Research in Psychotherapy: Psychopathology, Process and Outcome

Patient personality and therapist responses in the psychotherapy of adolescents with depressive disorders: toward the Psychodynamic Diagnostic Manual - third edition

2024-03-27T09:15:08+00:00

Depressive disorders in adolescence pose unique challenges for assessment and treatment, particularly due to their high comorbidity with various personality disorders. Moreover, young depressed patients may elicit very intense and difficult-to-manage emotional responses in therapists (in this context, countertransference). This study aimed at empirically identifying specific personality disorders (or subtypes) among adolescents with depressive pathology and exploring distinct countertransference patterns emerging in their psychotherapy: 100 adolescents (58 with depressive disorders; 42 with other clinical conditions) were assessed by their respective clinicians (n=100) using the psychodiagnostic chart-adolescent of the Psychodynamic Diagnostic Manual (PDM) - second edition, and the therapist response questionnaire for adolescents. Results showed that depressed adolescent patients exhibited marked traits of four personality subtypes (i.e., depressive, anxious-avoidant, narcissistic, and borderline) characterized by different levels of mental functioning and personality organization. These subtypes were predictably related to specific clinicians’ emotional responses, even when controlling for the intensity of depressive symptomatology. Patients with depressive or anxious-avoidant personality subtypes evoked more positive countertransference responses, whereas patients with narcissistic or borderline subtypes elicited strong and hard-to-face emotional responses in therapists. Consistent with the next edition of the PDM, the study emphasizes the importance of comprehensive psychodynamic assessment in the developmental age, which frames depressive disorders in the context of accurate emerging personality and mental functioning profiles. This approach, which also relies heavily on the clinician’s subjective experience in therapy, provides crucial information on how to specifically tailor interventions that more effectively meet the needs of adolescents with these heterogeneous and complex clinical conditions.

Personality characteristics, music-listening, and well-being: a systematic and scoping review

2024-03-25T11:14:33+00:00

When researchers and clinicians try to identify appropriate and effective ways to improve well-being among different populations, music is often included in interventions or research projects. The existing literature has consistently reported interactions between the effects of personality traits and music listening. However, the interrelations between individual traits and well-being after music listening are still partially unclear. This systematic review, registered on PROSPERO, investigates the relationship between everyday music listening, individual characteristics — operationalized as stable and transient personality traits — and well-being. Articles were searched on PubMed, Scopus, and Google Scholar, with a final result of 115 records. After eligibility screening, eight studies were included in the review. The results showed that both stable and transient personality traits influence music's effect on well-being. As a result of the scoping review, a theoretical perspective combining the emotional dimension, the principle of emotional congruence, and the dimension of music immersion and well-being was identified. Based on this knowledge, music listening could be systematically introduced into daily routines to improve everyday well-being and prevent or reduce stressful states.

Development and preliminary validation of the Clinician Affective REsponse (CARE) scale

2024-03-21T15:00:55+00:00

The present study reports on the development and validation of the clinician affective response (CARE) scale. The CARE scale was designed as a self-report measure of therapists’ patterns of thoughts, feelings, and behaviors toward the patient during an individual psychotherapy session. An initial pool of 116 items was generated, and its quality was evaluated by subject matter experts. Validation data were gathered from licensed psychotherapists (n=554). We used exploratory factor analysis and item response theory-graded response modeling to select items, confirmatory factor analysis to test how well the factor structure fit the data, and k-fold cross-validation to ascertain the robustness of the model. Criterion validity was evaluated by correlating the scores of the scale with the characteristics of therapists, patients, and treatment. The selected model consists of 15 items and a 3-factor structure, which showed excellent model fit, good internal consistency, and evidence of criterion validity. The CARE scale, short and quick to complete, enables therapists to reflect on and recognize their inner experiences and quantify these experiences in ways conducive to statistical analysis and research. Furthermore, the monitoring of these affective reactions toward their patients can guide therapeutic interventions and inform clinical supervisors.

