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Journal: Psychotherapy (Chicago, Ill.)

27

Mentalizing-the capacity to understand others' and one’s own behavior in terms of mental states-is a defining human social and psychological achievement. It involves a complex and demanding spectrum of capacities that are susceptible to different strengths, weakness, and failings; personality disorders are often associated with severe and consistent mentalizing difficulties (Fonagy & Bateman, 2008). In this article, we will argue for the role of mentalizing in the therapeutic relationship, suggesting that although mentalization-based treatment may be a specific and particular form of practice, the “mentalizing therapist” is a universal constituent of effective psychotherapeutic interventions. (PsycINFO Database Record © 2014 APA, all rights reserved).

Concepts: Psychology, Therapy, Clinical psychology, Psychiatry, Psychotherapy, All rights reserved, Psychoanalysis, Carl Jung

27

Yalom and Leszcz (2005) indicated that interpersonal learning is a key therapeutic factor in group psychotherapy. In this study, we conceptualized interpersonal learning as the convergence over time between an individual’s and the group’s perception of the individual’s cohesion to the group. First, we developed parallel measures of: (a) an individual’s self-rated cohesion to the group (Cohesion Questionnaire-Individual Version [CQ-I]), and (b) the group’s rating of the individual’s cohesion to the group (CQ-G) based on the original Cohesion Questionnaire (CQ; Piper, Marache, Lacroix, Richardsen, & Jones, 1983). Second, we used these parallel scales to assess differences between an individual’s self-rating and the mean of the group’s ratings of the individual’s cohesion to the group. Women with binge eating disorder (N = 102) received Group Psychodynamic Interpersonal Psychotherapy. Participants were assigned to homogeneously composed groups of either high or low attachment anxiety. Outcomes were measured pre- and post-treatment, and the CQ-I and CQ-G were administered every fourth group session. We found significant convergence over time between the CQ-I and mean CQ-G scale scores in both attachment anxiety conditions. Participants with higher attachment anxiety had lower individual self-ratings of cohesion and had greater discrepancies between the CQ-I and CG-G compared with those with lower attachment anxiety. There was a significant relationship between greater convergence in cohesion ratings and improved self-esteem at post-treatment. More accurate self-perceptions through feedback from group members may be a key factor in facilitating increased self-esteem in group therapy. Group therapists may facilitate such interpersonal learning, especially for those higher in attachment anxiety, by noting discrepancies and then encouraging convergence between an individual and the group in their perceptions of cohesion to the group. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: Psychology, Eating disorders, Attachment theory, Bulimia nervosa, Family therapy, Binge eating disorder, Psychodynamic psychotherapy, Drama therapy

2

An interpersonal model of Binge Eating Disorder (BED) posits that difficulties with social functioning precipitate negative affect, which in turn causes binge eating as a means of coping. Thus, long-term decreases in attachment insecurity may be important for women with BED. No research has assessed if long-term change in attachment insecurity is associated with sustained change in other outcomes. In the current study, we hypothesized that changes in attachment anxiety and avoidance will decrease at posttreatment and will be maintained up to 12 months after Group Psychodynamic Interpersonal Psychotherapy (GPIP). We further hypothesized that long-term stability of these changes in attachment insecurity will be related to other long-term outcomes. Women with BED (N = 102) attended 16 sessions of GPIP. Measures were completed pretreatment, posttreatment, at 6 and 12 months follow-up. Attachment anxiety, attachment avoidance, and the other outcome variables decreased significantly at 12 months posttreatment. Reductions in attachment anxiety and avoidance were significantly related to decreases in interpersonal problems up to 12 months posttreatment, and reduction in attachment anxiety was significantly related to decreases in depressive symptoms 12 months posttreatment. Further, the significant relationship between reduced attachment avoidance and decreased interpersonal problems strengthened over the long term. This is the first study to show an association between change in attachment insecurity and change in other outcomes in the long term, and to show an adaptive spiral in which greater reduction in attachment avoidance is increasingly associated with ongoing improvement of interpersonal problems. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: Time, Psychology, Eating disorders, Term, Attachment theory, Bulimia nervosa, Binge eating disorder, Attachment measures

