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.

The National Institute on Drug Abuse Collaborative Cocaine Treatment Study was designed to assess the efficacy of four different psychosocial interventions (cognitive therapy, supportive-expressive dynamic therapy, and individual and group drug counseling) for cocaine dependence. This report addresses the treatment integrity and discriminability of the three individual treatments. Therapists' adherence and competence for all three individual treatments during early and late sessions were rated reliably by three sets of independent expert judges (one set of expert clinicians for each treatment condition). Results indicated that therapists and counselors made use of the therapeutic techniques described in their respective treatment manuals rather than those from different treatment manuals. Thus, treatments were easily discriminable by the independent judges.

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.

This study examined endorsement of 12-step philosophy and engagement in recommended 12-step activities as a mediator of the outcomes of individual plus group counseling for cocaine dependence. Assessments of drug use outcomes and the mediator were made at baseline and monthly for 6 months. Engagement in recommended 12-step activities was found to be a partial statistical mediator of drug use outcomes of individual (plus group) drug counseling, but no evidence for change in the mediator preceding change in drug use was found. In addition, a measure of beliefs about addiction developed to test mediation of outcome of cognitive therapy was found to correlate moderately with drug use outcomes in both cognitive therapy and individual drug counseling.

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.

We describe our clinical experience with a subset of chronically depressed patients characterized as introverted, with an early onset of feeling different from, and often feeling more sensitive than, others. We outline six central issues that concern a psychodynamic approach to chronically depressed people. This article describes and illustrates how a modified supportive-expressive psychotherapy influenced by the relational perspective can help in the treatment of these patients. In particular, we facilitate an interaction in which the patient speaks from rather than merely about his or her depressed self. A couple of clinical moments are presented to illustrate how a lack of recognition by the therapist of the self the depressed patient is at the moment leads to a kind of lifeless despair, and conversely, how the therapist's recognition facilitates the patient talking from his depressed state rather than merely about it.