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> <p>This journal does not apply the article processing charge to Authors as it is supported by institutional funds.</p> en-US <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> (Francesca Baccino) (Tiziano Taccini) Fri, 19 Apr 2019 00:00:00 +0200 OJS 60 In the shadow of Apartheid: intergenerational transmission of Black parental trauma as it emerges in the analytical space of inter-racial subjectivities <p>Using the construct of projective identification and integrating it with the body of literature on intergenerational transmission of unsymbolized parental trauma, I describe the case of an adult black South African woman called Sibulelo. It is suggested that Sibulelo has unconsciously identified with the disavowed parents and grandparents trauma that they suffered as a result of the system of Apartheid. Such trauma is expressed through her feelings of being dis-located in time and space, as if she is <em>living outside</em> of herself, unplugged from life, and living someone else’s life. The paper details the unfolding therapeutic process in relation to my whiteness in the context of her blackness. This brings into sharp focus an exploration of black-white racialized transference-counter-transference matrix in the context of intergenerational trauma. It is a reflective paper and opens up my own counter-transference, thus foregrounding the notion of therapeutic inter-subjectivity. A further contribution to psychoanalytic theory concerns the role of recognition and being seen as a powerful process in facilitating the symbolization of trauma. In addition, if there is no interruption of the cycles of intergenerational trauma, and therefore no symbolization, it becomes an unconscious <em>familial compulsion to repeat</em>. Moreover, this therapy case highlights the idea that as a traumatised family living within a bruised culture of intergenerational transmission of trauma, such repetition of trauma becomes a <em>cultural compulsion to repeat</em> what has not been spoken or named.</p> Zelda Gillian Knight ##submission.copyrightStatement## Fri, 19 Apr 2019 12:55:58 +0200 Effectiveness of mental footnotes in the cognitive therapy for panic attack: two case-studies <p>New findings in the area of experimental, cognitive psychology point out that the implicit meanings determine the information that is being processed. The so-called <em>mental footnotes</em> can even modify the path trajectory in a driving task. This influence has been proposed to go beyond this kind of task. Mental footnotes have been proposed as determining factors in the information processing in specific psychopatological syndromes. The objective of this study is to evaluate the adequacy of applying these <em>implicit pieces of information</em>, in form of mental footnotes, to stop the series of catastrophic thoughts in the panic attack syndrome. Following the theory of mental models and the iconic representation of the real world, two cases of panic attack have been treated. By using the <em>negation illusory-reality technique</em>, a mental footnote of <em>this does not have to happen</em> was added to the catastrophic representation of the world in patients with this syndrome. As a result, these two patients have not reported panic attacks in, at least, 2 year after the last session of therapy. A deeper study of the efficacy of this technique is encouraged in order to be recommended for the treatment of patients who suffer from panic attacks.</p> Jose Luis Vilchez Tornero ##submission.copyrightStatement## Fri, 19 Apr 2019 12:52:14 +0200 Linguistic features of the therapeutic alliance in the first session: a psychotherapy process study <p>Critical aspects of the therapeutic alliance appear to be established as early as the first session. Specifically, the affective bond between the therapeutic dyad appears to develop early in treatment and tends to remain stable over time, while agreements on goals and tasks tend to fluctuate over the course of treatment. Are there distinguishable early signs of a strong therapeutic alliance? In this study, we examined how some linguistic measures indicative of joint emotional elaboration correlated with a measure of the therapeutic alliance assessed within a single session. Initial intake sessions with 40 patients with varying diagnoses were videotaped, transcribed, and analyzed using linguistic measures of referential process and then scored with the Segmented Working Alliance Inventory-Observer form. Results showed that patients who were rated as more emotionally engaged in relating their experiences and then reflecting on them by mid-session also had higher scores in the therapeutic alliance by the final part of that same session. An implication of this study is that the interpersonal factors facilitating elaboration of inner experience, including elements of warmth, safety, and analytic trust, are related to the development of early therapeutic alliance. These findings did not appear to be dependent on the patient’s psychopathology. This study is one in a growing line of research exploring how patients speak rather than just the content of what they say.