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"Psychotherapy -- methods"
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Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders?
Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses).
Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18months, and 3 and 6years.
RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program.
These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.
Journal Article
Understanding therapy : how different approaches solve real-world problems
\"This accessibly written book explores many types of psychotherapy, discussing the history, tenets, advantages, and shortcomings of each. It also compares and contrasts how different approaches address real-world mental health concerns\"-- Provided by publisher.
Book
The effects of intranasal oxytocin on the efficacy of psychotherapy for major depressive disorder: a pilot randomized controlled trial
Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance.
Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT (
= 12;
) or placebo (
= 11). Depressive symptoms were assessed with the
at pre- and post-treatment, and at a six month follow-up.
Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time (
< 0.05), with medium-large effect sizes at post-treatment (Cohen's
= 0.75) and follow-up (Cohen's
= 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance (
< 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome.
In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities (
).
Journal Article
Narrative therapy : an introduction for counsellors
Drawing on the ideas of Michael White and David Epston, this fully revised, extended and updated Second Edition incorporates the progression of their thinking over the past five years and introduces developments initiated by other narrative therapists worldwide. New material has been added around counseling for post-traumatic reactions, couples conflict and a sense of personal failure.
eBook
The outcome of short- and long-term psychotherapy 10 years after start of treatment
Empirical evidence on whether patients' mental health and functioning will be more improved after long-term than short-term therapy is scarce. We addressed this question in a clinical trial with a long follow-up.
In the Helsinki Psychotherapy Study, 326 out-patients with mood or anxiety disorder were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT) and were followed for 10 years. The outcome measures were psychiatric symptoms, work ability, personality and social functioning, need for treatment, and remission.
At the end of the follow-up, altogether 74% of the patients were free from clinically elevated psychiatric symptoms. Compared with SPP, LPP showed greater reductions in symptoms, greater improvement in work ability and higher remission rates. A similar difference in symptoms and work ability was observed in comparison with SFT after adjustment for violations of treatment standards. No notable differences in effectiveness between SFT and SPP were observed. The prevalence of auxiliary treatment was relatively high, 47% in SFT, 58% in SPP and 33% in LPP, and, accordingly, the remission rates for general symptoms were 55, 45 and 62%, respectively.
After 10 years of follow-up, the benefits of LPP in comparison with the short-term therapies are rather small, though significant in symptoms and work ability, possibly due to more frequent use of auxiliary therapy in the short-term therapy groups. Further studies should focus on the choice of optimal length of therapy and the selection of factors predicting outcome of short- v. long-term therapy.
Journal Article
Creative ways to help children manage BIG feelings : a therapist's guide to working with preschool and primary children
Help children to stay on top of \"big\" feelings like anger, sadness and anxiety with this ingeniously easy-to-use therapy toolkit. Focusing on making therapy for children both purposeful and playful, the book provides 47 activities to transform your sessions using everyday materials and a variety of tried-and-tested therapy models. The authors deliver sage advice on how to work with children, adapting your approach for different age groups and judging how and when to involve parents and teachers. The handy reference table allows you to quickly fish out the perfect activity for the moment, according to the emotion the child is experiencing, or the therapeutic method needed -- Provided by the publisher.
Book
Transference-focused psychotherapy for borderline personality disorder : a clinical guide
The book is a treatment manual designed for mental health professionals who work with individuals presenting with moderate to severe forms of personality disorder. The book focuses on the broader group of patients with borderline personality organization, expanding the reach and utility of this volume.
eBook