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Podlogar T, Žvelc G, De Leo D. Slovene Translation of the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ). CRISIS 2024; 45:323-329. [PMID: 38597228 DOI: 10.1027/0227-5910/a000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Background: Mental health professionals encounter numerous difficulties when working with suicidal clients. To understand these difficulties in clinical practice better, a valid instrument measuring them is needed. Aims: This study aimed to translate the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ) to Slovene, validate it, and explore Slovenian professionals' experiences with it. Method: The participants were 106 professionals (19 men, 87 women), aged 26-66 years. Apart from the DSBQ, scales on attitudes toward suicide prevention and coping strategies in difficult clinical situations were used. The data were collected between October 2017 and January 2019. Results: Although slightly diverging from the originally reported component structure, the Slovene translation of the DSBQ measures difficulties in working with suicidal clients with acceptable/good reliability and sensitivity, and adequate construct validity. Slovenian professionals most commonly experience difficulties related to working with children, followed by technical, system and setting, and other types of difficulties. Limitations: The sample of participants was relatively heterogeneous. Conclusion: Further studies of the DSBQ structure and validity, as well as difficulties, especially those related to working with children/adolescents and facing the theme of death, are warranted. Considering the difficulties most frequently reported in this investigation, more efforts are also needed in Slovenia to address technical and logistic aspects.
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Affiliation(s)
- Tina Podlogar
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
- Department of Psychology, FAMNIT, University of Primorska, Koper, Slovenia
- Department of Psychology, Faculty of Arts, University of Ljubljana, Slovenia
| | - Gregor Žvelc
- Department of Psychology, Faculty of Arts, University of Ljubljana, Slovenia
| | - Diego De Leo
- Slovene Centre for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
- Department of Psychology, FAMNIT, University of Primorska, Koper, Slovenia
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Hartmann A, Orlinsky DE, Rønnestad MH, Willutzki U, Schröder TA, Heinonen E. Measuring psychotherapist functioning with the Therapist Work Involvement Scales (TWIS): reliability, factor structure, and measurement invariance. Psychother Res 2024:1-13. [PMID: 39159177 DOI: 10.1080/10503307.2024.2389857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES The Therapist Work Involvement Scales (TWIS) is a self-report research instrument that enables a multilayered description of psychotherapists' experiences when treating clients. The TWIS was created in a comprehensive study of close to 5,000 psychotherapists, and has been used in multiple studies. The aim of the current paper is to clarify the organization and statistical characteristics of the TWIS, and to present an updated version for longitudinal and cross-sectional research. METHODS Collection of a large sample of psychotherapy trainees made possible the use of confirmatory factor analysis (CFA) to evaluate the dimensions and structure of therapists' process experiences, assessing reliabilities, measurement invariance over gender, item statistics, and correlations with other measures to show concurrent and predictive validity. RESULTS The CFAs largely confirmed the factor structure of four of the five facets, and of the global super-factors. The global factors of Healing Involvement and Stressful Involvement each showed substantial correlations with therapists' attachment style and professional growth, and were used to describe four practice patterns that typify the experiences of therapists. CONCLUSION The results have shown the TWIS to be a statistically sound, multidimensional research instrument enabling therapists to describe their experience in current therapeutic work.
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Affiliation(s)
- Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg im Breisgau, Germany
| | - David E Orlinsky
- Department of Comparative Human Development, University of Chicago, Chicago, USA
| | | | - Ulrike Willutzki
- Department of Clinical Psychology, Witten/Herdecke University, Witten, Germany
| | | | - Erkki Heinonen
- Department of Psychology, University of Oslo, Oslo, Norway
- Finnish Institute for Health and Welfare, University of Helsinki, Helsinki, Finland
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Schaffrath J, Bommer J, Schwartz B, Lutz W, Deisenhofer AK. Where it all begins: Predicting initial therapeutic skills before clinical training in cognitive behavior therapy. PLoS One 2024; 19:e0294183. [PMID: 38386643 PMCID: PMC10883575 DOI: 10.1371/journal.pone.0294183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/27/2023] [Indexed: 02/24/2024] Open
Abstract
To train novice students adequately, it is crucial to understand where they start and how they develop their skills. This study examined the impact of novice students' characteristics on their initial clinical micro-skills when treating simulated patients with cognitive behavior therapy. The sample consisted of 44 graduate psychology students treating seven simulated patients. Clinical micro-skills were measured both using video-based ratings in reaction to short video clips of simulated patients (via the Facilitative Interpersonal Skills (FIS) performance task) and by using video-based ratings within a session with a simulated patient (using the Inventory of Therapeutic Interventions and Skills; ITIS). Two separate LASSO regressions were performed using machine learning to select potential predictors for both skills assessments. Subsequently, a bootstrapping algorithm with 10,000 iterations was used to examine the variability of regression coefficients. Using LASSO regression, we identified two predictors for clinical micro-skills in standardized scenarios: extraversion (b = 0.10) and resilience (b = 0.09), both were not significantly associated with clinical micro-skills. Together, they explained 15% of the skill variation. Bootstrapping confirmed the stability of these predictors. For clinical micro-skills in sessions, only competitiveness was excluded by LASSO regression, and all predictors showed significant instability. The results provide initial evidence that trainees' resilience and extraversion should be promoted in the clinical training of cognitive behavior therapy. More studies on clinical micro-skills and training with larger sample sizes are needed to fully understand clinical development.
