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The authors investigated changes of emotional experience and expressivity in 34 inpatients undergoing psychodynamic therapy and in 29 healthy persons who were assessed at parallel time intervals. Participants completed 2 measures of psychopathology (Symptom Checklist-90 Revised and Inventory of Interpersonal Problems-64) and took part in relationship episode interviews. The emotional experiences they reported and their nonverbal emotional expressivity during the interviews were assessed by independent raters. Regardless of when they were assessed, the patients reported a greater number of emotions and a greater variety of emotions. Psychopathology in the patient group decreased in the course of treatment, but there were no systematic changes in the emotional domain. The findings challenge the common notion of psychopathology being associated with impaired awareness and expression of emotions. [c] 2010 Wiley Periodicals, Inc. J Clin Psychol 66:1027-1043, 2010. Keywords: emotions; psychotherapy DOI: 10.1002/jclp.20704

Dynamic treatment regimes are time-varying treatments that individualize sequences of treatments to the patient. The construction of dynamic treatment regimes is challenging because a patient will he eligible for some treatment components only if he has not responded (or has responded) to other treatment components. In addition, there are usually a number of potentially useful treatment components and combinations thereof. In this article, we propose new methodology for identifying promising components and screening out negligible ones. First, we define causal factorial effects for treatment components that may be applied sequentially to a patient. Second, we propose experimental designs that can be used to study the treatment components. Surprisingly, modifications can be made to (fractional) factorial designs--more commonly found in the engineering statistics literature--for screening in this setting. Furthermore, we provide an analysis model that can be used to screen the factorial effects. We demonstrate the proposed methodology using examples motivated in the literature and also via a simulation study. KEY WORDS: Causal inference; Experimental design; Multi-stage decisions.

Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may result in improved self-esteem, increased ability to resolve reactions to trauma through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

The objective of this study was to investigate the prevalence and timing of sudden gains over the course of brief, psychodynamically oriented treatment for generalized anxiety disorder (GAD). Data were used from two studies of brief (i.e., 16-session) supportive-expressive psychotherapy for GAD. Anxiety symptoms were measured at every weekly treatment session. Sudden gains in anxiety symptoms were defined to parallel previous research on sudden gains in major depressive disorder (MDD). Overall, sudden gains were found for 11 of 68 participants (16.2%), with 4 (36.4%) of these patients experiencing reversals of these gains and losing over 50% of the sudden gain during subsequent treatment sessions. Applying a baseline severity cutoff and a duration criteria similar to those used in previous studies of sudden gains resulted in 10 of 29 (34.5%) patients showing sudden gains. Of these sudden gainers, 4 (40.0%) experienced a reversal and 7 (70%) experienced an upwards spike in symptoms during their psychotherapy course. When defined in a parallel fashion, rates of sudden gains in GAD are similar to those found in MDD, although anxiety symptoms are highly variable. Keywords: generalized anxiety disorder; sudden gains; brief psychotherapy; psychodynamic treatment; symptom variability

The authors address psychodynamic therapies, particularly transference-focused psychotherapy (TFP), in the treatment of patients who present with non-suicidal self-injury. In doing so. they briefly discuss various psychodynamic approaches with empirical evidence for their effectiveness. They describe TFP, including its treatment rationale, putative change mechanisms, and outcome research. They then present a case illustration of a patient with borderline personality disorder who engages in non-suicidal self-injury to demonstrate how TFP can be applied to such cases. Keywords: psychodynamic treatment; transference-focused psychotherapy: self-injury; borderline personality disorder

Silverman in 1983 held that the unconscious encoding of MOMMY AND I ARE ONE triggers a fantasy of symbiotic union with the good mother of early childhood. In contrast, later Sohlberg and Birgegard contended that MOMMY AND I triggers associations to similarity issues with mother, associations that may be influenced by the words following MOMMY AND I. Although their messages produce, almost invariably, no reportable sensation, Sohlberg and Birgegard claimed strong evidence for the influence of such messages on perception, motivation, and memory, 10 days poststimulation and suggestive evidence 4 mo. later. Their findings are not compelling evidence for these claims; and there is no evidence that any result was associated with the unconscious encoding of the psychodynamic meaning of a multiword message.

Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapists provided 'think aloud' case formulations in response to 6 standardized patient vignettes varying in disorder and prototypicality. The 390 formulations were reliably transcribed, segmented into idea units, content coded, and rated on multiple dimensions of quality. As hypothesized, the formulations of experts were more comprehensive, elaborated, complex, and systematic. Judges did not rate them as more coherent or precise in the use of language. In addition, the treatment plans of experts were more elaborated and linked better to the formulations. Effect sizes for overall ratings of quality ranged from medium to large. Few differences based on therapy orientation were observed. Results are discussed in terms of therapist training. Keywords: case formulation, therapist expertise, cognitive-behavioral therapy, psychodynamic therapy

The authors do not see any benefit to J. C. Coyne, R. Thompson, and V. Whiffen's (2004) proposal to draw sharp boundaries between psychodynamic vulnerability theories, research on the onset of syndromal depression, and research with vulnerable, nondepressed populations. These domains have been and remain mutually relevant. Coyne et al. did not bring forward new evidence concerning the 6 issues addressed by D. C. Zuroff, M. Mongrain, and D. A. Santor (2004); consequently, the authors stand by their conclusions. According to Lakatos (as cited in B. Gholson & P. Barker, 1985), scientists justifiably continue to invest in research programs as long as the programs remain progressive. The personality vulnerability program is theoretically and empirically progressive and merits continued investment. Nevertheless, the field would benefit if Coyne et al. articulated a systematic contextualist research program to compete with the personality research program.

For Americans in the new Millennium, there is a revival of interest in spiritual matters. Simultaneously, attention to spirituality in the social work profession is a cutting edge theme. Social work has a holistic focus on person-in-environment, acknowledging the psychological, emotional, physical and social aspects of the individual. The spiritual is also a defining aspect of each individual. Bidden or unbidden, therapists are confronted daily with the manifestations of the spiritual yearning of their clients while also being confronted with their own spiritual attitudes. The endeavor to understand the human dilemma must include the spiritual dimensions of both therapist and client. This article defines the author's therapeutic attitude as it is informed by social work training, personal life experience, and spiritual religious beliefs. Several case examples are included. KEY WORDS: psychotherapy; psychodynamic; spirituality; religion; mystery; transitional phenomena; image; symbol; imagination; reverie.

The aim of this article is to show how psychodynamic theory and its application can inform the management of change in organizations. The article outlines a psychodynamic framework for the management of change, emphasizing the interrelation between individual and collective emotional experience and power relations. The phrase a politics of imagined stability is used to describe the role that social and strategic politics play in the perpetuation of emotions and fantasies that have an impact on organizing. The framework involves understanding how the organization is imagined, experienced and maintained through the influence of social and strategic politics, as well as the resulting emotional and political relations within which attempts at change have to be managed. The conceptual framework is illustrated and developed through a case example from Hyder plc, formerly the largest private company in Wales, UK. The discussion and conclusion outline the articles contribution to knowledge concerning psychodynamic thinking and the management of change. KEYWORDS emotions * management of change * organizational behaviour * politics * psychodynamic

ABSTRACT. In this article, the author describes the principles of the Experiential Reintegration Model (ERM), a new formulation of the therapeutic propensity of psychodramatic and role-playing enactment. The model is [...]

Methodological changes in subliminal psychodynamic activation experiments based on the assumption that multiletter messages can be encoded automatically (Birgegard & Sohlberg, 1999) are questioned. Their contention that partial experimental messages and appropriate nonsense anagram controls (Fudin, 1986) need not be presented in every experiment is supported, with a reservation. If the difference between responses to the complete message and its control is significant in the predicted direction, then Fudin's procedure should be used. A nonsignificant difference between the response to each partial message and its control is needed to support the assumption of proponents of subliminal psychodynamic activation that successful outcomes are effected by the encoding of the meaning of a complete message. Experiments in subliminal psychodynamic activation can be improved if their methodologies take into account variables that may operate when subliminal stimuli are presented and encoded.

A clinician's sense of hope is not easily maintained in the therapeutic situation. Exploring the psychodynamics of hope in two interviews--one focusing on a community mental health psychotherapist and the other on a school social worker--this paper proposes that maintaining hope requires an intense affect state, an active blend of emotional and intellectual reflections in the mind of the clinician. Ongoing hope is the product of a delicate balance between a clinician's tolerance for the tragic in life and the expectations of positive treatment outcome. These reflections occur in an intrapsychic space, a point of juncture between the clinician's primary process longings/fears and secondary process thoughts. Hope is constructed in this space. It gains its language, form, and substance from the integration of personal experience, client observation and clinical theory. Reflective activity helps a clinician avoid disabling transference to a client and promotes identifications that lead to realistic treatment goals. Keywords: hope; clinician; transference; affect state; intrapsychic space; object relations theory.

