Faculty Bibliography

The authors examined the relations among therapeutic alliance, outcome, and early-in-treatment symptomatic improvement in a group of 86 patients with generalized anxiety disorders, chronic depression, or avoidant or obsessive-compulsive personality disorder who received supportive-expressive dynamic psychotherapy. Although alliance at Sessions 5 and 10, but not at Session 2, was associated with prior change in depression, alliance at all sessions significantly predicted subsequent change in depression when prior change in depression was partialed out. The results are discussed in terms of the causal role of the alliance in therapeutic outcome.

The authors examined frequency and patterns of self-help group attendance and active participation over a 6-month period among 411 patients receiving treatment in the NIDA Collaborative Cocaine Treatment Study. Nearly two-thirds of patients attended at least one self-help group, and nearly all of these actively participated. Alcoholics Anonymous and Narcotics Anonymous meetings were attended most frequently. Statistical analyses included chi square, one-way analyses of variance, and cluster techniques. While patterns of attendance were relatively consistent over time, findings suggest that a treatment emphasizing the importance of self-help groups is likely to encourage more self-help group attendance and participation over time.

The construct of transference has been central to theories of dynamic psychotherapy. This investigation evaluated the similarity between patients' interpersonal themes, derived from pretreatment interpersonal interviews, and the theme evident in psychotherapy narratives about the therapist for 18 patients (mean age 38 yrs) treated in supportive-expressive psychotherapy for major depression. This investigation was designed to sort out the potential confound of the therapist's influence on the report of interpersonal themes and to explore how transference might vary over the course of therapy. The results indicated that 33% of patients demonstrated a significant relation between the most pervasive theme evident from the pretreatment narratives and the narratives about the therapist. These results remained consistent when early and late session therapist narratives were evaluated separately. Further, patients rated with higher quality of interpersonal relationships and lower symptoms prior to treatment demonstrated greater similarity between their pretreatment interpersonal themes and the theme described in the therapeutic relationship.

Examined the relation between core interpersonal patterns measured by the Core Conflictual Relationship Theme (CCRT) method and psychopathology in 55 27-53 yr old patients selected for long-term dynamic psychotherapy. Psychopathology was assessed by the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R), symptom self-report, and the Karolinska Psychodynamic Profile (KAPP). Patients with different DSM-III-R diagnoses did not differ in their CCRTs abstracted from the Relationship Anecdote Paradigm interview. Furthermore, lack of flexibility (pervasiveness) in the use of different CCRT components was not associated with psychiatric symptoms. Only one significant correlation between character pathology and the CCRT was found: problems concerning the patients' experience of social significance were associated with more negative responses of the other. Limitations of the CCRT method and the sample used are discussed.

The present study examined the extent to which individuals' central relationship patterns, specifically their desires or wishes, their perceptions of others' responses to them, and their own responses to both of these, vary across different types of significant others in a non-patient sample. Fifty undergraduates (21 females, 29 males with a mean age of 21 years) were asked to complete a measure of central relationship patterns separately for their mothers, fathers, same-sex friends, and romantic partners. Analyses suggested that participants made differentiations among significant others, particularly romantic partner, and at the same ti me, provided considerable consistency in their central relationship patterns across differ ent types of significant others. Contrary to expectations, greater consistency across the four relationships was related to fewer interpersonal difficulties.

Change in self-understanding of maladaptive interpersonal patterns has been an important mechanism of symptom change in theories of dynamic psychotherapy and has been specified as an important treatment outcome by psychotherapy clients. The current investigation evaluated the reliability and validity of a new self-report measure of Self-Understanding of Interpersonal patterns (SUIP). The measure was administered to 3 clinical samples and a student sample. The measure demonstrated good internal consistency, test-retest reliability, and discriminant validity. The SUIP further demonstrated convergent validity with measures of analytical and self-improving personality traits in a clinical sample. Finally there was significantly greater change in self-understanding in a dynamic psychotherapy as compared with a medication treatment condition, despite comparable symptom change across both treatment conditions.

BACKGROUND: This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients. METHODS: Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Patients were assessed monthly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index-Drug Use Composite score and the number of days of cocaine use in the past month. RESULTS: Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index-Drug Use Composite score. Individual group counseling plus GDC was also superior to the 2 psychotherapies on the number of days of cocaine use in the past month. Hypotheses regarding the superiority of psychotherapy to GDC for patients with greater psychiatric severity and the superiority of cognitive therapy plus GDC compared with supportive-expressive therapy plus GDC for patients with antisocial personality traits or external coping style were not confirmed. CONCLUSION: Compared with professional psychotherapy, a manual-guided combination of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence.

This paper attempts to examine and compare prevalence rates and symptom patterns of DSM substance-induced and other mood disorders. 243 cocaine-dependent outpatients with cocaine-induced mood disorder (CIMD), other mood disorders, or no mood disorder were compared on measures of psychiatric symptoms. The prevalence rate for CIMD was 12% at baseline. Introduction of the DSM-IV diagnosis of CIMD did not substantially affect rates of the other depressive disorders. Patients with CIMD had symptom severity levels between those of patients with and without a mood disorder. These findings suggest some validity for the new DSM-IV diagnosis of CIMD, but also suggest that it requires further specification and replication.

Transference interpretations have been considered an important technique in models of short-term dynamic psychotherapy. This article explored the role of transference interpretations in the early sessions of 29 patients (mean age 37 yrs) treated with Supportive-Expressive (SE) psychotherapy for depression. Hierarchical multiple regressions were used to evaluate the relationship between proportion of transference interpretations and treatment outcome measured across levels of quality of interpersonal relationships. High levels of transference interpretations were significantly associated with poor treatment outcome for patients with poor interpersonal functioning. The results suggest that transference interpretations should be used sparingly in the early sessions of SE psychotherapy with patients who demonstrate a poor quality of interpersonal relationships prior to treatment.