2

The subject of therapist’s crying in therapy (TCIT) has been virtually ignored in the literature, with only 1 qualitative dissertation and 3 case studies devoted to the topic. This mixed-method survey study explored therapists' experiences with and attitude toward TCIT. Six hundred eighty-four U.S. psychologists and trainees filled out the survey online, revealing that 72% of therapists report having cried in therapy in their role as therapist. Data analysis indicated that the act of crying in therapy has less to do with personality or demographic factors (i.e., Big Five traits, sex, empathy) and more to do with the unique aspects of the therapy itself and the therapist’s identity in the therapeutic context (theoretical orientation, clinical experience, affective tone of the session). Clinicians with more experience, who are older, cried more in therapy than novice clinicians, despite lower crying frequency in daily life, suggesting that more experienced therapists feel more comfortable allowing themselves to experience and/or express such emotions in therapy sessions. Psychodynamic therapists reported slightly higher rates of TCIT than cognitive-behavioral therapists despite no difference in crying in daily life. Despite significant differences in crying rates in daily life, male and female clinicians report similar rates of TCIT. Data regarding the relationship between TCIT and Big Five personality traits, empathy, and perceived consequences of TCIT are reported. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: Psychology, Therapy, Clinical psychology, Cognitive behavioral therapy, Psychotherapy, Emotion, Big Five personality traits, Psychodynamic psychotherapy

1

What do patients prefer in their psychotherapy? Do laypersons and mental health professionals (as patients) want the same, or different, things? The authors systematically examined patients' psychotherapy preferences and quantitatively compared two samples of laypersons (N = 228, 1,305) with one sample of mental health professionals (N = 615) on the four dimensions of the Cooper-Norcross Inventory of Preferences: Therapist Directiveness Versus Client Directiveness, Emotional Intensity Versus Emotional Reserve, Past Orientation Versus Present Orientation, and Warm Support Versus Focused Challenge. On average, laypersons wanted therapist directiveness and emotional intensity. Robust differences were found between laypersons' and professionals' preferences on these two dimensions: Mental health professionals wanted less therapist directiveness than did laypersons (gs = 0.92 and 1.43 between groups) and more emotional intensity (gs = 0.49 and 1.33). Women also wanted more warm support than men (gs = 0.40 and 0.57). These findings suggest that psychotherapists should be mindful of their own treatment preferences and ensure that these are not inappropriately generalized to patients. (PsycINFO Database Record © 2019 APA, all rights reserved).

1

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. (PsycINFO Database Record

1

Parenting after pregnancy loss is often complicated for people who have not effectively grieved the loss and worked through the trauma. Reproductive losses can trigger shame and self-doubt, damage the sense of self-as-parent, and inflict narcissistic injuries, which, in turn, may impede the resolution of grief. If not addressed, these unresolved feelings may be projected onto subsequent children, potentially disrupting attachment relationships and the child’s sense of self. The reproductive story, a lifelong internal narrative that comprises the thoughts, feelings, and hopes about how parenting and adulthood will unfold, and forms the core of parental identity, can be used as a tool in helping parents understand the depth of their feelings, integrate current and past losses into the self, and resolve grief. The authors discuss 3 crucial aspects of intervention with parents who have had pregnancy losses, aimed both at healing the parents themselves and at protecting attachment relationships with subsequent children: (a) initially staying present-focused and engaging with the painful details of the loss experience, to normalize and validate the patient’s grief and trauma, counteract shame, and begin repairing narcissistic injuries; (b) eliciting the reproductive story to identify and integrate past losses, and in its revision, to allow for hope and repair; and © attending to both acknowledged and denied grief. The challenges and satisfactions of working with this population and potential countertransference reactions are also discussed. (PsycINFO Database Record

