Faculty Bibliography

The Recovery Attitude and Treatment Evaluator-Research (RAATE-R) scale is a structured interview that assesses readiness for substance abuse treatment in five subscales: resistance to treatment, resistance to continuing care, bio-medical acuity, psychological acuity, and environmental/ social problems. Psychometric properties, based on an interrater reliability analysis of 23 raters and administration of the scale to 116 cocaine-dependent outpatients, included high interrater reliability, high internal consistency, independence of subscales, and a factor structure that partially supports the scale's original design. The authors discuss limitations of these conclusions and the lack of concurrent validity with a self-report measure of therapy readiness.

Reviews the book, Models of brief psychodynamic therapy by Stanley B. Messer and C. Seth Warren (see record 1995-98730-000), stating that the book organizes the prevailing models of brief psychodynamic therapy (BPT) into a clear and easily comprehended framework. The opening chapter sets the stage for the remainder of the book through a general overview of the current and historical contexts in which brief psychodynamic therapies have been performed and developed. Current views of brief psychotherapy are reviewed from the perspectives of the patient, the therapist, and managed care. This is followed by a review of the historical background of BPT, in which credit is given to Freud, Rank, Ferenczi, Alexander, and Reich for their relevant technical and theoretical contributions. Next, the authors survey some of the research relevant to BPT. The chapter concludes with a comprehensive discussion on the learning and teaching of BPT. Once this groundwork is laid, the authors delve into a discussion of the major models of BPT currently practiced and researched. The authors group the BPTs along theoretical lines.

Examined the relationship between Affiliative Trust-Mistrust, an object-relations measure, and several quantitative immune measures in a sample of 27 depressed adults (aged 22-60 yrs) in short-term psychodynamic psychotherapy. Individuals with high Trust-Mistrust scores believe that they will be treated well by people with whom they are involved, whereas those with low scores expect to be abandoned, disappointed, or deceived. Ss with higher Trust-Mistrust scores at baseline had significantly higher natural killer (NK) cell percents at baseline, treatment termination, and a follow-up 6-mo later. However, Trust-Mistrust was not associated with depression scores or 4 other immune measures that were examined. Trust-Mistrust did not moderate response to therapy in terms of changes in depression or immunity, although Trust-Mistrust did moderate the relationship between changes in depression and changes in NK percents during therapy. The magnitude of the relationship between Trust-Mistrust and NK cells was not diminished when other potentially confounding variables were controlled.

This article presents the development of a new 82-item rating scale of therapist adherence and competence for supportive-expressive (SE) dynamic psychotherapy for the treatment of cocaine dependence. Sixty-four items are rated for adherence, appropriateness, and quality of prescribed interventions. As part of the pilot/training phase of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, two independent expert judges rated 32 audiotapes of SE therapy sessions with cocaine-dependent patients, 10 tapes of cognitive therapy (CT) sessions, and 10 tapes of individual drug counseling (IDC) sessions. Reliability was acceptable for adherence but poor for quality and appropriateness. SE therapists used more expressive (interpretative) techniques than did either CT therapists or IDC counselors, and they used more supportive techniques than did IDC counselors.

This paper reports on the development of a 43 item rating scale that assesses therapist adherence and competence in individual drug counseling (IDC) for the treatment of cocaine dependence. Three independent judges rated 41 audiotaped IDC sessions from the pilot/training phase of the NIDA collaborative cocaine study. Judges also rated 11 tapes of Cognitive sessions and ten tapes of Supportive Expressive psychodynamic sessions. Interjudge reliability for the total scale score and subscales ranged from 0.55 to 0.89 and internal consistency coefficients ranged from 0.43 to 0.95. Ratings indicated that IDC counselors used IDC techniques more frequently and competently than did therapists from other modalities.

This paper reports on the prevalence and the pretreatment psychiatric, drug use, and demographic correlates of DSM-III-R personality disorders (PD) in a sample of 289 cocaine dependent outpatients accepted into the pilot phase of a randomized, multisite, clinical trial comparing different psychotherapy and drug counseling treatment modalities. Diagnoses were established using the SCID, administered to patients after a brief drug free period by highly experienced evaluators. Results showed that 48% of the patients had at least one PD and 18% had two or more. Of those with a PD, 65% had a Cluster B disorder with antisocial (APD) and borderline (BPD) PD being the most common, Men were significantly more likely to be diagnosed with APD than women, but no other gender differences were found, Patients with PDs were significantly more likely to receive another Axis 1 diagnosis and to have more severe psychiatric symptoms than patients without PDs. However, the groups did not differ on other measures of drug use severity or demographic variables, Additional subgroup analyses showed that patients with comorbid BPD had the highest level of depression, and patients who had both APD and BPD were more functionally impaired than patients with no PD. While the prognostic significance of these findings remains unclear, the results suggest that personality disorders are apt to play an important role in the treatment of cocaine dependence, and should be incorporated into the development of future treatments and research studies.

This article examines the hypothesis that cognitive therapy (CT) is more effective than interpersonal therapy (IPT) for treatment of depressed patients with an elevated level of avoidant personality, whereas the reverse holds for depressed patients with elevated level of obsessive personality. This hypothesis was derived in part from the preliminary results of previous unpublished pilot work, which examined the course of dynamic and cognitive therapies for avoidant and obsessive-compulsive personality disorders. With the "completer" data set available from the Treatment for Depression Collaborative Research Program (I. Elkin et al., 1989), the expected significant interactions between treatment (CT vs. IPT) and avoidance and between treatment and obsessiveness were found. A significant interaction was also found between marital status and treatment, indicating that married patients did better after CT, whereas single and noncohabiting patients improved more after IPT. Similar patterns of results were found using the Hamilton Rating Scale for Depression and the Beck Depression Inventory. A matching factor formula of patients to CT vs. IPT is presented.

The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. Twenty-nine depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression. Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results.

Presents results of several meta-analytic reviews summarizing findings concerning the efficacy of short-term dynamic psychotherapy (STDP), as well as a brief review of recent findings concerning the process of change in STDP. Empirical research on STDP has been relatively fruitful in the past year. The prevailing belief continues to be that, with certain provisos, STDP is as effective as CT. Future important areas of research include comparing the efficacy of STDP with other forms of treatment for patients with personality disorders.

This paper reports on the development of the Penn Adherence/Competence Scale for Supportive-Expressive (SE) Dynamic Psychotherapy. The rating scale includes 45 items which are rated separately for both frequency (adherence) and quality (competence) of therapists' application. Audiotaped from four SE therapists who saw a total of 33 depressed patients were rated by two independent judges. The same judges also rated four cognitive (CT) therapists who saw a total of seven patients. Interjudge reliability for the six subscales and the two total scale scores ranged from .35 to .79, and internal consistency coefficients ranged from .62 to .95. While SE therapists used more expressive and interpretative techniques than did CT therapists, the two groups did not differ in their use of supportive and general techniques. In addition, SE therapists were judged to be more competent in their use of SE specific techniques than were CT therapists. SE therapists' adherence and competence were not associated with patients' level of psychiatric severity as indicated by pretreatment and concurrent levels of depression, comorbid personality disorder, or level of psychological health. Therapists' adherence and competence were unrelated to a concurrent measure of the therapeutic alliance.