Book of Abstracts

Transcrição

Book of Abstracts

Book of Abstracts
Society for Psychotherapy Research
8th European Conference on Psychotherapy Research
Klagenfurt, Austria
September 24 - 26, 2015
Book of Abstracts
8th European Conference on Psychotherapy Research
Klagenfurt, Austria
September 24 - 26, 2015
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4
Table of Contents
Governance and Committees
6
Preface
8
Abstracts (in chronological order)
Thursday
10
Friday
12
Saturday
97
Author Index
160
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Governance and Committees
President
J. Christopher Perry
Past President
Jeanne Watson
President Elect
J. Christopher Muran
Executive Officer
Tracy D. Eells
European Chapter Presidents
President
Henning Schauenburg
Past President
Mikael Leiman
President Elect
Stig Poulsen
Past Presidents of the European Chapter
1987-1990
Winfrid Huber
1990-1993
Klaus Grawe
1993-1996
Horst Kaechele
1996-2000
Hans Kordy
2000-2004
Eva Baenninger-Huber
2004-2007
Giuseppe Nicolò
2007-2010
Wolfgang Tschacher
2010-2013
Mikael Leiman
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Scientific Program Committee
Henning Schauenburg (Chapter President & Program Chair),
Stig Poulsen,
Sven Rabung,
Svenja Taubner (Local Host),
Orya Tishby,
Wolfgang Tschacher,
Katharina Weitkamp
Local Organizing Committee
Svenja Taubner (Local Host),
Sylke Andreas,
Sven Rabung,
Michael Wieser
Web & IT
Sven Schneider
Meetingsavvy.com
Brad Smith
Sponsored by the research council &
Faculty of Cultural Studies,
Alpen-Adria-Universität Klagenfurt
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Preface
Dear colleagues,
The European chapter of SPR welcomes you to Klagenfurt, Austria, for the 8th European conference of our
society!
We expect around 250 participants from all over Europe and other continents – the presenters alone represent
31 different countries. We are very happy to host several countries from Eastern Europe (Albania, Bulgaria,
Latvia, Poland, Russia, Serbia, Slovak Republic, and Slovenia) and also welcome colleagues traveling very far for
this meeting, coming from China, India, USA, Chile and Mexico.
The scientific program consists of 101 Papers in 28 Panels, 62 Papers in 12 Brief Paper Sessions, 45 Posters, four
Pre-Conference Workshops, eight Structured Discussions and two plenary sessions. The range of topics is broad
from therapist factors to cultural comparisons, from experimental designs to case observations. Many
presenters have taken the general theme of the meeting into account and discuss diversity and pluralism in
psychotherapy and psychotherapy research.
The main topic of our meeting is “Psychotherapeutic diversity: How many approaches do we need?” This topic is
relevant for our changing field discussing common factors vs. specialized treatment forms and refers to the
unique situation for psychotherapy in our hosting country. In Austria, 23 different schools of psychotherapy are
accepted in the federal health system and training in psychotherapy is open for every occupational background
or academic qualification. This is in strong contrast to Germany where only three therapeutic approaches are
paid for by the statutory and private health insurances and only psychologists and physicians can complete
psychotherapy training.
We will frame this topic with an introductory lecture by Dr. Mark Hilsenroth from the Derner Institute of
Advanced Psychological Studies at Adelphi University, New York, with the title „Psychotherapy Diversity: Many
Paths to the Mountaintop”. Dr Hilsenroth will review recent empirical data on both the general effects of
psychotherapy as well as the relative efficacy of different treatment orientations in achieving therapeutic
change. Given the diverse pathways various therapeutic orientations have demonstrated with regard to
achieving treatment benefits, several salient issues will be explored that help to explain these findings. These
issues will include common factors of psychotherapy, most especially the therapeutic relationship, as well as
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therapist effects, specific-technique effects and therapeutic integration. Implications for training and practice
will also be explored. The talk will be held at the Auditorium in the big plenary room HS A. Afterwards we
welcome you for a reception in front of the plenary room.
Sessions on Friday and Saturday will take part in one single building at the campus of the Alpen-Adria-Universität
Klagenfurt: the Canteen Building. On the ground floor you will find the registration and one plenary room. On
the first floor will be another six lecture rooms including a coffee lounge. The poster session on Friday at 18.30h
will take place around the HS A in the auditorium.
Our conference will provide us with several opportunities to intensify the exchange also with members from
smaller or “new” countries, e.g. in Eastern Europe. Plans for further networking in the field of psychotherapy
research therefore will be discussed in separate workshops, but also in the business meeting. There we also
want to broach again the issue of local coordinators in each country. So, if you are a member of the European
chapter or plan to become one, please do not miss the business meeting on Friday between 14 and 15h at the
HS 10 in the Canteen Building.
On Saturday late afternoon, the meeting will close with a final plenary that will pick up the topic of the meeting
discussing “Psychotherapy – the future of Diversity, Visions for SPR-EU” with our former, present and future
chapter presidents Franz Caspar, Eva Baenninger-Huber, Wolfgang Tschacher, Henning Schauenburg and Stig
Poulsen.
In the evening, we invite you to join our banquet at the beautiful lake Wörthersee at the restaurant Villa Lido.
We will start at 19h with a one hour boat tour on the lake and start dinner at around 20h with the possibility to
dance afterwards.
On behalf of the local organizing committee and the program council we wish to thank all colleagues for their
submissions and contributions to what we are sure will be a stimulating and successful conference.
Henning Schauenburg (program chair)
Svenja Taubner (local host)
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Thursday, 24 September 2015
1.
Pre-Conference Workshop
Couple
Thursday | 2:30 PM-4:30 PM | HS 11
Who within me talks to whom within you? Dialogue and Metalogue or
understanding the understanding. A new approach for the therapeutic work
with couples and families
Ulrich Peter Hagg, University of Klagenfurt, Austria
By introducing verbal and non-verbal metacommunicative interventions a deeper way of
mutual understanding can be achieved. Contradictory ego states are named and integrated in
the voices dialogue of multipartial settings. This allows to treat reproductive communication
problems as well as cold and hot conflicts and destructive interactive patterns.
The Workshop begins with an improvised couple therapy situation by two actors to introduce
in the interventive approach and will be followed by practical and theoretical background
informations according to the questions of the participants.
2.
Linguistic
Peter Muntigl, Ghent University, Belgium;
Anssi Peräkylä, University of Helsinki
Exploring Therapist-Client Interactions through Conversation Analysis
The aim of this workshop led by Peter Muntigl and Anssi Peräkylä is to explore how the
methods of Conversation Analysis/CA allows us to gain a better understanding of how clients
and therapists accomplish important therapeutic work with each other on a turn-by-turn and
moment-by-moment basis. The workshop is divided into two parts. In the first part, we
provide a basic outline of CA methodology. Important concepts for understanding how social
interaction is achieved in real time will be reviewed, and the key activities of
psychotherapeutic interaction -- such as formulating, interpreting and questioning -- will be
discussed. In the second part, a more hands-on approach is taken, which will involve applying
CA methodology to video-recorded psychotherapy sessions. Participants will be given
transcripts of selected sequences of psychotherapy interactions and, while watching the
video, be asked to examine and identify potentially relevant episodes of talk. The discussion
may include topics such as: how an affiliative or disaffiliative therapeutic relationship is
interactionally achieved; how therapists challenge the clients` views and experiences; how
therapists orient to the client`s ownership of personal experience.
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3.
Depression
Bao-Chau Du, University Health Network
Grieving Mindfully: Living with Loss, Change and Grief
Grief is a personal journey and it is never the same for any two people. Grief can take place
after the loss of a loved one, or any major changes in a person`s identity such as losing a job,
divorce, kids going off to college, and even moving residence. Although loss is an inevitable
part of life, how individuals approach this experience can make the difference between
meaningless pain and the manifestation of understanding and wisdom through mindfulness.
Mindfulness enables individuals to live in the present moment with openness, compassion
and equanimity. When applied to the grieving process, mindfulness allows us to observe the
impermanence of pain and loss, develop acceptance and self-compassion and how to grow
through our grief journey.
4.
Research funding
Sylke Andreas, Alpen-Adria Universität, Klagenfurt;
Johannes Krall, University of Klagenfurt, Austria;
Anton-Rupert Laireiter, University of Salzburg, Austria;
Stig Poulsen, University of Copenhagen, Denmark;
Henning Schauenburg, UniversitätsKlinikum Heidelberg, Germany;
Jana Volkert, University Medical Center Hamburg-Eppendorf, Germany
5.
Plenary
Thursday | 5:00 PM-7:00 PM | HS A (Auditorium)
SPR-EU goes Horizon 2020
Opening Plenary
Psychotherapy Diversity: Many Paths to the Mountaintop
Mark Hilsenroth, Adelphi University, New York, USA
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Friday, 25 September 2015
6.
Structured Discussion
Trauma
Moderator: Sophia Kes Rath,
Washington State University
Friday | 9:30 AM-11:00 AM | HS 9
Efficacy of mainstream treatment modalities for complex trauma among
refugees: A structured discussion
Discussants: Sophia Kes Rath, Washington State University; Rebecca A Klott, River City
Psychological Services; Raymond L Sheets, Jr., University of Tennessee, Knoxville, USA
While there has been substantial progress toward identifying effective treatment modalities
for posttraumatic stress disorder, more research is needed regarding effective treatment
modalities for complex trauma among the refugee population (Cloitre, 2009). When working
with refugees, clinicians often need to address the co-morbid emotional, social, and physical
health consequences of complex trauma (Kruse, et al, 2009). Furthermore, effective
treatment often needs to be community based, incorporating larger systems of care.
Traditional psychotherapy modalities may fail to address such systemic concerns.
In our Structured Discussion, we plan to facilitate conversation that explores the crosscultural efficacy of mainstream therapeutic modalities for addressing complex trauma. We
will also invite dialogue on how therapists experience the mental healthcare needs of
refugees, particularly with regard to the complexities arising from continuous trauma. Finally,
we will address the relevance of multicultural competency with respect to providing
culturally informed treatment and referral to accessible auxiliary services.
7.
Panel
Therapist factors
Moderator: Henriette LoefflerStastka, Medical University of
Vienna, Austria
Friday | 9:30 AM-11:00 AM | HS 10
Becoming a psychotherapist - which competencies do we need and how are
they acquired?
Psychotherapeutic processes and clinical reasoning processes are recognized, understood
and easy to be applied by the experienced clinician, but hard to be acquired by the (under)
graduates. Clinicians with their implicit knowledge gather experiences, do conceptual
research, some build up new theories, manuals, search for consensus in working groups, but
the point of the development and learning procedure is an underrepresented research topic:
First, ingredients of the needed competences have to be elucidated - what has to be done,
which knowledge has to be retrieved? Second, how do we have to teach it, train it, and how
do we end up with an effective, respected psychotherapist? These two points are influenced
by several conditions that should be focused and discussed in this panel. It is to provide an
outline of how to achieve a competence based learning method, how it can be implemented
and which infrastructure is needed for research driven education. With a trans-disciplinary
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approach using qualitative methods (for the elaboration of the core-competences) and
quantifying methods (for evaluation) we discuss the procedural development to elaborate
and focus core-competences, including those to be acquired in psychotherapeutic
propaedeutics as well as in 4 different psychotherapeutic methods, in Psychoanalysis,
Gestalt-therapy, Systemic Therapy as well as Person-centred core-competences are
elaborated.
Self-reflexion -- a core-competence in the development of psychotherapeutic competence
Margit Finger-Ossinger, Medical University of Vienna, Austria; Henriette Loeffler-Stastka
Which question is tried to be answered? Is there any improvement of self-reflexion at the
end of the propaedeutics? Background: Self-reflexion is one of the competences students
should improve, when becoming a psychotherapist. Each action, and there are many during
the therapeutic sessions, and especially the therapeutic process, has to be examined. One
should improve the awareness of essential aspects of the action or situation and create
alternative methods if necessary (eg. Korthagen 2005). Methods/Design: Using thematic
analysis (Braun and Clarke 2006) a data set of overall 24 self-reports of eight students are
examined. The first part of the data set consists of 16 self-reports reflecting the personal and
cognitive improvement from the first and last tutorial. The second part of the data set
consists auf 8 self-reports. In the final stages of the propaedeutics the personal and cognitive
improvement of the whole period of the propaedeutics should be reflected. Results and
Discussion: The students of the propaedeutics have very different education and studies,
which can be splitted into four groups. All groups will be represented in the study. Students
from universities from the clinical department: psychology or medicine. Students from
universities from philosophical studies: philosophy, theology, education. Students of other
universities: law, management of affairs. Students from an educational establishment for a
specialized discipline: nurses, teachers. Men and women will be chosen equally.
