Freud's work establishes a link between an excessive amount of excitation, the infant's experience of helplessness, and trauma. The idea of excess emphasises a quantitative element, not reducible to ...the field of representation. In this paper I explore the notions of excess and closure in relation to two clinical examples. A patient who lived through experiences of excess and flooding is contrasted with another patient whose experience of excess is expressed through withdrawal. The complex process of elaboration and working through in their analyses takes place by bringing together affect, representation, sensorial and somatic experiences, dreams, associations and enactments as they are gathered and given meaning après coup through analytic work. Two concepts were central to the understanding of what took place in the analyses: excorporation and figurability. The paper emphasizes the place of temporality in creating a triadic space in an analysis as it relates the here and now with the there and then in the work of après-coup. The paper also traces the roots of this modern approach that relates the analyst's work of regression, time, and the creation of a triadic space to Freud's metapsychology.
Although the assessment of therapeutic competence in psychotherapy research is essential for examining its possible associations with treatment outcomes, it is often neglected due to high costs and a ...lack of valid instruments. This study aimed to develop two therapeutic competence scales that assess disorder‐specific and treatment‐specific therapeutic competence, and to examine these scales’ psychometric properties along with those of the already established Cognitive Therapy Scale (CTS) in a posttraumatic stress disorder (PTSD) sample. Using an inductive procedure, two rating scales for assessing disorder‐specific and treatment‐specific competence were constructed. The psychometric properties of these scales and those of the CTS were assessed in a sample of 30 videotaped sessions of eight patients from a multicenter study in which PTSD related to child abuse was treated using cognitive processing therapy. Two raters assessed therapeutic competence in 30 videotaped psychotherapy sessions. Interrater reliability, internal consistency, and content validity were determined. The scales (all items and total scores) demonstrated good to excellent interrater reliability, intraclass correlation coefficients (ICCs) = .67 to .97, and internal consistency, Cronbach's α = .73 to .92. The PTSD experts’ ratings confirmed good internal validity. We found statistically significant associations with therapeutic adherence, r = .62 to .85; p < .001; and therapeutic alliance, r = .47, p < .001. These preliminary data imply that the two newly developed competence scales and the CTS can be reliably used to assess different types of therapeutic competence in PTSD samples and may be useful as possible predictors of treatment outcomes.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
Escalas de competencias terapéuticas específicas del trastorno y del tratamiento para el tratamiento del TEPT: Desarrollo y propiedades psicométricas
ESCALA DE COMPETENCIAS TERAPÉUTICAS PARA EL TRATAMIENTO DEL TEPT
Aunque la evaluación de la competencia terapéutica en la investigación en psicoterapia es esencial para examinar sus posibles asociaciones con los resultados del tratamiento, a menudo se descuida debido a los altos costos y la falta de instrumentos válidos. El objetivo de este estudio fue desarrollar dos escalas de competencias terapéuticas que evaluaran aquellas específicas del trastorno y las específicas del tratamiento; y examinar las propiedades psicométricas de estas escalas junto con las ya establecidas de la Escala de Terapia Cognitiva (CTS) en una muestra con trastorno de estrés postraumático (TEPT). Utilizando un procedimiento inductivo, se construyeron dos escalas de calificación para evaluar la competencia específica del trastorno y la competencia específica del tratamiento. Las propiedades psicométricas de estas escalas y las de la CTS se evaluaron en una muestra de 30 sesiones grabadas en video de ocho pacientes de un estudio multicéntrico en el que el TEPT relacionado con el abuso infantil fue tratado mediante terapia de procesamiento cognitivo. Dos evaluadores calificaron la competencia terapéutica en las 30 sesiones de psicoterapia grabadas en video. Se determinó la confiabilidad entre pares, la consistencia interna y la validez de contenido. Las escalas (todos los ítems y las puntuaciones totales) demostraron una fiabilidad entre pares de buena a excelente, coeficientes de correlación intraclase (ICCs) = .67 a .97, y consistencia interna, α de Cronbach = .73 a .92. Las calificaciones de los expertos de TEPT confirmaron una buena validez interna. Se encontraron asociaciones estadísticamente significativas con adherencia terapéutica, r = 0.62 a 0.85; p <0.001; y alianza terapéutica, r = 0.47, p <0.001. Estos datos preliminares implican que las dos nuevas escalas de competencia desarrolladas y el CTS pueden utilizarse de manera confiable para evaluar diferentes tipos de competencia terapéutica en muestras de TEPT y pueden ser útiles como posibles predictores de resultados del tratamiento.
