Research in Psychotherapy: Psychopathology, Process and Outcome <p><strong>Research in Psychotherapy: Psychopathology, Process and Outcome</strong> (RIPPPO) is an online, open-access, peer reviewed journal published by the Italian Area Group of the Society for Psychotherapy Research (<a href="">SPR Italy Area Group</a>). Its aim is to promoting a fruitful communication between the Italian and International communities, enriching clinicians and researchers mutual collaboration. It welcomes high quality articles from any part of the world, concerning a variety of topics (<em>e.g.</em>, psychotherapy process and outcome, diagnosis and assessment, psychopathology <em>etc.</em>), with different formats (<em>e.g.</em>, reviews, empirical studies, methodological works, clinical studies) and from different epistemological, theoretical and methodological perspectives of the contemporary research in psychotherapy.</p> <p>Particular attention will be paid to works sensitive to the close interconnection between psychotherapy process and psychopathology, as well as theory and clinical practice; the focus on intensive case analysis; the study of the psychotherapies delivered within the different institutional settings and with attention to the interdisciplinary dialogue.</p> <p>RIPPPO publishes two issues every year and provides immediate open access to its contents, on the basis of the principle that making research results freely available to researchers and practitioners supports a better exchange of knowledge.</p> <p>RIPPPO adopts a two-phase peer review procedure, to which only papers written in English are allowed and considered. Firstly, the Manuscript is read by the Editors for verifying its consistency with the aims, and the formal and content standards of the journal. Then, if the paper is suitable for publication, Editor submits it to blind peer reviewing phase. The process of reviewing is intended as an opportunity to promote scientific exchange designed to guarantee a high scientific standard for the journal, as well as to provide Authors with the chance to improve the quality of their manuscripts. This journal utilizes the PORTICO system to create a distributed archiving system among participating libraries, and permits those libraries to create permanent archives of the journal for purposes of preservation and restoration.</p> <p>RIPPPO has been included for indexing in&nbsp;<a href="">SciVerse (Scopus)</a> and <a href="">PsycInfo</a>.</p> PAGEPress Scientific Publications, Pavia, Italy en-US Research in Psychotherapy: Psychopathology, Process and Outcome 2499-7552 <p>PAGEPress has chosen to apply the <a href="" target="_blank" rel="noopener">Creative Commons Attribution NonCommercial 4.0 License</a> (CC BY-NC 4.0) to all manuscripts to be published. <br> <br> An Open Access Publication is one that meets the following two conditions:<br> <br> 1. The author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.<br> 2. A complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.<br> <br> Authors who publish with this journal agree to the following terms: 1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. 2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. 3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</p> ERRATUM: Metacognition, borderline pathology and psychotherapeutic change: a single-case study Not available. Raffaella Perrella Antonio Semerari Francesca Scafuto Giorgio Caviglia ##submission.copyrightStatement## 2018-04-12 2018-04-12 10.4081/ripppo.2018.298 Alexithymia and emotional processing: a longitudinal mixed methods research <p>Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients processing emotions and engaging in emotional tasks. The possibility of alexithymia being modified by psychotherapy remains a topic of great debate but with little empirical research. In this study a mixed methods longitudinal design was used to better understand alexithymia, emotional processing and change process in psychotherapy. Twelve clients, five with alexithymia, were studied considering the development of alexithymia, emotional awareness, differentiation, regulation and severity of symptoms. The reliable change index was used to interpret the evolution of those emotional variables' scores for each case and thematic analysis was used to analyze individual interviews. Thematic analysis generated several themes, organized in two broad domains: i) perception of emotions and ii) description of change. The three alexithymic patients that changed in alexithymia also changed in at least one of the emotional variables – lack of emotional awareness, emotion differentiation or emotion regulation. Generally, alexithymic patients were able to accomplish change in psychotherapy although they had a tendency to focus on physical complaints, describe changes in a more rational rather than emotional way and present vaguer descriptions of their problems. These results point that alexithymia may change through therapy and reinforces that those changes are associated with improved emotional processing.</p> Ana Nunes da Silva Antònio Branco Vasco Jeanne C. Watson ##submission.copyrightStatement## 2018-04-12 2018-04-12 10.4081/ripppo.2018.292 The effect of positive psychotherapy in test anxiety among Zahedan students with hemophilia Hemophilia is a chronic disease which due to several reasons, including frequent absences from school and reduced motivation, leads to the incident of test anxiety among patients. This study was conducted with the aim of evaluating the effectiveness of positive psychotherapy in test anxiety among students with hemophilia. The current study followed a pretest, posttest, and two-month followup quasi-experimental design with an experimental group and a control group. This study had a statistical population including all senior elementary and junior high school students with hemophilia who had medical records in Zahedan Hemophilia Society. After screening them, 60 students were selected and