We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process‐outcome study at the University of Oslo, Norway. The study includes audio‐recording from all sessions and separate post‐therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical‐phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational management. Metaphors based on travel (how they have moved); cleaning (how they have cleaned up and sorted out things); sensing (how the clients have grown stronger, got their heads above water and see things differently); and the clients’ feeling of having received something (gifts or tools) are widely used. Such metaphors are created in the interaction with a mutual sensitivity to their capacity to confirm and regulate affect towards the end. In this sense, the metaphors celebrate accomplishments in a way that exceeds therapy, and the client can keep them to use afterwards.     

Innovative moments and poor outcome in narrative therapy

Aims: To analyse a poor outcome case of narrative therapy with a woman victim of intimate violence. Method: The Innovative Moments Coding System: version 1 was applied to all sessions to track the innovative moments (i‐moments) in the therapeutic process. I–moments are the narrative details that occur in psychotherapeutic conversations that are outside the influence of the problematic narrative. This research aims to describe the processes involved in the stability of meanings in psychotherapy through a dialogical approach to meaning making. Findings: Contrarily to what usually occurs in good outcome cases, re‐conceptualization i‐moments are absent. Moreover, two specific types of i‐moments emerged with higher duration: reflection and protest. Qualitative analysis showed that the potential meanings of these i‐moments were surpassed by a return to the problematic narrative. Conclusion: The therapeutic stability seems to be maintained by a systematic return to the problematic narrative after the emergence of novelties. This process was referred from a dialogical perspective as a mutual in‐feeding of voices, one that emerges in the i‐moment and another one that supports the problematic narrative, which is maintained by an oscillation between these two types of voices during therapy.     

What difference does counselling make? – The perceptions of drug‐using clients on low incomes

Context: This paper reports on a qualitative study looking at the perceptions of clients who use drugs and are on low income. Research suggests that counselling services can experience difficulties in reaching and retaining such clients, and outcomes of counselling can be disappointing. Aim: To learn from clients who had engaged in counselling for over six months what difference it had made to their lives. Method: Grounded theory methodology was used to analyse semi‐structured interviews with six participants. Findings: Findings included changes in the clients’ internal world, their connectedness with society, their familiarity with counselling, and their perception of the relationship with the counsellor. Factors within the counselling process which helped and hindered change were identified. The study documents how participants were able to use counselling to improve their lives.     

Practice‐based evidence in school‐based counselling

Aims: Counsellors are becoming commonplace within the support structures of secondary schools. To date, research findings from practice‐based outcome studies suggest this is a positive move. There are, however, numerous limitations to this work, and this project aims to develop this existing body of literature. Method: Nine 13–15 year olds attending counselling in six school‐based services participated in the project – one individual withdrew. A standardised self‐report questionnaire (YP‐CORE) was collected at four intervals: (1) the point of referral; (2) the onset of counselling; (3) the completion of counselling; and, (4) a two‐month follow‐up. The change indicated in each of these phases is examined and reported here. Additionally, YP‐CORE was completed during each session. Findings: The YP‐CORE indicates an improvement in the well‐being of this small sample, while waiting for and attending therapy. Further examination of session‐by‐session data also highlights how pre‐ and post‐outcome data should not necessarily be viewed as linear in nature. Discussion: This is a small‐scale investigation and further work is needed in this area. It does, however, raise a number of issues regarding the complexity inherent in conducting outcome research that warrant further investigation.     

Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder

Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome.     

Ecstasy Use,Outcome Expectancies,and Sexual Risk Taking

Ecstasy has become one of the most widely used illicit drugs in Australia. This study investigated outcome expectancies as possible motivating and maintaining factors in ecstasy use and sexual risk‐taking behaviour. A sample of regular ecstasy users (N = 220) from Sydney and Canberra, Australia, was recruited for structured face‐to‐face interviews. They also completed an Ecstasy Expectancy Questionnaire. Seven of eight subscales significantly differentiated regular users from non‐users. Interestingly, light and heavier users held similar outcome expectancies, except that light users endorsed items on the sexual enhancement subscale more strongly than heavier users. Further investigation showed that the level of sexual risk taking observed in this sample was high, with the majority of participants reporting multiple partners, “casual” sexual encounters, sex under the influence of substances, and inconsistent condom use. Using logistic regression analyses, a key finding was that positive sex‐related ecstasy outcome expectancies were associated with involvement in disinhibited sexual behaviour under the influence of ecstasy. These effects persisted after statistically controlling for the frequency of ecstasy use. The findings suggest that sexual risk taking is related not only to the disinhibiting properties of ecstasy but also to beliefs that users hold about the effects of the drug.     

Vicissitudes of ideas of cure in analysands and their analysts: a longitudinal interview study

This longitudinal prospective study focuses on analysands' and analysts' implicit ideas of how psychoanalysis might help analysands' psychological problems. Seven analysands and their analysts were periodically interviewed. Single ideas of cure from 75 interviews were inductively categorized. Nine distinct types of cures emerged, representing the wished-for goals of psychoanalysis, as well as the actions to achieve the wished-for changes. Each category might comprise more or less utopian ideas of wished-for cure as well as ideas of an attainable, more limited cure, or combinations of these. The utopian ideas of wished-for cures persisted throughout the psychoanalytic process for more than half the analysands and analysts. The abandonment of these ideas was related to the experienced outcome of psychoanalysis. The relation between the theories of one analysand and her analyst is explored in depth in a case study with special emphasis on the analytic process. The study suggests that the psychoanalytic process might profit from the analyst's observance of such incongruities and an openness to work through them.     

利他惩罚中的结果评价—— ERP研究

利他惩罚是指个体为惩罚违反社会规范的人, 自愿支付成本。前人研究发现利他惩罚行为激活了背侧纹状体等与奖赏有关的脑区, 因此可以认为利他惩罚的结果是一种相当于金钱奖赏的正性结果, 不惩罚结果则是一种负性结果。本研究利用事件相关电位技术考察了被试在多次信任博弈游戏中观察“利他惩罚结果”和“不惩罚结果”的脑电成分, 结果发现被试产生了明显的反馈相关负波(feedback related negativity, FRN), 且负性程度更大的“不惩罚”结果其FRN波幅大于负性程度更小的“惩罚”结果。因为FRN是对负性反馈结果敏感的一个脑电成分。可见个体并非把利他惩罚结果知觉为一种正性结果, 因此FRN反映了对社会结果的情绪动机意义的评价。     

Output order reflects the cognitive accessibility of goals

Goal accessibility--the ease or speed with which a goal is activated--increases the likelihood that it will be acted on. The present studies validate output order as a measure of goal accessibility that can be applied to goal lists in both laboratory and naturalistic settings. In three studies, output order (the order in which goals are listed in a free-response format) was related to self-reported goal value but was not redundant with it. Furthermore, output order was affected by motivational priming whereas value was not, and order associated with typical student goals (e.g., achievement) compared with atypical goals (e.g., power). Output order is well suited to bring the study of accessibility to naturalistic studies of goals and goal pursuit.