抽象
Traditional and Simplified Chinese s by AsianSTSS
Disorder‐ and treatment‐specific therapeutic competence scales for PTSD treatment: Development and psychometric properties
Traditional Chinese
標題: 用於評估PTSD治療的疾病特殊與療法特殊的療效量表:發展與心理測量特性
撮要: 在心理治療研究裡༌評估療法功效對於檢視其跟心理治療結果的潛在關連實屬必要。可是༌由於成本高和欠缺有效的測量工具༌我們仍缺乏對療法功效的評估。本研究旨在設計兩種療效量表༌評估疾病特殊和療法特殊的療效༌並透過一項創傷後壓力症(PTSD)樣本༌檢視這兩個量表及已有的認知治療量表(CTS)的心理測量特性。我們採用歸納程序༌建立了疾病特殊和療法特殊的功效測量表。有一項多中心的研究༌為因兒時受虐而患PTSD的人提供認知整理治療。我們基於該研究裡8名患者參與的30個錄影節段༌評估兩個新量表以及CTS的心理測量特性。共有兩名測量員在那些節段裡進行心理測量特性評估。我們找出了評判間的信度、內部一致性和內容效度。所有量表༈所有項目和總分༉都有良好至優等的評判間信度༌組內相關係數(ICCs)為 .67 至 .97༌亦有良好至優等的內部一致性(Cronbach's α = .73 至 .92)。PTSD專家的評估確認了量表有良好的內部效度。我們發現治療配合度(r = .62 至 .85; p < .001)跟治療聯盟(r = .47, p < .001)有具統計顯著性的關連。這些初步數據反映༌兩種新的量表以及CTS屬可靠工具༌可用以評估PTSD樣本裡各種療法的功效。它們亦有可能是治療結果的預測變量
Simplified Chinese
标题: 用于评估PTSD治疗的疾病特殊与疗法特殊的疗效量表:发展与心理测量特性
撮要: 在心理治疗研究里༌评估疗法功效对于检视其跟心理治疗结果的潜在关连实属必要。可是༌由于成本高和欠缺有效的测量工具༌我们仍缺乏对疗法功效的评估。本研究旨在设计两种疗效量表༌评估疾病特殊和疗法特殊的疗效༌并透过一项创伤后压力症(PTSD)样本༌检视这两个量表及已有的认知治疗量表(CTS)的心理测量特性。我们采用归纳程序༌建立了疾病特殊和疗法特殊的功效测量表。有一项多中心的研究༌为因儿时受虐而患PTSD的人提供认知整理治疗。我们基于该研究里8名患者参与的30个录像节段༌评估两个新量表以及CTS的心理测量特性。共有两名测量员在那些节段里进行心理测量特性评估。我们找出了评判间的信度、内部一致性和内容效度。所有量表༈所有项目和总分༉都有良好至优等的评判间信度༌组内相关系数(ICCs)为 .67 至 .97༌亦有良好至优等的内部一致性(Cronbach's α = .73 至 .92)。PTSD专家的评估确认了量表有良好的内部效度。我们发现治疗配合度(r = .62 至 .85; p < .001)跟治疗联盟(r = .47, p < .001)有具统计显著性的关连。这些初步数据反映༌两种新的量表以及CTS属可靠工具༌可用以评估PTSD样本里各种疗法的功效。它们亦有可能是治疗结果的预测变量
Objective:
Video teleconferencing (VTC) is used for mental health treatment delivery to geographically remote, underserved populations. However, few studies have examined how VTC affects individual ...or group psychotherapy processes. This study compares process variables such as therapeutic alliance and attrition among participants receiving anger management group therapy either through traditional face-to-face delivery or by VTC.
Method:
The current study represents secondary analyses of a randomized noninferiority trial (
Morland et al., in press
) in which clinical effectiveness of VTC delivery proved noninferior to in-person delivery. Participants were male veterans (
N
= 112) with posttraumatic stress disorder (PTSD) and moderate to severe anger problems. The present study examined potential differences in process variables, including therapeutic alliance, satisfaction, treatment credibility, attendance, homework completion, and attrition.
