A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Personality and the coherence of psychotherapy narratives

The stories people construct about themselves and their social worlds are key aspects of their identities [Bruner, J. S. (1990). Acts of meaning. Cambridge, MA: Harvard University Press; McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5, 100–122]. Whereas certain expected life experiences (e.g., leaving home, getting a job) may be relatively easy to narrate, more unexpected and difficult events, such as undergoing psychotherapy, may pose a challenge to successful narration. Yet it is especially important to successfully narrate one’s experience in psychotherapy in order to maintain the gains from treatment [Frank, J. D. (1961). Persuasion and healing: A comprehensive study of psychotherapy. Baltimore, MD: Johns Hopkins University Press; Spence, D. P. (1982). Narrative truth and historical truth: Meaning and interpretation in psychoanalysis. New York: W.W. Norton]. The present study collected psychotherapy narratives from 76 adult former clients and coded them for the fundamental story criterion of coherence [Baerger, D. R., & McAdams, D. P. (1999). Life story coherence and its relation to psychological well-being. Narrative Inquiry, 9, 69–96]. Former clients that were high in trait Openness to experience and those at higher stages of ego development told more coherent stories about therapy. The relationship between ego development and narrative coherence remained significant even when controlling for Openness. The findings suggest that high ego development may provide narrators with the kind of sophisticated frameworks for meaning-making that are especially well-suited for the important task of making good sense of psychotherapy.     

Bulletin Board

Abstract

When psychotherapy is viewed as shared reconstruction, there are implications for both clients and therapists. My clients become sources of expectations, myths, thought, and feelings about themselves and their therapists. I, as therapist, become a source of intentions and reflections, with capacities for self-awareness and abilities to construe my clients and their constructs, languages, and metaphors. Both participants in psychotherapy can then be seen as involved in reconstruction through the sharing and rebuilding of narratives. It is the life stories of clients that are likely to be more changed in therapy, but my life stories and my stories about the therapeutic process are also open to change     

Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial

Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n = 31) or wait-list control (n = 30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly – S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohen’s d = 0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohen’s d = 0.61, 95% CI [0.04, 1.19], and quality of life, Cohen’s d = 0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.     

Effectiveness of cognitive behavioral therapy on health‐related quality of life: An evaluation of therapies provided by trainee therapists

The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health‐related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism.     

Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial

A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes—alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes—emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen's h = 0.74–1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27–1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14–0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14–0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16–0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.     

Clinical Validation of the Swedish Version of the Quality of Life Inventory in Crime Victims with Posttraumatic Stress Disorder and a Nonclinical Sample

The Swedish version of the Quality of Life Inventory (QOLI) was cross-culturally validated with a crime victim sample (N = 53) with posttraumatic stress disorder (PTSD) and a nonclinical group (N = 100) with no lifetime and current psychiatric disorder from the general population in the Stockholm county of Sweden. The QOLI showed excellent internal consistencies in the clinical and the nonclinical sample. In addition, PTSD participants displayed a significantly lower self-perceived quality of life in 13 out of 16 domains of life than the nonclinical individuals. Furthermore, the QOLI was inversely correlated with interview and self-report measures of PTSD symptoms, depression, and anxiety. Overall, the results support the utility of the Swedish QOLI version as a potentially useful measure of self-perceived quality of life in Swedish clinical and nonclinical samples. The results are discussed in relation to the Swedish cross-cultural validation of the QOLI, methodological limitations and future directions.     

Predictors and impact of psychotherapy side effects in young adults

What should we tell our younger clients—who may or may not have chosen to come to therapy—about possible risks of engaging in psychotherapy? To explore this question, we examined psychotherapy side effects in 366 young adults with a history of psychotherapy or counselling. Psychotherapy side effects were common, with 41% of participants reporting at least one. Perceived lack of control over the decision of when and how to engage in therapy was the strongest predictor of experiencing therapy side effects. Of the different kinds of side effects, feeling that therapy had gone on too long and experiencing worsening of existing symptoms were the most strongly predictive of poor therapy outcomes such as dissatisfaction with care and lower perceived improvements. Finally, there was a significant association between reporting side effects of psychiatric medications and side effects of psychotherapy, suggesting common factors that contribute to side effect experience across treatment modalities. These findings highlight the need to monitor possible side effects during psychotherapy and counselling, and to have an open dialogue with our youngest clients and their families about the likelihood for negative outcomes when they are compelled to engage in therapy.     