Models of practice and training in psychotherapy: cross-national perspectives from Italy and Canada

2024-03-14T07:37:49+00:00

Internationally, there is ongoing concern about accessibility to mental health care and training. The goal of this study was to explore commonalities and differences within models of clinical psychology and psychotherapy in Ontario, Canada, and Lombardia, Italy, respectively, to inform improvements to the accessibility of mental health care and training. Using key informant sampling, we recruited ten students and professionals in Italy and Canada who study or work in psychology for semi-structured interviews. We analyzed the interview content using an inductive approach for thematic analysis within countries and meta-theme analysis across countries. The findings indicated three cross-national meta-themes: the need to integrate evidence with practice, the limited accessibility of training for students and treatment for patients, and the importance of the quality of training programs. Despite some differences regarding the amount of scientific training, personal therapy for trainees, and the prominence of cultural diversity training, Canadian and Italian psychology professionals and students shared experiences of psychotherapy practice and clinical psychology training. The three cross-national meta-themes indicate which issues in training and practice may be relevant worldwide and where to focus resources. The findings can inform international collaborations regarding training model structures that may increase access to psychology training and may increase consensus on professional recognition standards to improve mobility for professionals. These changes could reduce barriers to mental healthcare services for patients.

Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms

2024-01-15T12:45:07+00:00

A comprehensive investigation of psychological features in chronic patients is very important for tailoring effective treatments. In this study we tested anxiety, depression, health related quality of life (HR-QoL), alexithymia, coping styles, and defense mechanisms, in eighty-four patients with Crohn disease (CD) and ulcerative colitis (UC). Participants reported low to moderate HRQoL and anxiety, apart from alexithymia. Women experienced lower QoL and higher levels of anxiety and depressive symptoms. Coping and defense strategies were related to distress symptoms and QoL. Positive attitude and principalization, showed negative associations with depression, anxiety and alexithymia and were also found to be associated with mental health. CD patients used significantly more turning against objects (p=0.02) and projections (p=0.01) and UC patients used more reversal (p=0.04). Elderly women showed higher anxiety symptoms and lower perceived QoL. Multiple regression analysis revealed anxiety and depression were independently associated with QoL. Significant differences emerged in defense styles among CD and UC. CD participants used more maladaptive coping and defense styles which were related to mental distress, depression and anxiety, together with higher level of alexithymia. Findings suggest that psychological aspects play a key role in mental health in patients suffering from inflammatory bowel diseases. A multi-integrated clinical strategy including psychotherapeutic interventions should be considered in treating CD and UC.

Defense mechanisms are associated with mental health symptoms across six countries

2024-01-16T13:04:09+00:00

Defense mechanisms are adaptative processes that are related to mental health and psychological functioning and may play an important role in adaptation to distress, as well as in mental health interventions. The present study aimed to compare the use of defense mechanisms and their relationship to mental health symptoms across six countries. In a large-scale descriptive study, we collected data from community- based individuals (N=19,860) in the United States, Australia, Canada, Germany, Italy, and the United Kingdom about the use of defense mechanisms and experienced mental health symptoms during the early phase of the pandemic. We found that the use of defense mechanism categories was similar across countries. Moreover, lower defensive functioning, specifically, neurotic and immature defenses were related to experiencing higher distress across countries, whereas mature defenses were generally inversely related to symptoms. Furthermore, these findings were relatively similar across the six countries. Cross-cultural research on defense mechanisms and mental health has important clinical implications. Our results are consistent with the goal of promoting more adaptive defensive functioning to increase psychological well-being and mitigate the detrimental impact of situational stress

Crying in psychotherapy: an exploratory mixed-methods study on forms of emotional crying and associated therapeutic interventions

2024-04-17T12:08:54+00:00

Emotional tears can be interpreted as expressions of our deepest inner lives, and yet they have largely been ignored in psychotherapy research. This study addresses this gap. Based on grounded theory and using a sequential mixed-methods design, we examined the interaction between therapist and patient during episodes of crying in video-recorded psychotherapy sessions. This resulted in two rating systems: one differentiates forms of patient emotional crying, and the other categorizes therapeutic interventions associated with crying. In this sample, including 46 video sequences from 32 therapy sessions, both rating systems were found to be reliable. To identify potential interactional patterns, we examined the statistical correlation between the two systems through multiple linear regression analyses. We found that certain forms of crying were associated with specific therapeutic interventions. Despite methodological limitations, the study contributes to a subject of clinical relevance that is still in its beginnings. To our knowledge, this is the first study to examine therapeutic events in episodes of crying in a process-oriented and comprehensive way.

