Borderline personality disorder level predicts change in depressiveness after short‐term group psychotherapy: A study in a daily psychiatric clinic

The project examined the comorbidity between depression symptoms and the level of borderline personality organisation among patients admitted for group psychotherapy (Study 1). It also aimed to analyse how the level of borderline personality organisation relates to the reduction in depression symptoms after short‐term psychotherapy (Study 2). The study was conducted in a day clinic where patients were receiving psychotherapy for emotional problems affecting their functioning (N = 57). The study used the Borderline Personality Inventory (BPI) and the Patient Health Questionnaire. The analysis showed that BPI was positively related to depression symptoms. The higher borderline personality organisation patients presented when entering group psychotherapy, the greater was the decrease in depression symptoms after 3 months of psychotherapy. We discuss the results in relation to the notion that the presence of depression could be a positive prognostic indicator for patients with borderline personality.     

Using time‐lagged panel data analysis to study mechanisms of change in psychotherapy research: Methodological recommendations

The introduction of novel methodologies in the past decade has advanced research on mechanisms of change in observational studies. Time‐lagged panel models allow us to track session‐by‐session changes and focus on within‐patient associations between predictors and outcomes. This shift is crucial as change in mechanisms inherently takes place at a within‐patient level. These models also enable preliminary casual inferences, which can guide the development of effective personalised interventions that target mechanisms of change, used at specific treatment phases for optimal effect. Given their complexity, panel models need to be implemented with caution, as different modelling choices can significantly affect results and reduce replicability. We outline three central methodological recommendations for use of time‐lagged panel analysis to study mechanisms of change: (a) taking patient‐specific effects into account, separating out stable between‐person differences from within‐person fluctuations over time; (b) properly controlling for autoregressive effects; and (c) considering long‐term time trends. We demonstrate these recommendations in an applied example examining the session‐by‐session alliance–outcome association in a naturalistic psychotherapy study. We present limitations of time‐lagged panel analysis and future directions.     

What do clinical supervision research reviews tell us? Surveying the last 25 years

What do clinical supervision research reviews across the last 25 years tell us? That question is subsequently examined. Based on database and literature searches, 20 reviews appearing from 1995 through 2019 were identified for survey examination; consistencies, inconsistencies and other defining features were determined across reviews; and the survey findings and their implications are considered. Primary findings are as follows: (a) ‘proof’ for supervision appears to be more ‘proof by association’ than otherwise, being primarily a product of ex post facto, cross‐sectional, correlational study; (b) evidence supporting supervision impact of any type is weak at best, especially so for worker and client outcomes; (c) supervision models generally lack empirical foundation; (d) evidence‐based supervision appears to be more a hope and dream than supervision‐based reality at present; and (e) the primary methodological problems that plagued supervision research in the 1990s are still all too frequent in modern research. Some questions to entertain about supervision going forward, and some remedies for improving its research, are proposed.     

Engaging with the unknown: How Judaism enabled Freud's psychological discoveries

A large literature has formed around the question of how Freud's Jewishness and/or Judaism influenced his psychological discoveries and development of psychoanalytic theory and methods. The article organizes the literature into several core theses but brings new clarity and insight by applying two essential criteria to demonstrate an impact of Judaism on Freud's thinking: direct content and historical timing. First, there should be evidence that Freud incorporated actual content from Jewish sources, and second, this incorporation must have occurred during the most crucial period of Freud's early discovery, conceptualization, and development of psychoanalysis, roughly 1893–1910. Thus, for example, Bakan's well-known theory that Freud studied Kabbala is completely negated by the absence of any evidence in the required time period. Part I reviews the literature on the influence of Freud's ethnic/cultural Jewish identity. Part II introduces the Judaic sacred literature, explores Freud's education in Judaism and Hebrew, and presents evidence that Freud had the motive, means, and resources to discover and draw from the “Dream Segment” of the Talmud—along with the traditional Judaic methods and techniques of textual exegesis. Freud then applied these same Judaic word-centered interpretive methods—used for revealing an invisible God—to revealing an invisible Unconscious in four successive books in 1900, 1901, and 1905.     

