A multicentre study: Comparison of 3-LM group output and therapeutic outcome measures. Adding to the trustworthiness of the 3-LM? Part 2

This is the second report (part 2) of an investigation whose general objective was to provide evidence regarding the trustworthiness of the Three-Level Model (3-LM). Three groups of analysts from different IPA regions worked with this model on the same clinical case.

SPECIFIC OBJECTIVES

1) To analyze group output with the same structured qualitative methodology (part 1); 2) To compare the results of the 3-LM group output reported in the 3-LM forms with the process-outcome measures used in the clinical case (part 2); 3) To describe the presence-absence of anchor points in the groups, their similarities and differences (part 2); 4) To exemplify the interrelationship of the three levels of the 3-LM in relation to patient change and the analyst's interventions (part 2).

SAMPLE

verbatim transcript of three 3-LM groups.

MATERIALS

3-LM forms, process and outcome measures (APS, DIS and PHI-RADIO) and Operationalized Psychodynamic Diagnosis.

RESULTS

Objective 2 found global convergence in the PHI, DIS and APS scores across sessions. Objective 3 showed convergences and divergences in the themes relating to the anchor points. Objective 4 showed how an anchor point corresponds to the focus of treatment and how this is present in the analyst's attitudes and interventions.

DISCUSSION

The results offer preliminary support for the trustworthiness of the 3-LM.

The therapeutic effects of the therapists' ability to pass their patients' tests in psychotherapy

INTRODUCTION

According to Control-Mastery Theory (CMT)-a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy-patients come to therapy with an unconscious plan to disprove their pathogenic beliefs and achieve adaptive goals. One of the primary ways patients work to disconfirm their pathogenic beliefs is by testing them within the therapeutic relationship.

OBJECTIVES

The present study aimed to replicate and expand the results of previous studies suggesting that therapists' responses that disconfirmed patient's pathogenic beliefs were predictive of patients' within-session progress. Moreover, we wanted to investigate whether these interventions correlated with the therapeutic alliance.

METHODS

Transcriptions of 81 sessions from five brief psychodynamic psychotherapies were assessed by 11 independent raters. For each case, the patient's plan was formulated and tests identified, the accuracy of the therapist's responses to these tests was rated, and the impact of the therapist's interventions on the patient's subsequent communications and their relationship with the therapeutic alliance was measured.

RESULTS

The results supported the central hypothesis of the CMT that when the therapist's interventions passed the patient's tests, the patient showed signs of improvement. Moreover, the ability of the therapist to pass the patient's tests correlated with the therapeutic alliance.

CONCLUSIONS

The clinical implications and the limitations of these findings are discussed, together with the relevance of a good case formulation for clinicians' optimal responsiveness.

The MATRIX, a novel tool exploring dynamic psychotherapy: Preliminary psychometric properties

Most measures in the field of psychodynamic psychotherapy are bound to a specific theory, and usually focus only on patient processes or therapist interventions. The MATRIX is a newly developed research tool that focuses on events within both the patient and the therapist individually, as well as on dyadic events, and provides the simple and meaningful coding of content for therapy session transcripts in psychotherapy. The present study describes the inter-rater reliability and construct validity of the MATRIX. Reliability of the MATRIX was assessed by applying it to 805 fragments of psychodynamic-oriented psychotherapy sessions. Three independent experts coded fragments, and the tool was examined for reliability. Validity in identifying the theoretical inclinations was assessed by applying the MATRIX to 30 segments (containing 1309 fragments) of sessions that reflect different theoretical orientations. Findings evinced high inter-rater reliability for all dimensions. The MATRIX was found to have high degree of validity for differentiating the theoretical inclinations of segments of sessions. The MATRIX is a reliable and valid measure that may enable moment-to-moment, quantitative, analysis of psychodynamic psychotherapy.

Listening to a patient: An exploratory experimental investigation into the effects of vocalization and therapist gender on interpreting clinical material

Carefully listening to the patient is of paramount importance for psychoanalysis and psychoanalytic psychotherapy. The present study explored whether patient vocalization as well as the gender of the analyst play significant roles in clinical listening. Fifty-one psychoanalysts and psychoanalytic therapists were randomly assigned to listen to one of two dramatized psychoanalytic sessions. The content of the sessions was the same for both versions, but the sessions were dramatized differently. Some differences emerged between the versions, especially on ratings of reality testing, impulse control, pressured speech, patient was confusing, and awareness of imagery. Furthermore, differences emerged between male and female analysts in terms of ratings of intervention strategies and countertransference reactions to the patient material. Session version and gender affect different ratings. Implications of the findings are discussed as is the utility of using more ecologically valid material in conducting empirical research into clinical judgment.

