| 1. |
- Barber, JP, et al.
(författare)
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The central relationship questionnaire: Initial report
- 1998
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Ingår i: JOURNAL OF COUNSELING PSYCHOLOGY. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 45:2, s. 131-142
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Falkenström, Fredrik, Professor, 1972-, et al.
(författare)
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Patient Attachment and Reflective Functioning as Predictors for Therapist In-Session Feelings
- 2024
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Ingår i: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 71:3, s. 190-201
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Tidskriftsartikel (refereegranskat)abstract
- Therapists' in-session feelings in psychotherapy can be seen as indications of the development of the therapeutic relationship and the therapeutic process. To manage them appropriately, it is important to know to what extent they may be influenced by patients' pretreatment characteristics. This study aims to improve the understanding of therapists' emotional reactions in the psychotherapeutic setting by investigating if patients' pretreatment mentalization ability and attachment style predicted therapist in-session feelings. In a sample of 87 therapy dyads treated with interpersonal psychotherapy and cognitive behavioral therapy for depression, patient attachment was measured using self-reported Experiences in Close Relationships (ECR) and mentalization using Reflective Functioning (RF). ECR and RF were hypothesized to predict therapist feelings measured by the Feeling Word Checklist-24 at different treatment phases over the full course of treatment. Treatment method, patient age, gender, and pretreatment depression were evaluated as potential confounders. Multilevel modeling was used to analyze the data. Lower RF in patients predicted more negative therapist feelings in the mid- to late-treatment phases and less positive feelings in the late-treatment phase. Self-reported attachment anxiety or avoidance did not predict therapist feelings. Findings indicate that patients' ability to mentalize is important to consider when conducting psychotherapy, as it can influence therapists' feelings in the therapeutic process. Limitations of the present study's approach are discussed, and directions for future research are considered.
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| 3. |
- Falkenström, Fredrik, et al.
(författare)
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Therapeutic Alliance Predicts Symptomatic Improvement Session by Session
- 2013
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Ingår i: Journal of counseling psychology. - : American Psychological Association. - 0022-0167 .- 1939-2168. ; 60:3, s. 317-328
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Tidskriftsartikel (refereegranskat)abstract
- The therapeutic alliance has been found to predict psychotherapy outcome in numerous studies. However, critics maintain that the therapeutic alliance is a by-product of prior symptomatic improvements. Moreover, almost all alliance research to date has used differences between patients in alliance as predictor of outcome, and results of such analyses do not necessarily mean that improving the alliance with a given patient will improve outcome (i.e., a within-patient effect). In a sample of 646 patients (76% women, 24% men) in primary care psychotherapy, the effect of working alliance on next session symptom level was analyzed using multilevel models. The Clinical Outcomes in Routine Evaluation–Outcome Measure was used to measure symptom level, and the patient version of the Working Alliance Inventory–Short form revised (Hatcher & Gillaspy, 2006) was used to measure alliance. There was evidence for a reciprocal causal model, in which the alliance predicted subsequent change in symptoms while prior symptom change also affected the alliance. The alliance effect varied considerably between patients. This variation was partially explained by patients with personality problems showing stronger alliance effect. These results indicate that the alliance is not just a by-product of prior symptomatic improvements, even though improvement in symptoms is likely to enhance the alliance. Results also point to the importance of therapists paying attention to ruptures and repair of the therapy alliance. Generalization of results may be limited to relatively brief primary care psychotherapy.
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| 4. |
- Halstensen, Kari, et al.
