This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. A summary of how the ...concept of alliance has evolved over time and the more popular alliance measures used in literature to assess the level of alliance are presented. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. The emerging picture suggests that the quality of the client-therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. In our opinion, with regard to the relationship between the therapeutic alliance and outcome of psychotherapy, future research should pay special attention to the comparison between patients' and therapists' assessments of the therapeutic alliance. This topic, along with a detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects.
Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of ...personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states - here termed metacognition - which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients' symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variables.
This article analyzed the process of change and the effectiveness of 10 sessions of Family Constellations (FC), explored elements that may aid reconciliation effectiveness, and decrypted factors ...underlying four variables of interest: suicidal ideation, verge of divorce, depression, and anxiety. Using a mixed methods design, this single case study used a triangulation of data: quantitative (DASS-21) and qualitative (the notes from the consultations and the patient's responses to the Psychotherapeutic Process Data Mining Questionnaire, or PPDMQ). The Reliable Change Index (RCI) was used to gauge clinical change in the DASS-21 scores. RCI analysis showed a clinically and statistically significant change at process termination, and at the 6-month follow-up, on the patient's symptoms of anxiety and depression. As a member of a couple on the verge of divorce, by undoing that drive to divorce, the suicidal ideation of the patient seemed to stop. Two focuses of interventions are proposed to mitigate divorce rates, suicide rates linked to divorce, as well as depression and anxiety levels associated with divorce and suicidal ideations. FC, as a psychotherapy, seems to possess a substantial financial and societal positive change potential (e.g., at the judicial sphere) and perhaps needs to be addressed from an unbiased perspective.
Recovery from serious mental illness (SMI) is a complex process that can be supported by different levels of mental health care, for example, individual psychotherapy. Current individual ...evidence-based psychotherapy for persons with SMI is often focused on specific objective recovery outcomes, including symptom reduction and functional improvement, and requires a minimum level of insight. Less common but also important are broader, more flexible approaches that allow clients to explore their needs and challenges, without predetermined goals or a certain level of insight. The current article aims to describe (1) the development of metacognitive reflection and insight therapy (MERIT), an evidence-based psychotherapy that is focused on self-determination, or self-directed recovery, and (2) how MERIT advances care for persons with SMI by addressing a significant gap in the field for the treatment of people with SMI with limited metacognitive capacity and insight, offering an adaptable approach emphasizing self-directed recovery. MERIT utilizes a metacognitive framework that is guided by flexible key elements and an interpersonal environment. Training MERIT therapists early in their careers may be helpful in providing a holistic view of SMI to promote self-directed recovery in ways that are personalized and meaningful for each person. MERIT training has been completed in multiple countries across different levels of training (e.g., internship and psychology practicum). Professionals such as psychologists and social workers have effectively played a role in MERIT development and dissemination, which ultimately strives to advance psychotherapy for a wide range of individuals with SMI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Objective: Despite arts advancement and advocacy in education, research, and clinical practice, the arts, including music, dance, theater, and visual art, continue to be largely viewed as stimulating ...and not necessarily scientifically sound disciplines. This article describes the intentional and methodical use of artistic inquiry to expand the grasp of the mental health condition of depression and suggest ways to engage with it. Methods: Different art forms, dance/movement, collage, sculpting, photography, and watercolor were utilized in separate artistic inquiries to explore and better understand the phenomenon of depression, specifically the elements emptiness, hopelessness, and uncertainty. Results: The engagement with art revealed that darkness promotes the germination of something new and valuable. Another discovery was that change is constant in life and can be a comforting fact considering that depression may feel interminable. Last, connection was found to be crucial. When two colors were blended, they yielded another hue and thus a novel outlook on life. Conclusions and Implications for Practice: Artistic inquiry is not only an intuitive and freely accessible tool, but it also offers a unique understanding of the human condition that is rich in meaning and personally relevant. By methodically engaging with art during uncertainties or when facing a clinical or personal challenge, practitioners can increase their insight and develop exceptional and creative solutions that may contribute to psychiatric rehabilitation and recovery.