Results:
No significant differences were found between the two modalities on most process variables. However, individuals in the VTC condition exhibited lower alliance with the group leader than those in the in-person condition. Mean self-leader alliance scores were 4.2 (
SD
= 0.8) and 4.5 (
SD
= 0.4), respectively, where 5 represents
strongly agree
and 4 represents
agree
with positive statements about the relationship, suggesting that participants in both conditions felt reasonably strong alliance in absolute terms. Individuals who had stronger alliance tended to have better anger outcomes, yet the effect was not strong enough to result in the VTC condition producing inferior aggregate outcomes.
Conclusion:
Our findings suggest that even if group psychotherapy via VTC differs in subtle ways from in-person delivery, VTC is a viable and effective means of delivering psychotherapy.
Resumo Esta pesquisa exploratória objetivou avaliar a relação entre evolução dos indicadores genéricos de mudança e qualidade da eficácia adaptativa de uma paciente adulta atendida em psicoterapia ...breve psicodinâmica. Os vídeos e transcrições das 11 sessões deste processo foram analisados com os Indicadores Genéricos de Mudança e com a Escala Diagnóstica Adaptativa Operacionalizada Redefinida. Os resultados demonstraram evolução dos indicadores de mudança e progresso nas respostas adaptativas. Se por um lado respostas mais adequadas sugeriram mudanças na vida da paciente, por outro, essas melhoras puderam ser captadas pelos Indicadores Genéricos de Mudança. As duas medidas usadas em conjunto podem auxiliar o terapeuta na avaliação de progresso do paciente e na compreensão dos fatores que ocasionam ou que limitam a mudança. Sugere-se a realização de pesquisas que compreendam maior número de casos, contem com processos considerados mal sucedidos e envolvam abandono por parte do paciente.
Experience of violence or abuse from an intimate partner (intimate partner violence, IPV) can result in a variety of psychological and mental health impacts for which survivors may seek psychotherapy ...or other mental health services. Individuals experiencing IPV may have specific needs and preferences related to mental health care, yet the question of how to best provide client-centered mental health care in the context of IPV has received little attention in the literature. In this article, we report on findings from qualitative interviews with 50 women reporting past-year IPV who received care through the Veterans Health Administration regarding experiences with and recommendations for mental health services. Participants described client-centered mental health care in the context of recent or ongoing IPV as being characterized by flexibility and responsiveness around discussion of IPV; respect for the complexity of clients' lives and support for self-determination; and promoting safety and access to internal and external resources for healthy coping. We discuss findings in terms of their implications for the mental health field, highlighting the need for flexibility in application of evidence-based treatments, improved coordination between therapeutic and advocacy services, and training to enhance competencies around understanding and responding to IPV.
Impact Statement
This study's findings suggest that client-centered mental health care for survivors of intimate partner violence (IPV) is characterized by a flexible, individualized approach that (1) provides opportunities for expression and validation of IPV-related experiences, (2) respects the complexity of clients' lives and supports their right to determine their own best interests, and (3) promotes safety and adaptive coping by strengthening internal resources and actively facilitating access to external resources and supports.
When people complete psychotherapy, they carry the story of the experience with them. This retrospective reconstruction serves several psychological purposes, including contributing to narrative ...identity and influencing the maintenance of therapeutic gains after termination. Based on a prior qualitative investigation of therapy narratives (Adler & McAdams, 2007a), a new sample of 104 former clients wrote about their psychotherapy after treatment end. Quantitative analyses indicated that the retrospective narratives of participants high in subjective well-being focused on the protagonist's agency in struggling with a discrete problem. In addition, the narratives of participants high in ego development described a coherent story of growth. These findings suggest that the stories clients construct about psychotherapy reliably vary depending on their psychological health.
The development and factor analysis of the Adventure Therapy Experience Scale (ATES) is the first attempt found in the literature to empirically and quantitatively identify therapeutic factors ...theorized to affect change in the adventure therapy experience (Russell & Gillis, 2017). This study utilizes the ATES to explore how its inherent factors may impact treatment outcome utilizing a routine outcome monitoring process to empirically test how these factors may contribute to treatment outcome over time. The sample of 168 males 21.5 years of age completed an average of 79.6 days in the 90-day adventure-based substance use disorder residential treatment program. In the model, adventure-based experiences are a primary treatment tool. For outcome monitoring, all clients were administered the Outcome Questionnaire (OQ-45.2) at intake, every 2 weeks, and at discharge. In addition, clients were administered the 18-item ATES every 2 weeks. The ATES contains 2 items measuring how helpful the adventure experience was as well as how mindful they were of their treatment process during the experience. Clients also answer 16 Likert items measuring responses on 4 subscales: group adventure, nature, challenge, and reflection. Results reveal that clients, on average, improved in their psycho-social functioning as measured by the OQ 45.2. Weeks with higher helpfulness, mindfulness, and group adventure scores than the client's average helpfulness, mindfulness, and group adventure score, had greater decreases in OQ scores than weeks with lower helpfulness, mindfulness, and group adventure scores. Clients with higher aggregate helpfulness and group adventure scores, across all treatment weeks, had greater decreases in OQ scores than clients with lower aggregate helpfulness and group adventure scores. Implications for practice and future research are also discussed.