Concepts: Pregnancy, Parent, English-language films, Mother, Identity, Self

1

In this study, we sought to compare racial/ethnic minority participants' preference for racial/ethnic matching in psychotherapy with preferences for other methods of addressing cultural factors in treatment. Using a delay-discounting method, college students (331 racial/ethnic minority students from 2 universities) and a nationwide sample of self-reported clients (n = 77) were asked to indicate their strength of preference for 4 different methods for addressing culturally related variables in psychotherapy, including a desire to (a) work with a therapist whose race/ethnicity matches their own, (b) work with a therapist with a high level of multicultural training and experience, © receive a culturally adapted treatment, and (d) receive a therapist who is also a member of a racial/ethnic minority group, but not the same as the participant (i.e., a racial/ethnic minority pairing). We found that participants were willing to make significant sacrifices in treatment efficacy in order to receive each of the variables tested. In both samples, preferences were significantly stronger for therapist multicultural training/experience and use of culturally adapted treatments compared with racial/ethnic matching and racial/ethnic minority pairing. Further analyses indicated that clients expressed stronger preferences for racial/ethnic match and minority pairing than college student participants, and preference strength for 3 of the 4 scenarios was significantly related to strength of minority culture identification. The results of this study have important implications for preference accommodation in psychotherapy with racial/ethnic minority individuals. (PsycINFO Database Record

Concepts: Sociology, Culture, University, Minority, Student, Match

1

Laypeople and psychotherapists alike tend to assume that psychotherapists are more effective than the average population in regulating negative emotions. Being receptive to patients' distress and being able to downregulate negative emotions are important skills for psychotherapists to provide effective help and sustain their own well-being. We investigated whether psychotherapists react to negative material differently and downregulate emotions more effectively than individuals working in other, nontherapeutic, professions. Practicing psychotherapists (n = 21) and a control group of nontherapists (n = 18) were exposed to pictures designed to elicit negative emotions in varying intensities and were asked to rate their emotional response, first after viewing them naturally and then after choosing and applying one of two given regulation strategies (i.e., distraction and reappraisal). Both groups responded similarly in terms of emotional reactivity and strategy choices, but psychotherapists were more effective than nontherapists in reducing their emotional response after applying emotion regulation strategies. We suggest that psychotherapists' comparable emotional reactivity and more effective emotion regulation make them well prepared to provide effective help to patients and safeguard their own well-being. (PsycINFO Database Record

Concepts: Psychology, Psychiatry, Emotion

1

For many years, there have been heated debates about the best way to evaluate the efficacy and effectiveness of psychological therapies. On the one hand, there are those who argue that the randomized controlled trial (RCT) is the only reliable and scientifically credible way to assess psychological interventions. On the other hand, there are those who have argued that psychological therapies cannot be meaningfully assessed using a methodology developed to evaluate the impact of drug treatments, and that the findings of RCTs lack “external validity” and are difficult to translate into routine clinical practice. In this article, we advocate the use of mixed-method research designs for RCTs, combining the rigor of quantitative data about patterns of change with the phenomenological contextualized insights that can be derived from qualitative data. We argue that such an approach is especially important if we wish to understand more fully the impact of therapeutic interventions within complex clinical settings. To illustrate the value of a mixed-method approach, we describe a study currently underway in the United Kingdom, in which a qualitative study (IMPACT-My Experience [IMPACT-ME]) has been “nested” within an RCT (the Improving Mood With Psychoanalytic and Cognitive Behavioral Therapy [IMPACT] study) designed to evaluate the effectiveness of psychological therapies in the treatment of adolescent depression. We argue that such a mixed-methods approach can help us to evaluate the effectiveness of psychological therapies and support the real-world implementation of our findings within increasingly complex and multidisciplinary clinical contexts. (PsycINFO Database Record © 2013 APA, all rights reserved).

Concepts: Psychology, Clinical trial, Randomized controlled trial, Educational psychology, Qualitative research, Cognitive behavioral therapy, Psychotherapy, Quantitative research