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Affiliation(s)
- Jana Schaffrath
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Jana Bommer
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Brian Schwartz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Wolfgang Lutz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
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Gossmann K, Rosner R, Barke A. Work involvement and work satisfaction of psychotherapists-A nationwide online survey among psychotherapeutic practitioners in Germany. Clin Psychol Psychother 2023; 30:73-85. [PMID: 35920059 DOI: 10.1002/cpp.2772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/30/2022] [Accepted: 06/29/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to explore psychotherapist characteristics associated with work involvement and work satisfaction among psychotherapists in Germany. METHOD In total N = 1358 psychotherapeutic practitioners with different levels of training participated in our nationwide online survey, we assessed work involvement and its sub-concepts of healing involvement (HI), stressful involvement (SI) and work satisfaction (WS) using the Therapist Work Involvement Scale (TWIS) and combined HI and SI into practice patterns. RESULTS In our study, the levels of HI and WS were high, whereas SI was low. The percentage of effective practice patterns was higher than in previous studies, whereas challenging practice patterns were lower. HI, SI and WS were associated with gender and age, indicating that male and younger participants showed more SI but less HI and WS. Psychodynamic therapists reported more SI and WS. The number of weekly therapy sessions was related to HI, SI and WS. Furthermore, HI was positively related to WS and negatively to SI, while SI and WS were negatively correlated. CONCLUSION Our results indicated that therapist characteristics influenced their work involvement and work satisfaction. Therefore, therapist training and interventions should consider individualized approaches based on the relevant therapist characteristics to foster HI and WS while reducing SI. One could speculate whether the changes in psychotherapeutic training may have already contributed to improved practice patterns over the last decades.
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Affiliation(s)
- Katharina Gossmann
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Antonia Barke
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
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Zhang Y, Shi L, Wei J, Hartmann A, Leonhart R, Bassler M, Fritzsche K. Perceived professional development of Chinese psychotherapy trainees: a pilot study. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35912927 PMCID: PMC9422321 DOI: 10.4081/ripppo.2022.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 07/11/2022] [Indexed: 11/23/2022]
Abstract
For more than 30 years counselling and psychotherapy services in China have progressed rapidly. Currently, various Chinese universities, hospitals, official mental health centres, and private mental health service organizations provide psychotherapy training programs. However, little is known about Chinese psychotherapy trainees and their development. This pilot study investigated the characteristics and perceived professional development of 20 Chinese trainees during and after an advanced training program for psychosomatic medicine and psychotherapy, which is a collaboration project between Peking Union Medical College Hospital and the Department of Psychosomatic Medicine and Psychotherapy from the University Medical Center Freiburg in Germany. Trainees completed questionnaires from the SPRISTAD (Society for Psychotherapy Research Interest Section on Therapist Training and Development) study at the beginning (T1), at the end (T2), and one year after finishing the program (T3). Seventeen of the twenty participants were clinicians. Trainees reported a prominent rise of Currently Experienced Growth throughout the training period, which nearly dropped to the baseline level after the training, although Retrospective Career Development showed a trend of an overall increase. Both ‘experience in therapy with patients’ and ‘participation in courses or seminars’ were the most important positively perceived sources of influence on trainees’ development. This implies the importance of continuous psychotherapy training for the development of therapists during their career. Future research with a larger sample size should also assess trainees’ development from the viewpoint of trainers, supervisors, and patients.
