Interpersonal problems and outcome in outpatient psychotherapy: findings from a long-term longitudinal study in Germany

We used a comprehensive longitudinal data set from Germany to examine trajectories of symptom distress depending on interpersonal problems at study intake measured via the Inventory of Interpersonal Problems-64 (IIP-64; Horowitz, Strau, & Kordy, 1994). Participants (N=622) underwent mid- or long-term outpatient psychotherapy (either psychodynamically oriented psychotherapy, cognitive behavioral therapy, or analytic psychotherapy). Data comprises up to 5 assessments during a 2-year period and was analyzed via hierarchical linear modeling. In the analytic psychotherapy subgroup, initial symptom level was higher in submissive patients. Initial interpersonal problems were not predictive of the rate of symptom change during therapy. Only in psychodynamic treatments, low affiliation positively affected treatment outcome. Interpersonal problems at intake were not related to the number of utilized sessions and utilization rate across treatment subgroups. We discuss the findings and outline future research topics.     

Interpersonal subtypes in social phobia: diagnostic and treatment implications

Interpersonal assessment may provide a clinically useful way to identify subtypes of social phobia. In this study, we examined evidence for interpersonal subtypes in a sample of 77 socially phobic outpatients. A cluster analysis based on the dimensions of dominance and love on the Inventory of Interpersonal Problems-Circumplex Scales (Alden, Wiggins, & Pincus, 1990) found 2 interpersonal subtypes of socially phobic patients. These subtypes did not differ on pretreatment global symptom severity as measured by the Brief Symptom Inventory (Derogatis, 1993) or diagnostic comorbidity but did exhibit differential responses to outpatient psychotherapy. Overall, friendly-submissive social phobia patients had significantly lower scores on measures of social anxiety and significantly higher scores on measures of well-being and satisfaction at posttreatment than cold-submissive social phobia patients. We discuss the results in terms of interpersonal theory and the clinical relevance of assessment of interpersonal functioning prior to beginning psychotherapy with socially phobic patients.     

Change during and after long-term analytic group psychotherapy

There are very few empirical studies of long-term, analytic group psychotherapy. Sixty-nine patients in long-term analytic group psychotherapy were evaluated from pretherapy to posttherapy, and one year after termination. The primary outcome measures were the Symptom Checklist-90 (Revised) and the Inventory of Interpersonal Problems. In addition, the Global Assessment of Functioning (GAF) was scored independently by two evaluators. The average time in treatment was 32.5 months. The patients improved significantly during treatment, up to 30 months, on all measures. The improvement continued during the follow-up period. Sixty to 86% of the patients were recovered or significantly changed at follow-up.     

Being Brave, Being Nice: Themes of Agency and Communion in Children's Narratives

Although much is known about the presence of themes of agency and communion in adults' autobiographical stories, little is known about the presence of these themes in children's autobiographical stories. In this paper we examine the extent to which children describe themselves and others as agentic and communal beings in ordinary conversational narratives. Subjects were 96 rural, working-class children between the ages of 4 and 9 years. Personal narratives were elicited in the course of informal conversations with an adult experimenter. Narratives were analyzed for the presence of storyworld participants, and for the presence of themes of agency and communion. For both genders, themes of agency were more common than were themes of communion. Girls, however, were more likely to describe themes of communion than were boys, and were more likely to include family members in their narratives than were boys. Finally, correlations between themes of agency and communion were generally low. The findings extend the age to which the concepts of agency and communion can be productively applied to personal narratives. Implications for future theoretical and empirical work are also discussed.     

Problems of Initial Training for Group Psychotherapy in Israel

Abstract

This study examined the interactions of individuals who showed symptom improvement and those who showed deterioration during the course of short-term group psychotherapy. A qualitative hermeneutic analysis was used to identify and describe themes from the group interactions. Both broad group themes, as well as themes specific to improvers and deteriorators, were found. Findings suggest that the differences in group behavior between those who get worse and those who improve are subtle and thus difficult for group leaders to detect. Although the differences were not immediately apparent, a deeper examination of group process did reveal distinct patterns for deteriorators that were different from those of improvers. These patterns of interaction are discussed as well as variables related to client, leader, and group as a whole that may have contributed to the outcome of group members.     

Gendered themes in family reminiscing

Previous research conducted in laboratory settings has shown reliable gender differences in autobiographical memory. However, these studies have primarily focused on structural or emotional aspects of memory narratives told to an unfamiliar experimenter. The present study extends this literature by investigating gender differences in social references and interpersonal themes in parent-child narratives about the past. Participants were 17 white, middle-class children and their mothers and fathers, who were interviewed when children were 40 and 70 months of age. Parent-child narratives about shared activities in the past, as well as narratives about parents' own childhood, were examined. Results indicated that when discussing shared events, both parents talked in similar ways across children, although fathers referred to self more than mothers. However both parents referred to their girls more than their boys. Regarding event themes, parents discussed more social events with girls than with boys. Children themselves showed different gendered patterns; girls mentioned self and others, and relationships more than boys did, and children mentioned self and others more often when talking with fathers than with mothers. With respect to narratives about parents' childhood experiences, however, no gender differences were observed, save that parents referred to others more often in retrospective narratives told to girls than to boys. These findings suggest that gendered behaviours are best understood within the specific contexts and purposes of relational interactions.     

