Faculty Bibliography

This naturalistic study focuses on changes in central relationship patterns after long-term dynamic psychotherapy (mean duration = 3 years) with experienced psychotherapists. Relationship patterns before and after treatment were assessed according to the core conflictual relationship theme (CCRT) method, which includes 3 components: most frequent wish, response from others, and response of the self. Overall, the main CCRT did not change substantially after therapy. There were, however, a few significant changes for some of the standard cluster categories after therapy. Patients' flexibility regarding their use of different wishes and negative responses from others and the self increased, as did the frequency of positive responses from others and the self. The positive changes in relationship patterns were only rarely related to changes in symptoms and character pathology.

Patient views of the helpful aspects of treatment were examined in the NIDA Collaborative Cocaine Treatment Study, a multi-site trial comparing four psychosocial treatments: individual cognitive therapy (CT), individual supportive expressive dynamic therapy (SE), individual drug counseling, and group drug counseling only, for the treatment of cocaine dependence. Factor analysis of the items of Helpful Aspects of Treatment measure suggested a general therapy factor, a group treatment/education factor, and a treatment structure factor. No differences were found among the four treatments on the ratings of helpfulness of these three factors, common factors, or drug intervention components. However, treatment specific cognitive therapy items (e.g. use of the cognitive model) and treatment structure differentiated individual CT from individual SE, and to a lesser extent from individual drug counseling. Ratings of helpfulness were significantly related to retention and alliance but were largely unrelated to changes in drug use or psychiatric outcomes.

Psychoanalytic psychotherapy in clinical practice is traditionally a long-term treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for long-term psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study. The psychotherapists had a mean of 15 years of professional experience. The 36 patients who completed psychotherapy manifested a substantial reduction in symptomatic suffering and decreased levels of character pathology, as measured by the Karolinska Psychodynamic Profile (KAPP) and the Karolinska Scales of Personality. Generally, such changes were not found in the individuals who did not engage in treatment. In the therapy group, improvements were found on eight KAPP subscales defining different aspects of character: Intimacy and Reciprocity, Frustration Tolerance, Regression in the Service of the Ego, Coping with Aggressive Affects, Conceptions of Bodily Appearance and their Significance for Self-esteem, Sexual Function, Sexual Satisfaction, and Personality Organization. The results indicate that individuals who engaged in psychotherapy improved their capacity to handle crucial aspects of life and reduced their symptomatic suffering.

Reviews the book "Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings," by Leslie R. Greenberg, (see record 2002-00066-000). The main goal of emotion-focused therapy is to help clients increase their emotional wisdom so that they can then use their emotions to overcome their problems with emotion. Greenberg provides a vivid and clear outline of the principles and techniques of his psychotherapy. His writing is clear and informative and he integrates relevant empirical findings from many areas of psychology to provide support for his message. The clinical examples are strikingly illustrative of clients' emotional experiences and the power of emotion in therapy, as well as demonstrative of how the techniques of emotion-focused therapy are best performed and how they help clients to change. Finally, many instructive exercises in emotion-focused therapy techniques (e.g., exercises to help raise emotion awareness or to distinguish between different types of emotions; daily emotion episode logs) are presented throughout the text and at the end of many of the chapters. These exercises can help clinicians to master emotion-focused therapy interventions and to begin to incorporate them in their therapy style.

The authors present basic psychometric data for a new 21-item Cognitive Therapy Adherence and Competence Scale (CTACS; Liese, Barber, & Beck, 1995), which is based on the widely used Cognitive Therapy Scale (CTS; Young & Beck, 1980). The CTACS attempts to provide a wider coverage of cognitive therapists' activities than the CTS. Two expert cognitive therapists rated randomly chosen audiotaped therapy sessions from cocaine-dependent patients randomized to receive cognitive therapy, supportive-expressive dynamic therapy, or individual counseling as part of the training phase and the clinical phase (n = 60 and n = 69, respectively) of the National Institute on Drug Abuse Cocaine Collaborative Treatment Study. Results indicate that the CTACS has acceptable levels of interjudge reliability and criterion validity.

Very few studies have examined the relationship between personality traits and long-term postoperative psychosocial adjustment. In a sample of 46 patients, we examined the relation between personality traits before pelvic pouch surgery for ulcerative colitis and psychosocial adjustment seven years postoperatively, controlling for the effects of surgical functional outcome. The Karolinska Psychodynamic Profile (KAPP) was used for personality assessment. Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale were also used. As assessed by the KAPP, poor frustration tolerance, long-standing preoperative problems in sexual functioning, perfectionistic body ideals, and lack of alexithymia predicted poorer postoperative long-term psychosocial adjustment in the areas of health concerns, sexuality, family relations, and psychological distress. Surgical functional outcome itself was a poor predictor of long-term adjustment. The results indicate that it may be beneficial to take personality factors into account in preoperative assessment.

The goal of the current investigation was to explore the variables that predict therapist responsiveness in implementing specific therapist interventions. The authors found that therapists who were trained to adherence in manualized cognitive-behavioral (CBT) and interpersonal (IPT) psychotherapies demonstrated flexibility in the delivery of specific therapist techniques in response to specific patient characteristics and in-session therapeutic processes. Therapists used more clarifications and restatements with patients who rated the therapeutic empathy higher, more clarifications and questions with patients who rated higher on depression, and more learning statements with patients who provided more complete interpersonal narratives. Differences in responsiveness between treatment groups are discussed.