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James G, Schröder T, De Boos D. Changing to remote psychological therapy during COVID-19: Psychological therapists' experience of the working alliance, therapeutic boundaries and work involvement. Psychol Psychother 2022; 95:970-989. [PMID: 35838134 PMCID: PMC9349398 DOI: 10.1111/papt.12413] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
RESEARCH AIMS This study aimed to investigate psychological therapists' perceived ability to form a working alliance and maintain therapeutic boundaries, and their work involvement patterns whilst working remotely via telephone or videoconferencing. Furthermore, the study aimed to explore therapists' experience of therapeutic boundaries when working remotely and how they managed these. METHOD A mixed-method sequential explanatory design was adopted. Descriptive and inferential statistics were used to analyse quantitative data, with thematic analysis used to analyse qualitative data. RESULTS In total, 161 psychological therapists completed an online survey, and 12 participants were selected using maximum variation sampling to engage in a semi-structured interview. Although results between therapists varied, some perceived abilities regarding the working alliance and therapeutic boundaries differed when working remotely compared to face-to-face therapy. Therapists' work involvement patterns also differed compared to existing data for face-to-face therapy, indicated by increased rates of stressful involvement. Considering therapists' experience of therapeutic boundaries, four overarching themes were identified: 'different boundaries in remote therapy', 'work home boundary', 'changes in the therapeutic safe space' and 'impact of boundaries when working remotely'. CONCLUSIONS Aspects of the working alliance and therapeutic boundaries are experienced differently by therapists working remotely, which relates to how they experience their work. The findings have clinical implications for increasing therapists' awareness of potential changes in their perceived abilities regarding the working alliance and therapeutic boundaries when working remotely, therefore, enabling them to address these changes where required. Future research possibilities are considered.
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Patient Perspectives on Co-Therapists’ Behaviors in Group CBT. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Litam SDA, Ausloos CD, Harrichand JJS. Stress and Resilience Among Professional Counselors During the COVID‐19 Pandemic. JOURNAL OF COUNSELING AND DEVELOPMENT 2021; 99:384-395. [PMID: 35571009 PMCID: PMC9088614 DOI: 10.1002/jcad.12391] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
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Moore CM, Foxx SP. The Development and Initial Validation of the Interpersonal Stress Scale-Counselor. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1080/07481756.2020.1827433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moore CM, Andrews SE, Parikh‐Foxx S. “Meeting Someone at the Edge”: Counselors’ Experiences of Interpersonal Stress. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- C. Missy Moore
- Department of Counseling and Human Development Services, University of Georgia
| | - Sara E. Andrews
- Department of Counseling, University of North Carolina at Charlotte
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Chui H, Hill CE. Keep calm and alert and carry on: therapist calmness and fatigue in relation to session process. COUNSELLING PSYCHOLOGY QUARTERLY 2018. [DOI: 10.1080/09515070.2018.1502160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Harold Chui
- Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Clara E. Hill
- Department of Psychology, University of Maryland, College Park, MD, USA
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Bhola P, Raguram A, Dugyala M, Ravishankar A. Learning in the crucible of supervision: Experiences of trainee psychotherapists in India. CLINICAL SUPERVISOR 2017. [DOI: 10.1080/07325223.2016.1233478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Poornima Bhola
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Ahalya Raguram
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Nissen-Lie HA, Rønnestad MH, Høglend PA, Havik OE, Solbakken OA, Stiles TC, Monsen JT. Love Yourself as a Person, Doubt Yourself as a Therapist? Clin Psychol Psychother 2015; 24:48-60. [DOI: 10.1002/cpp.1977] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Per A. Høglend
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Odd E. Havik
- Department of Clinical Psychology; University of Bergen; Bergen Norway
| | | | | | - Jon T. Monsen
- Department of Psychology; University of Oslo; Oslo Norway
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Hartmann A, Joos A, Orlinsky DE, Zeeck A. Accuracy of therapist perceptions of patients' alliance: Exploring the divergence. Psychother Res 2014; 25:408-19. [DOI: 10.1080/10503307.2014.927601] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Nissen-Lie HA, Havik OE, Høglend PA, Rønnestad MH, Monsen JT. Patient and therapist perspectives on alliance development: therapists' practice experiences as predictors. Clin Psychol Psychother 2014; 22:317-27. [PMID: 24574034 DOI: 10.1002/cpp.1891] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 11/09/2022]
Abstract