The narrative and social construction metaphors are used as the conceptual frame for the clinical work with a client who felt trapped in an emotionally abusive relationship. To help the client deconstruct a problem-saturated narrative, questions were asked which drew from psychodynamic, cognitive-behavioral, and solution-focused models. The rationale for the use and timing of deconstructive questions from the various models is discussed. The problem-saturated stow during the time of intake is presented, as is the change process that led to a more solution-focused narrative. An effective short-term treatment was created through the use of interventions drawn from multiple clinical models. Effectiveness was judged by client's improved emotional state, and the ability of the client to imagine and pursue identified solutions. Keywords: narrative; psychodynamic; cognitive behavioral; solution focused.

Recent integration among approaches to perception without awareness has brought the usefulness of Subliminal Psychodynamic Activation into renewed focus. Several authors have discussed the possible detrimental impact on interpretation when control phrases are used that for some participants may be less than affectively neutral (e.g., Fudin, 1986; Greenberg, 1997). In this continuing commentary, we argue that the neutrality of a substantive stimulus is an insoluble issue, and instead the suitability of controls for a given study should be emphasized. Also, we discuss the apparent confusion between experimental psychodynamics and efforts to answer Greenwald's 1992 'two-word challenge.'

Theories of psychotherapy are implemented by therapists' intentional actions within sessions. This study examined the structure and construct validity of the Therapist Session Intentions (TSI) form. Ten therapists rated their therapeutic intentions following each of 2,305 therapy sessions of cognitive-behavioral or psychodynamic-interpersonal therapy in the Second Sheffield Psychotherapy Project. Seven conceptually coherent clusters of intentions, or therapeutic foci, were identified: treatment context, session structure, affect, obstacles, encouraging change, behavior, and cognition-insight. Contrasting patterns of therapeutic focus across treatments and changes in focus across sessions within treatments appeared conceptually coherent. Correlations across a subsample of sessions confirmed correspondences of the TSI foci with dimensions found previously in observers' ratings.

The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. Twenty-nine depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression. Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results.

The generic model of psychotherapy is offered as a transtheoretical model of universal change processes. Session 3 change processes are examined in a naturalistic study of dynamic therapy guided by the generic model. Findings replicate and extend earlier work addressing propositions of the generic model in dynamic therapy. Openness and bond contributed to in-session realizations, whereas bond and realizations fostered session progress. Session progress, bond, use of experiential operations, and less frequent use of dynamic interventions contributed to change between Sessions 2 and 4. Discussion outlines a model of change in early dynamic therapy and highlights the usefulness of the generic model for the evaluation of change processes.

A verbal exchange is a set of 2 people's co-occurring speech-act categories that accomplish some subtask within an interpersonal encounter. Factor analysis of verbal response mode (speech act) frequencies in 1,630 segments (each approximately 10 to 12 min) drawn from the brief psychodynamic-interpersonal or cognitive-behavioral treatment of 39 mainly depressed clients identified 6 exchanges in each treatment - 4 that were the same in both treatments (Revealing, Storytelling, Explaining, and Inquiring) and 2 that distinguished each treatment (Exploring and Interpreting in psychodynamic-interpersonal treatment; Prescribing and Reframing in cognitive-behavioral treatment). The exchanges showed distinctive temporal patterns across segments of sessions and across sessions of each time-limited treatment. The verbal exchange is a midsize concept that links atomistic verbal codes with clinical or theoretical concepts.

Interest in linking psychoanalysis with scientific psychology waxes and wanes. In part, the difficulties have been caused by the preference of psychoanalysts for Freud's clinical theory (and its emphasis on narrative truth) as opposed to his metapsychology (with its requirement for historical truth). Even though contemporary scientific psychology evolved largely independently of psychoanalysis, the articles on object relations, transference, and defense published in this special issue show that the theory remains a source of inspiration, observations, and hypotheses.

This study examined two aspects of psychodynamic theory concerning bulimia nervosa, that bulimic patients ascribe to a traditionally feminine sex-role and that bulimic women have difficulty differentiating emotional from visceral sensations. 18 bulimic and 18 control women were administered the Bem Sex-role Inventory and the Eating Disorder Inventory. Contrary to dynamic theory, bulimic women were not more likely classified as traditionally feminine than control subjects; however, significantly more controls than bulimic women were classified as androgynous. Analysis of scores on the Eating Disorder Inventory's Interoceptive Awareness scale indicated a significant difference between bulimic persons and controls, providing strong support for the hypothesis that bulimic women have a difficult time differentiating emotional from visceral sensations.

