Clients’ experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief,manualised psychodynamic therapy in the NHS

Dynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures.     

Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.     

Probabilistic Inferences Under Emotional Stress: How Arousal Affects Decision Processes

Many models of decision making neglect emotional states that could affect individuals' cognitive processes. The present work explores the effect of emotional stress on people's cognitive processes when making probabilistic inferences. Two contrasting hypotheses are tested against one another: the uncertainty‐reduction and attention‐narrowing hypotheses of how emotional stress affects decision making. In the experimental study, emotional stress was induced through the use of highly aversive pictures immediately before each decision. Emotional state was assessed by both subjective (state anxiety, arousal, and pleasantness ratings) and objective (skin conductance) measures. The results show that emotional stress impacts decision making; in particular, emotionally aroused participants seem to have focused on the most important information and selected simpler decision strategies relative to participants in a control condition. The results are in line with the attention‐narrowing hypothesis and suggest that emotional stress can impact decision making through limited predecisional information search and the selection of simpler decision strategies. Copyright © 2015 John Wiley & Sons, Ltd.     

Acknowledge,repeat, rephrase,elaborate: Witnesses can help each other remember more

Crimes are often observed by multiple witnesses. Research shows that witnesses can contaminate each other's memory, but potential benefits of co-witness discussion have not yet been investigated. We examined whether witnesses can help each other remember, or prune each other's errors. In a research design with high ecological validity, attendees of a theatre play were interviewed approximately one week later about a violent scene in the play. The couples that signed up for our study had known each other for 31 years on average. Participants were first interviewed individually and then took part in a collaborative interview. We also included a control condition in which participants took part in two individual interviews. Collaboration did not help witnesses to remember more about the scene, but collaborative pairs made significantly fewer errors than nominal pairs. Further, quantitative and qualitative analyses of retrieval strategies during the discussion revealed that couples who actively acknowledged, repeated, rephrased, and elaborated upon each other's statements remembered significantly more information overall. Taken together, our findings suggest that, under certain circumstances, discussion between witnesses is not such a bad idea after all.     

Take-the-best and the influence of decision-inconsistent attributes on decision confidence and choices in memory-based decisions

Take-the-best (TTB) is a decision strategy according to which attributes about choice options are sequentially processed in descending order of validity, and attribute processing is stopped once an attribute discriminates between options. Consequently, TTB-decisions rely on only one, the best discriminating, attribute, and lower-valid attributes need not be processed because they are TTB-irrelevant. Recent research suggests, however, that when attribute information is visually present during decision-making, TTB-irrelevant attributes are processed and integrated into decisions nonetheless. To examine whether TTB-irrelevant attributes are retrieved and integrated when decisions are made memory-based, we tested whether the consistency of a TTB-irrelevant attribute affects TTB-users’ decision behaviour in a memory-based decision task. Participants first learned attribute configurations of several options. Afterwards, they made several decisions between two of the options, and we manipulated conflict between the second-best attribute and the TTB-decision. We assessed participants’ decision confidence and the proportion of TTB-inconsistent choices. According to TTB, TTB-irrelevant attributes should not affect confidence and choices, because these attributes should not be retrieved. Results showed, however, that TTB-users were less confident and made more TTB-inconsistent choices when TTB-irrelevant information was in conflict with the TTB-decision than when it was not, suggesting that TTB-users retrieved and integrated TTB-irrelevant information.     

不同任务类型条件下4～6年级儿童比例推理策略的表现

随机选取小学4~6年级被试86名,从辅助策略、比例推理策略的策略选择和策略效用三方面,通过五种类型的天平任务考察儿童比例推理策略的表现。结果表明:(1)儿童最常使用手指动作辅助加工基本数量信息。辅助策略的使用率随年龄增长而减少,五年级开始使用出声思维,反映出元认知能力的发展。(2)在正式学习比例知识之前,各年级儿童都能使用两种以上策略,也能根据任务难度自发产生新策略,具备策略选择的多样性和适应性。其中,三个年级均能使用定性比例推理策略(双维策略,IIIA策略,补偿策略),表明儿童初步认识了距离和重量两个维度的共变关系。此外,六年级儿童能使用"运货车策略"将冲突问题灵活地化解为简单问题。(3)儿童的错误策略表现为:在冲突任务中盲目使用补偿策略、简单策略或加法策略。(4)分层回归分析表明,在控制年龄后,儿童的一般推理能力越高,其对重量策略的依赖性越低,且可能更容易发掘距离维度的意义,其使用运货车策略的频次更多。此外,一般推理能力对解决冲突类天平任务的正确次数有正向预测作用。     

多特征决策策略的信息搜索模式分析

决策策略的使用是不可见的内在过程 ,有效识别出决策者在信息整合时使用的策略对研究策略学习与转换、决策辅助与训练有重要意义。本文介绍了用过程追踪技术获取的信息搜索模式识别多特征决策策略的方法 ,即单步与多步跳转分析 ,并比较了两种方法的应用效果 ,讨论了跳转分析法的优点和局限。     

学习困难儿童的问题解决特点研究

本研究选取学习困难儿童和正常儿童各 3 2名 ,设置河内塔问题解决的情境 ,采用临床观察法 ,对学习困难儿童在问题解决中的特点作了初步的探究。研究发现 :1与正常儿童相比 ,学习困难儿童在发现和有效运用策略方面明显不足 ,但当学习困难儿童对问题情境比较熟悉后 ,有明显的进步 ;2一定的提示并不能帮助学习困难儿童最有效地应用策略。     

小学儿童规则发现的类比迁移研究

本研究以小学儿童为被试,证实了在策略提示条件下解决规则发现(合取规则和析取规则)的类比问题时,任务难度和表面相似性是影响策略的迁移的重要因素,并且发现小学儿童的思维能力存在着较大的个体差异.他们在问题解决时主要使用单维检验策略,多数小学儿童缺乏较强的元认知监控.     

PDP启动型实验程序与Richardson-Klavehn模型的比较研究

2个实验对PDP的启动型实验程序与Richardson-Klavehn的修正模型进行了比较研究,通过对指示语的操纵,考察提取策略是否完全受意志控制,以及注意水平、刺激材料、测验类型、加工水平对被试作业的影响.结果发现刺激材料对有意识控制记忆的实验结果影响很大,对PDP的无意识自动加工参数无影响;启动型实验程序的结果与PDP理论相当一致;提取策略不一定是受意志精确控制的.