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 <strong>Italian Area Group of the Society for Psychotherapy Research</strong> (<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>RIPPPO publishes three 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> PAGEPress Scientific Publications, Pavia, Italy en-US Research in Psychotherapy: Psychopathology, Process and Outcome 2499-7552 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(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:</p> <ol> <li class="show">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.</li> <li class="show">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.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">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.</li> <li class="show">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.</li> <li class="show">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.</li> </ol> The perception of the illness and the self-efficacy in the management of emotions in cardiac patients <p>Cardiac Rehabilitation is the sum of psychological, physical and social treatments that are offered to cardiac patients to maintain or regain an active position in society. This study wants to evaluate changes in the perception of the illness and in the self-efficacy of the management of positive and negative emotions in patients who went through cardiac rehabilitation. Sixty-seven patients (20 females, 47 males) were selected within the cardiac rehabilitation unit in the Hospital of Cittadella (Italy). IPQ-R and the Scale for the self-efficacy of the management of positive and negative emotions were submitted at the beginning and at the end of the rehabilitation program. Anova one-way were performed to evaluate different answers in questionnaires between pre and post-evaluation, and to explore gender differences. A significant change was found in the perception of duration of illness, perceived as permanent and longer after the cardiac rehabilitation program. Furthermore, at the end of the cardiac rehabilitation program men perceived the illness more chronic than women, even if they are less worried and anxious. Intensive cardiac rehabilitation has a great emotional impact on cardiac patients, influencing their perception and management of the illness. Working on emotions, through psychological groups, helps patients change their beliefs by offering them a different perspective to approach the illness.</p> Cristina Marogna Sofia Elena Russo Floriana Caccamo Alessandro Pinton Vito Sava Roberto Carlon ##submission.copyrightStatement## 2018-10-31 2018-10-31 10.4081/ripppo.2018.310 Italian adaptation of the brief modified experiences in close relationships scale in a sample of cancer patients: factor analysis and clinical implications <p>The current study presents and evaluates the factor structure of the Italian adaptation of the Brief Modified Experiences in Close Relationships (ECR-M16), a self-report measure of the state of mind towards attachment with reference to close others. The questionnaire was administered to cancer outpatients, as in the original research. The number of factors to be extracted was calculated via Parallel Analysis. Subsequently, an Exploratory Factor Analysis was run to calculate the first order factor structure, which was compared to the original one via Procrustes Rotation and Tucker's Coefficient. Finally, a second-order factor structure was calculated by factor-analyzing the first-order factor-scores. The Italian adaptation of the ECR-M16 is characterized by a first-order factor structure composed by four factors, as the original one. The degree of similarity between the two ranged between fair and not-similar. The second-order factor structure is composed by two higher order dimensions as in the original study. Although partially similar, the two second-order factor structures show relevant differences. A clinically-oriented discussion centered on the similarities and differences between the two factor-structures is provided, along with indications for future studies.</p> Davide Ghirardello Jacopo Munari Silvia Testa Riccardo Torta Fabio Veglia Cristina Civilotti ##submission.copyrightStatement## 2018-10-31 2018-10-31 10.4081/ripppo.2018.319 XII Congresso Nazionale SPR | 5-6 ottobre 2018, Palermo (Italy) <p>Not available.</p> the Editors ##submission.copyrightStatement## 2018-09-03 2018-09-03 10.4081/ripppo.2018.335 Phenomenological-narrative contributions to understand the narrative strategies that shape the autobiographical account throughout different moments of the therapeutic process <p>Different studies suggest that the strategies and narrative styles that people use to construct their autobiographical accounts have repercussions on their self-organization, as well as on their identity experience and their conception of the world. Empirical evidence supports changes in different aspects related to process, structure, and content in the narrative of clients during the course of the therapeutic process; these, in turn, seem to condition the course and the results of the process. In this paper we will seek to show, based on a case study and through the application of a method of phenomenological-narrative analysis, what are the predominant narrative strategies that a client uses in order to shape her autobiographical narrative in the initial and final moments of her psychotherapeutic process. Our data suggest that the narrative strategies at the beginning and end of the therapy are qualitatively differentiable. Changes are observed in the plot of the respective accounts, as well as a differentiated mode in the use of narrative functions. More specifically toward the end of psychotherapy, the client makes a deeper characterization of herself and others, based on predicates of a subjectivating, interpretive, and evaluative-reflective kind. She also predominantly uses proconcluding metacomments, which could facilitate the integration of problematic experiences. In summary, our data suggest that after a successful therapeutic process the client uses more complex and integrated narrative strategies for the construction of her autobiographical account.