Measuring Verbal Psychotherapeutic Techniques-A Systematic Review of Intervention Characteristics and Measures

Language is one of the most important “tools” of psychotherapists. The working mechanisms of verbal therapeutic techniques, however, are still marginally understood. In part, this is due to the lack of a generally acknowledged typology as well as a gold standard for the assessment of verbal techniques, which limits the possibility of conducting studies focusing this topic. The present study reviews measures used in clinical research which assess directly observable dimensions of verbal interventions in a reliable manner. All measures were evaluated with respect to their theoretical foundation, research goals, assessment modes, and various psychometric properties. A systematic search in databases (PubMed, PsycInfo, PsycArticles, PSYNDEX, Web of Science, Embase) followed by an additional “snowballing” search covering the years 1940–2013 yielded n = 179 publications eligible for review. Within these publications, 34 measures were identified showing great heterogeneity regarding the aspects under study. Only two measures reached the highest psychometric standards and can be recommended for clinical use without any reservation. Central problems include deficiencies in the systematization of techniques as well as their partly ambiguous and inconsistent definitions. To promote this field of research, it will be important to achieve a consensus concerning the terminology, conceptions and measures of verbal interventions.

Manual for Transference Work Scale; a micro-analytical tool for therapy process analyses

BACKGROUND

The present paper is a manual for the Transference Work Scale (TWS). The inter-rater agreement on the 26 TWS items was good to excellent and previously published. TWS is a therapy process rating scale focusing on Transference Work (TW) (i.e. analysis of the patient-therapist relationship). TW is considered a core active ingredient in dynamic psychotherapy. Adequate process scales are needed to identify and analyze in-session effects of therapist techniques in psychodynamic psychotherapy and empirically establish their links to outcome. TWS was constructed to identify and categorize relational (transference) interventions, and explore the in-session impact of analysis of the patient-therapist relationship (transference work). TWS has sub scales that rate timing, content, and valence of the transference interventions, as well as response from the patient.

METHODS

Descriptions and elaborations of the items in TWS are provided. Clinical examples of transference work from the First Experimental Study of Transference Interpretations (FEST) are included and followed by examples of how to rate transcripts from therapy sessions with TWS.

RESULTS

The present manual describes in detail the rating procedure when using Transference Work Scale. Ratings are illustrated with clinical examples from FEST.

CONCLUSION

TWS might be a potentially useful tool to explore the interaction of timing, category, and valence of transference work in predicting in-session patient response as well as treatment outcome. TWS might prove especially suitable for intensive case studies combining quantitative and narrative data.

TRIAL REGISTRY NAME

First Experimental Study of Transference-interpretations (FEST307/95).

REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT00423462. URL: http://clinicaltrials.gov/ct2/show/NCT00423462?term=FEST&rank=2.

Therapists' professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis

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.

The role of the couch in psychoanalysis: proposed research designs and some preliminary data

Ever since Freud, the couch has been viewed as an important--some would argue essential--component of psychoanalysis. Although many theoretical papers and case reports have addressed the use of the couch in psychoanalysis, no empirical study has investigated its effect on psychoanalytic process or outcome. After a review of the literature, a number of research designs are proposed that might be used in such an investigation. Finally, preliminary empirical data are presented from archived audiotapes of two psychoanalyses: one in which the patient switched from lying down to sitting up, and one in which the opposite occurred. The aim is to stimulate research-oriented psychoanalysts to undertake empirical investigations of the theoretical concepts underlying use of the couch and, more generally, to present a specific example of research as a paradigm for a broader research agenda for empirical investigation of the key theoretical ideas underlying psychoanalysis.

A view from Riggs--treatment resistance and patient authority: I. A psychodynamic perspective on treatment resistance

Treatment resistance has emerged as a significant issue in our era emphasizing biological treatments for psychiatric disorders. This article suggests that, particularly when Axis II disorders are part of the clinical presentation, a subset of treatment refractory patients responds to a psychodynamic treatment approach that includes careful attention to the meaning of treatment resistance, and to the importance of relationships and of patient authority in recovery. The importance of engaging the negative transference and countertransference in treatment is also emphasized. A case example is offered to illustrate the article's thesis.

Saying the right thing at the right time: a view through the lens of the analytic process scales (APS)

Skillful psychoanalytic technique presumably involves knowing what to say, and when and how to say it. Does skillful technique have a positive impact upon the patient? The study described in this article relied on ratings by experienced psychoanalysts using the Analytic Process Scales (APS), a research instrument for assessing recorded psychoanalyses, in order to examine analytic interventions and patient productivity (greater understanding, affective engagement in the analytic process, and so on). In three analytic cases, the authors found significant correlations between core analytic activities (e.g., interpretation of defenses, transference, and conflicts) and patient productivity immediately following the intervention, but only if it had been skillfully carried out. Findings were independently replicated by psychology interns.