Exploring In-Session Process with Qualitative and Quantitative Methods in Psychotherapy with an Adolescent

ABSTRACT

There is emerging evidence for the effect of psychotherapy in adolescents with depression. Research indicates that therapists often use techniques from different theoretical models when working with adults. Research on the therapy process in adolescents is scarce. We explore the therapist’s interventions in a time-limited psychodynamic adolescent therapy with Susanna suffering from major depression. Susanna quite suddenly became worse at mid-treatment, with self-harming and suicidal ideations. Rating scales for analyzing in-session relational processes included the Structural Analysis of Social Behavior (SASB), the Adolescent Psychotherapy Q-set (APQ), and the Transference Work Scale (TWS). Self-reports on symptoms, interpersonal problems, and working alliance were obtained before, during, and at the end of and one year after treatment. Different tools seemed to expose different aspects of the process and the patient’s development. Only patient-rated questionnaires revealed the mid-treatment crises. Combining different and pan-theoretical rating scales on here-and-now interventions (TWS and SASB) and whole sessions (APQ), as well as clinician-rated measures and a variety of self-reports, indicated that different psychotherapeutic techniques were integrated in the therapy and seemed beneficial to patient’s outcome. The therapist adhered to the treatment manual. This way of exploring the therapy process may be used for different treatment modalities.     

Factor Analysis of the Italian Version of the Alabama Parenting Questionnaire in a Community Sample

Despite difficulties measuring parenting styles, many studies have demonstrated a significant relationship between disruptive children and certain parenting practices. One of the most frequently used scales to measure parenting styles is the Alabama Parenting Questionnaire (APQ). This scale was originally defined based on theoretical dimensions and using samples from the USA. Therefore, both factor analysis studies and its adaptation to other countries have been proposed to improve and widen its use. The aim of this study was to adapt the APQ to the Italian population. A community sample of 258 mothers and children (94 %) and 192 fathers (70 %) from 274 families with children from 10- to 14-years-old who agreed to participate and met the inclusion criteria completed the APQ. Principal components and exploratory factor analyses resulted in a unique 19-item version of the APQ for mothers, fathers, and children. This unified version has resulted in two factor categories: positive (12 items) and negative parenting (7 items). The internal consistency and goodness of fit of the model were satisfactory. Moderate and significant convergent validity were found for mothers and fathers but not for children. In fact, we found differences in validity rates among the participants. Children perceived less positive and more negative parenting than did fathers and mothers, and mothers believed that they provided more positive parenting than did other parents. In conclusion, the APQ Italian version of the parents and children global report forms are considered a suitable measure for positive and negative parenting styles with acceptable validity and reliability indices.     

Brief psychodynamic psychotherapy in adolescent depression: Two case studies

In this paper the authors outline the basic principles of a manualized, brief psychodynamic approach that was evaluated as part of an outcome study within the National Health Service researching the effectiveness of two different forms of psychotherapy for major depression in childhood/adolescence: Focused Individual Psychodynamic Psychotherapy and Systems Integrative Family Therapy. As well as describing some of the difficulties encountered in short-term dynamic psychotherapy with adolescents, the authors present therapeutic work with two adolescents with major depressive disorder who were both seen as part of the research study. The authors depict some of the challenges and unavoidable difficulties which emerged during the therapy, arising from the needs of the research programme.     

儿童青少年正念量表(CAMM)在中国青少年群体中的信效度检验

目的:检验儿童青少年正念量表(CAMM)在中国青少年群体中应用的信效度,为青少年正念研究提供科学工具。方法:选取310名中学生(样本1)进行条目分析和探索性因素分析,再选取309名中学生(样本2)进行验证性因素分析、效标效度、增量效度和信度分析。结果:中文版CAMM抽取2个因素最为合适,并具有良好的结构效度、效标效度、增量效度及较高的信度。结论:中文版CAMM具有良好的心理测量学指标,可以在中国青少年群体中使用。     

Personality, gender and violent criminality in prison inmates

The Antisocial Personality Questionnaire developed by Blackburn and Fawcett (1999) has shown adequate reliability and validity in studies of male offenders interned in psychiatric hospitals. This paper provides data on the APQ collected from a sample of offenders (males and females) without any diagnosed mental illness. The sample was made up of 216 offenders (108 males and 108 females) confined in Spanish prisons. We analyzed the psychometric properties of the instrument and we also examined differences in personality as a function of gender and type of crime (violent vs. non-violent). Results support the reliability of the APQ scales as well as the structure proposed by Blackburn. Additionally, we selected items that discriminate between offenders convicted for violent and non-violent crimes; when these items are factorized, a three-factor structure emerges, resembling Eysenck's model.     