The manifestation of transference during early psychotherapy sessions: Exploring an alternate data source for therapist narratives in transference research

Introduction: Previous transference studies have compared in‐session client narratives about significant others to in‐session client narratives about the therapist, limiting data to the information that clients are willing to share with the therapist. Method: The first three sessions of 30 therapies with high‐functioning individuals were examined using the Core Conflictual Relationship Theme (CCRT) method. Client narratives about others were drawn from the psychotherapy sessions and client narratives about the therapist were drawn from a Participant Critical Event (PCE) interview conducted after the third session of therapy. Results: Factor analyses of the CCRT components indicated several relational patterns: a complementary pattern of relating characterised by a devaluation of the therapist and idealisation of others; a concordant relational transfer where clients feel bad with both the therapist and others; and as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. The results suggest that the source of therapist narratives may influence the results of transference research.     

Relationship between pathogenic beliefs and interpersonal problems: a cross-sectional study of Thai patients with depression

Pathogenic beliefs (PBs) are a key construct within control-mastery theory, a dynamic cognitive-relational psychotherapy approach. It is common for these beliefs to trigger interpersonal problems. The present study explored the relationship between PBs and interpersonal problems. Sixty-eight patients with depressive disorder were assessed using a 54-item Pathogenic Belief Scale (PBS), and the Inventory of Interpersonal Problems (IIP-32). Eight sub scales of the IIP-32 were analysed, along with the interpersonal circumplex (IPC) dominance and love dimensions. The PBS was significantly associated with the IIP-32 total score (r?=?.608, p?r?=??.285, p?相似文献   

Interpersonal rigidity and complementarity

The relations among behavioral complementarity, interpersonal rigidity, as indicated by the Interpersonal Adjective Checklist (IAS, Wiggins, 1995) vector score, and interpersonal distress, as indicated by the Inventory of Interpersonal Problems (IIP, Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988), were examined in two studies. In Study 1, 214 undergraduates viewed videotapes depicting different interactions and then provided their responses. In Study 2, 122 undergraduates interacted in randomly paired dyads on a mutual task. These interactions were videotaped and the interchanges were rated using the Interpersonal Communication Ratings Scale (ICRS, Strong, Hills, & Nelson, 1988). The extent to which each participant demonstrated complementary behavior was determined. Results of the studies demonstrated support for interpersonal rigidity as related to complementarity and as a moderator of the adaptability of behavior. Further complementarity was a mediator in the behavioral rigidity–interpersonal distress relation.     

Living into the story: agency and coherence in a longitudinal study of narrative identity development and mental health over the course of psychotherapy

Narrative identity is the internalized, evolving story of the self that each person crafts to provide his or her life with a sense of purpose and unity. A proliferation of empirical research studies focused on narrative identity have explored its relationship with psychological well-being. The present study is the first prospective, multiwave longitudinal investigation to examine short-term personality change via an emphasis on narrative identity as it relates to mental health. Forty-seven adults wrote rich personal narratives prior to beginning psychotherapy and after every session over 12 assessment points while concurrently completing a measure of mental health. Narratives were coded for the themes of agency and coherence, which capture the dual aims of narrative identity: purpose and unity. By applying in-depth thematic coding to the stories of participants, the present study produced 47 case studies of intraindividual personality development and mental health. By employing multilevel modeling with the entire set of nearly 600 narratives, the present study also identified robust trends of individual differences in narrative changes as they related to improvements in mental health. Results indicated that, across participants, the theme of agency, but not coherence, increased over the course of time. In addition, increases in agency were related to improvements in participants' mental health. Finally, lagged growth curve models revealed that changes in the theme of agency occurred prior to the associated improvements in mental health. This finding remained consistent across a variety of individual-difference variables including demographics, personality traits, and ego development.     

The facilitative interpersonal skills method: Difficult psychotherapy moments and appropriate therapist responsiveness

The Facilitative Interpersonal Skills (FIS) task is a performance test of therapists’ use of common relational skills (e.g. empathy, building expectations). The FIS method includes (a) materials that simulate difficult client moments on video, which are used to collect therapists’ responses to these situations; and (b) independent ratings of these responses. Many of the FIS items are informed by psychotherapy processes that have been linked to outcome and facilitative conditions that have been reframed as individual therapist skills (e.g. alliance bond capacity). Overall, the FIS has predicted psychotherapy outcome. A single study is described in which FIS predicted the therapist effect using multilevel modelling of a large sample of clients who were nested within therapists. We also summarise two additional outcome studies that used experimental designs. One future direction is to better understand how therapists form responses to these difficult moments. We conclude that forming an optimal therapeutic response during challenging, emergent in‐session situations involves responsiveness (Stiles et al., 1998), or finding a response that fits the clients’ needs within any moment.     

