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In this paper, we argue (1) that self-report measurement is meaningful. ‘John’, a patient-participant in psychotherapy research, is presented to illustrate meaning-making processes in self-report measurement. We show that neglecting individual scoring processes might lead to invalidation of data. Therefore, (2) we argue that it is vital to actively validate data collected by validated measures. As numerical data themselves do not ‘show’ whether they are valid, the story of data collection must be taken into account. Therefore, we argue that mixing qualitative and quantitative methods is necessary for meaningful measurement, which is paramount to progress in psychological science and practice.

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.

Case study methods are increasingly recognized as crucial methods to enhance understanding of the complexity of psychotherapy processes and as way to bridge the science-practice gap. The Single Case Archive (SCA) was constructed to facilitate access to the existing field of case study research for academic, clinical, and educational purposes. Cases were selected through systematic screening of relevant peer-reviewed journals in the field of psychotherapy research and rigorous snowball sampling. All cases meeting inclusion criteria were inventoried using the Inventory for Basic Information in Single Cases that maps study, patient, therapist, and therapy characteristics. 3471 cases from 175 peer-reviewed journals published between 1955 and 2019 were included in the SCA database. The SCA comprises cases from different theoretical backgrounds, discussing patients from different age categories, with different presenting problems going through a diversity of psychotherapeutic treatments that are studied using a range of methods. Cases differ strongly with respect to the amount of information that is present in the case study, and the field should pay more attention to ethical considerations like informed consent and providing relevant basic descriptive information. An online platform makes the SCA database searchable by researchers, clinicians and students. In conclusion, the SCA is a unique resource that makes case studies more easily accessible, facilitates meta-studies and reviews of case studies, and stimulates methodological developments in the field of case study research.

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.

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.

In the present paper we examine four cases in which the assumption that good outcome necessarily means good therapy did not hold. Cases were selected that reported good pre-post outcome (i.e., clinically reliable decrease in symptom severity) but a negative (disappointing) therapy experience, drawn from a randomized controlled trial (the Ghent Psychotherapy Study) and a naturalistic outcome study (the Stockholm Young Adults Psychotherapy Project). Analysis of these seemingly contrasting findings made it possible to identify three distinct patterns of client experience of outcome. Implications for research and practice are discussed.

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.

This study explored the meaning of "good outcome" within and beyond the much-used statistical indices of clinical significance in standard outcome research as developed by Jacobson and Truax (1991). Specifically, we examined the experiences of patients marked as "recovered" and "improved" following cognitive-behavioral therapy and psychodynamic therapy for major depression. A mixed-methods study was conducted using data gathered in an RCT, including patients' pre-post outcome scores on the Beck Depression Inventory-II and posttreatment client change interviews. We selected 28 patients who showed recovery and 19 patients who showed improvement in self-reported depression symptoms. A grounded theory analysis was performed on patients' interviews, ultimately resulting in a conceptual model of "good outcome." From patients' perspectives, good outcome can be understood as feeling empowered, finding personal balance and encountering ongoing struggle, indicating an ongoing process and variation in experience. The Jacobson-Truax classification of "good outcome" could not account for the (more pessimistic) nuances in outcome experiences, especially for "improved" patients, and did not grasp the multidimensional nature of outcome as experienced by patients. It is recommended that statistical indications of clinical meaningfulness are interpreted warily and ideally contextualized within personal narratives. Further research on the phenomenon of change and good outcome is required, aiming at integrating multiple perspectives and methods accordingly the multidimensional phenomenon under study.

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 instru, SCOPUS: ar.j, info:eu-repo/semantics/published

Bei Perversionen ist die Übertragung durch spezifische Probleme charakterisiert, so etwa eine aufsässige und polemische Haltung, erotische Übertragung, Projektionen und Aggression. Eine solche Übertragung bereitet in der Behandlung von Perversionen besondere Probleme und kann die analytische Arbeit mit diesen Patienten unmöglich machen. Die Autoren schlagen vor, mithilfe von Lacans Schema L zwischen produktiven und nicht-produktiven Übertragungsaspekten zu differenzieren, weil es eine imaginäre und eine symbolische Dimension in der Übertragung unterscheidet. In dieser Metasynthese von elf publizierten Fallstudien zu sexuellen Perversionen werden Übertragungsmuster analysiert. Zur imaginären Dimension fanden die Autoren heraus, dass perverse Patienten dazu neigen, den Analytiker (un)bewusst in eine durch Identifizierung, Verschmelzung und Rivalität charakterisierte Beziehung hineinzuziehen. Zur symbolischen Dimension stellten sie fest, dass perverse Patienten ihre Motive, Fehlleistungen, Symptome und subjektive Identität hinterfragen können. Die thematische Analyse zeigte, wie wichtig die Position des Analytikers in dieser Arbeit ist, die im Schema L als die Repräsentation der Andersartigkeit des Anderen beschrieben wird. Folgerungen für die klinische Praxis und Empfehlungen für die weitere Forschung werden skizziert.

In his article « Le temps logique et l’assertion de certitude anticipée » Lacan makes a distinction between three different instances of time : « l’instant de voir, le temps de comprendre et le moment de conclure ». The purpose of this paper is to explain how the body and its jouissance in the case of trauma may function as a kind of “moment the conclure” in such a way that the body acts without the subject’s understanding of what is happening. Based on a case of trauma we will show how the body anticipates on a kind of enjoyment, without the subject knowing it, let alone being able to speak about it. “Le temps pour comprendre” comes with the subject wanting to know because this wanting initiates “l’instant de voir”. If the subject comes to a real understanding via symbolization of what happens, this bodily inscribed knowledge may be transformed into symbolic knowledge. Ideally, this will provide the subject with the possibility of making a choice, instead of being subjected to the traumatic repetition compulsion.

In this paper, we will elaborate on an article by Hélène Deutsch on the psychology of the impostor. The impostor is a specific type of liar who imposes on others dishonest stories about his identity. From a psychoanalytic point of view, identity is by definition fraudulent as there is no real Self. But the impostor duplicates this fraud by presenting dishonest stories about personal attainments, position, or worldly possessions. Referring to Freud’s text on ‘Two lies told by children,’ we will demonstrate that in the neurotic subject (a) the motive for lying is love, and (b) the purpose of lying is to deny symbolic castration in order to preserve an imaginary ideal. The impostor takes this one step further: here the motive is not love but admiration, and the purpose is not denial but disavowal of the symbolic castration. Finally, we will discuss the ambivalent relation of the public towards the impostor that seems all too willing to be deceived. In that sense, the lies of the impostor anticipate the Other’s truth about castration.