Faculty Bibliography

The concept of the therapeutic alliance and its operationalization have received much attention in recent years. One of the early self-report measures of the therapeutic alliance was the Helping Alliance questionnaire (HAq-I). This scale was recently revised to exclude the items that explicitly reflect improvement. Using the revised 19-item HAq-II on a sample of 246 patients diagnosed with DSM-III-R cocaine dependence, the authors found that the new scale had excellent internal consistency and test-retest reliability. Further, the HAq-II demonstrated good convergent validity with the California Psychotherapy Alliance Scale (CALPAS) total score. Alliance levels as measured by the CALPAS or the Helping Alliance questionnaire during early sessions were not associated with pretreatment psychiatric severity or level of depression.

The benefits, and variables influencing the benefits, of short-term dynamic psychotherapy for chronic major depression versus nonchronic major depression were examined for 49 patients. The two diagnostic groups started at the same level on the Beck Depression Inventory (BDI) and Global Assessment of Functioning Scale (GAF) and benefited similarly. The bases for the benefits were examined by linear models explaining 35% of termination BDI variance and 47% of termination GAF scores. By far the largest contributor to outcome was initial GAF, followed by presence of more than one comorbid Axis I diagnosis. Initial level of depression on the BDI was not a significant predictor of termination BDI. The chronic/ nonchronic distinction accounted for less than 1% of explained variance, and little was added by personality disorder, age, or gender.

This report shows (a) that the Core Conflictual Relationship Theme (CCRT) can be rated reliably either from therapy sessions or from a special pretreatment interview in a group of depressed patients, and (b) that the CCRTs obtained before treatment are similar to the CCRTs extracted from the early sessions of brief dynamic psychotherapy. The data suggest that, at least in the early sessions of treatment, the therapist's influence did not significantly alter the patients' CCRTs.

The Hamilton Anxiety Rating Scale (HARS) is the most widely used semistructured assessment scale in treatment outcome studies of anxiety. Interrater reliability coefficients for the HARS have been previously reported. However, differences in the way clinicians assess symptom severity may reduce reliability. A structured interview guide--The Hamilton Anxiety Rating Scale Interview Guide (HARS-IG)--was developed to standardize clinical probe questions and to minimize interrater variance. Joint-interview and test-retest methods of interrater reliability assessment were used in a group of 30 inpatients. Intraclass coefficient calculations revealed improved interrater agreement with the HARS-IG versus the HARS. The findings of this study demonstrate that the HARS-IG is a more reliable assessment instrument than the semistructured HARS and that it meets established standards of reliability assessment.

Discusses the essence of what is in common among the 7 transference-related measures in the articles by L. Luborsky et al, M. J. Horowitz, J. T. Curtis et al, T. E. Schacht and W. P. Henry, L. M. Horowitz and S. E. Rosenberg, Rosenberg et al, J. C. Perry, and H. Dahl and V. Teller (see PA, Vol 82:34005, 34001, 33988, 34020, 34000, 34017, 34014, and 33989, respectively). They all turn out to be moderately similar. The most similar of all are the Consensual Response Psychodynamic Formulation, the Structural Analysis of Social Behavior-Cyclic Maladaptive Pattern, the Core Conflictual Relationship Theme, and the Fundamental Repetitive and Maladaptive Emotion Structures methods. Their primary clinical applications are to help derive reliable formulations, focus on transference-related congruent treatment interventions, and locate the conflicts associated with recurrent symptoms.

Presents and compares 7 transference-related measures that were applied to the interview with Ms. Smithfield (see record 1995-33983-001). The paper proposes criteria for inclusion of measures in this class, explains why these measures were created now, summarizes the existing comparisons of these measures, as well as compares the main hoped-for benefits of using them.

116 psychotherapy patients (aged 21-62 yrs) who were diagnosed using either the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) or the Personality Disorders Examination (PDE) also filled out the Wisconsin Personality Disorders Inventory (WISPI). Adequate internal consistency was found for the WISPI subscales using raw scores. Three- to 4-mo test-retest reliability coefficients of the WISPI had a median correlation of .75. Five out of 11 SCID-II dimensional scores and 5 out of the 11 PDE dimensional scores for personality disorders demonstrated good convergent and discriminant validity with their respective WISPI scales. Good convergent and discriminant validity between structured interviews and the WISPI were found for avoidant, obsessive-compulsive, and borderline personality disorders.

The author outlines the history of brief dynamic psychotherapy, describes some of its characteristics, and addresses methodological requirements for assessing the efficacy of psychotherapy. Review of two major meta-analyses suggests that manual-based brief dynamic psychotherapy by trained therapists is likely to be as effective as other forms of psychotherapy and more effective than no treatment. More studies are needed that 1) compare brief dynamic psychotherapy with other forms of treatment for specific psychiatric disorders; 2) use theory-specific measures of outcome in addition to measures of symptoms; and 3) compare brief dynamic psychotherapy with long-term psychotherapy.