</p> Attà Negri, Christopher Christian, Rachele Mariani, Luca Belotti, Giovanbattista Andreoli, Kerri Danskin ##submission.copyrightStatement## Fri, 19 Apr 2019 12:22:24 +0200 Ruptures and repairs of group therapy alliance. An untold story in psychotherapy research <p>Although previous studies investigated the characteristics of therapeutic alliance in group treatments, there is still a dearth of research on group alliance ruptures and repairs. The model by Safran and Muran was originally developed to address therapeutic alliance in individual therapies, and the usefulness of this approach to group intervention needs to be demonstrated. Alliance ruptures are possible at member to therapist, member to member, member to group levels. Moreover, repairs of ruptures in group are quite complex, <em>i.e</em>., because other group members have to process the rupture even if not directly involved. The aim of the current study is to review the empirical research on group alliance, and to examine whether the rupture repair model can be a suitable framework for clinical understanding and research of the complexity of therapeutic alliance in group treatments. We provide clinical vignettes and commentary to illustrate theoretical and research aspects of therapeutic alliance rupture and repair in groups. Our colleague Jeremy Safran made a substantial contribution to research on therapeutic alliance, and the current paper illustrates the enduring legacy of this work and its potential application to the group therapy context.</p> Gianluca Lo Coco, Giorgio A. Tasca, Paul L. Hewitt, Samuel F. Mikail, Dennis M. Kivlighan, Jr. ##submission.copyrightStatement## Fri, 19 Apr 2019 12:13:49 +0200 The subjective experience of psychotherapists during moments of rupture in psychotherapy with adolescents <p>The study of the ruptures of the therapeutic alliance has impacted research in psychotherapy by highlighting the relational nature of this phenomenon. Despite ruptures are frequent and relevant during adolescent psychotherapy, most of the empirical evidence in this field has been carried out with adults. Understanding the subjective experience of the therapist during ruptures while working with adolescent is proposed as a starting point for the study of this type of interactional scenarios. The study examined the meanings that emerge from the therapists’ experience in terms of their explanations about the causes and effects of ruptures with adolescents. Eight psychotherapists were interviewed about their experiences during ruptures with young patients. The data was qualitatively analyzed through the Interpretive Phenomenological Analysis method. Four categories emerged: the failure to recognize the adolescent’s experience, the intensity of the affective experience of adolescents in psychotherapy, therapeutic boundaries as an articulator of the therapeutic purpose and, the obstacles that family generates during the therapeutic process. This study concurs with the literature on the need to make explicit with the family about the meaning, roles and limits of the therapy, and to prevent the exercise of control from an adultcentered position. It is concluded that in order to avoid and repair ruptures with adolescents in psychotherapy, an approach that integrates a sensitive attitude, an ecological point of view and mentalizing about the origin of the rupture is needed.</p> Javier Morán, M. Francisca Díaz, Claudio Martínez, Carlos Varas, Roxana Parra Sepúlveda ##submission.copyrightStatement## Fri, 19 Apr 2019 10:42:52 +0200 Carrying Jeremy Safran into sessions: relying on internal representations of researchers to facilitate emotion regulation, clinical intervention, and self-efficacy <p>Relying on positive internal representations facilitates our ability to feel safe and secure when taking risks and provides a road map to guide us during interpersonal exchanges. Although most graduate programs encourage students to engage in research, we rarely link participating in research as directly influencing positive internal representations that can influence treatment. We used a qualitative method to examine how watching videos of Jeremy Safran, coding therapy sessions using his model, and reading his articles on ruptures and repairs influenced students’ ability to self-soothe, take risks, and engage when patients confront them or withdraw. Results revealed that students often thought of Jeremy Safran and his colleagues during a session and recalled how he addressed ruptures in the videos they watched. When they were anxious during a session, they reported relying on the video coding training to facilitate emotion regulation during sessions. Having the research experience increased their clinical skills and overall clinical self-efficacy. Implications of our findings and future recommendations are discussed.