Development and Validation of a Parent Report Measure for Assessing Social-Emotional Competencies of Children and Adolescents

Based on the premises that strength-based assessment of children and adolescents is an important emerging area, and that additional tools for this purpose are needed, this study details development and validation efforts on a new strength-based assessment: the Social-Emotional Assets and Resilience Scale, parent form (SEARS-P). Following careful development of a comprehensive research prototype assessment, a large and diverse nationwide sample of more than 2,000 ratings of school-age children and adolescents were obtained from their parents and other caregivers. Factor analytic procedures revealed a robust and replicable underlying factor structure, including Self-Regulation/Responsibility, Social Competence, and Empathy factors. The factor scores and total score of the SEARS-P were shown to have strong internal consistency reliability, as well as strong interrater reliability between mother-father pairs who rated the same child. Convergent construct validity of the SEARS-P was established through findings of significant correlations with two established strength-based rating scales for use by parents. Construct validity of the SEARS-P was further bolstered through findings of significant gender differences in scores (with females rated as having higher levels of competency than males), as well as significant differences in scores based on educational disability status. Limitations and future research needs are discussed, as are implications of this study for research and practice with children and families.     

Transference focused psychotherapy: overview and update

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy.     

What Happens in Therapy? Adolescents’ Expectations and Perceptions of Psychotherapy

A measure of adolescent pre-treatment expectations/perceptions of psychotherapy was developed, evaluated, and used to examine adolescent expectancies of psychotherapy. The development of the Psychotherapy Expectations and Perceptions Inventory (PEPI) is described and initial psychometric properties reported. Utilizing a sample of adolescents (N = 546), expectancies of psychotherapy were assessed using the PEPI. Results indicate adequate internal consistency and a 3 factor structure. Specifically, factors identified were labeled (1) measuring negative expectancies, (2) process/outcome expectancies, and (3) expectancies for a positive therapeutic relationship. Boys reported greater negative expectancies, but also greater expectancies for a positive therapeutic relationship. Girls reported greater therapy process/outcome expectancies. Prior contact with mental illness was not related to any studied factors. Clinicians may benefit from assessing adolescent expectancies to facilitate rapport and engagement in the therapy to foster more therapeutic change. Future research that examines the relationships between specific demographic characteristics (e.g., socioeconomic status, race/ethnicity, etc.) and service utilization variables among adolescents is warranted.     

The Trauma Memory Quality Questionnaire: preliminary development and validation of a measure of trauma memory characteristics for children and adolescents

It has been suggested that post-traumatic stress is related to the nature of an individual's trauma memories. While this hypothesis has received support in adults, few studies have examined this in children and adolescents. This article describes the development and validation of a measure of the nature of children's trauma memories, the Trauma Memory Quality Questionnaire (TMQQ), that might test this hypothesis and be of clinical use. The measure was standardised in two samples, a cross-sectional sample of non-clinic referred secondary school pupils (n=254), and a sample participating in a prospective study of children and adolescents who had attended a hospital Accident and Emergency department following an assault or a road traffic accident (n=106). The TMQQ was found to possess good internal consistency, criterion validity, and construct validity, but test-retest reliability has yet to be established.     

Inventar zur therapeutischen Beziehung (ITB)

A successful psychotherapy requires a good therapeutic relationship. An adequate operationalization by German diagnostic instruments has to be improved. A new instrument for measuring the therapeutic relationship from the patient’s perspective is presented. It is suitable for various therapeutic orientations, integrates current empirical findings in a broad theoretical framework and corrects methodological deficits of the existing German questionnaires. The therapeutic relationship questionnaire (ITB) was developed with a sample of 44 therapists and 519 inpatient, outpatient and day clinic patients. The ITB findings confirm a very good reliability (internal consistency and retesting reliability). There is initial evidence for convergent, divergent and differential validity and for associations with therapy effects. The ITB is an economic instrument that in contrast to other questionnaires measures a general factor which could be replicated in several confirmatory and exploratory factor analyses.     