(författare)
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Depression and Mentalizing : A Psychodynamic Therapy Process Study
- 2021
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Ingår i: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 68:6, s. 705-718
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Tidskriftsartikel (refereegranskat)abstract
- The present study aimed to explore the relationship between changes in depressive symptoms and the capacity to mentalize over the course of a 3-month inpatient psychodynamic therapy in a sample of 56 patients with depression. Depressive symptoms and mentalizing were assessed weekly during treatment and at 1-year follow-up with the Beck Depression Inventory and the Reflective Functioning Questionnaire (RFQ). Data were analyzed using Latent Growth Curve (LGC) modeling with structured residuals. In the total sample, depressive symptoms improved on average from baseline to the end of treatment, while mentalizing skills did not. However, individual variations were observed in mentalizing skills, with some patients improving while others did not. Within-patient residual changes in mentalizing skills did not predict residual changes in depressive symptoms. Accordingly, the results did not support mentalizing as a mechanism of change at this level. Nonetheless, between-patient effects were found, showing that patients with higher levels of mentalizing at baseline and patients whose mentalizing skills improved over the course of therapy also had greater reductions in depressive symptoms. We suggest that the presence of relatively higher mentalizing skills might be a factor contributing to moderately depressed individuals' ability to benefit from treatment, while relatively poor or absent mentalizing capacity might be part of the dynamics underlying treatment resistance in individuals with severe depression.
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| 5. |
- Lilliengren, Peter, et al.
(författare)
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Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults
- 2015
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Ingår i: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 62:1, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning whereas the alliance predicted deterioration when both variables were modeled together. While limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of post-treatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.
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| 6. |
- Nissen-Lie, Helene A., et al.
(författare)
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Are Therapists Uniformly Effective Across Patient Outcome Domains? A Study on Therapist Effectiveness in Two Different Treatment Contexts
- 2016
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Ingår i: Journal of counseling psychology. - : AMER PSYCHOLOGICAL ASSOC. - 0022-0167 .- 1939-2168. ; 63:4, s. 367-378
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Tidskriftsartikel (refereegranskat)abstract
- As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patients change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct.
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| 7. |
- Sun, Qiwu, et al.
(författare)
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Separating the effects of alliance ruptures and improvements on outcome session-by-session using the asymmetric fixed-effect model
- 2021
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Ingår i: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 68:6, s. 696-704
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this paper was to introduce the Asymmetric Fixed Effects model to psychotherapy mechanisms of change researchers as a novel way of studying the effects of improvements and deteriorations in the candidate mechanism(s) separately. Alliance-outcome research was used to illustrate the possibility of estimating separate effects of improvements and deteriorations in the allianceMethod: Two archival datasets were used. One was from community-based primary care services in Sweden using theClinical Outcomes in Routine Evaluation — Outcome Measure (CORE-OM) and the Working Alliance Inventory—Short form (WAI-S, therapist form) each session with 1096 patients. The other dataset was from a university counseling center in China using the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS) each session with 292 patients. Data was analyzed using the asymmetric fixed-effects model.Results: The findings indicated that with raw scores, improvements in alliance from one session to the next were followed by lower symptoms/distress scores by the next session, but alliance deteriorations had no effect on next-session symptoms/distress. With alliance deteriorations and improvements defined relative to the sample’s average linear change over time, improvements and deteriorations had equal but opposite effects on next session symptom level.Conclusion: Findings confirm the utility of the Asymmetric Fixed Effect model across two cross-national samples in showing that alliance deteriorations and improvements can predict next session symptoms separately at the within-person level. Findings raise new questions regarding the use of detrending in within-patient mechanism of change studies.
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| 8. |
- Sun, Qiwu, et al.
(författare)
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Separating the Effects of Improvements and Deteriorations in Mechanisms on Outcome Using the Asymmetric Effects Model
- 2021
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Ingår i: Journal of counseling psychology. - : AMER PSYCHOLOGICAL ASSOC. - 0022-0167 .- 1939-2168. ; 68:6, s. 696-704
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this article was to introduce the Asymmetric Fixed Effects (AFE) model to psychotherapy mechanisms of change researchers as a novel way of studying the effects of improvements and deteriorations in the candidate mechanism(s) separately. Alliance-outcome research was used to illustrate the possibility of estimating separate effects of improvements and deteriorations in the alliance. Method: Two archival data sets were used. One was from community-based primary care services in Sweden using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and the Working Alliance Inventory-Short form (WAI-S, therapist form) each session with 1,096 patients. The other data set was from a university counseling center in China using the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS) each session with 292 patients. Data were analyzed using the AFE model. Results: The findings indicated that with raw scores, improvements in alliance from one session to the next were followed by lower symptoms/distress scores by the next session, but alliance deteriorations had no effect on next-session symptoms/distress. With alliance deteriorations and improvements defined relative to the samples average linear change over time, improvements, and deteriorations had equal but opposite effects on next session symptom level. Conclusions: Findings confirm the utility of the Asymmetric Fixed Effect model across two cross-national samples in showing that alliance deteriorations and improvements can predict next session symptoms separately at the within-person level. Findings raise new questions regarding the use of detrending in within-patient mechanism of change studies.