The dermatology life quality index (DLQI) and the hospital anxiety and depression (HADS) in Chinese rosacea patients

The study aims to investigate the quality of life (QOL) and the psychological situation in Chinese patients with rosacea. A total of 196 healthy controls and 201 rosacea patients were involved in the final analysis. The general information, the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Scale (HADS) were collected. Significantly higher DLQI, anxiety and depression score were observed in the rosacea group compared to the control group (p < .01). Total DLQI score of patients was positively related with anxiety (r = .526, p < .001) and depression scores (r = .399, p < .001) in HADS. Rosacea had significant psychological impact on Chinese patients and had substantial influence on their QOL. Physicians should address the psychosocial needs of rosacea patients as much as its physical symptoms.     

Quality of Life Before and After Cataract Surgery: Research in a Sample of Polish Patients

The goal of this paper is to present possible change in quality of life (QoL) in older sample of people with vision disturbances. The patients were investigated twice: before (N = 193) and 4 month after the cataract surgery (N = 69), by means of the scale for vision functioning, and the Life Quality Questionnaire (Schalock & Keith, 1993) extend with the items measuring health related quality of life (HRQoL). Two problems were formulated: To what extent are visual defects associated with the decreased subjective QoL? What changes are observed in perceived QoL during the period of treatment of visual defects? The patients reported significant increase of HRQoL, however they did not report similar increase of a general QoL. Few reasons are considered: overlapping of the content of visual function scales and HRQoL and different indices of a general QoL and HRQoL, lack of a proper postoperative care, low socio-economic status of the participants, and too high expectation concerning better functioning after the surgery.     

The Güttingen study of psychoanalytic therapy: First results

Results of a naturalistic study of the effectiveness of psychoanalytic therapy are reported. Outcome data are presented for a sample of N = 36 patients who were treated with psychoanalytic therapy. For a sample of n = 23 of these patients, data for 1-year follow-up are available at present. According to the results, psychoanalytic therapy yielded signifi cant improvements in symptoms (Symptom Checklist 90-R, SCL-90-R and rating of psychoanalysts), in interpersonal problems (Inventory of Interpersonal Problems, IIP), in quality of life (Questionnaire of Quality of Life, FLZ), in well-being (Questionnaire of Changes in Experience and Behaviour, VEV) and in target problems defi ned by the patients (Goal Attainment Scaling, GAS). Large effect sizes between 1.28 and 2.48 were found in symptoms (GSI of the SCL-90-R), interpersonal problems (IIP-total), quality of life (FLZ-total), well-being (VEV) and target problems (GAS). At 1-year follow-up, all improvements proved to be stable or even increased. The self-reported improvements in symptoms were corroborated by the ratings of the psychoanalysts. At the end of therapy, 77% of the patients showed clinically signifi cant improvements. In the 1-year follow-up group, this was true for 80%. Further results are presented and discussed.     

Alexithymie bei Neurodermitis

Background

The study shows correlations between atopic dermatitis (AD) and alexithymia. Furthermore it examines their influences on skin-related quality of life.

Patients and methods

A total of 62 adult AD patients were compared with a control group (n=62) of skin healthy persons. Alexithymia (Toronto Alexithymia Scale-20, TAS-20) and impairment of the skin-related quality of life (Dermatology Life Quality Index, DLQI) were assessed as well as duration, severity [patients?? self-evaluation based on scoring of atopic dermatitis (SCORAD)] and onset of AD.

Results

The prevalence of alexithymia (TAS-20 ??61) in AD patients was 22.6% (control group 4.9%). Problems with identifying feelings (TAS-20 scale) and also the severity of AD were significant predictors for the impairment of skin-related quality of life.

Conclusions

Atopic dermatitis patients showed a prevalence of alexithymia (22.6%) similar to diseases found in the field of psychosomatic and psychiatric patients (Leweke & Bausch 2009). From a psychotherapeutic point of view the study may provide a further reason for the observance of mental features in AD treatment. A possible indication for a specific psychotherapy in atopic dermatitis is discussed.     