Psychoanalytic core competence --Organisation and collection of psychoanalytic core
competences to understand, bear and work with unconscious mental processes and their
implementation as a process and outcome research method
Karoline Parth, Medical University of Vienna, Austria; Henriette Loeffler-Stastka
The aim of the study is twofold: First, to find a theory and expert based definition of the
psychoanalytic core competences of working with and understanding unconscious mental
processes. The goal is to identify those components and aspects of the analyst's capacity to
understand and work with unconscious mental processes which constitute the essence of
the psychoanalytic process. The clinical manifestation of these concepts will be elaborated in
order to make them observable in clinical practice. Here, the aim is to establish an expert
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based comprehensive collection of these core competences as well as an understanding of
the way in which the ability to work with unconscious mental processes can be observed and
assessed. Secondly, to apply this collection of core competencies as a research tool to
analyse how analysts use their understanding of their own and the patient's unconscious
mental processes in the analytic session. On the basis of a sample of three successful and
three unsuccessful treatments, the analyst's capacity to apply these core competences, to
bear the analytic situation and to maintain and preserve space for thought will become
explicit. Consequently, we seek to observe and measure the process of effecting change in
the patient and ultimately to empirically show the connection between these competences
and internal change, development and improvement in the patient.
On Developing Person-centred Core Competencies in Trainee Psychotherapists - Does it
lead to an Improvement of Key Competencies?
Brigitte Macke-Bruck, Medical University of Vienna, Austria
Presented is a proposed pilot-study in the field of training research. Main objective is to
determine specific qualitative criteria of monitoring 'person-centred core competencies' in
trainees during their clinic term. Additionally it will be highlighted how experts register a
possible relationship between 'person-centred core competencies' and the concept of 'key
competencies' according to EU-guidelines. Purpose of this study is to record data through
conducting a focus group, followed by person-centred and client-centred experts' interviews
collected amongst four training-centres. Prior aim is to identify relevant components of
'person-centred core competencies', whereas the latter is to assess explicit and implicit
criteria used by trainer stuffs at mid-term evaluations addressed to their trainees' progress
and need for specific support. All in all, the expected outcome of these investigations is
twofold. Beside effects concerning the training-quality via the reflecting function on the
conducted interviews per se, there will be seen less similarity between the concepts of
person-centred 'core competencies' and common 'key competencies' in contrast to the
models 'core-competencies' and 'traditional person-centred core concepts'. A possible
explanation to the last conclusion might be, that, due to Carl R. Rogers' research on
characteristics of a therapeutic relationship and his interest in 'invariant aspects of change in
personality and behaviour', he adapted the 'process-scale'. This dimensional instrument,
representing process-outcomes, is in mind of most of the person-centred training
psychotherapists.
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Core competences in Gestalt-therapy -- definition and collection with view on
developmental aspects in psychotherapy training and education
Ursula Grillmeier-Rehder, Medical University of Vienna, Austria; Henriette Loeffler-Stastka
The study proposes, that a part of the theoretical and methodological basic competences
that lay in the realm of knowledge acquisition and techniques, can be learned with
appropriate didactical means, if the trainee is basically eligible and interested in. That
comprises fundamental anthropological and philosophical theories, clinical aspects,
interventional repertoire and so on. Furthermore the study assumes, that there exist a
compound set of core competences, that are essential for the development of the identity as
a psychotherapist, that cannot be learned and imparted by transfer of mere knowledge, but
have to be comprehended and realized in another way by means of self-experience, practical
training, feedback, supervision, that have to be in permanent interlacing to each other. The
study describes a set of core competences concerning the therapeutic attitude and the
ability to build up and maintain a therapeutic relationship. There are planned two parts of
the study: The first part defines and describes those core competences and their special
aspects and will be evaluated by experts with regard to their importance in Gestalt-Therapy.
The second part contains a survey, in which graduates, trainees and teachers are asked about
their understanding, relevance, personal importance and implementation of those
competences in their practical doing. Special aspects of their acquisition during the
psychotherapy training are included. At the panel the results of the first part of the study is
presented (in form of a poster presentation).
Discussant: Svenja Taubner, Alpen-Adria-Universität Klagenfurt
8.
Panel
Linguistic
Moderators: Peter Muntigl,
Ghent University, Belgium;
Anssi Peräkylä, University of
Helsinki
Friday | 9:30 AM-11:00 AM | HS 5
Conversation analytical psychotherapy research I
There is increasing recognition within the psychotherapy community that language and
therapist-client interactions may reveal important aspects of the therapeutic process. In fact,
eminent psychotherapy researchers such as William Stiles and Robert Elliott have recently
suggested that conversation analytic (CA) based methods show great promise not only in
describing and accounting for what actually happens, moment-by-moment, during
therapeutic consultations, but also in building "meaning bridges" between psychotherapy
theory and practice and CA-informed views of social interaction. The formation of a
therapeutic alliance, client change, narrative production and client emotions are just some
examples of "meaning bridges" in which traditional, psychotherapy research topics have
been receiving a discursive focus.
For this panel, we will showcase new cutting edge, CA-focused work on psychotherapy by
bringing together experts from an international community. We will organize two 90-minute
sections to present these CA studies. For this first section, three papers will be given that
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focus on interactional practices that play an important role in achieving a positive
therapeutic relationship. The first paper explores how a therapist and client achieve a
dynamic balance between conflictive tension and security during psychoanalytic
psychotherapy. The second paper focuses on the interactional structures and practices that
index client-identified important events during short-term psychodynamic therapy. Finally,
the third paper examines how therapeutic collaboration is re-established following a
momentary impasse in narrative therapy.
Affiliation in Psychoanalytic Psychotherapy: Interactional Sequences that Maintain a
Balance between Conflictive Tension and Security
Peter Muntigl, Ghent University, Belgium; Eva Baenninger-Huber; Adam Horvath
According to psychoanalytic theory, one of the psychoanalyst's tasks is to maintain a balance
between "conflictive tension" and a "basic sense of security" (e.g., Moser, Piaget). We are
interested in showing the practices through which this balance is achieved at both the verbal
and nonverbal levels. For example, psychoanalysts may engage in a practice known as
abstinence, which may produce both conflictive tension and place relationship security at
risk. At the same time, however, other interactional practices may work to maintain a
balance by providing the client with relationship security. For this paper, we draw from two
complementary approaches to interaction analysis: Conversation Analysis/CA and AMA (=
Affective Micro-Sequence Analysis). This combinatory approach is important as it takes into
account a full range of interactional resources that work to maintain an affiliative
relationship. For example, a secure relationship may be established nonverbally through an
affiliative PAM (Prototypical Affective Microsequence) as when the therapist returns the
patient's smile or laughter, as well as through a therapist's verbal response that displays
affiliation and/or empathy.Drawing from a corpus of video-recorded psychoanalytic
psychotherapy, 2 sessions involving a female patient diagnosed with depression were
selected for analysis. Based on our examination of the interactional sequences within these
sessions, we will discuss how practices of abstinence may lead to 'productive' sequences of
talk and how affiliative verbal and non-verbal (i.e., PAMs) sequences facilitate opportunities
for patients to deal with difficult topics.
A conversational analytical perspective on the therapeutic collaboration reestablishment in
a good outcome case of narrative therapy
Eugénia Ribeiro, University of Minho; Cátia Sofia Vasconcelos; Dulce Pinto
Therapeutic collaboration involves the coordination of actions between the therapist and the
client, framed in their unfolding and moment-to-moment conversation in the
psychotherapeutic context. However, their conversation and mutual understanding are
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sometimes characterized by moments of impasse that must be repaired right after their
occurrence in order to reestablish the therapeutic collaboration and promote the therapeutic
success. The aim of our study was to analyze the therapist's action right after an invalidation
response of the client to a challenging intervention of the therapist, in a good outcome case
of narrative therapy composed by 19 sessions. All the sessions were previously coded with
the Therapeutic Collaboration Coding System, a qualitative method that allowed us to
describe the therapeutic interaction at a micro-level in terms of collaboration. Base on the
TCCS coding we identified the specific unit of analysis of interest -- the therapeutic exchange
resulting from the combination of a challenging intervention by the therapist side and a
subsequent response of intolerable risk by the client side (Challenging -- Intolerable risk).
Posteriorly, all the sequences of Challenging -- Intolerable risk were analyzed from a
conversational analytical perspective. Preliminary results show that the therapist tend to
perform several types of actions right after these particular therapeutic exchanges that
threaten the therapeutic collaboration, reflecting different attempts to reestablish the
mutual understanding of the dyad. These results will be discussed in terms of their potential
to inform the clinical practice.
Discussant: Bill Stiles, Department of Psychology, Miami University, EUA
9.
Panel
Integration
Moderator: Tiago A. G.
Fonseca, Faculty of Psychology
of University of Lisbon
Friday | 9:30 AM-11:00 AM | HS 6
Needs and Schemas
Paradigmatic Complementarity Model: Schematic Functioning and Regulation of
Psychological Needs Satisfaction
Intra-Individual and Inter-Individual Dimensions of Schematic Functioning based on the
Paradigmatic Complementarity Model: A Qualitative Study
Tiago A. G. Fonseca, Faculty of Psychology of University of Lisbon; António Branco Vasco
Based on the Perturbation Theory of the Paradigmatic Complementarity Model (e.g. Vasco,
2005, 2006), an integrative model of psychotherapy, this study postulates the schematic
functioning of the individuals as adaptive or non-adaptive, where the schematic functioning
rigidity is central in its definition, determining whether or not the adaptive nature of the
functioning of individuals. Initially, deepening the perturbation theory on the model, we have
conceptualized the Schematic Functioning, based on the Paradigmatic Complementarity
Model, which is attributed a greater importance to the form of the schematic functioning
than to its content. In a non-adaptative side, we have conceptualized the schematic
functioning in its dimensions, intra-individual - Absence of Schema, Not Complete Integration
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of Schema's Experience, Hypo-valence of Schema, Hyper-valence of Schema and, Conflict of
Schema - and inter-individual - Conflict of Schema - in regard to the rigidity of its form.
Schemas are seen as being cognitive-emotional structures and as the basis for behaviors that
lead to the Regulation of Psychological Needs Satisfaction. We've tested two samples,
therapists and non-therapists, with two qualitative methodology techniques, individual
interviews and focus group sessions, to assess the theoretical conceptualization. In this brief
paper we'll present the first results, proceed to the discussion and their conclusion. Finally,
we present the implications for clinical practice.
Profile of Discrepancies of Psychological Needs: Relationships with Psychological WellBeing and Distress
Sofia Vieira Lopes, Faculty of Psychology of University of Lisbon; António Branco Vasco
This work, conceptually framed by the integrative Paradigmatic Complementarity Model,
focuses on the study of the profile of discrepancies in the regulation of psychological needs
satisfaction. Based on the conception that needs discrepancies underlie the development of
maladaptive and rigid personality patterns, the Needs Discrepancies Profile Scale (EPDN) was
developed. The study addresses the relationships between the aforesaid discrepancies and
the regulation of psychological needs satisfaction, psychological well-being and distress. It
was created an online platform where three instruments to measure the referred variables
were filled in by a global convenience sample of 312 adults, being the majority non clinical.
The results showed that well-being and the regulation of psychological needs satisfaction
were negatively correlated to discrepancies, while distress was positively correlated to the
same variable; besides the existence of exceptions. Also, the discrepancies were predictive of
these three variables. The individuals with high scores on EPDN showed higher levels of
distress, lower levels of well-being, and greater regulation of psychological needs satisfaction
than those with lower scores that showed lower levels of distress and higher levels of wellbeing and greater regulation. Finally, it was observed that individuals with low results on
EPDN and a greater regulation psychological needs satisfaction had higher levels on wellbeing and lower in distress. These results empirically support the Perturbation Theory
defended by the Paradigmatic Complementarity Model with clear implications for clinical
practice regarding psychological assessment and intervention.
Dialectic Polarities Of Psychological Needs: Needs Discrepancies Profile and Relation with
Symptomatology
Elisabel Soares Barcelos, Universidade de Lisboa, Portugal; António Branco Vasco
The psychotherapy integrative model named Paradigmatic Complementarity (MCP),
postulates the influence of the regulation of psychological needs satisfaction on the
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psychological well-being, distress and symptomatology development. Based on the
conception that needs discrepancies underlie the development of maladaptive personality
patterns, it was firstly created the Needs Discrepancies Profile Scale (EPDN) in order to
analyze psychometric properties and to study its intercorrelations and relationships with the
regulation of psychological needs satisfaction and symptomatology. To assess these variables,
it was created an online platform where the EPDN, Psychological Needs Satisfaction
Regulation Scale -- 57 (ERSN-57) and Brief Symptom Inventory (BSI) were applied to a global
sample of 312 adults. The results supported the EPDN internal consistency, furthermore,
revealed positive and significant relations into the profiles and among those and
symptomatology, only with the exception of +Pleasure/-Pain, +Coherence/-Incoherence and
+Self-esteem/-Self-criticism profiles. The results demonstrated, also, negative and significant
relations between profiles and the regulation of psychological needs satisfaction, excepting
on +Pleasure/-Pain, +Exploration/-Tranquility, +Coherence/-Incoherence and +Self-esteem/Self-criticism. EPDN was more predictive of symptomatology and the individuals "with
disorder" showed the highest profiles' levels, excepting +Coherence/-Incoherence and +Selfesteem/-Self-criticism . The highest symptomatology levels were present on the individuals
with high degree of global profile levels and low degree of global regulation levels. These
results validate the MCP perturbation theory, highlighting the contribution of psychological
needs deregulation for personality disorders and symptomatology development., and, bring
clinical implications on personality psychological assessment and therapeutic intervention,
based on patient structural functioning.