Investigation of the psychometric properties of the Perceived Parental Autonomy Support Scale in the Southeastern European context

The Perceived Parental Autonomy Support Scale (P-PASS) is an instrument designed to measure parental autonomy-support and control of late adolescents and emerging adults. The present paper examines the process of adapting the P-PASS to the Romanian culture. Four studies were conducted, investigating: 1) the adequacy of the translation, using a multidimensional scaling of expert ratings; 2) construct validity, through exploratory approaches; 3) various psychometric properties, such as reliability and construct validity, through confirmatory approaches; convergent validity through comparisons with other measures of parental autonomy support (College-Student Scale of the Perceptions of Parents Scales) and control (Psychological Control Scale–Youth Self-Report), and predictive validity in relation with general self-efficacy; 4) test-retest reliability. The results show that the Romanian version of the P-PASS has sound psychometric properties. Confirmatory Factor Analysis indicates that a structure with two second order factors fits the data best and that the measure is equivalent with the original Canadian version. Also, it shows adequate test-retest reliability at 6 months and one year between administrations, good convergent validity, and a good prediction of general self-efficacy.

     

Theoretical Orientation and Therapists' Attitudes to Important Components of Therapy: A Study Based on the Valuable Elements in Psychotherapy Questionnaire

The authors describe the inception and subsequent testing of a questionnaire on attitudes regarding how psychotherapy ought to be pursued: the Valuable Elements in Psychotherapy Questionnaire (VEP-Q). A sample of 416 Swedish therapists (161 psychodynamic, 93 cognitive, 95 cognitive behavioral, and 67 integrative/eclectic) responded to the 17-item VEP-Q. A factor analysis of these items resulted in three subscales: PDT, CBT, and Common Factor, as validated by analyses of covariance. The internal consistency and test–retest reliability of the scales were excellent. In addition to theoretical orientation, variables such as gender and basic professional training influenced how respondents answered the VEP-Q. The authors conclude that the VEP-Q seems to be an appropriate instrument for describing similarities as well as differences among practitioners of various schools of psychotherapy.     

Implications of the Empirically Supported Treatment Movement for Psychoanalysis

In this article, I critique the empirically supported treatment (EST) movement and discuss the limitations of traditional psychotherapy research from a psychoanalytic perspective. The EST movement is based on a medical model that assumes that a psychotherapeutic treatment can be conceptualized independent of the human relationship in which it takes place. Psychotherapy and psychoanalysis are, however, treatments only in a metaphorical sense and are more akin to educational processes than medical treatments. Every therapeutic dyad is unique, and research that treats therapy as a standardized, disembodied entity will not contribute to our understanding. Nevertheless, there is a real need for psychoanalysts to become more actively involved in psychotherapy research both for political and scientific reasons. Although I do not believe that “empirical validation” in the form envisaged by the American Psychological Association task force is a realistic goal, I do believe in the value of microscopic studies of therapeutic process, particularly in the context of research-informed case histories.     

What Is and Can Be Attributed to the Therapeutic Relationship?

This paper reviews findings from two studies that support the contentions of the Generic Model of Psychotherapy that therapeutic outcome must be viewed as arising from a complex interaction of common and specific factors. Patient, therapy, and relationship factors are shown to selectively add to the variance predicted in psychotherapy outcome studies. Moreover, an inspection of procedures that are common to two different therapies, and those that are unique to these approaches reveal that both contribute to outcome and do so in ways that suggest the presence of both synergistic and inhibiting effects.     

Conceptual and empirical approaches to developing family-based assessment procedures: resolving the case of the Family Environment Scale

This article focuses on the reliability and validity of the Family Environment Scale (FES). The FES subscales generally show adequate internal consistency reliability and stability over time when applied in samples that are diverse; the items also have good content and face validity. An extensive body of research supports the construct, concurrent, and predictive validity of the FES. More generally, reliability and validity are a joint function of scale items and response formats and of the characteristics and diversity of specific samples. To contribute to further advances in family assessment, researchers need to use both conceptual and psychometric criteria rather than rely too heavily on the pursuit of internal consistency reliability and factor analytic approaches to scale construction and validation.     