Validation of Iranian Version of FI-QOL Scale in Patients with Fecal Incontinence

Pelvic floor dysfunction is a general public health problem with great impact on quality of life. Inability to control the passage of stool can produce embarrassment and may limit daily activities. One of the most important indicators of effectiveness of therapy in patients with fecal incontinence (FI) can be patient’s quality of life. Therefore, a well-constructed questionnaires studying quality of life is necessary. The objective of this study was to assess the Iranian version of Fecal Incontinence Quality of Life Scale in a hospital-based study on patients with FI. Two hundred women were recruited in the study. One group included patients with FI (n = 100) and the control group (n = 100) included patients with any gastrointestinal (GI) problems except FI. The Persian version of fecal incontinence quality of life scale completed by two groups. The FI patients completed the SF-36 questionnaire too. Reliability and validity of questionnaire were evaluated by Cronbach’s alpha, test/retest using correlation analysis, Intraclass correlation coefficient, paired t-test, and analysis of variance. There was not any significant differences between two groups for age, marital status, education, and occupation. The mean age of FI patients and controls were 42.6 (±13.3) and 44.5 (±15.0) respectively. Cronbach’s-α for all domains ranged between 0.72 and 0.92. All scales showed significant correlation between the test and retest administration of questionnaire. The FI patients had lower scores than the controls for all domains adjusted for gender. All correlations between six selected domains of Sf-36 scales and FIQL scales were significant at P ≤ 0.05 levels. The Persian version of FIQL had a good validity and reliability and can be used for accurate measure of quality of life in FI patients.     

The Well-being of Salvadoran Refugees

Recently arrived and settled Salvadoran refugees and Anglo-Canadians in London, Ontario were compared with respect to psychological distress, quality of life, and life satisfaction. A matched sample of 60 participants in each group completed a demographic questionnaire, the Brief Symptom Inventory, a shortened version of the Quality of Life Questionnaire, and the Satisfaction with Life Scale in either English or Spanish. Significant group differences were obtained on measures of quality of life and life satisfaction, but not of psychological distress. The results are discussed in relation to findings with other refugee groups.     

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.     

Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial

The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale—Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.     

Leadership behavior,group climate and outcome in group psychotherapy: A study of outpatient psychotherapy groups

A recent clinical study of outpatient psychotherapy groups in a community mental health center explored the linkage between group leadership variables, group climate, and outcome. The study involved nine outpatient therapy groups, over 50 group clients, and several group therapists. A repeated measures design involving assessment of clients' outcome and level of functioning, group leadership style, and group climate was used to assess changes over a 6-month period. The findings suggest: 1) a reduction in symptoms and improved functioning for clients; 2) a similarity of perceptions by members and leaders of perceived leadership behaviors and group climate; 3) the presence of direct and indirect influences of group climate and leadership behavior on clients' outcome; and 4) a linkage between leadership behavior and group climate with the theoretical orientation of the group. The findings of the research are discussed in relation to the understanding of specific effects in group psychotherapy and the implications for construction of group psychotherapy theory.The authors would like to thank Robert Dies, Ph.D., for his helpful suggestions in the early phase of this study; Roy MacKenzie, M.D., for permission to use the Group Climate Questionnaire; Diane DePalma, Ph.D., for permission to use the Global Leadership Behavior Index; Chris Boltwood, B.A., for her untiring efforts in administering the instruments and coding and entering the data; and most importantly, the psychotherapy group members and the group therapists for their cooperation in this endeavor—without their help, this clinical study would not have been possible.A version of this paper was presented at the Annual Meeting of the American Group Psychotherapy Association, 1987, New Orleans, Louisiana. Lenore Phipps, R.N., M.S., C.S., was formerly Director, Group Psychotherapy Program at Park Ridge Mental Health Center, Rochester, now in private practice at Guild Medical Center, Norwood, MA 02062.     

Therapist attitudes and countertransference as predictors of professional quality of life and burnout among psychotherapists

This study aimed to examine the role of attitudes towards psychotherapy and countertransference dimensions as predictors of professional quality of life and burnout among psychotherapists in Iran. Participants were 259 psychotherapists who worked in mental health centres in Tehran (Iran), and they completed the Professional Quality of Life questionnaire, the Therapist Response Questionnaire and the Therapist Attitudes Scale. Professional quality of life was associated with countertransference dimensions and attitude towards psychotherapy. This study concludes that psychotherapists can benefit from working on their specific countertransference issues and re-evaluating their basic attitudes towards psychotherapy to achieve the highest levels of professional satisfaction. Culture may play a role in a specific therapist's attitude and difficulties in addressing certain aspects of countertransference.