Discussants: Tiago A. G. Fonseca, Faculty of Psychology of University of Lisbon; Elisabel
Soares Barcelos, Universidade de Lisboa, Portugal; Sofia Vieira Lopes, Faculty of Psychology
of University of Lisbon
10.
Panel
Process-Outcome
Moderator: Antonello Colli,
University of Urbino, Italy
Friday | 9:30 AM-11:00 AM | HS 7
Therapeutic Technique: Treatment Fidelity, Rupture-Repair and Outcome
This panel will examine a range of important clinical topics with regard to how various
treatment interventions can be coded effectively with regard to treatment fidelity, are
associated with alliance rupture-repair, as well as aspects of the treatment process and
outcome. The first paper examines treatment fidelity in relation to the Psychoanalytic and
Cognitive-Behavioral therapy of chronic depressed patients. The second paper examines
therapeutic interventions related to the rupture and repair process. The third paper presents
the development of a new scale to quantify differences between Psychoanalysis and
Psychodynamic therapy. The final paper will report data on psychoanalysts use of techniques
along with other patient and process variables in relation to different treatment outcomes.
Issues of clinical utility, training and future research will also be reviewed in relation to the
specific findings presented.
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The LAC depression study - The Effectiveness of Psychoanalytic and Cognitive-Behavioral
Therapy of Chronic Depressed Patients: Measuring the therapeutic adherence using the
Comparative Psychotherapy Process Scale (CPPS)
Lisa Kallenbach, Sigmund-Freud-Institut, Frankfurt, Germany; Andreas Will; Johannes
Kaufhold; Marianne Leuzinger-Bohleber
Aim: The longterm effectiveness of cognitive-behavioural and psychoanalytic therapy of
chronic depressed patients remains open to debate due to the paucity of high quality studies
investigating longterm therapies. The LAC study is the first to compare the longterm
effectiveness of cognitive-behavioural (CBT) and psychoanalytic treatment (PAT) of chronic
depressed patients with a study design that investigates the influence of treatment
preference in contrast to randomized assignment. The aim of the LAC study is to compare
those two treatments according to their longterm and shortterm effects on different
outcome variables regarding depressive symptoms, relapse rate, level of psychosocial
outcome variables. The study protocol was published in Trials (Beutel et al., 2012). The
present paper investigates the adherence measurement in the LAC study using the
Comparative Psychotherapy Process Scale (CPPS) (Hilsenroth et al., 2005) to distinguish
between psychoanalytic and cognitive-behavioural treatment and their techniques.
Methods: A total of 139 therapy sessions were used to assess treatment adherence using the
german translation of the CPPS by Beutel & Edinger (2008) (unpublished manual). The two
patient samples consisted of 91 psychoanalytic and 48 cognitive-behavioural therapy
sessions. For each patient audiotapes of the first 40 sessions were selected randomly. Three
advanced psychology graduate students rated the therapy sessions as external raters, after
an intense, supervised training phase. Psychometric parameters for the two CPPS subscales
were determined, as well as analysis of variance to compare the two patient samples on the
CPPS subscales. Results: The analyses shows that each of the CPPS-PI items had significantly
higher mean ratings in the psychoanalytic therapies than in the cognitive-behavioural
therapies. The same result was found according for CPPS-CB scale. Each Item had
significantly higher mean ratings in the cognitive-behavioural sample than in the
psychoanalytic one. Discussion: In an initial analysis we could show, that the CPPS distinguish
significantly between cognitive-behavioral and psychoanalytic therapies in the LAC-study,
which is an important precondition for the analyses of the main study. In a further step we
will compare these findings with different outcome-measures, i.e. symptom severity, and
with other process variables. Some of these preliminary results will be also presented and
discussed at the conference.
20
Which kind of therapists' interventions discriminate between rupture and repairing
sessions?
Antonello Colli, University of Urbino, Italy; Daniela Gentile; Valeria Condino; Veronica Di
Donato; Vittorio Lingiardi
Therapeutic alliance (TA) is one of the most important active factor in the psychotherapy
process and outcome (Bordin, 1979; Colli & Lingiardi, 2009; Horvarth, 1994). Even though
several studies have investigated the impact of specific therapist's techniques on TA
(Ackerman & Hilsenroth, 2001, 2003), few researches investigated the association between
therapist's interventions and in-session collaboration level shifts. The aim of the present
study is to identify the therapeutic tech-niques and elements of the psychotherapy process
characterizing sessions with increasing versus decreasing trend of TA. The sample consisted
of 156 audiotaped and transcripted sessions (N=156) of different therapeutic approaches.
Therapeutic alliance and collaboration shifts inside sessions have been evaluated with
Collaborative Interactions Scale (Colli & Lingiardi, 2009), the therapeutic interventions with
the Comparative Psychotherapy Process Scale (Blagys & Hilsenroth, 2000, 2005), the
psychotherapy process with the Psychotherapy Process Q-set (Jones, 1985, 2000). Three
groups, each of three independent raters, evaluated the sessions. Discriminant analysis
(Garson, 2008; Barbaranelli, 2006) identified the distinctive features of the sessions with (a)
increasing and (b) decreasing trends of alliance. Results showed that sessions with TA
increasing trend are characterized mainly by the presence of therapist's interventions
focused on the here and now of the relationship and exploration of affects. The sessions with
TA decreasing trend were characterized by a stance of major rigidity of the therapist, that
were more focused on manualized treatment of his/her therapeutic approaches and not on
the patient's concrete experience. Data will be discussed with attention to everyday clinical
practice.
Applicability of COPPS-AS to unmanualized psychodynamic and psychoanalytic
psychotherapy
Melanie Ratzek, International Psychoanalytic University Berlin; Dorothea Huber; Guenther
Klug
The assessment of adherence can be regarded as an important quality criterion of the
internal and the construct validity of both manualized RCTs and unmanualized effectiveness
studies. Adherence is defined as the extent to which therapists implement those
psychotherapeutic techniques prescribed by a treatment manual or which are considered
prototypic for the treatment intended in case of unmanualized treatments. As that,
adherence measures have to be of high reliability as well as discriminant ability. Caligor et al.
(2005) succeeded in presenting an adherence scale -- the COPPS-AS -- of high interrater
reliability and discriminant ability which is applicable to three treatment methods:
21
psychoanalysis, supportive-expressive psychotherapy and cognitive-behavioral
psychotherapy. In the frame of a research project which aims at the development of an
adherence measure of high discriminant ability for differentiation between psychodynamic
psychotherapy and psychoanalytic psychotherapy, according to the German Guidelines for
Psychotherapy, we additionally applied the COPPS-AS to these two treatment methods. Reallife, unmanualized psychodynamic and psychoanalytic therapy sessions (middle part
sequences) from the Munich Psychotherapy Study (MPS; Huber, Henrich, Clarkin, & Klug,
2013) served as the basis for the applicability study. In the MPS, psychoanalytic
psychotherapy and psychodynamic psychotherapy were compared in a prospective,
randomized design. Because of the broad conceptual overlap and the practical similarity
between these two treatment methods, we determined 'expert therapy sessions' which can
be regarded as prototypic psychodynamic or prototypic psychoanalytic. Twelve blinded
experts (experienced training analysts and training psychodynamic therapists) carefully and
attentively listened to audiotaped therapy sessions and rated whether it was a
psychoanalytic or a psychodynamic session. Sessions were considered 'expert therapy
sessions' if the two experts agreed in their ratings and these were identical with the therapy
label defined by the treating therapist. The selection of 'expert therapy sessions' resulted in
three psychodynamic and three psychoanalytic 'expert therapy sessions', which were
regarded as calibration standard. Both, COPPS-AS and the newly developed adherence scale
were then applied by another group of ten experts (psychodynamic therapists and
psychoanalysts with 5 years clinical experience at least), being divided into six varying rater
groups (three raters in each group). The goal was to examine whether the items of the
psychoanalytic or psychodynamic subscale were rated reliably and consensually with the
label of the expert therapies. Interrater reliability of both, COPPS-AS and our own developed
adherence scale, will be presented.
Fostering the capacity of the patients to oscillate between experiencing and reflecting: an
empirical study on process and outcome of psychoanalyses
Francesco Gazzillo, Sapienza University of Rome, Italy; Sherwood Waldron; Federica Genova;
Federica Angeloni; Filippo Faccini; Valentina Mellone; Chiara Ristucci; Vittorio Lingiardi
Aim: The aim of this study is to identify the technical and relation factors which contribute to
the good outcome of psychoanalysis. Method: In order to accomplish this goal, we have
assessed 600 sessions from 30 psychoanalytic treatments audio recorded an transcripted, 8
sessions from the first month, 4 from the middle of the therapy and 8 from the last month.
The 8 sessions from the first month and the 8 sessions from the last month were assessed
with the Shedler-Westen assessment Procedure-200 (SWAP-200; Shedler, Westen, 1999a, b),
the Global Assessment of Functioning Scale (GAF, APA, 2000); the first 8 sessions were
assessed also with the Helping Alliance Rating Scales (HAR; Luborsky, Crits-Cristoph,
Alexander, Margolis, & Cohen, 1983) and all the sessions were assessed with the Analytic
22
Process Scales (APS; Waldron et al., 2004) and the Dynamic Interaction Scales (DIS; Waldron
et al., 2013). Results: The comparison between good and poor outcome treatments pointed
out the relevance of both classical analytic interventions (clarification and interpretation of
defenses, conflicts and emotional and behavioral patterns) and relational factors
(straightforwardness, warmly and attuned responsiveness, empathy). Moreover, our data
pointed out the correlation of the capacity of the patients to oscillate between experiencing
and reflecting of the patients on their experience with the level of their Personality Health
Index (PHI; Waldron et al., 2011).Finally, we explored what are the technical and relational
elements of therapist communication that foster the patients capacity to oscillate between
experiencing and reflecting. Discussion: The clinical and training implications of these data
will be discussed.
Discussant: Mark Hilsenroth, Adelphi University, New York, USA
11.
Panel
Process
Moderator: Jarl Wahlström,
University of Jyväskylä
Friday | 9:30 AM-11:00 AM | HS 8
Agency constructions in psychotherapy and counseling discourse
Seeking help from conversational therapies is usually motivated by subjectively experienced
psychological symptoms, resulting in a sensation of lost mastery of life. Theoretically this can
be defined as an agency problem. In order to present him- or herself as a credible client, the
person needs to formulate this sensation in accounts of his/her life situation. He/she has also
to present him- or herself as a person who is, at least to some degree, both willing and able
to participate in conversational therapy. Interesting contrasts to this are the situations where
counseling or therapy is semi-mandatory, or in some other way dependent of the will of
others, as is the case in couple therapy. In those situations are clients not accountable for
participation in the same sense as those who seek help individually and voluntarily. For many
the rhetorical quest may be to present oneself as a `non-client`, and evade such ownership of
one`s own action which would lead to a subjective sense of lost agency. In this panel we
present findings from discursive research on initial problem formulations and accounts of
non-desired actions given by clients both in voluntary individual, semi-mandatory individual,
and in couples treatment. We look at the variety of discursive and narrative means clients
use to present themselves as both agentic and non-agentic with respect to life situations and
the treatment context. The presenters are researcher-practitioners at different career stages.
23
Agency display in therapeutic discourse
Jarl Wahlström, University of Jyväskylä
Aim: To analyze the usefulness of the concept of agency in psychotherapy research. Method:
Conceptual analysis. Results: Core features of human agency include intentional causality,
conscious understanding thereof, as well as the capacity to distinguish self-caused from
externally caused phenomena. This entails self-consciousness which emerges from
intersubjective perspective-taking and dialogue, enabling the actor to take a perspective
outside of the immediate situation. Taking the perspective of others involves also the
possibility to establish a critical attitude towards the self so that some acts, impulses or
desires can be seen as problematic, in-authentic or unwanted. An agentic narrative
organization of experiences is expected to include the three interrelated qualities of
subjectivity, symbolization and historicity. From a social-constructionist point of view is the
position of the person within a social and moral order a crucial defining aspect of agency or
the lack of it. In psychotherapy discourse reflexivity has been seen as central to clients'
experience of agency. Discussion: An integration of different conceptual approaches to the
concept of agency may contribute to solving methodological issues in empirical studies on
the discursive displays of a lack of sense of agency, typical for client self-representations in
therapy talk. It is proposed that clients' agency positions - in the therapeutic encounter as
well as in different life contexts -, as they are being co-constructed by him or her and the
therapist, should be regarded as the essential substance of conversational therapies, and as
the actual constituent of the collaboration between clients and professionals.
Constructions of non-agency in the initial problem formulations of psychotherapy clients
Heidi Toivonen, ; Jarl Wahlström; Katja Kurri
Aim: A sense of loss of agency, a feeling of not being in control, has been suggested to be the
reason behind seeking therapeutic help. This presentation focuses on how the sense of nonagency is represented by clients in the beginning of their first psychotherapy session when
telling their reasons for starting therapy. Method: The analysis of the clients' initial problem
accounts was conducted from the joint perspective of discourse analysis, discursive
psychology, and conversation analysis combined with grammatical analysis. During the data
analysis it was created a model of The Nine Discursive tools, 9DT, representing nine
discursive principles of constructing agency and non-agency. Using this model we identified
and classified problem formulations within the clients' problem talk. Results: 8 non-agency
tools from the 9DT --model were used in varying combinations by the clients to construct lost
agency within the problem formulations that fell into 14 formulation categories. The use of
non-agency and agency tools was independent of the semantic content of the presented
problems. The clients also expressed a sense of agency with regards to their issues.