Absract Background Contemporary treatments assume that the inability to downregulate negative emotional arousal is a key problem in the development and maintenance of psychopathology and that lack of ...effective regulation efforts and a preference to use maladaptive regulation strategies is a primary mechanism. Though ubiquitous, there is limited empirical evidence to support this assumption. Therefore, the aim of the current study was to examine whether self-reported emotion dysregulation equated to difficulties reducing emotional arousal during a behavioral task and to primary use of maladaptive strategies to manage negative emotions. Methods 44 anxious and depressed adults with high emotion dysregulation induced negative distress using autobiographic memory recall. After induction, participants were instructed to downregulate but were not provided any specific instructions in strategies to use. Self-reported emotional arousal was assessed before and after induction and after regulation. Qualitative descriptions of regulation efforts were collected and codedinto effective and maladaptive strategies. Results The task was successful in inducing emotional arousal and participants were successful in their efforts to down regulate negative emotions. Additionally, effective regulation strategies were used more frequently than maladaptive strategies. Limitations Data collected was exclusively self-report and the sample size was small. Conclusion Adults who report high emotion dysregulation may still have effective emotion regulation strategies in their behavioral repertoire and are more likely to engage in these effective strategies when given an unspecific prompt to regulate negative emotional arousal. Despite reporting problems with emotion regulation, adults with anxiety and depression can successfully downregulate distress when prompted to do so.
Purpose of Review
Racial trauma is a severe psychological response to the cumulative traumatic effect of racism. This review synthesizes emerging theoretical and empirical evidence of racial trauma, ...outlines the mechanisms, and lists available assessment and treatment options for racial trauma.
Recent Findings
Emerging evidence illustrates that these cumulative experiences can result in the cognitive, behavioral, and affective presentations of PTSD in people of color. As a result, the evidence to inform the assessment, treatment, and implications of racial trauma has grown exponentially. There are several validated interview and self-report instruments for clinicians to better understand client’s experiences of racism, discrimination, and traumatic stress. There are several emerging treatment options for people of color experiencing racial trauma. However, given the scarcity of literature, we need more studies to establish the validity and efficacy of available assessment and treatment options.
Summary
Emerging and promising advancements can extend our knowledge on racial trauma, including incorporating the cumulative and lasting negative impacts of racism on people of color in how we define PTSD. Additionally, strengthening clinical training and continued education programs for professionals to hone their capacity to discuss the impact of racism effectively administer appropriate assessment tools and implement interventions specific to racial trauma.
BACKGROUNDThe therapeutic environment is commonly acknowledged as a significant influence on mental inpatient treatment experiences and outcomes. Therapeutic milieu interventions provide a distinct, ...secure hospital ward/unit atmosphere where patients with mental illness receive therapeutic interactions and collaborative attentiveness. The review aimed to explore the studies related to the role of a nurse using therapeutic milieu/milieu therapy in a psychiatric setting. MATERIALS AND METHODSA systematic literature search was conducted between 1976 and 2021 using PsycINFO, Medline, Embase, and Scopus. A total of 13 papers were identified for a full review. RESULTSA total of 70 studies were found, out of which 13 of them were analyzed. These studies looked at several therapeutic milieu concepts, such as therapeutic communication, patient satisfaction, nurse involvement, ward design and structure, and a mixture of therapeutic milieu concepts. Most of the studies explored the concepts of milieu therapy in community settings. CONCLUSIONIn the mental health nursing literature, the milieu, as well as milieu therapy, is a well-debated subject. Though the importance of therapeutic milieu in psychiatric settings is recognized, empirical studies on milieu implementation are scarce. Therefore, research is needed to explore the effectiveness of milieu therapy in inpatient psychiatric care, which facilitates patient recovery, safety, and good interpersonal relationships.
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