Helping and change without traditional therapy: Commonalities and opportunities

The therapeutic elements of four types of helping interactions (friends/family, religion, cinematherapy/bibliotherapy, and self-help groups), and their commonalities with traditional psychotherapy are explored. Empirical findings in these areas are discussed, along with suggestions for process and outcome research. Recommendations for the integration of self-help and paraprofessional counseling with professional therapy are presented.     

选择一致性影响结果评价的ERP研究

本研究通过两个实验探讨了当被试主动做出与他人一致/不一致的选择行为(实验1)或看到他人做出与自己一致/不一致的选择行为(实验2)时,其选择行为的一致性是如何影响结果评价过程的。脑电数据表明在结果评价的早期阶段,无论被试是主动或被动地与他人做出相同选择,这种选择一致性都会放大输赢结果之间的差异:体现在选择一致情况下比不一致情况下诱发更大的d FRN。而在结果评价的晚期阶段,当被试先做出选择之后,看到他人做出与自己不一致的选择时(实验2),相比他人与自己选择一致时,诱发了更大的P3和LPP波幅。说明被试很可能把他人的不一致选择加工为一种冲突。因此投入了更多认知资源来加工这一结果。本研究是一个探索性的创新研究,首次从时间维度上分离了选择行为和结果反馈两个阶段,并提供了选择一致性对结果评价有影响作用的脑电证据。     

Investigating the outcome of the initial assessment at a national transgender health service: Time to review the process?

Background: Globally, there is a lack of a standardized assessment process prior to the initiation of gender affirming medical interventions and consequently there is a discrepancy in this process among different transgender health services.

Aim: The main objective of this study is to investigate the outcome of the initial assessment process at a national transgender health service.

Method: The outcome of people over the age of 17 years, assessed at a large national transgender health service in the United Kingdom during a 2-year period was categorized into: (1) recommendation for cross-sex hormone treatment, or (2) no recommendation for cross-sex hormone treatment. In addition, 200 case notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process.

Results: During the study period, a total number of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for cross-sex hormone treatment, leaving 237 (38.4%) patients who required a longer assessment period or were discharged. The factors associated with being recommended for cross-sex hormone treatment were having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88% (n = 176) of the cases.

Discussion: Although the results of the study may not be generalizable to other international centers, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the routine inclusion of two assessors needs to be reviewed.     

Empirically Documenting Clinically Significant Change in Rational Emotive Behavior Therapy

The purpose of the present article is to outline the conceptual foundation and practical methodology of the Jacobson-Truax Clinically Significant Change index, derived from psychotherapy outcome research. This way of considering what constitutes clinically significant change in psychotherapy puts a premium on social validation. It empowers clinicians to evaluate the meaningfulness of their client's progress and to communicate that progress to third parties such as other clinicians, researchers, and insurers. Application of the method is demonstrated in the case of a client treated with Rational Emotive Behavior Therapy (REBT). The discussion focuses on the advantages of this procedure for satisfying the intellectual interest of the practitioner-scientist and for furthering informed discussion of the value in various applications of REBT to clinical problems.     

How to study the ‘quality of psychoanalytic treatments’ and their long‐term effects on patients' well‐being: A representative,multi‐perspective follow‐up study3

How can we study the ‘quality of psychoanalytic treatments’? The authors attempt to answer this question by discussing a naturalistic, multi‐perspective and representative follow‐up study of psychoanalyses and long‐term psychoanalytic psychotherapies. We studied a representative sample (n = 401) of all the patients who had terminated their psychoanalytic treatments with members of the German Psychoanalytical Association (DPV) between 1990 and 1993. Between 70 and 80 per cent of the patients achieved (average 6.5 years after the end of treatment) good and stable psychic changes according to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non‐psychoanalytic experts, and questionnaires commonly applied in psychotherapy research. The evaluation of mental health costs showed a cost reduction through fewer days of sick leave during the seven years following the end of long‐term psychoanalytic treatments. The results achieved using non‐psychoanalytical instruments are complemented by the richness of the idiosyncratic findings, gained by the psychoanalytic research instruments.     

When less is more: An exploration of psychoanalytically oriented hospital‐based treatment for severe personality disorder4

This paper discusses the main findings of a prospective study based at the Cassel Hospital, a centre dedicated to the psychoanalytically informed residential treatment of severe personality disorders. The results‐showing that significantly greater improvements on a number of outcome indicators were found in patients exposed to the psychoanalytically informed treatment programmes compared to a general psychiatric approach based on management and pharmacotherapy alone‐underscores the importance and the centrality of the psychoanalytic input in the treatment of severe personality disorders. However, the results of the study also suggested that some features of long‐term hospital treatment might carry the risk of iatrogenic and anti‐therapeutic effects for a sub‐group of patients with severe borderline core pathology. The authors present the clinical and psychodynamic implications of the study results based on an understanding of the internal and interpersonal mode of functioning of borderline patients.     

Comorbid anxiety and mood disorders among persons with social anxiety disorder.

Axis I comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. We evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of cognitive-behavioral group treatment and at follow-up, to be more severely impaired than those with no comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential rates of improvement of social anxiety disorder.     

Defensive self-esteem and aggression in childhood

Research examining the association between self-esteem (SE) and aggressive behavior in childhood has produced mixed findings. Some of the confusion may stem from the fact that researchers have relied on explicit measures of SE, thus conflating two distinct types of positive self-regard: secure SE (characterized by high levels of explicit and implicit SE), and defensive SE (characterized by high levels of explicit but low levels of implicit SE). The current study tested the hypothesis that children with high levels of defensive, but not secure, SE would engage in higher levels of aggressive behavior. Ninety-three children completed measures of both explicit and implicit SE. Teachers assessed children’s level of physical and relational aggression in the school setting. As predicted, there was a positive association between explicit SE and aggression when levels of implicit SE were low, but not when levels of implicit SE were high.     

Adolescent Report of Interparental Conflict: The Role of Threat and Self-blame Appraisal on Adaptive Outcome

Research consistently shows that children exposed to interparental conflict are at-risk for experiencing psychopathology. Establishing a link, however, between interparental conflict and maladjustment is not the same as understanding how specific outcomes manifest. Therefore, we examined the relation of interparental conflict and appraisal with adolescent outcome with 169 high school students (ages 14–19 years). Specifically, threat and self-blame appraisals were hypothesized to mediate the relation between interparental conflict and both adaptive and maladaptive outcomes. Results suggest that threat partially mediated the relation between interparental conflict and externalizing problems, interparental conflict and internalizing problems, and interparental conflict and adaptive behaviors. Additionally, self-blame appears to partially mediate the relation between interparental conflict and internalizing problems. Implications of the current findings are discussed.