Discussion: The traditional way of viewing the client's agency as simply lackadaisical in the
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beginning of therapy leaves unnoticed the richness and variance of the problem formulations
and the agency displays. This research underlines the importance of listening beyond the
content level of the clients' talk and being open for the information offered by the discursive
level of presentation.
Constructions and disclaims of agency in semi-mandatory counseling for drunk driving
offenders
Minna-Leena Seilonen, University of Jyväskylä; Jarl Wahlström
Aim: To look in detail on drunk driving (DD) offenders' accounts that appeared to serve the
function of disclaiming personal agency in semi-mandatory counseling and to explore the
usefulness of a tentative model of aspects of agency. Method: One case from each of three
agency story types found in a data-base of 30 DD-stories was analyzed. The cases
represented the most frequent agency story type (unconcerned agency story type), and the
story types exhibiting the highest (akratic agency story type) and the lowest (disowned
agency story type) level of displayed agency. The videotaped and transcribed accounts of the
clients' DD incidents presented at the outset of counseling were analyzed with respect to
how five interrelated aspects of constructing or disclaiming agency - reflexivity, historicity,
intentionality, causal attribution, and relationality -- were present in or missing from them.
Results: It was found that the model of (non-)agentic display based on those five aspects
could differentiate between the cases in a meaningful way and contribute to an
understanding of the clients' ways of positioning themselves in semi-mandatory counseling
as well as of their uses of the counseling context. Discussion: The model of aspects of agency
construction which integrated viewpoints from epistemology and cognitive psychology,
psychoanalytic views on the organization of experiences, social constructionist positions, and
contemporary conceptualizations of relationality, recognized the interrelatedness and
interdependence of the various aspects of agency construction and of the multiplicity and
complexity of agency display.
Conversational positions, moral order and agency constructions in couple therapy
Katja Kurri, University of Jyväskylä; Jarl Wahlström
Aim: To analyze how, in a couple therapy conversation, agency constructions form the core of
establishing and negotiating the participants conversational positions and the moral order of
the couple's relationship, as well as the moral order of the conversation. The question is
approached within the context of one couple therapy conversation, and under the particular
circumstance where one of the spouses presents with a distinct mental health problem.
Method: Discourse analysis and positioning theory. Results: Moral work in couple therapy is
mostly done implicitly in the construction of different narrative versions of the couple's life.
25
Agency constructions play an important role in this implicit negotiation of what and who
should change and the possibilities of doing this. The therapists can work on this implicit
level of communication by challenging and changing the interaction order of the couple, or
on a more explicit level by reformulating the narration of the spouses, thus inviting more talk
around the issues at hand. Discussion: Different narrative versions construct more or less
agentic positions. Different expressions of agency can be viewed not only from the
phenomenological viewpoint of mirroring the lived experience, but also from the viewpoint
of social action -- different agency expressions have different functions in the local context of
the conversation, and the global narration of the relationship and its moral order. This
implicit level of conversation forms an essential part of the work in couple therapy.
Discussant: Evrinomy Avdi, Aristotle University of Thessaloniki
12.
Integration
Moderator: Hanna Kirnoha,
Sigmund Freud University,
Vienna, Austria
Friday | 11:30 AM-1:00 PM | HS 9
How much do different psychotherapeutic modalities really matter in working
with refugees?
Discussant: Hanna Kirnoha, Sigmund Freud University, Vienna, Austria
In 2014 Lower Austria began a project providing mobile psychotherapy to asylum seekers in
remote areas. These therapies were given by psychotherapists of different modalities:
psychoanalysis, gestalt and systemic family therapy. But all the psychotherapists went to
regular supervision sessions with the head of the project who is an existential analyst herself.
All participants read about Narrative Exposure Therapy (NET) as a form of trauma therapy
applicable for all therapists. And some of them went to the NET workshop and practised its
methods. The work with refugees constituted a unique combination of dealing with trauma
and the general problems of uncertainty and ambiguous loss all of them suffer from.
This discussion session aims to hear about different experiences concerning work with this
target group (asylum seekers) and discuss whether or how far psychotherapeutic modalities
matter and/or what kind of specific approach psychotherapists and researchers found useful
in this kind of work, as well as reflections on another possible techniques, peculiarities and
further research done on the current project. Everyone is very welcome to discuss one´s
experience in enriching not only the project but one´s own practice in the field of refugee
work, combining possibilities and gaining from the exchange.
26
13.
Panel
Attachment
Moderators: Alessandro Talia,
University of Copenhagen,
Denmark; Svenja Taubner,
Alpen-Adria-Universität
Klagenfurt
Friday | 11:30 AM-1:00 PM | HS 10
Attachment and reflective functioning in psychotherapy: assessment, process
and outcome
In recent years, psychotherapy research has studied intensely and fruitfully the ways in which
attachment and mentalization impact the process and the outcome of psychotherapy. The
majority of studies have used a variety of self-report measures to assess attachment, while a
relative minority has used methods such as the Adult Attachment Interview, which are more
labor intensive but capture more implicit dimensions of the attachment construct. The
papers in this panel focus on four different aspects related to the assessment and the study
of attachment and reflective functioning, and all of them utilized methods that are related to
the AAI. The first paper presents the PACS, an observer-based measure of in-session
attachment that has showed high concurrent validity with the AAI. The PACS allows for a
process based assessment of attachment, and seems to yield a highly dependable
measurement of attachment. The second paper applies the PACS in a study that tries to track
the impact of in-session attachment on the process and outcome of psychotherapy, and
investigates whether a change towards a more secure attachment predicts good outcome.
The third paper presents a validation study of the Brief Reflective Functioning Interview, a
measure that assesses RF in a valid way, while requiring a considerably shorter
administration time with respect to the AAI interview. The fourth paper explores the role of
reflective functioning in psychoanalytic psychotherapy, especially with regards to how
mentalization predicts outcome.
Observer-based assessment of in-session attachment with the Patient Attachment Coding
System: validation, stability, and change
Alessandro Talia, University of Copenhagen, Denmark; Svenja Taubner; Madeleine MillerBottome; Sofie Folke; Hannah Katznelson; Lydia Bremer; Susanne Lunn; Stig Poulsen; Sarah
Daniel
The Patient Attachment Coding System (PACS) is a measure developed for psychotherapy
research and training, which classifies patients' in-session attachment based on any single
transcribed session of treatment, in different therapeutic modalities. Rather than focusing on
content or form alone, this measure analyzes how the discourse shapes the relationship
between the patient and the therapist, and yields a classification patients'in-session
attachment (secure, avoidant, or preoccupied) based on four dimensional scales (Contact
seeking, Avoidance, Resistance, Exploring). Aim: In this paper we present inter-rater and testretest reliability of the instrument, factor structure and concurrent validity with the Adult
Attachment Interview. Method: Patients came from Denmark, Italy, Germany, and the United
States, and were engaged in different types of psychotherapy (psychoanalysis,
27
psychoanalytic, relational, supportive, cognitive behavioral, and behavioral). The AAI was
administered to 180 patients prior to treatment and two sessions for each patient (one at the
beginning of treatment, one after 5 months) were rated with the PACS by independent
raters, blind to the AAI classification. Results: Validity, stability of the PACS, and change of insession attachment assessed with the PACS will be presented, together with the other
psychometric properties of the instrument. Discussion: these results make the PACS the first
clinical measure validated with the AAI, and show that the different AAI classifications have
distinctive manifestations in treatment, whose nature and change can be tracked by external
observers.
Do changes in the patient-therapist-attachment predict outcome? -- A process-outcome
analysis of the Munich Psychotherapy Study
Svenja Taubner, Alpen-Adria-Universität Klagenfurt; Dorothea Huber; Guenther Klug; Carolina
Seybert; Alessandro Talia
Aim: The therapeutic relationship can be considered an attachment relationship as it shares
some characteristics with a caregiver child relationship. However, how attachment
representations change within psychotherapies has rarely been studied using session
material. The purpose of this study is to investigate the attachment relationship between
therapist and patient using the Patient Attachment Coding System (PACS) and its change over
the course of long-term therapy. The PACS is a measure that classifies patients' attachment
based on any single session of psychotherapy. The PACS has showed to reliably predict
(k=.84) patients' Adult Attachment Interview (AAI) classification. Secondly, changes in
attachment to the therapist are related to changes in outcome. Procedure: This processoutcome study uses session transcripts and outcome data from the Munich Psychotherapy
study. In this study, 78 patients with depression were randomized into outpatient
psychodynamic or psychoanalytic therapy. From this sample, 30 patients were randomly
picked to analyzed in the present process-outcome study. Attachment relationships were
coded with the PACS from one session at the beginning of therapy and one session from the
middle of therapy by independent raters, blind to therapeutic modality, session position and
symptom level. Symptom level was assessed before and after therapy as well as in a threeyear follow up using the Beck Depression Inventory, the Symptom Check List and Inventory of
Interpersonal Problems. Results: Analysis are still ongoing and will show whether attachment
changes from the beginning to middle sessions. A multiple regression analysis will test
whether attachment changes are a predictor of symptomatic improvement.
28
Reliability and validity of the German version of the Brief Reflective Functioning Interview
(BRFI)
Sylke Andreas, Alpen-Adria Universität, Klagenfurt; Paul Plümer; Katharina Reichholf; Maria
Dehoust; Holger Schulz; Pia K. Müllauer; Markus C. Hayden
Objective: The mentalization-concept, first described by Fonagy et al. (1997), has become
increasingly important for the treatment of patients with mental disorders. Many studies
show the effectiveness of mentalization-based treatment (MBT) for borderline-personalitydisorder and its usefulness is described for a number of other mental disorders. The aim of
the MBT is the improvement of reflective functioning of patients with mental disorders.
Nevertheless short and feasible interviews to assess the reflective functioning in patients are
lacking. The Brief Reflective Functioning Interview (BRFI) was developed by Rudden et al.
(2005) and was translated into German. The aim of the current study was to evaluate the
reliability and validity of the German version of the BRFI. Method: The Adult Attachment
Interview (AAI) and the BRFI were administered to students of psychology and business
economics (N = 60) at the Alpen-Adria University of Klagenfurt (Austria). Furthermore the
students were also asked to fill in a questionnaire including symptom severity, mentalization
ability, childhood trauma, interpersonal problems and attachment behaviour. The rating of
the reflective functioning scale of the AAI and the BRFI were conducted by well-trained
students. Results and dicussion: The correlation between the reflective functioning score of
the AAI and the BRFI was r = .71. The interview duration differed significantly between M =
25 minutes for the BRFI and M = 78 minutes for the AAI. There was no significant difference
between the relationship of the reflective functioning scale of the BRFI and the AAI regarding
various other clinical aspects (e.g., symptoms, traumatic experiences). Thus the German
version of the BRFI can be a valide and feasible alternative to the AAI.
The role of reflective functioning in psychoanalytic psychotherapy for bulimia nervosa
Hannah Katznelson, University of Copenhagen, Denmark; Sarah Daniel; Sofie Folke; Signe
Holm Pedersen; Susanne Lunn; Stig Poulsen
Objective: There has been a growing interest in the role of mentalization in relation to
psychotherapeutic process and outcome. The present study aims to examine the relationship
between change in mentalization and change in symptoms after psychoanalytic
psychotherapy for bulimia nervosa. Methods: Thirty-three participants diagnosed with
bulimia nervosa according to the DSM-IV received psychoanalytic psychotherapy (PPT) for
two years. Participants were assessed prior to treatment, after 5 month and after 24 months
with the Adult Attachment Interview (AAI), which was subsequently rated with the Reflective
Functioning scale (RF). Results: Multilevel analyses of the data showed that greater increases
in RF were significantly related to a greater reduction of binging episodes. Discussion:
Symptomatic improvement in psychoanalytic psychotherapy for bulimia nervosa seems to be
29
related to an enhanced ability to mentalize suggesting that difficulties can be thought about
rather than acted out as a result of treatment.
Discussant: Henning Schauenburg, UniversitätsKlinikum Heidelberg, Germany
14.
Panel
Training
Moderators: Silke Birgitta
Gahleitner, Danube University
Krems; Brigitte Schigl, DanubeUniversity Krems
Friday | 11:30 AM-1:00 PM | HS 5
Self-awareness work -- both 'sacred' and controversial in all schools of
psychotherapy
A research project entitled "Quality Characteristic or Myth? The Role of Self-Awareness Work
in the Training of Psychotherapists", a multicenter study conducted by the Department of
Psychotherapy and Biopsychosocial Health at Danube University Krems over a period of
several years investigated the question as to what importance is accorded to personal selfawareness work in psychotherapy training and what benefits psychotherapists (in training) of
the various different basic schools of psychotherapy attribute to this element of training. The
findings of both the qualitative and quantitative sections of the study show that selfawareness work is seen as an essential component of training in all schools of therapy and
sample cohorts. However, both training candidates and psychotherapists with relatively little
experience have different appraisals of how much self-awareness work is "useful" in training
than experienced psychotherapists. The results regarding the association between the
burden of symptoms and the subjective appraisal of self-awareness work are also interesting.