</p> Cheri L. Marmarosh, Chiara Abbatelli, Molly Tulipan, Jasmine Kaleka, Jordan Ohanesian, Charlotte Howson ##submission.copyrightStatement## Fri, 19 Apr 2019 10:24:09 +0200 Detecting alliance ruptures: the effects of the therapist’s experience, attachment, empathy and countertransference management skills <p>Accurate alliance rupture detection is a prerequisite to any successful repair process. Despite its importance, however, rupture detection remains a struggle for most therapists. Supporting the existence of a therapist effect on therapy outcomes, rupture detection skills may rely on certain therapists’ personal characteristics. The aim of this study was to verify whether alliance rupture detection performance is related to therapists’ personal characteristics. One hundred and eight undergraduates, trainees and mental health professionals participated in an experimental task assessing their alliance rupture detection ability. Participants also completed attachment, empathy and countertransference management self-reported measures. Participants with clinical experience (trainees and professionals) reported more alliance ruptures, accurate or not, than those with no clinical experience (undergraduates). Trainees reported more accurate ruptures and less inaccurate ones than the two other groups. Attachment anxiety was positively associated with accurate ruptures detection for undergraduates, while this association proved negative for trainees and therapists. Perspective-taking, a cognitive dimension of empathy, was negatively associated with accurate rupture detection, whereas personal distress, an affective dimension of empathy, was negatively associated with accurate ruptures detection for trainees, and positively associated for undergraduates. Self-insight, a component of countertransference management, revealed a negative association with accurate rupture detection for trainees. These findings suggest that therapists vary as to their rupture detection ability and that this ability is related to certain personal characteristics. They also highlight the importance of specific training and clinical supervision for both trainees and experienced therapists in order to improve their detection ability.</p> Corinne Talbot, Rose Ostiguy-Pion, Esther Painchaud, Claudelle Lafrance, Jean Descôteaux ##submission.copyrightStatement## Fri, 19 Apr 2019 10:04:19 +0200 Ruptures, repairs, and reflections: contributions of Jeremy Safran <p>Jeremy D. Safran’s contributions to our understanding of the complexities of the therapeutic relationship, and its role in the process of patient change in psychotherapy, have been profound. In this paper, we briefly summarize the evolution of his thinking about the alliance and highlight how his ambivalence about this construct contributed to his seminal work delineating rupture resolution models, defined as negotiated intersubjective processes between patient and therapist that are the very essence of the therapeutic process for some patients. Responding to strains in the alliance throughout the rupture resolution process is critical and is an aspect of the treatment model that trainees find most challenging. A clinical example is included to illustrate how Jeremy’s attempts at metacommunicating about his experience with a frustrated patient initiated a productive shift in the process that also contributed to additional ruptures, requiring a simultaneous focus on the strained alliance.</p> Lisa Wallner Samstag, J. Christopher Muran ##submission.copyrightStatement## Fri, 19 Apr 2019 09:50:09 +0200 Jeremy Safran: a hero's journey <p>In this essay I explore Jeremy Safran’s intellectual career as a hero’s journey or monomyth within the specific context of psychotherapy research. I argue that he fits such model in the sense that his work – though deeply informed by theories – was singularly focused and driven by his own sense of his role and mission within the profession. Rather than attempting to review in detail the entire scope or specific parts of his research contributions, I look at his scholarship as a kind of quest, a pursuit that was trans-theoretical but unified by foundational questions about the unique nature of the relationship between therapist and patient.</p> Adam Otto Horvath ##submission.copyrightStatement## Fri, 19 Apr 2019 09:34:53 +0200 The legacy of Jeremy Safran <p>Not available.</p> Vittorio Lingiardi, Daniela Gentile ##submission.copyrightStatement## Fri, 19 Apr 2019 09:24:04 +0200