Relationship between environmental factors and burnout of psychotherapists: Meta‐analytic approach

The present study aims to extend the scope of understanding on the relationships between environmental factors and burnout symptoms by targeting and including more extensive occupational demanding variables related to therapist burnout. The present study includes not only common occupational stressors (e.g., working hours, role overload and role conflict) but also variables reflecting the quality of relationship with clients (e.g., case load and negative clientele) that have not been dealt with before in meta‐analytic studies. A meta‐analysis was conducted on 27 original studies published from the year 2006 to 2018. The findings showed that, among environmental factors, role overload had the most significant positive correlations with exhaustion. In addition, negative clientele had the most significant positive correlations with depersonalisation and reduced accomplishment. Furthermore, caseload and low income had relatively weak relations with therapist burnout. Based on these results, implications and limitations of the study are discussed.     

A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)

There is a growing body of evidence suggesting that domestic abuse (DA) should be conceptualised within the complex post‐traumatic stress disorder (C‐PTSD) model. Recently, in the draft of the International Classification of Diseases, Eleventh Revision, produced by the World Health Organization (WHO), C‐PTSD was included as a separate criterion in which DA is incorporated (ICD‐11, WHO, 2018). In this study, a thematic analysis was used to explore to what extent practitioners working with DA survivors are familiar with PTSD and C‐PTSD. Research into such a prevalent and detrimental problem as DA is important to understand whether the development of theoretical knowledge about DA and C‐PTSD is addressed in practice. In a Women's Centre in South London, six semi‐structured interviews with middle‐aged female practitioners were conducted to investigate each counsellor's experiences, knowledge and reflections. Six final themes were constructed to summarise the main results. The findings demonstrate limited practitioner understanding of DA in terms of C‐PTSD, which seems to impact not only the effectiveness of treatment plans with DA survivors, but also counsellors’ own psychological and physical states. It is also indicated that DA can be conceptualised within the C‐PTSD model that corresponds with previous literature indicating the complex nature of DA. The overall results of the current research acknowledge that DA sectors should not be neglected and better funding and effective psychoeducation in this field are needed.     

Resistance and outcome expectations in cognitive‐behavioural therapy for generalised anxiety disorder

Greater client resistance has been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts such outcomes are underexplored. Given that client outcome expectation (OE) has been identified as an important common factor in psychotherapy, the goals of the present study were to examine: (a) the impact of resistance on subsequent client and therapist OE (COE & TOE, respectively); and (b) whether COE and/or TOE mediate the relationship between resistance and outcome. These relationships were tested among 44 clients with severe generalised anxiety disorder treated with cognitive‐behavioural therapy in the context of a randomised controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured at a mid‐treatment session, and COE and TOE were assessed at baseline and immediately after the resistance session. Treatment outcome was measured via client‐rated worry severity at post‐treatment. As predicted, higher resistance was associated with lower subsequent COE and TOE; B = ?.73, p < .001 and B = ?.46, p < .001, respectively. In turn, lower post‐resistance COE predicted higher post‐treatment worry (B = ?.5, p < .001), indicating mediation. In contrast, TOE did not mediate the relationship between resistance and outcome (B = ?.02, p = .876). These results suggest that resistance can be demoralising to both clients and therapists. However, only lower client morale may be detrimental to therapy outcome. This study contributes to understanding outcome pathways through two common therapy processes.     

Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self‐regulation,emotion, and interpersonal processes

Theory and research on self‐regulation, emotional adjustment, and interpersonal processes focus increasingly on parasympathetic functioning, using measures of vagally mediated heart rate variability (vmHRV) or respiratory sinus arrhythmia (RSA). This review describes models of vmHRV in these areas, and issues in measurement and analysis. We propose a framework organizing theory and research as examining (a) vmHRV as an individual difference or a situational response, and (b) resting, reactive, or recovery levels. Evidence supports interpretation of individual differences in resting vmHRV as a broad biomarker for adaptive functioning, but its specificity and underlying mechanisms require elaboration. Individual differences in vagal reactivity (i.e., trait‐like differences in vmHRV decreases during challenge or stress) are less commonly studied in adults and results are mixed. Many stressors and challenges evoke temporary decreases in vmHRV, and in some research self‐regulatory effort evokes increases. In a smaller literature, positive interpersonal experiences and some restorative processes increase resting vmHRV, whereas depletion of self‐regulatory capacity through related effort decreases it. Greater attention to conceptual distinctions regarding vmHRV constructs and several methodological issues will strengthen future research. Importantly, researchers should exercise caution in equating vmHRV with specific psychosocial constructs, especially in the absence of converging assessments and precise experimental manipulations.     

Beyond transference,countertransference, the silences and the opinion1

The author examines several works of an intersubjectivist trend, as well as writings by Hanly, Cavell and Bion, defending many of the named psychoanalysts' viewpoints. These viewpoints are expressed in the search and the struggle for truth, recognizing, like Popper, that truth exists but that we cannot know with certainty whether and when we touch upon it, only that this endless effort merits a lifetime's work because it is the attempt at an encounter with ourselves‐the true encounter. The author explains the criticisms by Green of Jacobs, and defends the maintenance of ‘a certain possible neutrality’ (Eizirik). He poses some questions with regard to Ogden's ‘third subject’, considering it, among other aspects, from the supervisory point of view, which may demonstrate the existence of ‘a certain possible objectivity’ of the emotional confl ict. He develops some criticisms concerning silence as an interpretative action by Ogden, and summarizes two case histories. Both were unconsciously attempting to manipulate the analyst intensely‐one of them to get the analyst to intervene in his love life, and the other to interrupt acting out.     

Autoshaping and automaintenance: a neural-network approach

This article presents an interpretation of autoshaping, and positive and negative automaintenance, based on a neural-network model. The model makes no distinction between operant and respondent learning mechanisms, and takes into account knowledge of hippocampal and dopaminergic systems. Four simulations were run, each one using an A-B-A design and four instances of feedfoward architectures. In A, networks received a positive contingency between inputs that simulated a conditioned stimulus (CS) and an input that simulated an unconditioned stimulus (US). Responding was simulated as an output activation that was neither elicited by nor required for the US. B was an omission-training procedure. Response directedness was defined as sensory feedback from responding, simulated as a dependence of other inputs on responding. In Simulation 1, the phenomena were simulated with a fully connected architecture and maximally intense response feedback. The other simulations used a partially connected architecture without competition between CS and response feedback. In Simulation 2, a maximally intense feedback resulted in substantial autoshaping and automaintenance. In Simulation 3, eliminating response feedback interfered substantially with autoshaping and automaintenance. In Simulation 4, intermediate autoshaping and automaintenance resulted from an intermediate response feedback. Implications for the operant-respondent distinction and the behavior-neuroscience relation are discussed.