In interpreting these results it is important to take into consideration the developments that
have taken place in society and educational policy over the last 50 years -- including the
Bologna orientation. The panel will give an overview of different aspects of the study and
discuss them with the audience.
Self-awareness work by the book -- Current developments in Training Behavior
Brigitte Schigl, Danube-University Krems
As a result of the many different schools of psychotherapy that are recognized in Austria
under the Psychotherapy Act, in training we work with many different curricula which differ
widely in, among other things, the number of hours of personal exper¬ience and selfawareness work that they require. In addition, the trainings range from academic (M.Sc.) to
non-academic settings and the candidates' routes of access to them also vary widely. The
quantitative data of the study confirm the pronounced benefits of self-awareness work for
psychotherapy training. However, there are differ¬ences in regard to the preferred setting
and views as to how much self-awareness work is necessary. Whereas in depth-psychological
and psycho-dynamic forms of therapy self-awareness work in the individual setting is
30
prioritized, self-awareness work in the group setting is particularly highly regarded in humanistically oriented forms of therapy. The number of units of self-awareness training considered
to be necessary is significantly correlated to the curricular requirement. These curricular
requirements are the most important criterion for subjects' assessments of their own need
for self-awareness work in acquiring the necessary professionality for their
psychotherapeutic practice. The more hours are prescribed for the respective therapy form,
the more hours of self-awareness work are considered necessary.
Self-awareness work and symptom burden -- surprising results
Michael Martin Maertens, Frankfurt University of Applied Sciences
That psychotherapists and counselors must themselves be disturbed if they are involved in
helping other people to heal their disturbances is a widely held view (not only among
experts). However, there is little evidence that members of these professions do in fact have
more mental disturbances than other professions. While personal experience of mental
disturbances and life crises are important for psycho-logical work, they can also have such a
strong effect on the practitioner's ongoing capacity to work that they cannot do so
responsibly. The perceived mental levels of mental stress of training candidates and those of
experienced psychotherapists are presented and compared. The results show that jobrelated biases are associated with the registering of mental symptoms in this population.
While there are indications that there are associations between symptom burden and
appraisals of the importance of personal self-awareness work, there is no evidence that selfregulative processes lead psychotherapists who are aware of having symptoms to enter
psychotherapy for themselves. Challenges of a personal nature and others related to
professional politics and ways that therapists can deal with them are discussed on the basis
of the study results.
Developing skills through personal self-awareness work? Suggestions for training as lifelong learning based on a qualitative study
Silke Birgitta Gahleitner, Danube University Krems
The qualitative results of the study show that training candidates benefit from the selfawareness oriented components of their psychotherapy training in the areas of personality
development, skills development and their ability to handle relationships with clients in a
professional manner. Psychotherapists (in training) describe their experience of theories and
methods in personal self-awareness work as useful in helping them to gain a basic
understanding of theories and develop skills and self-confident competence. Continuous selfawareness work during training thus leads to an intensification of learning experiences on
many levels. The expansion of candid-ates' knowledge of theories and methods is evident in
31
the study participants' subject-ive appraisals that it is closely linked to their practical
"experience and feeling" of theories and methods in their self-awareness work. A glance at
the resulting skill profiles reveals that these results are consistent with modern life-long
learning approaches (European Commission, 2008). They constitute a first step towards
integrating psychotherapy training in a classificatory structure that allows comparison across
all European Member States and psychotherapy in a transparent framework of life-long
learning.
15.
Panel
Therapist factors
Moderator: Holger Schulz,
University Medical Center
Hamburg-Eppendorf, Germany
Friday | 11:30 AM-1:00 PM | HS 7
Therapist factors
Immediate Therapist Self-Disclosure Bolsters the Effect of Brief Integrative Psychotherapy
on Psychiatric Symptoms and the Perceptions of Therapists: A Randomized Clinical Trial
Sharon Ziv Beiman, The College for Academic Studies Or Yehuda Israel; Golan Shahar; Elad
Livneh; Patrick Malone
We report the first randomized clinical trial examining the effect of immediate and nonimmediate therapist self-disclosure in the context of a brief integrative psychotherapy for
mild/moderate distress. Eighty-six adult patients with mild-to-moderate forms of distress
were randomly divided into four 12-session integrative psychotherapy conditions based
primarily on Hill's (2009) three-stage model. Therapists trained in this treatment modality
were instructed to use either immediate self-disclosure (expressing feelings towards the
patient/treatment/therapeutic relationship) or non-immediate self-disclosure (expressing
personal or factual information regarding the therapist's life outside the treatment). In the
comparison condition, the therapists were instructed to refrain from self-disclosure
altogether. Immediate therapist self-disclosure helped to mitigate symptoms amongst
patients with elevated pre-treatment symptoms (as assessed by the Brief Symptoms
Inventory) and bolstered a favorable perception of the therapist. Therapists in both the
immediate and non-immediate self-disclosure group evaluated themselves more favorably
than their counterparts in the non-disclosure group. Therapist self-disclosure, particularly of
the immediate type, might thus enhance the effect of brief integrative treatment on
psychiatric symptoms and the perceptions of therapists.
What makes therapy work - Approach or therapist?
Nevena Mitko Calovska, Faculty for Media and Communication Belgrade; Jelena Manojlovic
Since its beginnings as a profession, only a century ago, psychotherapy , has developed
exponentially. Multitude of different schools and approaches along with coexisting
32
competition with 'para-psychotherapeutic' activities, such as life coaching and/or meditation
classes, have made today's clients spoilt for choice. The absence of clear guidance makes this
choice a difficult one. Some approaches are better researched, others have been better
publicised or have more influential supporters. However, techniques, specific to an approach,
account only for 15 % of the outcome variance. It appears that factors related to the
therapist (personality make-up, skills and experience) and therapeutic relationship (that is
more the product of therapist action than of the approach) have considerably higher bearing
on therapeutic outcomes. If this is the case, do we need to be really concerned about the
approach at all? Authors argue that training in any established therapeutic approach is
necessary for cultivating professionalism of a novice and establishing one in the profession,
while the consecutive practise leans more on the personality factors, generic skills and the
ability to be flexible and adjust to the needs of the client.
Cross-cultural competency for mental health professionals -- needs, guidelines, examples
and developments
Holger Schulz, University Medical Center Hamburg-Eppendorf, Germany; Mike Mösko
One instrument to overcome utilisation and treatment barriers for patients with a migration
background in mental health care services are cross-cultural trainings following the goal of
enhancing cross-cultural sensitivity and competence for mental health professionals. The
needs of such trainings from different perspectives as well as current guidelines from Canada
and Germany are described. Afterwards two cross-cultural trainings, developed and
evaluated in different research projects, are presented: a training for staff of an inpatient
mental health care clinic and a training for licensed psychotherapists and psychotherapiststo-be. The trainings serve the enhancement of knowledge and skills (e.g. in the area of crosscultural diagnostic), the sensitivity of challenging cross-cultural situations and their coping
strategies in clinical setting as well as the self-reflection of ones own orientation systems.
Current developments illustrate the increasing integration of cross-cultural arrangements in
basic and further (mental) health care education in Germany.
16.
Panel
Process
Moderator: Joao Batista,
Universidade do Minho, Braga,
Portugal
Friday | 11:30 AM-1:00 PM | HS 8
Narrative change and ambivalence in different psychotherapy modalities
Narrative change has been consistently associated with psychotherapeutic success. The
Innovative Moment Coding System (IMCS) allows the identification of different types of
exceptions (Innovative Moments) to the client`s problematic self-narratives, tracking
narrative change in psychotherapy. The aim of this panel is to present IMCS results in
different therapy modalities for depression. The first paper presents the results of the IMCS
in a treatment using dilemma-focused therapy (i.e. a constructivist therapy). The second
33
paper presents the association between the IMCS and another self-narrative change
measure, the Core Conflictual Relationship Theme (CCRT) in three forms of psychotherapy
(Narrative Therapy, Cognitive-Behavioral Therapy and Emotion Focused Therapy). The third
paper analyses ambivalence in Cognitive-Behavioral Therapy (CBT), by tracking instances in
which an IM emerges, but is immediately after devalued by the client. The fourth paper
focuses on the analysis of the therapeutic collaboration in moments of ambivalence in two
cases of CBT (one recovered and one unchanged).
From symptom construction to the narrative reconstruction of identity: a study of
innovative moments after dilemma-focused therapy for depression
Adrián Montesano, University of Barcelona, Spain; Miguel M. Gonçalves
Objective: The aim of this study is to improve the understanding of narrative reconstruction
of identity after an intervention for depression focused on implicative dilemmas, a type of
cognitive conflict related to identity. As recent research highlighted the relevance of identityrelated dilemmas in clients with depression, we sought to assess the way in which clients
resolve such inner conflicts after a tailored intervention and how this is reflected in the
clients' self-narratives. Method: We used three instruments for observing differences
between good (n = 5) and poor (n = 5) outcome cases: (1) the repertory grid technique for
tracking the resolution of implicative dilemmas, (2) the change interview to compile clients'
account of changes at posttreatment, and (3) the innovative moments coding system for
examining the emergence of clients' novelties at such interview. Results: Groups did not
differ in terms of the number and relevance of client-identified helpful significant events.
However, between-group differences were found for the resolution of dilemmas and for the
innovative moments' profile. Good-outcome cases showed a higher level of conflict
resolution and also high-level innovative moments. Conclusions: Good outcome cases seem
to be associated with resolution of conflicts and high-level innovative moments. The results
are discussed, highlighting the main implications for practice and research.
Narrative changes in three therapeutic modalities: Narrative Therapy, Cognitive-Behavior
Therapy and Emotion Focused Therapy
Joao Batista, Universidade do Minho, Braga, Portugal; Miguel M. Gonçalves; Joana Silva;
Daniela Alves; Sara Freitas; Anabela Machado
This study aims to explore the relation between therapeutic and narrative change on a
sample of narrative therapy, cognitive-behavior therapy and emotion focused therapy for
major depression. The measures for assessing the narrative changes were the Core
Conflictual Relationship Theme (CCRT) (Luborsky, 1998) method and the Innovative Moments
Coding System (IMCS) (Gonçalves, et al. 2011). Whereas the CCRT method permits to identify
the change on narratives about relationships, and on the relational patterns, the IMCS is a
34
more micro-analytical measure, allowing the tracking of narrative novelty as it appears, as
well the alternative emerging self-narratives to the dominant and problematic self-narrative.
Ten cases of narrative therapy, six of cognitive-behavior therapy and six of emotion focused
therapy were analyzed. All sessions of the cases were coded with the IMCS and two sessions
from the beginning, two sessions from the middle and two from the end of the treatment
were coded with the CCRT. The hypotheses tested on this study were as following: a) the
changes of CCRT narratives are consistent with the therapeutic outcome in different
therapeutic modalities, i.e. in cases of good outcome the CCRT pervasiveness decreases and
positive responses increases and b) the IMs emergence pattern is consistent with the
changes on the CCRT narratives in different therapeutic modalities, i.e. in the cases where
the CCRT evolution is positive the IMs pattern presents the features observed in good
outcome cases in other samples (e.g. Mendes, 2011).With this study we aim to focus on how
the narrative micro-changes (i.e. innovative moments) along the psychotherapeutic process
build and promote the change of relationship patterns (i.e. CCRT) associated with good
outcome.
Ambivalence and Therapeutic Collaboration
António Pereira, Universidade do Minho, Braga, Portugal; Cátia Braga; Joao Oliveira; Eugénia
Ribeiro; Miguel M. Gonçalves; Bill Stiles
Aim: We understand ambivalence as a cyclical movement between two opposing parts of the
self. The emergence of a novel part produces an innovative moment, challenging the current
maladaptive self-narrative. However, the novel part is subsequently attenuated by a return to
the maladaptive self-narrative. This study focused on the analysis of the therapeutic
collaboration in instances in which the client expresses return-to-the-problem markers
(RPMs) -- Innovative Moments Coding System's measure for ambivalence -- in two cases of
Cognitive-Behavioral Therapy (one recovered and one unchanged). For our analysis we used
the Therapeutic Collaboration Coding System, developed to assess whether and how the
therapeutic dyad is working within the therapeutic zone of proximal development (TZPD).
Preliminary results showed that the therapist tended to challenge the client after the
emergence of ambivalence both in the recovered and in the unchanged case. The client in
unchanged case tended to invalidate (reject or ignore) the therapist's intervention. This
suggests that in such ambivalence episodes the therapist did not match the client's
developmental level, and by working outside the TZPD unintentionally contributed to the
maintaining the client's ambivalence.
35
Ambivalence in Cognitive-Behavioral Therapy: A Comparison between Recovered and
Unchanged Cases
Miguel M. Gonçalves, Universidade do Minho, Braga, Portugal; António Pereira; Joana Silva;
Daniela Alves; Sara Freitas; Inês Sousa
Research on the identification of poor outcome predictors is crucial for the prevention of
therapeutic failure. Previous research suggests that clients' persistent ambivalence operationalized as return-to-the-problem markers (RPMs) - is one possible path to
unsuccessful psychotherapy. The present study aims to replicate and extend these studies.