In response to Norcross and Rossi's (1994) comment on our article (Shapiro, Barkham, Rees, Hardy, Reynolds, & Startup, 1994), we note that research as reported does not fully represent the processes whereby it was designed and completed. The true statistical power of an investigation reflects all the analyses carried out, not just those that get reported. The power of our analyses was sufficient to address the substantive questions at issue. The importance of these questions does not depend on allegiance to equivalent outcomes of diverse therapies. The outcome phase of the Second Sheffield Psychotherapy Project is but part of its broad strategic approach to advancing our understanding of the mechanisms of change in the psychotherapies.

Clinically depressed family caregivers (N = 66) of frail, elderly relatives were randomly assigned to 20 sessions of either cognitive-behavioral (CB) or brief psychodynamic (PD) individual psychotherapy. At posttreatment, 71% of the caregivers were no longer clinically depressed according to research diagnostic criteria (RDC), with no differences found between the 2 outpatient treatments. The results suggested therapy specificity; there was an interaction between treatment modality and length of caregiving on symptom-oriented measures. Clients who had been caregivers for a shorter period showed improvement in the PD condition, whereas those who had been caregivers for at least 44 months improved with CB therapy. These findings suggest that patient-specific variables should be considered when choosing treatment for clinically depressed family caregivers.

This invited comment applauds the impressive outcome study conducted by Shapiro and his colleagues (1994) in which psychodynamic-interpersonal therapy was compared with cognitive-behavioral therapy in the treatment of depression. Our limited argument with their article is the uncritical support accorded to the equivalent outcomes conclusion and the implicit rejection of differential efficacy among the psychotherapies as a function of patient variables. Two principal objections are that Shapiro et al. overestimated the statistical power of their analyses to detect genuine interactions and selected variables that are not particularly relevant or amenable to psychological treatment.

A dynamical systems theory of transpersonal growth/evolution is sketched out, based on The Grand Evolutionary Synthesis.

This article presents a psychodynamic framework and research methods for investigating the significance of patients' internal representations of therapy-with-their-therapists. In this article, 2 instruments developed for this purpose - the Therapist Representation Inventory and the Intersession Experience Questionnaire - are introduced, and their psychometric characteristics are described. Also, findings from a series of studies conducted with these instruments are summarized. Finally, the types of questions these instruments appear to be well suited to are proposed for addressing in future research.

This article provides a review of research on the relationship between aspects of transference interpretation and outcome in dynamic psychotherapy. It also presents the results of a recently completed study that focused on 2 aspects of transference interpretations, concentration and correspondence. Significant relationships between each of these 2 aspects and both therapeutic alliance and outcome were found, as well as an interaction effect for outcome. The relationships differed as a function of the patient personality characteristic known as quality of object relations. The results concerning correspondence were consistent with those of previous studies that investigated the correctness of interpretations. The overall findings suggest that (a) variation in technique may make a difference in brief dynamic therapy and (b) variation and impact of technique may have been masked in some previous studies and reviews.

Recently published methods are reviewed to assess dynamic formulations derived from psychodynamic case material, especially those methods that emphasize central maladaptive interpersonal patterns. These methods are divided into those that yield psychometric data based on samples that are at least of moderate size and those in which the measures are derived from case studies. The psychometric properties of the first group of measures are reviewed, including interjudge reliability, internal consistency, and content, predictive, and concurrent validity. This article then examines how the measures have addressed and could address the question of construct validity. Also discussed are issues involving the comparison of the methods, particularly their importance for examining specific hypotheses in psychodynamic psychotherapy. Concrete suggestions are made for future research.

A comprehensive list of results from visual subliminal psychodynamic activation experiments is presented. This list includes results reported since the publication of the last comprehensive list by Weinberger and Hardaway in 1990 and several results not found on that list. On the present list, SPA results are categorized according to criteria that we contend are more objective than those used previously. In contrast to conclusions drawn from previous lists prepared by Silverman in 1980 and 1983, by Weinberger and Hardaway in 1990, and by Weinberger and Silverman in 1987, the present list indicates that the results of a majority of experiments do not clearly support hypotheses tested by the subliminal psychodynamic activation method. Aspects of Hardaway's meta-analyses from 1987 and 1990 for major areas of research on subliminal psychodynamic activation are discussed in terms of suggestions for further research.