Impact and Implications
This study suggests that systematically engaging in artistic inquiry through art, movement, and other expressive means, can be a useful method to gain unique insights about the human condition of depression as well as develop creative solutions that may contribute to restoration.
The coronavirus disease-2019 (COVID-19) pandemic has affected the mental health and alcohol consumption of individuals. Videoconferencing psychotherapy has become a fundamental mode of treatment for ...people with alcohol use disorders. However, there are still doubts about its effectiveness and the therapeutic relationship. The working alliance is considered a foundation of effective practice in cognitive behavioral therapy (CBT). Observer measurements of the working alliance have demonstrated reliability and meaningful associations with the reduction of symptoms. However, translations of instruments to evaluate the working alliance and examine its construct have not previously been conducted for online psychotherapy for alcohol addiction. This study aimed for the cross-cultural adaptation of the Working Alliance Inventory-Short Form-Observer (WAI-SR-O) for Brazil and the evaluation of its reliability and evidence of its validity in videoconferencing psychotherapy for alcoholism. The WAI-SR-O was applied by pairs of observers for the evaluation of the working alliance in 19 recorded sessions of videoconferencing psychotherapy of 10 clients with a diagnosis of alcohol addiction. The sessions were also evaluated by the therapist (WAI-T) and client (WAI-C). The WAI-SR-O shows a moderate inter-rater intraclass correlation coefficient (ICC = 0.67) for the general scale, higher ICC for the goals and bond subscales, and a moderate value for the task subscale. The internal consistency was good (a = 0.86). The results show low but significant correlations among the goals and bond subscales of the WAI-SR-O and the general, goals, and bond scales of the WAI-T. No correlations were found with the WAI-C. As the literature points out, the client, therapist, and observer versions of the WAI evaluated the alliance differently, requiring further study. The WAI-SR-O proved to be a reliable and valid measurement for the evaluation of the working alliance in videoconferencing psychotherapy for alcohol addiction, becoming an important tool for the study of the working alliance in telepsychotherapy.
Estruturas de interação são padrões repetitivos que ocorrem entre terapeuta e paciente, mesmo que não sejam conscientes por ambos. Na pesquisa empírica, elas ajudam a compreender como se estabelece o ...processo de mudança em psicoterapia. Nesse sentido, esta investigação utilizou 68 sessões de psicoterapia psicanalítica de um caso do uma jovem paciente com Transtorno de Personalidade Borderline (TPB) com o objetivo de identificar as estruturas de interação e sua correlação com o tempo de tratamento. Os dados foram gravados em vídeo e posteriormente codificadas através do Psychotherapy Process Q-Set (PQS), por duplas de juízes treinados na metodologia Q-Sort. A partir desses dados, foi realizada a análise fatorial do tipo Q de componentes principais que indicou quatro estruturas de interação, sendo Fator 1: Colaborativo; Fator 2: Resistência; fator 3: Aliança/Ruptura e fator 4: Apoio/Encorajamento. As estruturas indicaram que a interação se voltou para o trabalho de manutenção da interação colaborativa, através de uma posição empática do terapeuta, direcionado para o reconhecimento dos estados internos do paciente. Apesar do trabalho colaborativo, a resistência também surgiu como um padrão repetitivo. O terapeuta se tornou diretivo com intervenções estruturadas e questionando o paciente, desta forma contribuindo para o desenvolvimento da capacidade de mentalização. Implicações sobre o processo psicoterápico e indicações para estudos futuros são apresentados com o intuito de contribuir na compreensão sobre o tratamento de pacientes com TPB em psicoterapia psicodinâmica.
The central aim of the research was to verify and determine the strength of the relationships of therapeutic alliance to wellbeing, life satisfaction, and flourishing in patients attending individual ...psychotherapy. The relationships were assessed based on different sources of information about the quality of the working alliance: patient's evaluation and patient's and psychotherapist's joint evaluations.