Evaluation of the psychometrics properties of the alarm distress baby scale among 122 Brazilian children

The Alarm Distress Baby Scale (ADBB) aims at assessing infant withdrawal behavior. A previous validation study revealed acceptable reliability and validity indices. The present study investigated the psychometric properties of the scale in a larger sample from a culturally different population. Pediatricians evaluated the behavior of 122 infants, 2 and 19 months old, using the ADBB during routine physical consultation. Four investigators (two pediatricians and two nurses not specialized in pediatric care) examined video recordings of the evaluations. Results showed good interrater reliability coefficients among pediatricians and poor correlation when all professionals were grouped together. Test–retest reliability revealed good intraexaminer agreement (r = 0.91). The pediatricians' evaluation using the ADBB was compared with a psychiatric examination to investigate the scale's criterion validity. The cutoff point of 5 provided the best clinical validity (sensitivity of 79%, specificity of 81%). Results from construct validity showed that the scale had three dimensions. Comparison of the factor solution with other construct validity studies of the same instrument revealed similarities and differences. Results suggest that the ADBB may be a useful screening instrument to detect signs of psychiatric alterations related to withdrawal behavior in primary care services, and it is likely to provide consistent information.     

When Lightning Strikes: Reexamining Creativity in Psychotherapy

Creativity is paramount to the therapeutic process. This article explored the role of creativity in counseling and psychotherapy through a critical analysis of several key articles in a special issue of The Journal of Clinical Activities, Assignments, & Handouts in Psychotherapy Practice (L. L. Hecker, 2002). Implications for counselors/therapists and the future of the field are discussed.     

Group psychotherapy with alcoholics: Interface with self-help groups

This paper addresses recovering alcoholics' concurrent involvement in psychotherapy groups and self-help groups. A developmental model of alcoholism group psychotherapy is presented, differentiating between early and advanced sobriety. Psychotherapy and self-help groups are compared and contrasted. Multiple group membership entails various areas of compatibility. Divergence and conflict result from differences in underlying conceptual framework and approach. Clinical implications of members' involvement in partially discrepant group settings are explored with an emphasis on transference and countertransference reactions. Multiple group membership is identified as a salient factor in alcoholism group psychotherapy at all levels of recovery.She is also in private practice.This paper was presented at the American Group Psychotherapy Association Annual Conference, Boston, February 1990.     

Internal cohesion psychotherapy: The nature,principles and application

Psychotherapy is widely used to treat different mental health disorders and emotional difficulties. The main objective of psychotherapy is to help clients become aware of and have control over their thoughts, moods, feelings and behaviours, as well as create healthy strategies to respond to challenging situations. Since the existing psychotherapy approaches and other methods of treatment are not always effective in treating mental health disorders, there is still space for new approaches to fill this gap. In this paper, we provide information about internal cohesion psychotherapy, which is a new integrative approach. This paper presents a new approach to eclectic psychotherapy, focussing on four detrimental aspects of human functioning through different time perspectives.     

Group psychotherapy as taught by the polsters and the gouldings

Psychotherapy has been viewed by many as a subtle form of interpersonal persuasion. However, persuasion, or the lack of it, in a psychotherapy relationship is not always clearly definable. Most agree that persuasion is influenced by a number of important factors, of which the personal characteristics of the therapist are generally recognized as the most significant. Experience, credibility, training, dedication, values and enthusiasm are attributes usually agreed upon as being important contributors to the therapist's power to persuade. Understandably, psychotherapy conceptualized in this manner raises significant issues of values, ethics and responsibility in treatment. While not all agree or recognize persuasive influences existing in psychotherapy, it is suggested that persuasion is a salient feature of psychotherapy, whether or not it is identified as such. It is important to remember that in all psychotherapy, trouble is apt to follow the ignorant applications of important forces. Further, it is suggested that these persuasive influences cross doctrinal differences and can be augmented by applying them with a group psychotherapy setting. In the hands of a skilled and ethical psychotherapist, these persuasive influences can be enhanced and the group can become a powerful tool in the therapeutic process. These issues are explored in this paper in relation to two different group psychotherapy training experiences with Bob and Mary Goulding and Erv and Miriam Polster.