Faculty Bibliography

Responds to a comment by C. J. Douglas (see record 2011-15374-015) on the authors' original review (see record 2011-02156-007) of the quality of randomized controlled trials of psychodynamic psychotherapy. While we agree that the general issues raised by Dr. Douglas are important ones, we believe that there is insufficient evidence to accept either of her arguments as fact, nor is there reason to be too skeptical about the findings of randomized controlled trials on these bases. First, it is not clear that randomized controlled trials do not include complex cases. Second, we have relatively limited systematic data on how seasoned clinicians really practice or whether adherence to one approach or a blend of approaches is better for patients of all diagnoses under all conditions. While randomized controlled trials certainly do impose constraints on the treatment (most notably, with random assignment to treatment groups) that may limit generalizability, we believe that they remain the best method we have for minimizing the impact of researcher and therapist bias when evaluating differential treatment outcomes.

Isolated sleep paralysis (ISP) has received scant attention in clinical populations, and there has been little empirical consideration of the role of fear in ISP episodes. To facilitate research and clinical work in this area, the authors developed a reliable semistructured interview (the Fearful Isolated Sleep Paralysis Interview) to assess ISP and their proposed fearful ISP (FISP) episode criteria in 133 patients presenting for panic disorder treatment. Of these, 29.3% met lifetime ISP episode criteria, 20.3% met the authors' lifetime FISP episode criteria, and 12.8% met their recurrent FISP criteria. Both ISP and FISP were associated with minority status and comorbidity. However, only FISP was significantly associated with posttraumatic stress disorder, body mass, anxiety sensitivity, and mood and anxiety disorder symptomatology.

CONTEXT: In 2004, the American Psychiatric Association's Committee on Research on Psychiatric Treatments appointed a subcommittee to investigate the status of empirical evidence with regard to psychodynamic psychotherapy. OBJECTIVE: As a part of this effort, the committee developed a rating scale designed to assess the quality of randomized controlled trials (RCTs) of psychotherapy. DATA SOURCES: A 25-item RCT of Psychotherapy Quality Rating Scale was generated by expert consensus. Interrater reliability, internal consistency, and validity testing were undertaken using 7 trained raters. STUDY SELECTION: A PubMed search was conducted to locate all RCTs of psychotherapies identified by their authors as being "psychodynamic" or "psychoanalytic" in origin and implementation. DATA EXTRACTION: A total of 69 RCTs were independently rated by 2 raters. DATA SYNTHESIS: The scale was found to have good interrater reliability (total score intraclass correlation = 0.76), internal consistency (Cronbach alpha = .87), and external validity. CONCLUSIONS: This scale establishes a new standard for the design and execution of psychotherapy RCTs and provides a systematic empirical method for evaluating the quality of published RCTs.

OBJECTIVE: The authors conducted a meta-analytic review of adherence-outcome and competence-outcome findings, and examined plausible moderators of these relations. METHOD: A computerized search of the PsycINFO database was conducted. In addition, the reference sections of all obtained studies were examined for any additional relevant articles or review chapters. The literature search identified 36 studies that met the inclusion criteria. RESULTS: R-type effect size estimates were derived from 32 adherence-outcome and 17 competence-outcome findings. Neither the mean weighted adherence-outcome (r = .02) nor competence-outcome (r = .07) effect size estimates were found to be significantly different from zero. Significant heterogeneity was observed across both the adherence-outcome and competence-outcome effect size estimates, suggesting that the individual studies were not all drawn from the same population. Moderator analyses revealed that larger competence-outcome effect size estimates were associated with studies that either targeted depression or did not control for the influence of the therapeutic alliance. CONCLUSIONS: One explanation for these results is that, among the treatment modalities represented in this review, therapist adherence and competence play little role in determining symptom change. However, given the significant heterogeneity observed across findings, mean effect sizes must be interpreted with caution. Factors that may account for the nonsignificant adherence-outcome and competence-outcome findings reported within many of the studies reviewed are addressed. Finally, the implication of these results and directions for future process research are discussed.

BACKGROUND: In the context of a National Institutes of Mental Health-funded Interventions and Practice Research Infrastructure Programs (IP-RISP) grant for the treatment of depression, a partnership was developed between a community mental health organization and a team of researchers. OBJECTIVES: This paper describes the collaborative process, key challenges, and strategies employed to meet the goals of the first phase of the grant, which included development of a working and sustainable partnership and building capacity for recruitment and research. METHODS: This paper was developed through the use of qualitative interviews and discussion with a variety of IP-RISP partners. LESSONS LEARNED: Communication with multiple stakeholders through varied channels, feedback from stakeholders on research procedures, and employing a research liaison at the clinic have been key strategies in the first phase of the grant. CONCLUSION: The strategies we employed allowed multiple stakeholders to contribute to the larger mission of the IP-RISP and helped to establish an ongoing research program within the mental health organization.

The field of psychotherapy research has lost one of its founding fathers. Lester Bernard Luborsky, born in Philadelphia on May 15, 1920, to Meyer and Celia Luborsky, immigrants from Eastern Europe, died on October 22, 2009. Lester Luborsky is best known as one of the pioneers of empirical research on psychodynamic psychotherapy. Indeed, he operationalized many of its concepts. His core conflictual relationship theme (CCRT) method was a breakthrough in the formalization of clinical psychodynamic concepts (Luborsky & Crits-Christoph, 1998, Understanding Transference: The Core Conflictual Relationship Theme Method, APA Books). Until the end of his life, Lester was a strong believer that psychotherapy is effective and that different psychotherapies are equally effective (a belief known as the "dodo bird verdict"). On the basis of a qualitative review of about a hundred comparative treatment studies, Luborsky, Singer, and Luborsky (1975, Archives of General Psychiatry, 32, 995-1008) first concluded that all psychotherapies were equally effective. Lester's early contribution to psychosomatic research attempted to delineate the onset conditions for the appearance of both psychological and somatic symptoms. Using his symptom-context method, he compared the content of clients' narratives preceding the appearance of symptoms in psychotherapy to sections of a psychotherapy session preceding a randomly selected control event.