Faculty Bibliography

The California Therapeutic Alliance Rating System, CALTARS, was used by judges to rate four therapy sessions for each of 52 subjects treated in brief dynamic psychotherapy for pathological grief. A principal-components analysis provided support for the theoretically proposed domains of alliance. The interrater reliability at the treatment level was satisfactory for the five component-based scales. As hypothesized, scores reflecting positive contribution to the alliance were positively related to educational attainment, motivation for psychotherapy, pretreatment interpersonal functioning, patient experiencing in therapy, symptom improvement, and gains in interpersonal functioning but negatively associated with stressful life events and greater therapist emphasis on addressing patient resistances. As further hypothesized, scores reflecting negative contribution to the alliance were positively associated with greater therapist emphasis on addressing resistances. Alliance ratings were largely independent of pretreatment symptomatology. These findings build toward the construct validity of the CALTARS.

Sixty-one women who sought treatment for unresolved grief reactions 4 months to 3 years after the death of their husbands were randomly assigned to either brief dynamic psychotherapy with experienced clinicians or mutual-help group treatment led by nonclinicians. Women in both groups experienced a reduction in stress-specific and general symptoms as well as improvement in social and work functioning. Women in the brief psychotherapy group showed a greater decline in one measure of general symptoms, and there was greater attrition in the group treatment condition. When two subgroups who had completed the majority of sessions were compared, treatments were found to be equally effective

Discusses modifications of brief dynamic therapy for persons with transient narcissistic regression following traumatic life experiences. The approach described stresses initial supportive work to be followed by exploration of warded-off conflicts involving greater self-critical awareness on the part of the patient. Implications of this sequential strategy for the formation of the therapeutic alliance, the choice and working through of a problem focus, and the handling of termination, are illustrated through the case of a 34-yr-old male who experienced posttraumatic stress disorder (PTSD) following an assault.

52 Ss who had experienced the death of a parent or husband underwent 12 weekly psychotherapy sessions with 9 therapists. 208 sessions were rated. Compared were (a) ratings made from audiotapes vs videotapes; (b) ratings made from sessions 2, 5, 8, or 11; (c) ratings made from the 1st half vs ratings made from the whole session; (d) ratings made using a global response format vs a tally method of making judgments; and (e) ratings of therapist actions vs patient actions. Results indicate that small but significant differences in conclusions about process studies may emerge due to the operations of the conduct of the study and that these differences may have little relationship to the constructs being measured or their construct validity network.

This report provides data on symptom levels by using group means as well as categories of clinical relevance as they change over the course of treatment and also examines change 'beyond symptoms' as levels of adaptive functioning. This approach allows a more comprehensive analysis of change in a series of patients with pathological grief reactions treated with brief dynamic psychotherapy. The different perspectives on outcome of the patient, the evaluating clinician, the treating clinician, and independent judges are compared. The findings from all perspectives indicate that major symptom relief occurred in the majority of patients, with less change in adaptive abilities

Discusses difficulties involved in the use of the term splitting and examines the phenomenon, using configurational analysis (CA) to study moments in the verbatim transcript of brief psychotherapy with a 32-yr-old female borderline patient treated for posttraumatic stress disorder. Findings support the conception of splitting as an active process by which the S wards off anxiety associated with realistic integrated images of the self and others. It is concluded that the application of CA to the transcript materials helped clarify the concept of splitting. (25 ref)