We analyzed RPMs in 6 cases (3 recovered and 3 unchanged cases) of Cognitive-Behavioral
for major depression. Two independent judges identified instances in which clients oscillated
between the elaboration of Innovative Moments (IMs) -- new ways of thinking, acting,
feeling and relating - that temporarily break the dominance of the problematic self-narrative
and a return to the problematic self-narrative that allows them to reduce the discrepancy
created by IMs emergence. Preliminary results suggest that both recovered and unchanged
cases present RPMs. However, RPMs decrease throughout therapy in recovered cases, but
not in unchanged cases. Ambivalence toward change - here operationalized as RPMs - seems
to be a common process in psychotherapy. Furthermore, it seems clear that its resolution (or
lack thereof) may play a determining role in the therapy's evolution and outcome.
Discussant: Franz Caspar, University of Bern, Switzerland
17.
Brief Paper Session
Methods
Moderator: Anton-Rupert
Laireiter, University of Salzburg,
Austria
Friday | 11:30 AM-1:00 PM | HS 6
(New) Measures
Intersession processes in outpatient psychotherapy - Results from four exploratory studies
Anton-Rupert Laireiter, University of Salzburg, Austria; Nadia Joechler; Christine Schilcher;
Tim Kaiser
Aim: Psychotherapeutic processes are not limited to therapy-sessions, they also occur
outside and between them („intersession processes"). Although some research has been
done in inpatient settings and in the context of psychodynamic psychotherapy, intersession
processes seldomly were studied in outpatient treatment and beyond psychodynamic
therapy. Therefore, we started a project to explore the relevance of these processes under a
more general perspective in the outpatient setting. The paper gives an overview of the most
important findings of the exploratory phase of this project. Methods: Four studies were
conducted using a questionnaire to be filled in by patients to explore intersession processes
retrospectively in general terms (General Intersession Process Scale -- GIPS). The studies
focus on the development of the GIPS and its relation to in-session processes, the
therapeutic relationship, personal features of the patient, therapy variables and the outcome
36
of the therapies. Results: GIPS was found to be a reliable instrument measuring central
aspects of the intersession proecess (intensity, quality, active engagement, preparation for
therapy-sessions etc.). Outpatients are intensively dealing with their therapies between
sessions: In average, they are involved for at least one to two hours before and after a
session. Intersession processes were found to be related to in-session processes, the quality
of the therapeutic relationship, patient factors, therapy motivation and therapy outcomes.
Discussion: Results are promising and underscore the importance of intersession processes
for the process and outcomes of outpatient psychotherapy. Therefore a new study was
started to explore these processes prospectively and methodologically more adequate.
The protagonist's view on psychotherapy: A conceptual analysis of the advantages and
difficulties in investigating the first-person perspective in psychotherapy research
Melissa Miléna De Smet, Ghent University, Belgium
AIM: Research on the processes of change in psychotherapy has increased enormously in the
past few decades. Nonetheless, the how and why of these processes, or mechanisms
involved in therapy still more or less remain a black box. Considering its central role in
therapy, it is promising that the patient's point of view is increasingly being recognized as an
important additional perspective for studying these processes of change. However, no
thorough analysis has yet been performed concerning the advantages and difficulties the
investigation of this subjective experience entails. In order to optimize psychotherapy
research that focusses on the idiosyncratic perspective it is crucial to analyze and discuss this
matter critically. METHOD: A conceptual analysis of the subjective experience will be carried
out drawing on different philosophical perspectives. Special attention will be paid to the
various conceptualizations and operationalizations of this perspective existing in
psychotherapy research. RESULTS: Aimed is to present an overview of important advantages
and difficulties in investigating the first-person perspective on psychotherapy in order to
contribute to further research in this field. DISCUSSION: In this brief paper I will argue the
usefulness of investigating the first-person perspective on psychotherapy, however, taking a
critical stance and evaluating the pros and cons of this purpose. Possible ways to overcome
difficulties will be discussed.
The MATRIX, a novel theory-neutral tool exploring dynamic psychotherapy
Shlomo Mendlovic, Shalvata MHC; Adiel Doron; Saed Mar'e; Ori Ganor; Ariel Ben Yehuda
The study assessed the reliability and validity of a new analytical tool, the MATRIX,
constructed in order to typify events ("nodes") in psychoanalytically-oriented psychotherapy.
The MATRIX is a theory-neutral tool that analyzes each node via two axes: focus (whom the
node is attributed to?) and dimension (what is the space/content/order dimension of the
node?). In order to establish the reliability and validity of the MATRIX, five trained
37
psychotherapists wrote 15 demonstrative sessions reflecting one of the prototypic
approaches in psychodynamic psychotherapy (drive-conflict, developmental-arrest or
relational). The 15 sessions were then analyzed by the MATRIX, and reliability and validity
was assessed. It was found that the MATRIX has a high reliability and validity indices.
Psychotherapy is currently inaccessible to quantitative, event-close, research. The proposed
MATRIX allows reliably and validly studying dynamic psychotherapeutic sessions, exploring
their content and processes, and managing them better.
Psychometric Properties of the Russian Clinical Outcome in Routine Evaluation - Outcome
Measure (CORE-OM) using the Item Response Theory
Marina Zeldovich, Alpen-Adria Universität Klagenfurt; Sylke Andreas
The Clinical Outcome in Routine Evaluation - Outcome Measure (CORE-OM) is a selfassessment questionnaire for evaluation of psychological therapies by measuring of aspects
of patient's/client's life. Total of 34 items cover four domains: well-being,
problems/symptoms, functioning and risk. The questionnaire has been translated into
several languages and is widely used in the clinical routine. After translation of the
questionnaire into Russian, its psychometric properties were evaluated using the Classical
Test Theory (CTT). Because of the absence of psychometric analysis according to the criteria
of the Item Response Theory (IRT) the aim of this study is to evaluate the psychometric
properties of the Russian CORE-OM using the Rasch Model. A sample consisting of N=383
representatives of the clinical (n = 159) and non-clinical (n=224) population from Russian
Federation (Moscow and Moscow region) was used for the further analysis. The application
of the Partial Credit Model (PCM) shows that the high expressed answer categories are
undetermined and neither item nor person parameters can't be completely estimated.
Hence the data was dichotomised and the dichotomous Rasch Model (RM) was applied. The
model tests show partially unsatisfactory results: while the item homogeneity can be
assumed, the person homogeneity could not be approved. A possible reason for the violation
of the assumption of the RM could be explained by the small sample size as well as by
heterogeneity of the person groups.
Crises of meaning from logotherapeutic poin of view
Zalokar Divjak Zdenka, SFU Ljubljana
Results of Logo-test match the basic presumption of logotherapy that there are
approximately 20 % of people in general population in existential vacuum, which means that
they are experiencing their lives as meaningless. In our research, there are 18.5 % of such
people. In majority of cases it is about replacement of life's meaning with success. People
striving for material assets, career and work status overlook the sense in giving meaning to
their everyday with interpersonal relationships and assignments, presented to them by their
38
everyday life. Thus, they are soon confronted with tiredness, inner unrest, emptiness, and
stress, which are the signs of so-called existential frustration. Due to the specificity of
symptoms, people usually do not recognize them in time and they develop into existential
vacuum. It is also evident that 11 % of subjects are in existential frustration, which means
that the symptoms for more serious assessment of inner meaning deficiency are already
present. Similar results were shown with PIL test, with 13 % in existential vacuum and 19 % in
existential frustration. With factor analysis, we obtained six factors: meaning of life, goals,
satisfaction, responsibility, freedom, and death. Work in the future: our results, too, confirm
the factor structure, although PIL was designed as a one-dimensional test. We could perhaps
prepare a shorter variant of the first part of PIL test with some questions that would
approximately encompass the content of the basic test on the basis of this. The shorter
variant could perhaps be less reliable, but it would be faster and could include more people
in samples and thus test meaning in life on larger samples.
The ICD-10-Symptom-Rating-Plus (ISR+)
Karin Tritt, Universität Regensburg
The ISR+ is a tool for performing standardized ICD-10-diagnostics. It aims at guiding the
clinician through the variety of different diagnostic criteria of the over 850 specific diagnoses
of the ICD-10 as easily and quickly as possible while at the same time improving the quality
of the diagnostic process. The development of this ISR+ software program, which will be
made available free of charge and without requiring any license fees, will be presented. This
software is based on a reconstruction of the different diagnostic algorithms of the ICD-10
and leads the clinician step for step through the syndrome modules (diagnostic algorithms).
Only those modules that are relevant for a specific patient are evaluated each time. Each
syndrome modules covers the diagnostic criteria specific to this syndrome. The severity of
the diagnostic ICD-10-criteria that were viewed as suitable for self-rating through patients,
are evaluated prior to the clinician rating by the patient. These patient ratings are graphically
presented to the clinician while performing the clinician rating as additional information. It
should be emphasized that this software is merely constructed to assist in the diagnostic
process. The clinician is fully responsible for diagnostic decision making. Finally through
repeated use of this software, the clinician should become more and more acquainted with
the different diagnostic criteria of the ICD-10. Assuming that only approx. 2-3 syndrome
modules need to be rated on average per patient, diagnosing with the ISR+ should -- in
comparison to other standardized diagnoses systems -- be achieved quicker. At the same
time the instrument should improve the quality of clinical diagnoses, which remains to be
demonstrated empirically.
39
18.
Chapter Meeting
Friday | 2:00 PM-3:00 PM | HS 10
Business meeting
Moderator: Henning
Schauenburg,
UniversitätsKlinikum
Heidelberg, Germany
19.
Outcome
Moderator: Sven Rabung,
Klagenfurt
20.
Panel
Therapist factors
Moderators: Thomas Schröder,
University of Nottingham, UK;
Armin Hartmann, University of
Freiburg, Germany
Friday | 3:00 PM-4:30 PM | HS 9
The Dodo Bird – dead or alive?
Discussants: Mark Hilsenroth, Adelphi University, New York, USA; Falk Leichsenring,
University of Giessen, Germany
Friday | 3:00 PM-4:30 PM | HS 10
Difficulties in therapeutic practice: A common thread running through diverse
approaches.
As clinicians we all know that therapeutic work is difficult from time to time, irrespective of
our theoretical approach, professional background, career stage, or practice setting. We may
acknowledge our difficulties or ignore them, disclose them in supervision or conceal them,
hope that they can be trained out of existence or embrace them as opportunities for
professional development; but they are going to be with us, in one form or another, as long
as we practise. While particular difficulties, such as ruptures in the therapeutic alliance, have
engaged the specific attention of researchers, the broader area has occupied a relatively
small niche in the field of psychotherapy research. Nonetheless, there are an increasing
number of studies that shed light on the subject.
This panel reports research on therapists` difficulties from different vantage points. In the
first paper, Schröder presents an overview of the development of the area over the past 25
years, outlines three distinct approaches to its study, and synthesises findings to date.
Building on previous studies, Heath-Tilford and Schröder in the second paper report on the
findings of a series of single case studies, exploring the utility of a self-reflection tool in
helping trainee and experienced therapists manage their difficulties. In the third
contribution, Hartmann et al. explore the rates of unwanted events (UE) and adverse
treatment reactions (ATR) in inpatient and day clinic treatment. These concepts originating in
medical quality assurance point to therapeutic difficulties which may become also
mandatory to monitor in psychotherapeutic settings. A comprehensive and economic
40
instrument for the documentation of UE/ATR was developed. Rates of events and their
relation to treatment outcome (SCL-90-R) will be reported and discussed.
Therapist Difficulties: What do we know so far?
Thomas Schröder, University of Nottingham, UK
There are a number of reasons why therapists may be reluctant to admit to difficulties in
their practice, ranging from private concerns -- such as feeling shame about a perceived lack
of competence -- to the commercial and public spheres, where raising doubts about one's
proficiency may have adverse professional consequences. Yet, acknowledging difficulties is a
necessity for managing them and resolving them often promotes positive process, leading to
enhanced outcomes and potentially to professional and personal growth for the therapist.
Therapists' difficulties have in the main been studied using three distinct methodologies:
Qualitative analyses of interviews with therapists, content analyses of difficulty narratives
often complemented by measures of potential correlates, and quantitative measurement,
using the Therapist Difficulties Scale (TDS) and its derivatives. The latter approach has yielded
the largest number of studies, especially since the inclusion of the TDS in a large
collaborative international study on the professional development of therapists. This paper
reviews research conducted since 1987 within all three approaches (in addition to two
studies using different methods), charts the development of the area, reports current
findings and outlines future directions. It further discusses consequences for training,
supervision, and peer support.
"The answer is in an analysis of himself". Using a self-reflection tool to help therapists
manage difficulties in practice.
