Integrating Psychotherapeutic Processes with Cognitive Behavioral Procedures

There has been a recent focus on the processes that underlie intervention delivery for children and adolescents throughout the Cognitive-Behavioral Therapy (CBT) literature. Certain process variables have been associated with treatment outcome among youth receiving CBT. Data for these process variables including: the therapeutic alliance or therapeutic relationship, child and parent involvement, other child and therapist variables, and issues of diversity, are reviewed. Based on this data, specific clinical recommendations are made. The treatment relationship as a very important process (VIP), and the facilitation of CBT so that it is real and relevant to youth are emphatically discussed. Process issues in modular CBT are identified. Ultimately, genuine collaborative empiricism and guided discovery preserve the therapeutic relationship as a VIP, and foster the customization of therapeutic tools and the treatment trajectory.     

Are psychodynamic and psychoanalytic therapies effective?: A review of empirical data

There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence‐based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identifed by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty‐two RCTs were identifed of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identifed: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post‐traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance‐related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi‐experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.     

Development through interruptions and reparations – A case study of a dual challenging psychotherapy

The aim of this study was to understand how relational difficulties in psychotherapy may be handled to represent possibilities for change. Temporary interruptions and subsequent reestablishment of contact were chosen as the strategic focus in one severely challenging case of long term psychodynamic psychotherapy where outcome was known to be good. Interruptions and reestablishments were conceptualised by how the informants gave meaning to them. The choice of focus represented a strategic selection of events in the course of therapy where the regulation of the alliance by the therapist as well as by the patient was at stake. A detailed case record was studied and interviews with patient and therapist were conducted. A hermeneutical-phenomenological approach was used to analyse the material. The narrative dimension was important in structuring and interpreting the data. It was shown how important relational difficulties, such as mutual incompatible expectations and demands was handled both on a structural and interpersonal level, and some important steps and hallmarks of the healing process was identified. Close inspection of the course of events in psychotherapies is seen as a promising method for bringing a better understanding of how change processes unfold.     

Meeting Them “Where They're At”

Abstract

Child maltreatment is associated with serious psycho-social difficulties and enormous direct and indirect societal costs. As such, it is an area for which new and promising interventions are highly important. The purpose of this exploratory research is to examine intensive school-based psychodynamic therapy for severely maltreated children experiencing significant difficulties, by obtaining perceptions of therapeutic effectiveness by the children's parents, teachers and therapists. Themes include: therapists', parents', and teachers' perceptions of child's changes; parental perceptions of therapy and relationship with the therapist; therapists' perception of relationship with parents; school as the location of therapy; teacher-therapist relationship; and the child's academic status.     

Extending the temporal range of psychometric prediction by optimal linear filtering of mental test scores

Incorporating temporal decline in predictive validity into mental testing theory is outlined. Starting from multivariate regression of criterion on repeated measurements, an analytic extension results in a weighting function for repeated measurements, replacing the beta weights. Besides optimizing, the procedure permits an evaluation of any particular prognosis setting: In cases of exponentially declining predictive validity, prognostic range can be extended if concurrent validity is nonperfect by optimal weighting (predictive filtering) of repeated measurements. Considerable gain in prognostic range over the traditional approach can be achieved if predictive validity declines concavely downwards.This work was supported by grant Dr 58/3 from Deutsche Forschungsgemeinschaft.     

对一名受虐男孩的箱庭治疗

本研究采用个案研究法,对一名13岁受虐男孩（小N）实施了25次的箱庭治疗,研究了该儿童箱庭治疗过程的特点及箱庭疗法的治疗效果。结果发现：个案的箱庭治疗经历了问题呈现、自我调适、对抗斗争和问题解决四个阶段;箱庭治疗过程中,个案所使用的玩具数量及种类从贫乏单一转向丰富多样;经过箱庭治疗,个案的抑郁、焦虑情绪得以较大缓解,自我意识得到提高,同伴关系显著改善,学业成绩也得到较大提高。     

Interpersonal process in psychotherapy through the lens of the structural analysis of social behavior

As psychotherapy research focuses more and more on mechanisms of therapeutic change, increased attention has naturally been directed at therapy process. Over the past several decades, a variety of researchers have successfully applied Benjamin's 1974 Structural Analysis of Social Behavior (SASB) to the study of in-session psychotherapy events. This system for conceptualizing and analyzing interpersonal and intrapsychic processes has been shown to provide theoretically rigorous and empirically tractable instantiations of both helpful and hindering therapeutic exchanges. In this article the therapeutic alliance is conceived in terms of interpersonal processes as demarcated according to the SASB. This article also provides a review of SASB's wide-ranging applications to observing and studying the therapeutic relationship, therapy process, and client outcome. Also discussed are several data analytic and methodological considerations related to the SASB model and several new ancillary measures based on the SASB. Finally, the applied and clinical utility of the SASB system is discussed in light of a variety of contemporary empirical findings.     

病例报告与临床科研思维

病例报告属于描述性研究方法,是通过记录非同寻常的临床现象,可能揭示新病种、特殊机制、新疗法等,为临床工作经验介绍、总结的初步形式。在医学科学探索的历程中,病例报告拥有特殊的地位和曾经的辉煌,目前仍是医学研究的一种重要体裁。"一个好的病例报告就是一个有教育意义的好故事",一个不同寻常的现象,可能是一个新的病种、一个特殊的机制或一种特殊的组织病变或生理功能紊乱所致。一篇好的病例报告为临床医生和科研工作者提供直接生动的第一手临床资料,能促进临床医生和医学生热爱临床工作,养成面对难题、独立思考、追根朔源、发现与解决问题的能力,值得重视。     

11岁选择性缄默症女孩的箱庭治疗个案研究

采用箱庭疗法对11岁选择性缄默症女孩进行心理治疗的小M研究.经过18次个体箱庭和4次家庭箱庭治疗,来访者的箱庭作品由贫瘠、单调逐渐向丰富、多样转化,由孤立、静止走向开放、动态,自我力量逐步增强.来访者的学校适应、亲子关系也发生了积极改变.箱庭治疗使来访者的内心世界由创伤走向治愈.