Therapist self-awareness and perception of actual performance: the effects of listening to one recorded session

2024-02-15T10:46:07+00:00

Research in psychotherapy has emphasized the relevance of the therapist’s role, particularly the impact of deliberate practice and self-awareness (SA). This study aims to explore how SA is presented in the accounts of psychotherapists and assess the impact of attending to actual performance. Twenty cognitive behavioral therapy psychotherapists in training were interviewed before and after listening to their session recordings. The interview was based on five domains of self-awareness: recognition of emotional experience, assessment of personal skills, recognition of prejudices and implicit biases, and awareness of personal values. Results show that SA is frequently attained in skills identification and emotional experience. Recognizing the influence of personal values and bias, and emotional regulation was less frequently identified. There were minor differences before and after listening to the recording. There is an increase of SA in identifying the therapist’s personal skills, and aspects such as our prejudices and biases are more internalized and difficult to change. This article suggests the importance of deliberate practice strategies to promote SA and increase the effectiveness of psychotherapy.

Cooperation within the therapeutic relationship improves metacognitive functioning: preliminary findings

2023-11-08T13:25:13+00:00

Both clinical observations and empirical data suggest that metacognitive functioning is a factor strongly associated with a good psychotherapeutic outcome. It has been suggested that some interpersonal social motivations (i.e., attachment and cooperation) may be associated with different levels of metacognitive functioning also within the therapeutic relationship. The aim of this study was to explore the relationship between cooperation and metacognitive monitoring within 58 psychotherapy sessions from seven different patients. All patients were initially assessed through a detailed psychiatric interview. Patients’ adult attachment styles were evaluated using the Attachment Style Questionnaire. The association between the activation of patients’ interpersonal social motivations (e.g., cooperation and attachment) and the modifications of metacognitive abilities during sessions was investigated using the Assessing Interpersonal Motivations in Transcripts method and the Metacognition Assessment Scale have been used. Our results showed that the activation of the patient’s cooperative system is positively associated with an increase in metacognitive functioning, while the activation of attachment is not. The results of the present study have important implications for clinicians: they give empirical support for the role of cooperation in fostering metacognition within the therapeutic relationship.

Virtue, well-being, and mentalized affectivity

2024-01-08T14:11:29+00:00

Virtue ethics, featuring the claim that virtue leads to wellbeing, has been imported by psychologists from philosophy. In the first part of the paper, we re-examine the source of virtue ethics in Aristotle’s philosophy and question whether virtues can be the path to eudaimonistic well-being for us, given that contemporary society differs from ancient society in terms of a lack of consensus about virtues. We focus on the modulation of emotions as a good starting place for reconstruing virtue ethics, and we affirm a connection to well-being through the construct of “mentalized affectivity”, which is a specific kind of emotion regulation. In the second half of this hybrid paper, we provide evidence for the link between mentalized affectivity and well-being, based upon an empirical study with an adult sample (N=558). Our study examined how the Mentalized Affectivity Scale (MAS) predicts subjective well-being compared to five commonly used and related measures: Difficulty with Emotion Regulation Scale; Emotion Regulation Questionnaire; Flexibility Regulation of Emotional Expression scale; Reflective Functioning Questionnaire; Toronto Alexithymia Scale. The most important finding is that the MAS and Difficulties in Emotion Regulation Scale are most predictive of satisfaction with life. A second finding, less relevant for the present paper, is that the MAS (namely, its components of Identifying and Processing) strongly predicted psychopathology, including anxiety and mood disorders. This suggests that the MAS is a valuable tool for research on emotion regulation, well-being, and psychopathology, and that mentalized affectivity ought to be regarded as a promising construct for re-describing and specifying the contemporary relevance of virtue ethics.