Adelle Heath-Tilford, University of Lincoln, UK; Thomas Schröder
Whilst therapists are considered adept at managing the difficulties and associated distress of
others, they often struggle to manage their own difficulties. Supervision should help to
address this problem but the realities of public services in the UK often lead to case load
management taking priority over clinical concerns. Consequently, therapist difficulties may
end up being (inappropriately) presented to staff support and counselling services, as
evinced by the clinical experience of the first author. One approach to addressing this
problem involves developing aids for clinicians to reflect on their difficulties in a structured
format. The current investigation expanded an existing self-assessment form (Schröder,
2007) into a self-reflection tool and recruited 6 clinicians, 3 qualified and experienced
therapists and 3 in training, for a series of single case studies. Each participant had an initial
interview, followed by a six-week period of using the self-reflection tool and completing
quantitative measures in relation to difficulties they encountered in their practice, followed
by a second interview. Interviews were transcribed and analysed using deductive (template
41
analysis) and inductive Thematic analysis) coding. The emerging categories were put into
context by the quantitative results. We introduce the self-reflection tool, outline the
quantitative measures used, report the findings in detail and discuss consequences for
clinical practice and supervision, both generally and in the specific setting of British public
healthcare services.
Unwanted events and adverse treatment reactions in inpatient and day clinic
psychotherapy.
Armin Hartmann, University of Freiburg, Germany; Almut Zeeck; Ralf König; Kristina Flößer
We report on an ongoing study of unwanted events (UE) and adverse treatment reactions
(ATR) in inpatient and day clinic treatment. These concepts originate in medical quality
assurance. However, they point to therapeutic difficulties which may also be relevant to
monitor in psychotherapeutic settings. A comprehensive and economic instrument for the
documentation of UE/ATR for complex inpatient and day clinic settings was developed. It is
based on the UE-ATR Checklist for outpatient psychotherapy (Haupt & Linden, 2011; Linden,
2012; Strauß, Linden, Haupt, & Kaczmarek, 2012).Rates of events and their relation to
treatment outcome (SCL-90-R) will be reported. The usability of the scores for quality
management and supervision are discussed.
Discussant: Hadas Wiseman, University of Haifa, Israel
21.
Panel
Methods
Moderator: Ruth Inslegers,
Ghent University, Belgium
Friday | 3:00 PM-4:30 PM | HS 6
The pursuit of objectivity in psychotherapy research: reflections and
alternatives
This panel discusses the pursuit for objectivity in psychotherapy research and the tension
field between idiographic and nomothetic approaches from different angles. Starting from a
meta-perspective in the first presentation, more specific illustrations will be offered in the
second, while the third presentation will go into a possible alternative to gain knowledge in
the field of psychotherapy research.
More specifically, the first presentation discusses the validity and reliability of quantitative
psychological measures. The issue of measurement error and its consequences will be a
central starting point to move towards the impossibility of by-passing idiographic approaches
in the search for nomothetic knowledge. The second presentation will focus on two specific
types of outcome indicators that made their entry into psychotherapy outcome research
more recently, namely the use of biomarkers like cortisol as an indicator of stress and the
inclusion of health care cost data. It will question the assumption that these kinds of data
42
would provide more objective indicators of outcome than classical self-report measures.
Finally, in the third presentation, the Single Case Study archive is discussed as one way of
accumulating knowledge starting from the prototypical idiographic approach, namely the
single case study.
Measurement Error in Psychological Research: Subjectivity in the Dark Wood of
Quantification
Femke Truijens, Ghent University, Belgium; Mattias Desmet
Aim: In this presentation the provocative statement is made that an open and honest
consideration of the literature on validity and reliability of psychological measures inevitably
leads to the conclusion that they generally contain massive portions of error. In contrast with
mainstream beliefs, it is argued that widespread strategies designed to deal with
measurement error, such as Structural Equation Modelling, usually do not offer an adequate
solution, and potentially even aggravate the impact of error on statistical inference. Method:
A tentative estimate of the proportion of error based on the results of studies on crossmethod agreement is presented and Spearman's disattenuation formula is used to
demonstrate the dramatic consequences for psychology's most widely used research design,
namely the testing of the significance of correlations in cross-sectional designs. Results: It is
concluded that the problem of measurement error confronts psychology with the limits of its
present research paradigm. It seems that the relentless pursuit of objectivity by means of
quantification led psychology into uncontrollable subjectivity. Discussion: In line with
pioneering scholars such as Stern and Allport, it is suggested that the only way out of this
predicament lies in a re-appraisal of the value of idiographic information as an interpretative
context for quantitative data.
Subjectivity in so-called objective outcome indicators: an exploration of the value of
biomarkers and cost-effectiveness data in psychotherapy research
Reitske Meganck, Ghent University, Belgium
Aim: In prototypical efficacy studies outcome assessment focuses primarily on the symptom
or syndrome that is the topic of the study and mostly self-report questionnaires are used to
tap into these symptomatic dimensions. Besides the issue of whether this type of change
implies improved well-being and is the type of change desired by the patient, the extent to
which self-report questionnaires are able to measure the intended constructs is strongly
debated. Different tracks are explored in current psychotherapy research, such as including
qualitative data in outcome research. What seems to attract more interest however in large
scale efficacy studies is the inclusion of indicators that are assumed to be unbiased by human
judgment like changes in health care costs or the use of biomarkers. Method: In this presen-
43
tation, we will explore this assumption by means of longitudinal single case studies that
includes these types of indicators as well as other classical outcome measures and narrative
data. Results: We will illustrate how the interpretation of for example cortisol levels and fluctuation as biomarker for stress and of health care cost information also requires idiographic
information. Discussion: We conclude and discuss that so-called objective information also
do not provide an easy solution for the outcome problem in psychotherapy research.
Single case studies and beyond: the Single Case Archive
Ruth Inslegers, Ghent University, Belgium
Aim: As argued in the first paper of the panel, there is no way to by-pass idiographic
complexity when attempting to achieve nomothetic knowledge. The most exemplary method
of the idiographic approach is without doubt the single case study as it allows grasping the
full complexity of a case in its narrative context. In psychotherapy - as is the case in so many
other disciplines - case studies were at the origin of the field, however currently their
scientific merits are strongly debated. Nevertheless, there is a wealth of in-depth case
studies in the literature. Unfortunately, this does not lead to an accumulation of evidence
across cases. Reasons why meta-studies of single cases are still scarce are that 1. cases are
scattered across a large number of databases, 2. titles, abstracts or keywords only mention a
fraction of relevant case-descriptive information, and 3. despite huge differences in quality of
case studies there are no tools to appraise that quality. Method: The construction of the
Single Case Archive (SCA), an electronic database that organizes and assembles published
case studies and consequently tries to attend to these issues is discussed. Results: Recent
elaborations of the single case archive will be presented. Discussion: The use of the SCA for
researchers and clinicians in accumulating knowledge from the rich single case accounts
existing in the field will be discussed.
22.
Panel
Process-Outcome
Moderator: Wolfgang
Tschacher, Universität Bern
Friday | 3:00 PM-4:30 PM | HS 7
Process characterized by synchrony
Process in psychotherapy has many facets -- experiential, emotional, behavioral, cognitive.
These facets are usually conceptualized and expressed by common factors. In this panel, we
wish to focus on a novel candidate for a commonality of psychotherapy: Synchrony. This is
currently investigated empirically by a growing number of researchers. Synchrony is a
consequence of the approach of `embodied cognition`, which states that the mind is
expressed by the body and vice versa. One implication is a change of the focus of interest
towards patients` and therapists` body movement, bodily experiences, and facially-expressed
social behavior. In general, synchrony can draw on concepts from dynamical systems theory
44
that describe how systems emerge by the increasing coupling and synchronization of their
parts. We wish to show that this approach yields alternative quantitative markers of the
functioning of the therapeutic alliance, and is associated with therapy outcome. We will
present findings on different kinds of synchrony, such as nonverbal synchrony of therapists`
and patients` motor action, facial synchronizations during sessions measured on a FACS basis,
and verbal synchrony assessed by means of the Therapeutic Cycle Model.
The temporal evolution of nonverbal synchrony in outpatient psychotherapy: An
aggregation of single-case studies.
Fabian Ramseyer, University of Bern, Switzerland; Hansjoerg Znoj; Franz Caspar
Background: The way people experience one another in a social interaction is strongly
influenced by their nonverbal behavior. This phenomenon is of particularrelevnace for
psychotherapy dyads: Previous work has demonstrated that the relationship quality between
patient and therapist is embodied in the coordination of their nonverbal behavior. We called
this phenomenon nonverbal synchrony -- the association of patient's and therapist's body
movement -- and showed that it is associated with various facets of the therapeutic
relationship as well as with global therapy outcome. Method: Using automated video
algorithms (Motion Energy Analysis, MEA), we quantified nonverbal synchrony in N = 80
videotaped psychotherapy sessions taken from the treatments of eight single cases. The
sessions within each single case were selected in order to be representative for the temporal
evolution in each therapy. Global therapy outcome was assessed by pre-to-post self-report
scales, while session-level outcome was registered with the aid of post-session
questionnaires distributed to patients and therapists after each session. Results: A dyad's
average nonverbal synchrony was associated with its overall success of therapy, quantified by
pre-to-post outcome scales. Furthermore, a positive association between nonverbal
synchrony and relationship quality was found within single cases as well as across the entire
sample. Discussion: These results demonstrate that the quality of therapeutic relationships is
embodied by the amount of coordinated movement between patient and therapist. This
study extends previous findings by revealing the temporal stability of this phenomenon:
Nonverbal synchrony persists over relatively long therapy courses and thus likely reflects an
automatic, nonconscious manifestation of relationship formation and relationship
maintenance.
45
Nonverbal synchrony in psychotherapy: Different body parts have different associations
with outcome
Wolfgang Tschacher, Universität Bern; Fabian Ramseyer
Aim: The coordination of patient's and therapist's movement -- nonverbal synchrony -- has
been empirically shown to be associated with psychotherapy outcome, and with affect in
healthy dyads. These findings were based on movement patterns of the whole body. The
present evaluation is a re-analysis of an existing dataset (Ramseyer and Tschacher, 2011),
which extends previous findings by differentiating movements pertaining to head and body
regions. Method: In a sample of 70 patients (37 female, 33 male) treated at the Bern
outpatient psychotherapy clinic, we quantified nonverbal synchrony with an automated
objective video-analysis algorithm (Motion Energy Analysis, MEA) during the initial 15
minutes of video-recorded therapy sessions. Micro-outcome was assessed with self-report
post-session questionnaires provided by patients and their therapists. Macro-outcome was
measured with questionnaires of goal attainment and changes in experiencing and behavior
at end of therapy. Results: The differentiation of head- and body-synchrony yielded different
associations of these two facets of synchrony with outcome. Head-synchrony predicted
global outcome of therapy, while body-synchrony did not, and body-synchrony predicted
session outcome, while head-synchrony did not. Conclusions: The results pose an important
amendment to previous findings, which showed that nonverbal synchrony predicts both
outcome and interpersonal variables of psychotherapy dyads. The separation of head- and
body-synchrony suggests that distinct mechanisms may operate regionwise: Head-synchrony
embodied phenomena with long temporal extension (overall therapy success), whereas
body-synchrony embodied phenomena of a more immediate nature (session-level success).
Thus, explorations with fine-grained analyses of synchronization phenomena in nonverbal
behavior shed additional light on the embodiment of psychotherapy process.
Verbal synchronization and treatment outcome in experiential psychotherapy of
depression
Omar C.G. Gelo, University of Salento, Lecce, Italy and Sigmund Freud University, Vienna,
Austria; Fiorella Leopizzi; Enrico Ciavolino; Marcello Gallucci
According to a dynamic systems (DS) approach to psychotherapy, the therapeutic process: (a)
can be considered as an open complex system, comprised by either the client, the therapist
(intra-individual perspective), and/or their relationship (inter-individual perspective); (b) is
characterized by self-organization, that is, it shows an increase of order ("effect-of-order")
over time. This latter is mediated by the increasing synchronization of the system's
components over time. Up to now, several studies have supported the effect-of-order
hypothesis at different levels, as for example at the level of clients' and therapists' subjective
experience of the sessions (e.g., Schiepek, Tominschek, & Heinzel, 2014; Tschacher, Scheier,
46
Grawe, 1998), or at the level of their nonverbal behavior (Ramseyer & Tschacher, 2011,
2014). Moreover, it has been shown that this increase of order is predictive of and/or
associated with positive treatment outcome. In the present work, we aim at testing the
effect-of-order hypothesis at the level of verbal behavior (verbal synchronization; VS). We
expect that an increase of VS over time will be associated with positive treatment outcome.
The sample was comprised by respectively six good outcome and six poor outcome cases of
experiential therapy for depression. Speech production was assessed by means of the
Therapeutic Cycle Model (Mergenthaler, 1996). VS was operationalized by means of a
measure of order derived from information theory (Shannon & Weaver, 1949). It was
possible to confirm the hypothesis of an increase of VS as characteristic of good outcome
cases. The findings' implications for research and clinical practice are discussed.
Facial synchronizations in the course of psychotherapy
Eva Baenninger-Huber, Institute of Psychology, University of Innsbruck, Austria; Philipp
Eisendle; Melanie Malecek; Astrid Bock
Several empirical studies have proved a relationship between nonverbal synchronizations
and relationship quality in psychotherapies (Ramseyer & Tschacher, 2014). In these studies,
nonverbal synchrony was measured mostly by head- and body movements. Facial and gaze
behavior was not considered. In order to learn more about the role of facial synchrony in
psychotherapy, we analyzed twelve videotaped sessions of two different psychoanalytic longterm psychotherapies. The therapies are part of a larger research project at our therapy unit
in which processes of emotion regulation and their meaning for psychotherapeutic change
are studied. Coded were six sessions of a terminated therapy with a female patient and a
male therapist (sessions 1, 10, 20, 30, 40, 54) and six sessions of an ongoing therapy with a
male patient and a male therapist (sessions 1, 30, 60, 90, 120, 150).We differentiated
between two types of synchronization, namely "synchrony in movement" and "behavioral
matching". According to their function in the relationship regulation (enhancing affective
relatedness, reduction of affective relatedness, regulation of negative affects), different
variables were operationalized on the basis of the Facial Action Coding System (FACS).