</p> Dante Gabriel Duero Francisco Javier Osorio Villegas ##submission.copyrightStatement## 2018-08-24 2018-08-24 10.4081/ripppo.2018.309 You really are too kind: implications regarding friendly submissiveness in trainee therapists <p>To facilitate patient growth, therapists must immerse themselves in the patient’s world while also being able to see what is needed for change. This process requires finding a delicate balance between supporting and pushing patients. Therapists in training are additionally tasked with incorporating supervisors’ suggestions with their own views on what is needed to help their patients. Beginning therapists with tendencies to be overly accommodating may struggle to reconcile these competing demands. Thus, the aim of the present work is to explore how trainee friendly submissiveness (FS) interfaces with psychotherapy. Prior to training, clinical graduate trainee (<em>n</em> = 35) FS was assessed using the Inventory of Interpersonal Problems-32. Process and outcome data were then collected from each therapist’s first training case. Specifically, each trainee was assigned an undergraduate student volunteer with whom they had four non-manualized therapy sessions over the academic semester. After the third session, patients and trainees completed questionnaires assessing session impact and the working alliance, and two expert raters coded third session videotapes for techniques. Following termination, patients rated the overall helpfulness of the therapy. Trainee FS was significantly negatively associated with patient-rated depth, alliance, and overall helpfulness with moderate effects. Findings from a mediation analysis further suggested that trainees with higher FS struggled to focus the therapy in a way that felt productive to patients. Implications for clinical training are discussed.</p> Lylli Cain Hana Perkey Sabina Widner J. Aaron Johnson Zachary Hoffman Jenelle Slavin-Mulford ##submission.copyrightStatement## 2018-08-24 2018-08-24 10.4081/ripppo.2018.312 Alexithymia and therapeutic alliance: a multiple case study comparing good and poor outcome cases <p>Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients expressing emotions, engaging in emotional tasks and also poor therapeutic alliances. This study aims to better understand alexithymic patients in psychotherapy. A multiple case study design was used. Cases were selected from a larger research project considering their alexithymia level and outcome status, based on the reliable change index and the client perspective on change. Four cases are presented: with and without alexithymia with good and poor outcome. The therapeutic alliance was included as a process measure, evaluated from both client and therapist. At the end a semi structured interview was conducted with both participants, individually. The analysis concerned the integration and triangulation of the therapist and client experience for each case. Each patient was briefly presented and then a focus was made regarding the perception of both participants on the therapeutic alliance and the emotional processing and change process of the client. Both alexithymic cases and the non-alexithymic poor outcome case showed difficulties in the therapeutic alliance, especially from the perspective of the therapist. In these cases, emotional impairments may have contributed to a poor therapeutic alliance, impacting on the outcome. We suggest that a great focus on the therapeutic alliance with alexithymic patients may increase the quality of treatment and it may be more useful for case conceptualization to consider each feature of the alexithymia construct individual.</p> Ana Catarina Nunes da Silva António Branco Vasco Jeanne C. Watson ##submission.copyrightStatement## 2018-08-24 2018-08-24 10.4081/ripppo.2018.313 Dropout in schema therapy for personality disorders <p>Schema therapy (ST) is a relatively new, but promising, psychotherapy approach. Able to be implemented in both individual and group settings, research findings suggest that ST is a highly effective treatment for personality disorders. As in other treatments for personality disorders, some patients decide to drop out from treatment, feeling they did not benefit. To date, there has been no study in the literature that investigates the dropout rates across ST studies specifically. Consequently, this study systematically researched eight different ST studies in which dropout rates were reported. Together, these studies featured both individual and group therapy settings, inpatient and outpatient settings, and different personality disorder diagnoses. The weighted mean dropout rate was 23.3%, 95% CI (14.8-31.7%) across these studies. Although this finding is very similar to those meta-analyses that obtained their dropout rates from different orientations and diagnoses, namely psychotherapy in general, ST’s dropout rates might be significantly lower than studies that included personality disorders in particular.</p> İsmail Volkan Gülüm ##submission.copyrightStatement## 2018-08-08 2018-08-08 10.4081/ripppo.2018.314 An integrated approach to child psychotherapy with co-parental support: a longitudinal outcome study <p>Studies about the effectiveness of psychodynamic psychotherapy interventions with children and adolescents suggest potential adverse effects of this treatment when not supported by a parallel work with parents: it seems that it could damage family functioning and affect family balances. This research aims to assess psychopathological outcomes after two years of psychodynamic psychotherapy by comparing two groups (G) of children and adolescents, related to a Childhood Adolescence Family Service: G1 – individual therapy for child/adolescent only; G2 - therapy for child/adolescent and a separate session of co-parenting support. 21 families with children aged between 6 and 17 years completed the entire treatment. The research protocol involves: Lausanne Trilogue Play, Children Behavior Check List and Family Empowerment Scale. Results show a positive effect of the treatment on the child/adolescent psychopathological profile with a significant improvement concerning the reduction of both internalizing and externalizing problems. Results show the effectiveness of the integrated intervention in the improvement of parents’ abilities to validate the children emotional state. Our results suggesting that parenting support increase parental sensitivity, helping the parents to become more able to recognize the children’s emotional state and to validate it.</p> Marina Miscioscia Alessandra Simonelli Lorenza Svanellini Marta Sisti Laura Sudati Maria Elena Brianda Pier Antonio Battistella Michela Gatta ##submission.copyrightStatement## 2018-08-08 2018-08-08 10.4081/ripppo.2018.297 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 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