOR]

This article focuses on the therapist's emotional reactions to a young female client's revelations about her fear of being raped that came up in the course of an open-ended psychodynamic psychotherapy. The client suffered from depression and emotional disturbance related to the overwhelming developmental tasks of adolescence, including individuation and psychosexual development. The patient's fears and nightmares not only raised ethical dilemmas in the therapist regarding how to handle the implications of these revelations but also reactivated the therapist's own issues from her adolescent period. The fact that the material of the patient found a 'hook' (Gabbard, ) in the therapist enabled a deeper understanding of the patient that helped resolve her inner conflicts and move on in her development. [ABSTRACT FROM AUTHOR]