The original New Look integrated the constructivist-psychodynamic traditions of Bartlett and Freud The unconscious (Greenwald's 'New Look 3') is a logically different idea, although in practice it is often intertwined with constructivist-psychodynamic approaches. The unconscious is a pretheoretic term with a variety of problems: It has multiple and unsettled meanings; null reports need not signify null awareness; the conscious-unconscious dichotomy implied by the limen may not exist; even 'absolute subliminality' (chance-level accessibility) is relative to the time interval of testing, as accessibility can increase to above-chance levels over time (hypermnesia). Yet, the phenomena that the unconscious sloppily subsumes are not simple or dumb. The capacity of subliminal perception should not be confused with the capacity of subliminal (unconscious) memory and cognition.

Summary. - Research with the subliminal psychodynamic activation (SPA) method has led to improvements in subjects' functioning in a variety of areas, including but not limited to weight control, school grades, and feelings of general anxiety. In 1987, Hurvich proposed that the SPA method could be used to further the understanding of annihilation anxiety. 100 nonclinical subjects completed questionnaires pertaining to annihilation anxiety, psychological differentiation, and state anxiety and were tachistoscopically exposed to the subliminal message of symbiotic-like oneness, MOMMY AND I ARE ONE, and to control messages. Analysis showed that women with low annihilation anxiety had significantly lower state anxiety than women with high annihilation anxiety, regardless of the content of the subliminal message; results did not reach significance for men. Correlations among scores on the questionnaires also were noted.

In a review of 19 clinically relevant comparative outcome studies published 1978-1988, short-term psychodynamic psychotherapy (STPP) was evaluated as to overall effects, differential effects, and moderating effects vis-a-vis no-treatment controls (NT) and alternative psychotherapies (AP), respectively. Overall, STPP was superior to NT at posttreatment, inferior to AP at posttreatment, and even more so at 1-year follow-up. STPP was inferior to AP in treating depression and, in particular, to cognitive-bahavioral therapy for major depression. STPP was equally successful with mixed neurotics. As research quality increased, STPP grew less superior to NT. Furthermore, STPP decreased its overall superiority over NT and increased its overall inferiority to AT on a series of clinically relevant variables. Improvement in research quality from 1978 to 1988 was noted. Evidence, although limited, supported the view that STPP approaches do seem to differ along a few major dimensions.

The article discusses psychodynamic psychotherapy research evidence as put forth in 'Bambi meets Godzilla'. Results of a study to establish the efficacy of long-term psychodynamic psychotherapy (LTPP) in treating mental disorders have confirmed the effectiveness of LTPP.

Recently, Fudin critically evaluated Silverman's subliminal psychodynamic activation (SPA) method regarding issues of visual-field position of the stimulus, partial stimulus encoding, and structural matching of experimental and control stimuli. Fudin has outlined several ways to tighten the methodology and these suggestions have been followed herein. Consistent with previous research it was hypothesized that male and female nonclinical subjects (N = 100), highly differentiated from their mothers, would respond adaptively to the subliminal message of symbiotic-like oneness, MOMMY AND I ARE ONE, but not to an incomplete or anagram message. Results were in the predicted direction although short of statistical significance. Also, new avenues of research were explored concerning Silverman's Adjective Rating Scale.

COMMONPLACE phrases, expressions frequent and familiar in the common vernacular, may appear so repetitively in a patient's discourse that they lose significance and so evade analytic scrutiny. These phrases are so trite and shopworn that their function as conveyors of meaning disappears. Speaker and listener quickly habituate to these expressions and automatically exclude them from consideration. Their use illustrates a process whereby a small segment of behavior becomes engorged with frozen meaning and is then maintained by the unwitting collaboration of speaker and listener, both of whom fail to recognize them as meaningful and fail to subject them to scrutiny required of the believer in psychological determinism. I will here give case illustrations of these phenomena and explore such materials for evidence of their importance and significance in the individual's psychic economy. I will compare certain of the mechanisms that support these constructs to those of other psychic phenomena, and will offer some explanation to explain their exemption from analytic scrutiny.

Masling (1998) stated that we did not find the effects of subliminal psychodynamic activation because of experimental artifacts. We reject his assertion that our failure to uncover effects was due to procedural problems and reassert our claim that the method was sound.

Masling (1998) questioned Malik, Apel, Nelham, Rutkowski, and Ladd's 1997 suggestion that subliminal psychodynamic activation research with MOMMY AND I ARE ONE should be restricted. Problems in Masling's paper and the scope of research with MOMMY AND I ARE ONE are discussed. His position that such research should not be restricted is supported on the condition that subliminal psychodynamic activation research with MOMMY AND I ARE ONE (and other messages) use Fudin's 1986 procedure that could clarify the interpretation of successful experimental outcomes.