VIOLENCE AND MORALITY: The Concession of Loss in A Ghanaian Fishing Village

When African migrants disappear on the Mediterranean going to Europe they often leave no trace—except for the occasional bodies that wash ashore on the beaches of southern Europe. In this essay, the urgent social and existential ramifications of migrant fatalities on the sea are explored. Drawing on ethnographic fieldwork in a small Ghanaian fishing village on the coast of the Gulf of Guinea, it is discussed how the bereaved struggle to make sense of these deaths to high‐risk migration—how they struggle to deal with devastating loss while retaining a sense of moral order.     

Testing Clinical Intuitions About Barriers to Improvement in Cognitive-Behavioral Therapy for Panic Disorder

Although clinical intuitions influence psychotherapeutic practice and are a rich source of novel hypotheses for research, many remain to be empirically tested. This study evaluates whether clinicians’ beliefs about barriers to progress in cognitive-behavioral therapy (CBT) for panic disorder are supported by data. Data from a randomized-controlled trial comparing CBT to panic-focused psychodynamic psychotherapy (PFPP) for adults with primary panic disorder (N = 161) were used to evaluate 15 factors endorsed by clinicians as impediments to CBT in a recent survey. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Hierarchical linear modeling revealed that none of the perceived barriers were predictive of poor outcome. Contrary to clinicians’ intuitions, dissociation during panic attacks was associated with greater symptomatic improvement in both treatment arms (β = ?0.69, p < .05), above the effect of established predictors. Moderation analyses revealed that when patients had PTSD diagnosed with the Anxiety Disorders Interview Schedule (β = 1.71, p < .05) or less severe panic disorder (β = 0.45, p = .04), they changed more rapidly in CBT than in PFPP. Overall, clinician agreement was inversely related to the strength of a predictor (r = ?.24, p = .39). Although clinical intuitions can be useful as clinical and empirical signals, such beliefs should be critically examined before informing practice. Dialogue between academics and clinicians might be enhanced through research that incorporates input from front-line practitioners.     

Use of a reference group in researching children’s views of psychotherapy in Malta

This paper explores the process and outcomes of a children’s reference group within the context of child psychotherapy research in residential care. The reference group was set up to consult children about the design of a research project which seeks to evoke, represent and understand children’s views of psychotherapy. No work to date has explored the experience of reference groups in the context of child psychotherapy in residential care in Malta. The paper contextualises the research within the literature on reference groups in child research, which identifies the potential of reference groups as a participative and co-reflexive activity which can inform research design. The paper critically examines the nature and conduct of the reference group by acknowledging the specific context of this work rather than assuming this is necessarily positive. It does so by specifying and evaluating the outcomes of the reference group in line with its aims. The paper draws on the recordings of the reference group meetings and reference group field notes taken by the researcher as key data which were thematically analysed. The main outcomes of the reference group include children’s contribution to the design of data collection methods especially in terms of not relying only on words during data collection. Children also identified key ethical issues from the point of view of young psychotherapy service users, especially in relation to issues of trust within a residential care context. Children also reviewed and appraised research information material. The reference group process drew from the researcher’s and participants’ contexts and contributed significantly to the researcher’s reflexive process especially in terms of acknowledging his power and positioning as an adult and his dual role as a practitioner/researcher.     

Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service

Abstract

This paper is adapted from a presentation first given at the 2017 Association of Child Psychotherapists (ACP) Conference. We hope to give a feel of our work as psychoanalytic child psychotherapists working in a Tier 4 national assessment service for gender variant children and connect with our colleagues working therapeutically with these families in Child and Adolescent Mental Health Services (CAMHS) and other settings. Gender variance does not have a single cause, or straightforward developmental pathway; rather it is a complex interplay of multiple factors, akin to sexuality in the diverse manifestations and ‘tributaries’ taken. This paper is given as a plea for complexity, to counter the current intense focus on gender identity and the consequent reductionism this can lead to. To this end, three case studies from the clinic, taken from Under Five, Latency and Adolescent phases of development, are explored. The complexity of the cases is then discussed, followed by parallel issues of development, divergence and difference. These three ‘average’ cases from the Gender Identity Development Services (GIDS) serve to demonstrate the need for child psychotherapy as part of multi-disciplinary thinking about gender variance and how attention must be maintained to each unique story and process of identity development; as well as our clinical task to establish and encourage depressive functioning and secondary processes where possible.