The author applied Bordin's pantheoretical model of alliance and two different conceptions of wellbeing, operationalized as hedonistic and eudaimonic.
The 411 participants included 252 patients and 159 psychotherapists. To test the hypotheses, 16 joint and separate models of structural relations were built and analyzed empirically using SEM. Correlations were analyzed between alliance factors and those of wellbeing, satisfaction, and flourishing.
The actual impact of working alliance quality on psychological wellbeing proved to be stronger compared to the relations between alliance and satisfaction or flourishing. The results of analyses revealed low, though usually positive and significant, correlations between the dimensions of alliance and those of wellbeing, life satisfaction, and flourishing.
The empirical data and the strategy of analyses brought the expected results, confirming that patient's and psychotherapist's perception of a strong therapeutic alliance is crucial for the optimization of patient's functioning and wellbeing. It turns out that the therapeutic alliance is, above all, a factor of wellbeing understood more deeply than merely as current pleasure. The study also showed that no factor isolated from other components of alliance increased the quality of patient's mental functioning more than others.
Gaining insight is considered a cornerstone of psychodynamic psychotherapy. Existing tools used to measure insight mainly include patients' self-report questionnaires and external coding of therapy ...sessions. To expand on the available tools, the present study developed a comprehensive coding system for the Self-Understanding of Interpersonal Patterns Scales-Interview (SUIP-I; Gibbons & Crits-Christoph, 2017). A total of 55 patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression and were interviewed using the SUIP-I at baseline. A comprehensive coding system was developed for rating the interviews, based on a Likert scale for each of the six levels of insight. The content validity, psychometric properties, and the reliability and validity of the coding system were examined. The new SUIP-I coding system demonstrated interrater reliability in the "excellent" range, ICC (1, 1) = .91-.97, for all the six levels, and adequate internal consistency (Cronbach's α = .81). Support for convergent validity was gained, as manifested in a significant positive association of the SUIP-I with alliance expectation and affiliation, and a significant negative association with avoidance attachment. Support for discriminant validity was also gained, as manifested in a weak, nonsignificant association between the SUIP-I and self-esteem. The proposed comprehensive coding system shows good initial reliability and validity. Research is needed to further establish the psychometric properties of the new SUIP-I coding system.
Clinical Impact Statement
Question: Can a coding system be developed, based on a Likert-scale, for the Self-Understanding of Interpersonal Patterns Scales-Interview such that it can represent a systematic assessment of insight? Findings: The developed Likert-scale-based systematic coding system can be used by clinicians to evaluate the level of insight. Meaning: Insight can be reliably quantified as a continuous range based on a semistructured interview. Next Steps: After further validation of the SUIP-I coding system, it can be used to create an understanding of differences in level of insight between individuals, as well as changes within individuals throughout treatment.
This study assessed the psychometric properties of a Spanish version of the Shortened Outcome Questionnaire (OQ-30.2, Lambert et al., 2004) validated with a sample of 546 patients in an outpatient ...mental health clinic and 100 non-clinical adults in Chile. Our results show that this measure has similar normative data to the original measure, with a cutoff score for the Chilean population set at 43.36, and the reliable change index at 14. This Spanish OQ-30.2 has good internal consistency (α = 0.90), has concurrent validity with the Depressive, Anxious, and Somatoform disorders measuring scale (Alvarado and Vera, 1991), and is sensitive to change during psychotherapy. Consistent with previous studies, factorial analyses showed that both, the one-factor solution for a general scale and the three-factor solution containing three theoretical scales yielded poor fit estimates. Overall, our results are similar to past research on the OQ-45 and the OQ-30. The short version has adequate psychometric properties, comparable to those of the OQ-45, but provides a gain in application time that could be relevant in the setting of psychotherapy research with large samples, frequent assessments over time, and/or samples that may require more assistance completing items (e.g., low-literacy). We conclude that this measure will be a valuable instrument for research and clinical practice.
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