A comparison of two online cognitive‐behavioural interventions for symptoms of depression in a student population: The role of therapist responsiveness

Objectives: The study aimed to compare the efficacy of eight weekly sessions of a self‐administered online CBT treatment (cCBT; n=51) to a therapist‐assisted email CBT treatment (eCBT; n=50) in University students. Design: The design was a randomised parallel group trial. The study randomised participants with symptoms of depression to one of two available treatments. Method: Participants were offered eight weekly sessions of either cCBT or eCBT. Participants completed the Beck Depression Inventory‐II (BDI‐II) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) at pre‐and post‐treatment, at weeks 16 and 32 follow‐up. The Working Alliance Inventory‐Short Form (WAI‐SR) was completed at weeks 2, 4, and 6. Results: For both groups, pre‐post within group effect sizes reported were large for the BDI‐II and the CORE‐OM and these were maintained at follow‐up. Perceptions of working alliance were similar in each group, but Bond was significantly stronger for the eCBT condition. WAI scores correlated more positively with the outcome on BDI‐II for those in the eCBT condition than the cCBT condition, but not significantly. Conclusion: There were no significant differences between the two online treatments, both reduced depressive symptoms and improved general functioning. Similarly, at post‐treatment and follow‐up, clinical improvement and recovery was demonstrated for both groups equally. The study demonstrates the possibility for cCBT in a university setting that may contribute to addressing the shortcomings in meeting increasing demands that mental health services presently face.     

Extended problem solving treatment for depression

Introduction: Effective brief psychological approaches for depression that can be delivered by a variety of health professionals with minimal training increase access to treatment by patients. Problem Solving Treatment (PST) was developed for primary care and was modified for this study (EPST) to better meet the needs of mental health patients. Method: A total of 92 therapists from different professional backgrounds completed EPST workshops and treated 92 patients with major depression with interval clinical and treatment process assessments. Results: EPST achieved a significant reduction in depressive symptom scores, life problem scores, and there were few treatment non‐completers. Treatment outcome was predicted by process and therapist variables. Discussion: EPST is an effective and easy to teach treatment that can be delivered by a variety of practitioners and suitable for busy primary mental health care settings.     

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

Therapist Awareness of Client Resistance in Cognitive-Behavioral Therapy for Generalized Anxiety Disorder

Clients' resistance relates negatively to their retention and outcomes in psychotherapy; thus, it has been increasingly identified as a key process marker in both research and practice. This study compared therapists' postsession ratings of resistance with those of trained observers in the context of 40 therapist–client dyads receiving 15 sessions of cognitive-behavioral therapy for generalized anxiety disorder. Therapist and observer ratings were then examined as correlates of proximal (therapeutic alliance quality and homework compliance) and distal (posttreatment worry severity) outcomes. Although there was reasonable concordance between rater perspectives, observer ratings were highly and consistently related to both proximal and distal outcomes, while therapist ratings were not. These findings underscore the need to enhance therapists' proficiency in identifying important and often covert in-session clinical phenomena such as the cues reflecting resistance and noncollaboration.     

CONSIDERATIONS ON DEPRESSIVE CONFLICT AND ITS DIFFERENT LEVELS OF INTENSITY: IMPLICATIONS FOR TECHNIQUE

This article considers the problem of depressive conflict (DC) and the difficulties that arise in integrating aggression towards the object of libidinal cathexis. This conflict results, in particular, from the destructive omnipotence that infantile fantasies attribute to the aggression. In order to better clarify Klein's very broad concept of the depressive position, three levels of severity of depressive conflict are proposed, depending on the type of fantasies concerning the loss of the object that predominate in the individual. These are: fantasies of catastrophic and irreparable destruction of the object ('parapsychotic' DC); fantasies of death and serious damage of the object ('para-depressive' DC); and fantasies of rejection and loss of the love of the object ('para-neurotic' DC). Having looked at these theoretical hypotheses, their implications for technique will then be considered, particularly the importance of focusing the interpretation on guilt feelings rather than on drives in the transferential relationship. A clinical example drawn from the work of Klein and a clinical vignette of a particularly difficult analysis illustrate this technical hypothesis.     

The Use of Self of the Therapist

This article explores how the Satir model facilitates the development of the self of the therapist, which Virginia Satir strongly advocated. Discovering and developing creative ways to externalize the internal hidden processes of people, she invited therapists to work on their own unresolved issues in their training through various methods such as: family of origin, family reconstruction, ingredients of an interaction, and parts party. Her goal was to increase self-esteem, foster better choice making, increase responsibility, and facilitate personal congruence through a therapeutic process. Although very relevant in the training and professional development of therapists, there has been little exploration or research of this topic.     

Is how it is said important? The association between quality of therapist interventions and client processing

This study examined the association between the quality of therapist interventions and client in‐session processing using the York Therapist Process Measure (YTPM; Toukmanian and Armstrong, 1998). The instrument's three dimensions — attunement, tentativeness and meaning exploration — were tested separately for their impact on clients' manner of processing and depth of experiencing. For each of the 20 mild‐moderately depressed clients, treated in short‐term experiential therapy, a high and a low client‐process segment was isolated from a session that was judged by an experienced therapist to manifest the greatest amount of “good therapy moments”. Therapist interventions within these segments were then rated on the YTPM. Results revealed significant differences in the quality of therapist interventions between high and low segments. Attunement and tentativeness were associated significantly with greater complexity in manner of processing, and meaning exploration with greater depth in experiencing. The implications of these findings for psychotherapy research and practice are discussed.     

基于行为的绩效评定方法的研究进展

从20世纪60年代至今,基于行为的绩效评定一直是各类组织的主要绩效评定方法。基于工作结果的非判断性绩效测量有其难以克服的局限,各种基于工作行为的判断性绩效测量方法相继开发出来。行为指标的筛选成为研究的主要问题之一。组织公民行为、区分作业绩效与关系绩效等研究,向基于行为的绩效评定提出了新的问题。     

Journal Reviews

Covington, Coline. 'Learning how to forget – repeating the past as a defence against the present'.
Grotstein, James. 'Bion, the Pariah of O'.
Hinshelwood, R. D. 'The elusive concept of "internal objects" (1934–1943): its role in the formation of the Klein Group'.
Lippmann, Paul. 'On dreams and interpersonal psychoanalysis'.
Renik, Owen. 'Conscious and unconscious use of the self'.
Schaverien, Joy. 'Men who leave too soon: reflections on the erotic transference and countertransference'.
Williams, Gianna, 'Reflections on some dynamics of eating disorders: "no entry" defences and foreign bodies'.
Slavin, Malcolm & Kriegman, D. 'Why the analyst needs to change: towards a theory of conflict, negotiation, and mutual influence in the therapeutic process'.