randomly assigned to two 30-person groups of experimental and control. Since some patients refused to continue taking part in this study, the sample decreased to 57 people. Measurement tool used in this study was Sarason Test Anxiety Scale. Positive psychotherapy was held in 8 sessions (two 120-minute sessions per week) and a follow-up was conducted two months after completing the psychotherapy. Data were analyzed using a repeated measure analysis of variance. Results showed that positive psychotherapy significantly reduced test anxiety among the students with hemophilia. Moreover, the stability of the effects of this therapy in the follow-up was confirmed. The obtained results indicated that policymakers should pay a lot of attention to this new positive psychological training and its effects on reducing test anxiety. Mahbobe Ghavidel Heydari Mahmoud Shirazi Gholam Reza Sanagouyemoharer ##submission.copyrightStatement## 2018-04-12 2018-04-12 10.4081/ripppo.2018.307 A proposed conceptualization of therapeutic competence: the three level model A model of therapeutic competence that equally satisfies the requirements of practice and research is still lacking. The existing models are not widely accepted, at least partially because the postulated competences can often not be operationalized in a satisfactory manner. Yet, in order to be measurable, therapeutic competences need to be operationalized. We present the <em>Three Level Model of Therapeutic Competence</em> as a working model for studying therapeutic competence. The model proposes that therapeutic competence develops based on rather stable individual <em>Dispositions</em>, which promote the acquisition of therapeutic competences. We further distinguish between <em>Basic Competences</em>, which are mostly independent of the theoretical orientation of the therapeutic approach, and <em>Specific Competences</em>, which are defined based on the theoretical underpinnings of a therapeutic orientation (<em>e.g.</em> Cognitive Behavioral Therapy). We describe this model and outline how it can be used to operationalize and assess therapeutic competence. Christine Koddebusch Christiane Hermann ##submission.copyrightStatement## 2018-04-12 2018-04-12 10.4081/ripppo.2018.286 Navigating the complexity of the therapeutic and clinical use of photography in psychosocial settings: a review of the literature In contrast with the recent increase in the use of photography as a therapeutic tool in psychological settings, lack of clarity exists regarding this intervention modality. While the distinction among Photo Therapy, Therapeutic Photography, and Photo Art Therapy is theoretically established we examined whether this classification is confirmed also in practice. Electronic databases (PsychINFO, PubMed, MEDLINE, and Social Sciences Abstracts-EBSCO) were systematically searched for studies published in the last fifteen years utilizing photographic techniques as the elective method of intervention. A total of 124 articles were identified, of which 21 met the inclusion criteria. Results indicate that photography has been used in health, clinical, social, and community settings. Photovoice, Photographic Self-Portrait, and Photo Presentation are the methods most commonly implemented. Several contributions could be placed in more than one of the above-mentioned models of intervention; suggesting that the criteria to assign articles to each model are difficult to apply when the models are put into practice. Emanuela Saita Martina Tramontano ##submission.copyrightStatement## 2018-04-12 2018-04-12 10.4081/ripppo.2018.293 Change during psychotherapy: the perspective of children and adolescents who have been sexually abused <p>The aim of this research was to identify the meanings of psychotherapeutic change of children and adolescents who have suffered sexual abuse and were in psychotherapy. In order to do this, a qualitative study was carried out in which in-depth interviews complemented with drawings were conducted with 10 children and adolescents, aged between 6 and 16 years, who were taking part in psychotherapy due to sexual abuse. The interviews took place between 6 and 10 months after the start of the therapy and before it ended. Thematic narrative analysis was used for the interviews and visual narrative analysis for the drawings. The main findings showed that children and adolescents visualized psychotherapeutic change as a process in which gradual progress is made. The participants notice changes from an initial state of sadness and distress, mainly describing a positive shift in terms of emotional well-being. In addition, in this phase of the therapy only a few participants identified changes in their feelings regarding the abusive experience. The participants identified aspects of the therapy and supportive relationships with significant others as elements that foster these changes. In their view, hindering elements include changes of therapist, legal factors, and not being believed by their family. It is discussed the importance of knowing the children and adolescents' perspective regarding psychotherapeutic change while participating in therapy processes, using multiple methodologies, to generate interventions that suit the needs of this population and match the pace of children and adolescents' change.