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| 9. |
- Town, Joel M., et al.
(författare)
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The Anger-Depression Mechanism in Dynamic Therapy: Experiencing Previously Avoided Anger Positively Predicts Reduction in Depression via Working Alliance and Insight
- 2022
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Ingår i: Journal of counseling psychology. - : AMER PSYCHOLOGICAL ASSOC. - 0022-0167 .- 1939-2168. ; 69:3, s. 326-336
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Tidskriftsartikel (refereegranskat)abstract
- A central tenet of psychodynamic theory of depression is the role of avoided anger. However empirical research has not yet addressed the question of for which patients and via what pathways experiencing anger in sessions can help. The therapeutic alliance and acquisition of patient insight are important change processes in dynamic therapy and may mediate the anger-depression association. This study was embedded into a randomized trial testing the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for treatment resistant depression. In-session patient affect experiencing (AE) was coded for every available session (475/481) by blinded observers in 27 patients randomized to ISTDP. Dynamic Structural Equation Modeling was used to examine within-person associations between variation in depression scores session-by-session and both patient ratings (alliance) and observer ratings (AE and insight) of the treatment process. Alliance and insight were independent mediators of the effect of anger on next-session depression. However, the relative importance of these two indirect effects of anger on depression was conditional on pretreatment patient personality pathology (PP). In patients with higher PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through higher alliance. In patients with low PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through enhanced patient insight. These findings highlight an anger-depression mechanism of change in dynamic therapy. Depending upon patient personality, either an "insight pathway" or a "relational pathway" may promote the effectiveness of facilitating arousal and expression of patients insession feelings.
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| 10. |
- Uckelstam, Carl-Johan, et al.
(författare)
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Prediction of Treatment Outcome in Psychotherapy by Patient Initial Symptom Distress Profiles
- 2019
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Ingår i: Journal of counseling psychology. - : American Psychological Association (APA). - 0022-0167 .- 1939-2168. ; 66:6, s. 736-746
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Tidskriftsartikel (refereegranskat)abstract
- Understanding how different groups of patients change at different rates is important for treatment selection, planning and evaluation. This study aimed to assess whether an approach to classifying patients on the basis of initial symptom distress profiles (ISDPs) derived from a self-rated questionnaire measuring psychological distress may be useful in predicting treatment response. The Clinical Outcome in Routine Evaluation-Outcome Measure were collected from 1,095 first line mental health service patients (M [SD] age = 37.3 [14.3] years; 74% female) prior to every session. Latent profile analysis was performed on the questionnaires from the first session to classify participants into subtypes, which were then used to predict change rates. The best-fitting model identified 4 ISDP subtypes with significantly different treatment responses. Profile 1 predicted very slow change rate and indicated low initial distress coupled with low deviations among problem areas. Profile 2 predicted slow change rate with average initial distress and low emphasis on questions relating to risk of harming oneself and/or others. Profile 3 predicted fast improvement rate and showed high initial distress combined with low emphasis on the risk area. Profile 4 predicted moderate change rate and displayed very high initial distress accompanied with more emphasis on the risk area. Findings support the potential utility of ISDP subtypes to predict treatment response, suggesting that intake data that is easily collected by the clinician contain reliable information about treatment prognosis. The study is exploratory and needs to be replicated before stable conclusions can be drawn.
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