UNLABELLED Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore the development of the working alliance (using the Working Alliance Inventory), rated by both patients and therapists as a function of therapist in-session experiences. The therapist experiences were gathered by means of the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005). Data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (Havik et al., 1995) were used. Multilevel growth curve analyses of alliance scores from Sessions 3, 12, 20 and 40 showed that the therapist factors predicted working alliance levels or growths differently, depending on whether the alliance was rated by patients or by therapists. For example, it emerged that therapists' negative reactions to patients and their in-session anxiety affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of flow (Csikszentmihalyi, 1990) during sessions impacted only the therapist-rated alliance. The patterns observed in this study imply that therapists should be particularly aware that their negative experiences of therapy are noticed by, and seem to influence, their clients when they evaluate the working alliance through the course of treatment. KEY PRACTITIONER MESSAGE The findings of this study suggest that the working alliance is influenced by therapists' self-reported practice experiences, which presumably are communicated through the therapists' in-session behaviours. The study found a notable divergence between practice experiences that influenced the therapists and those that influenced the patients when evaluating the working alliance. Specifically, practitioners' self-reported difficulties in practice, such as their negative reactions to patients and their in-session anxiety, affected patient-rated alliance but not therapist-rated alliance, whereas therapist experiences of 'flow' during sessions impacted only the therapist-rated alliance. Practitioners should note that patient alliance ratings were more likely to be influenced by therapists' negative practice experiences than by positive ones. The divergence in the patient and therapist viewpoints has potential implications for therapist training and supervision and everyday self-reflection.
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Affiliation(s)
| | - Odd E Havik
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Per A Høglend
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Jon T Monsen
- Department of Psychology, University of Oslo, Oslo, Norway
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Heinonen E, Knekt P, Jääskeläinen T, Lindfors O. Therapists' professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis. Eur Psychiatry 2013; 29:265-74. [PMID: 24060629 DOI: 10.1016/j.eurpsy.2013.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/14/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Whether long-term psychodynamic therapy (LPP) and psychoanalysis (PA) differ from each other and require different therapist qualities has been debated extensively, but rarely investigated empirically. METHODS In a quasi-experimental design, LPP was provided for 128 and PA for 41 outpatients, aged 20-46 years and suffering from mood or anxiety disorder, with a 5-year follow-up from start of treatment. Therapies were provided by 58 experienced therapists. Therapist characteristics, measured pre-treatment, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). General psychiatric symptoms were assessed as the main outcome measure at baseline and yearly after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI). RESULTS Professionally less affirming and personally more forceful and less aloof therapists predicted less symptoms in PA than in LPP at the end of the follow-up. A faster symptom reduction in LPP was predicted by a more moderate relational style and work experiences of both skillfulness and difficulties, indicating differences between PA and LPP in the therapy process. CONCLUSIONS Results challenge the benefit of a classically "neutral" psychoanalyst in PA. They also indicate closer examinations of therapy processes within and between the two treatments, which may benefit training and supervision of therapists.
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Affiliation(s)
- E Heinonen
- National Institute for Health and Welfare, Finland
| | - P Knekt
- National Institute for Health and Welfare, Finland; Social Insurance Institution, Finland.
| | | | - O Lindfors
- National Institute for Health and Welfare, Finland
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Heinonen E, Lindfors O, Härkänen T, Virtala E, Jääskeläinen T, Knekt P. Therapists' Professional and Personal Characteristics as Predictors of Working Alliance in Short-Term and Long-Term Psychotherapies. Clin Psychol Psychother 2013; 21:475-94. [DOI: 10.1002/cpp.1852] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/19/2013] [Accepted: 05/24/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Erkki Heinonen
- National Institute for Health and Welfare; Helsinki; Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare; Helsinki; Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare; Helsinki; Finland
| | - Esa Virtala
- National Institute for Health and Welfare; Helsinki; Finland
| | | | - Paul Knekt
- National Institute for Health and Welfare; Helsinki; Finland
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Nissen-Lie HA, Monsen JT, Ulleberg P, Rønnestad MH. Psychotherapists' self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychother Res 2013; 23:86-104. [DOI: 10.1080/10503307.2012.735775] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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