</p> Claudia Capella Carolina Gutiérrez Loreto Rodrìguez Camila Gòmez ##submission.copyrightStatement## 2018-04-12 2018-04-12 10.4081/ripppo.2018.288 Psychotherapy with two late adulthood children of the colonies There are a small group of mature adults in their 50s and 60s, members of the so-called <em>third age</em> that arrive at the door for psychotherapy. As clients, they want to explore an overwhelming sense of being dis-located in space and time, and at odds with where they find themselves living. They have a deep and profound sense of not belonging and of being rootless. These older, white, adults are the baby-boomers of post World War II, and I refer to them as the adult <em>children of the colonies</em> because they are of European descent but born in the colonies of Africa. This paper describes the experiences of two clients, Robert and Caitlin, who find themselves feeling progressively psychically dis-located in South Africa and confronting not only their limited future in terms of impending death, but confronting existential givens of life that prevent them at this late stage of life from returning home to their ancestral lands. They present a unique group of older adult clients, and like fish out of water, they have no sense of belonging to Africa, and as a result, they experience a range of emotions such as despair and depression with a concomitant sense of fragmented identities. Discussion of the cases ensues and includes the concept of intergenerational transmission of trauma, fragmented identities, and belonging as linked to ancestral lands. Zelda Gillian Knight ##submission.copyrightStatement## 2017-10-27 2017-10-27 10.4081/ripppo.2017.287 Analytical psychodrama with college students suffering from mental health problems: Preliminary outcomes The aim of this work was to assess the therapeutic efficacy of analytical psychodrama groups for college students with psychological problems. Analytical psychodrama, as a form of group psychotherapy, is an integral part of the program of treatment of young adults in the Counselling Center of the University of Bologna, which provides a free service for its students, aimed at delivering psychological support. Thirty patients (22 females) from 20 to 26 years old (mean age 22.33, standard deviation±1.75), suffering from mental health problems, who completed one year of psychodrama, were assessed before and after group psychotherapy. The Italian validation of Clinical Outcomes in Routine Evaluation – Outcome Measure was used as test-retest questionnaire for clinical outcome evaluation. The results demonstrated the efficacy of the treatment in terms of symptom decrease and improvement of patients’ well being. After the treatment (40 sessions, once a week), patients showed a statistically significant reduction in clinical outcomes scores compared with pre-treatment scores. Moreover, the analyses of Reliable and Clinical Significant Change index showed that about 30% of patients improved, and this improvement was reliable and/or clinically significant. Our preliminary findings revealed that analytical psychodrama is a suitable treatment for college students, as it actually reduces young adults’ symptoms. These results contribute to the topic of the validity of psychodrama interventions to encourage research regarding the specific psychotherapeutic effects of its method. Roberta Biolcati Francesca Agostini Giacomo Mancini ##submission.copyrightStatement## 2017-10-27 2017-10-27 10.4081/ripppo.2017.272 Till the ocean do us part: Italian and American therapists representations of stepfamilies in treatment <p>Research often focuses on the characteristics of stepfamilies and their differences with first-union families; however, few studies take into account the therapis's perspective with regards to the treatment of such families. Also, cross-cultural research on the topic is limited. To fill these gaps, a content analysis of responses from 125 Italian and 45 American therapists regarding their representations of stepfamilies and stepfamily therapy was undertaken. Results show that American therapists emphasized specific stepfamily characteristics (<em>e.g.</em>, the lack of a shared family history, the occurrence of conflict between former spouses, the presence of unrealistic expectations towards treatment) to a greater extent if compared to Italian therapists. By contrast, besides being more general in their definition of stepfamilies, Italian therapists focused more on themselves, their theoretical models, and their professional and personal skills. The study provides insights on both the differences in the clinical cultures of the two countries and implications for stepfamily therapy and training.</p> Monica Accordini Scott Browning Marialuisa Gennari Kevin McCarthy Davide Margola ##submission.copyrightStatement## 2017-10-27 2017-10-27 10.4081/ripppo.2017.271 From turn-by-turn to larger chunks of talk: An exploratory study in psychotherapeutic micro-processes using conversation analysis <p>Independent of theoretical orientation therapies of all kind are <em>talk-in-interaction</em>. Influential overall conceptualizations (as <em>e.g.</em> intervention) belong to a certain model of medicalizing the psychotherapeutic endeavor. Talk-in-interaction is the base for applying Conversation Analysis (CA) in psychotherapeutic process research. CA is a powerful tool originating from social science taking data, hypotheses and theories from careful observing in a similar way as infant observers did. The common discovery is that conversation precedes language. Some features of infantile proto-conversation survive in adult life. CA has directed careful attention to processes like turn-taking, repair, conditional relevances, <em>etc</em>. in observing the rules of interaction. However, in studying psychotherapy process turn-by-turn analysis alone does not suffice. It can be completed by a new model of common ground activities and package-by-package analysis turning attention to new objects of observation in therapeutic conversation (allusions, metaphorical framing activities). We propose a methodology for both kinds of analyses based on transcribed examples from the CEMPP-Project. This exploratory designed project (Conversation analysis of empathy in Psychotherapy Process; supported by the Khler Foundation, Germany) compared psychoanalytic, psychodynamic and cognitive-behavioral treatments in five dyads each taking transcribed sessions from the beginning, the middle phase and the end; our database includes 45 transcribed sessions.</p> Michael B. Buchholz Horst Kächele ##submission.copyrightStatement## 2017-10-27 2017-10-27 10.4081/ripppo.2017.257