心理咨询中当事人的改变过程：同化模型的视角

摘 要 目的：选用心理咨询中获得成功改变的中国当事人,验证美国学者William B. Stiles等提出的同化模型。方法：采用同化分析这一用来追踪心理治疗中当事人问题经验发展进程的研究方法,对案例的会谈逐字稿资料进行分析。结果：三位研究者追踪到了两个主题（两对声音）,摘录了68个段落。其对两个主题摘录段落的同化评分与三位独立评定者的评分具有较高的相关（0.90和0.85）,同化的评分随着会谈的进程而提高（相关分别为0.89和0.91）。当事人在心理咨询中的改变过程遵循同化模型有关治疗改变的发展序列。结论：中国当事人的心理咨询改变过程支持同化模型的理论构想。     

Adolescent Patients’ Responses to Interpretations Focused on Endings in Short-Term Psychoanalytic Psychotherapy

Discussing endings is a crucial part of the work of short-term psychoanalytic psychotherapy with adolescents, but there are different views on how best this should be done and whether it is helpful or appropriate to link endings to interpretations of the transference. This study looks at how adolescent patients suffering from moderate to severe depression respond to interpretations around endings in a 28-session long, manualized psychoanalytic psychotherapy. Data come from a randomized clinical trial in which all sessions were audio-recorded. Purposive sampling was used to identify four sessions with four different adolescents in which therapists raised the issue of upcoming endings, explored the patients’ emotional responses, and linked these to the transference. The four extracts were transcribed and analysed using conversation analysis. Findings show that patients either emphasized or diminished the importance of their relationship to the therapists and the consequences of the separation from them in response to transference interpretations. They managed the conversational exchange by either “trouble-telling” or “story-telling.” The authors reflect on the implication of patients’ responses for treatment technique and consider whether transference work with adolescents should be paced and adapted more flexibly in short term psychoanalytic psychotherapy.     

Not starting psychotherapy is more often initiated by the therapist than the patient

The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.     

Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain.     

Blended courage: Moral and psychological courage elements in mental health treatment seeking by active duty military personnel

We propose that seeking mental health care in an environment with heightened stigma may combine elements of both psychological and moral courage. Interviews of 32 active duty US Army personnel about their process of seeking current mental health care were analyzed for themes of voluntary action, personal risk, and noble or worthwhile goals (benefits). Risks and benefits were divided into internal risks and benefits, characteristic of psychological courage; and external risks and benefits, characteristic of moral courage. Concerns about external risks were themes in all narratives, while concerns about internal risks were themes in only about half of narratives. Both internal and external benefits of treatment were themes in approximately three-quarters of the narratives, whereas doubts about internal (but not external) benefits were also expressed at a similar rate. Thus, participants described an act of blended courage, with social risks of moral courage taken for wellness goals of psychological courage.     

Exploring Associations Between Therapy Factors and Post-therapy Development After Naturalistic Psychotherapies

Earlier research on what contributes to long-term outcome after psychotherapy is scarce and scattered. Responding to this, the current study explores potential associations between therapy factors reported as salient by clients in naturalistic psychotherapy and variation in post-therapy-movement. Material from different codes and categories derived from an earlier content analysis was explored in relation to post-therapy-changes on OQ-45. In the first part of the study, two overarching themes (relational aspects and therapeutic operations) were included in a regression analysis of data from 32 clients. In the second part, more nuanced associations between material from different change- or process categories and post-therapy-movement were explored using data from 20 clients that showed reliable improvement at treatment termination but varied in later development. Reports of material related to relational aspects were recurrently associated with post-therapy improvement. Material suggesting that therapy was experienced as not fully complete (e.g., changes being superficial or wish for more treatment), as well as reports of more positive affect, correlated with later deterioration after improvement at termination. Different processes and changes appreciated by clients during therapy seem to vary as predictors of lasting gains.     

人际心理治疗的发展

人际心理治疗是一种有时间限制、基于操作手册和生活事件、诊断指向的实证性心理治疗方法。它最初主要被用于重型抑郁成年患者的门诊治疗,现已被用于治疗多种心理障碍。人际心理治疗过程变化包括：是否还赋予患者“病人”角色、人际关系问题领域的变化、如何处理结束和安排时间等。不过,有关治疗过程的研究还很少。为了更好地满足大众的需要,它与其他心理治疗成分进行了整合及其自身的简化。文章最后讨论了人际心理治疗发展的特点和问题     

Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly

Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.