Frequency and duration of all the relevant phenomena such as smiling, laughing, gazing,
head turns or mouth movements were determined. Preliminary data analysis shows an
increase of facial synchrony during the course of psychotherapy, especially in terms of
phenomena relevant to the enhancement of affective relatedness.
47
23.
Panel
Child/Adolescent
Moderator: Orya Tishby,
Hebrew University, Jerusalem,
Israel
Friday | 3:00 PM-4:30 PM | HS 8
Using mixed methodology to study psychotherapy process and outcome with
children and families
Studying child psychotherapy poses the challenge of capturing the complexity and richness
of the therapy process. Quantitative methods offer precise tools that are best for
generalizing and demonstrating causation, but they are limited in terms of reflecting process.
On the other hand, qualitative methods that can capture the subjective experience of
therapy are limited in generalization and causation. Mixed methodology offers the
advantages of both strategies and can be tailored to the specific research questions using
different designs: Sequential procedures, Concurrent procedures and transformative
procedures (Creswell, 2003). In this panel we will hear about three different studies
employing mixed methodology to study different kinds of child psychotherapy, with different
research questions. Esther Cohen and Yan Serdtse will present a study or child psychotherapy
in the aftermath of war, using "therapist diaries" written after every session. They will
demonstrate how they analyzed this data in conjunction with quantitative data (concurrent
procedures). Nina Tejs Jørring will present ways of measuring the impact of Narrative Family
Therapy for multi-stressed families, using quantitative measures. This type of therapy has not
been standardized and the families cannot be neatly grouped by well-defined diagnostic
criteria, as is usually done in outcome research (transformative procedures). Tamar AxelrodLevy will present a study of animal assisted child psychotherapy, in a concurrent-nested
design. In this study qualitative interviews capture the essence and main techniques of this
type of therapy. In the second phase -- therapy sessions are analyzed both quantitatively and
qualitatively, based on principles drawn from the interviews.
Using mixed methodology to study psychotherapy with children suffering from posttraumatic distress
Esther Cohen, Interdisciplinary Center, Herzliya, Israel; Yan Serdtse
Working with traumatized children presents unique challenges for therapists, especially in
handling the intense emotions invoked in the child and in the therapist when focusing on the
traumatic event. Finding ways to study the therapy process is no lesser challenge. In this
study we examined "therapy diaries" kept systematically by 20 Israeli therapists, following
each of the therapy sessions with a child, identified as suffering from posttraumatic distress
in the aftermath of war. We attempted to characterize the nature of the employed
therapeutic interventions using a qualitative analysis of the 255 reported sessions. We then
used these data to examine the associations between the type of employed interventions
and independent measures of symptomatic improvements in each child, using parental
reports on the children's behavior problems before and following the therapy. Our findings
show that therapists tended to use an eclectic combination of interventions adapted from
48
directive and non-directive treatments. The use of trauma-focused interventions was
significantly associated with symptomatic improvements in the child. A focus on
interpersonal relationships was associated negatively with symptomatic improvements.
However, children initiated an exchange about the trauma three times more frequently than
their therapists did. Surprisingly, the therapists expanded on this topic, when initiated by the
child, only in a third of the times. These findings have implications for the training and
supervision of child therapists, especially when working in a "shared reality" of war.
Conducting a mixed method research in children's psychotherapy, assisted by animals
Tamar Axelrad Levy, Hebrew University, Jerusalem, Israel; Michal Motro
In this paper we present a new concept for research in children's psychotherapy, assisted by
animals. The research design and the results analysis are in mixed methods, the Concurrent
Nested Strategy. Using this strategy in psychotherapy research helps to define the important
variables of a specific therapy and to promote a better understanding of the therapy process.
In this strategy data are collected in both ways at the same time, but are analyzed first
qualitatively and then quantitatively, based on the findings of the first analysis. The aim of
this research is to define and to describe the important variables in Animal Assisted
Psychotherapy and to get an extensive understanding of the therapy process and the
triangular relationships which are formed during therapy. This research has two stages: 1) ten
therapist were interviewed to describe the therapy as they practice daily. 2) Ten children are
registered for Animal-Assisted Psychotherapy, once a week, 25-30 meetings each. The
therapy sessions are taken in a therapy room which has different animals (mammals as
rabbits, hamsters, fowls, birds, reptiles as corn snake), and the child is free to choose the
animal/s which he/she likes to be with, the place in the room (inside/outside the animal
cage, the kitchen, the space which is free from animals) and the nature of the interaction
with the animal/s and the therapist. The therapy sessions are videotaped and documented
by questioners that parents, therapists and children fill in four times during the therapy
(YOQ, CCRT, Emotional regulation, Sessions reports). We'll present the concept of collecting
and analyzing data in concurrent nested strategy and some of the dilemmas related to the
question how to connect the findings of both methods in a valuable and beneficial way.
Using film and animation to explore young people's experiences of therapy
Nick Midgley, Anna Freud Centre
IMPACT-ME (Midgley et al., 2013) is a longitudinal, qualitative study looking at the
experience of young people and their parents taking part in a randomised controlled trial
(the IMPACT study) evaluating the effectiveness of CBT and short-term psychoanalytic
psychotherapy as treatments for depression in adolescence. In working with a steering group
49
made up of young people who had been part of the study, discussions took place about how
best to share what had been learnt from the study with a non-specialist audience, including
teachers, youth workers and counsellors, as well as with other young people experiencing
depression and seeking help from Child and Adolescent Mental Health Services. Could film and in particular animation - offer opportunities that more conventional forms of reporting
on the findings of a study not provide? This paper will describe the process by which the
IMPACT-ME project worked with a team of animators and film makers, and a group of young
people who had been part of the IMPACT study, to create two short animation films about
depression in adolescence and the experience of going to therapy. Some extracts from the
films will be shown, and some reflections on the process of working with research
participants to 'disseminate' the findings of a study will be shared.
24.
Brief Paper Session
Complex disorders
Moderator: Eva-Lotta
Brakemeier, Psychologische
Hochschule Berlin, Berlin,
Germany
Friday | 3:00 PM-4:30 PM | HS 5
Treatment of severe/complex disorders
Cognitive Behavioral Analysis System of Psychotherapy (CBASP): Do we really need this
integrative psychotherapy?
Eva-Lotta Brakemeier, Psychologische Hochschule Berlin, Berlin, Germany; Johannes
Zimmermann
Empirical research shows that chronic depression is difficult to treat. Compared to nonchronic depression, it is associated with a higher rate of childhood trauma or deprivation,
lower work productivity, more troubled intimate relationships, and higher suicidality. It often
becomes a lifelong problem. Response rates to the traditional psychotherapies like cognitive
behavioral or psychoanalytical approaches are lower than in non-chronic depression. Thus,
the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been specifically
developed for the treatment of chronic depression by James McCullough. It integrates
cognitive-emotional, behavioral, interpersonal, and psychodynamic/ psychoanalytical
theories and strategies across schools by directly addressing the specific psychopathology.
This integrative CBASP model is relatively popular among clinical practitioners and it is
empirically supported, albeit only by a small number of trials so far. In the presentation, all
the published outpatient trials will be summarized. In addition, an open study with
treatment-resistant chronically depressed patients conducted in an inpatient setting with a
modified inpatient CBASP program will be presented in detail (Brakemeier et al., Psychoth
Psychosom, 2011, 2015). Results show that the CBASP inpatient program is very well
accepted resulting in promising outcome: 75.7% of the intention-to-treat sample responded,
and 40.0% remitted, no patient deteriorated. S97% of these patients were treated before
with traditional psychotherapy approaches. Thus, these results might be interpreted as an
answer to the title question: CBASP is indeed needed for treatment-resistant chronically
50
depressed patients. Especially patients with childhood trauma and early onset seem to
benefit from this integrative intensive approach.
The relationship between intersession experience and level of personality functioning in
patients with mental disorders
Thorsten-Christian Gablonski, Institute of Psychology, Alpen-Adria-Universität Klagenfurt;
Birgit Senft; Sylke Andreas
Aim: The intersession experience is a conceptualization, which describes the processing and
internalization of psychotherapy and its contents between every single therapy session. In
recent years the intersession experiences has been investigated in patients with mental
disorders (e.g., borderline patients). Empirical studies showed that intersession experiences
are relevant in patients with mental disorders, but no study exists that examines the
relationship between intersession experiences and level of personality functioning. The aim
of the study was to investigate the relationship between intersession experiences in
inpatients with mental disorders in generally and especially the functioning level of
personality. Methods: Inpatients with mental disorders (N = 69) were asked to fill in the
Intersession Experience Questionnaire, the Brief Symptom Inventory, and the short version
of the OPD-Structure Questionnaire at beginning and end of the psychotherapy. Results: We
found that patients with different levels of functioning differ in some components of their
intersession experience at the beginning and at the end of therapy. While the differences at
the beginning of therapy were shown in situations, content and emotions of their
intersession experience, the patients with a lower level of functioning differed only in the
contents of their intersession experience at the end of the therapy. We could also show that
patients with a lower level of functioning tended to have more frequent intersession
experience. Discussion: Implications for promoting internalization and representation of
therapists between sessions should be discussed.
The overcoming of a psychosis with single and group psychotherapy
Lilly Merz Raff, Bildungszentrum Psychologie und Erziehung; Diethelm Raff; Fiorenza
Piraccini; Martha Koukkou
With the presentation of a single case study we would like to shortly discuss the outcome of
a combination of single and group therapy within a sociotherapeutic setting which we
practise in our therpeutic „Center for Psychology and Education" (Bildungszentrum
Psychologie und Erziehung). Method: We present a 30-year-old patient with psychosis who
took part in a psychotherapeutic setting for one and a half year. A half year he came every
day for the whole day. In total, he obtained 80 sessions of single psychotherapy plus 220
sessions of group therapy, as well as many hours of other activities in our therapeutic center.
51
Results and Discussion: The patient was able to overcome his loneliness, to build up a
partnership with a woman and to continue his studies at university. The factors indicated for
the therapeutic success of this patient on an outpatient basis are: confidence,
understanding, solidarity, support, identification in group therapy, the knowledge about the
origin of the psychosis in upbringing as well as developing the strength necessary to change
the maladaptive parts of life style.The neuroleptics could be stopped after 15 months of
treatment. www.bildungszentrum-psychologie.ch
Cognitive-Psychoeducative Therapy vs Bibliotherapy in Bipolar Disorder: A controlled
group-therapy study
Gerhard Lenz, Medical University of Vienna, Austria
Background: there is evidence for the efficacy of CBT (Cognitive Behaviour Therapy) in
addition to pharmacotherapy in patients with bipolar disorder. But until now there is only a
limited number of studies with therapy manuals in German language. Patients and methods:
The efficacy of Cognitive-Psychoeducative Therapy (CPT-manual of Schaub et al) vs
Bibliotherapy (BT) on relapse rates in patients with bipolar disorder was evaluated in a
controlled group therapy study. Results: 100 patients were treated, 52 in the CPT-group and
48 in the BT-group. At 12 months follow-up after start of treatment the patients of the CPTgroup had a significant better outcome in CGI than the BT-group. There was a significant
reduction of overall number of episodes in both groups (in the BT-group only for manic but
not for depressive episodes) and the number and duration of hospital admissions in the 12
months after start of treatment compared to the 12 months before. In both groups there was
a positive effect on illness concepts (Linden-scale) and a reduction of disability (Sheehanscale). Conclusions: Both groups were successful in relapse prevention of manic episodes,
the CPT-group also of depressive episodes and CPT was more effective according to CGI
(Clinical Global Impression Scale).
Treatment outcome in patients with mono-diagnoses compared with comorbid disorders -Considerations on individualized psychotherapy during rehabilitation
Birgit Senft, Reha-Klinik für Seelische Gesundheit Klagenfurt; Georg Spiel
In Austria there are 23 psychotherapeutic methods recognized by government, but there are
no recommendations regarding the question, which method should be applied for certain
disorders. In Germany there are three recognized methods and there are explicit guidelines
for ICD groups of diagnoses. Whereas efficacy seems to be ensured, effectiveness remains a
typical question of healthcare research within a naturalistic setting.Aim: This study deals with
medical-psychiatric rehabilitation, which has been offered for the past twelve years on the
basis of psychotherapeutic methods in a group setting. The study aims at analyzing therapy
52
outcome in patients with mono-diagnoses F3 and F4 and in patients with comorbid
disorders.Methods: Primary outcome was assessed by BSI (Franke, 2000), administered at
the start and at the end of rehabilitation as well as at a one-year follow-up. Out of N = 7,084
patients, 50% had one, 35% had two, and 15% had three ICD 10 diagnoses. N = 4,329
patients were included in the comparison.Results: Between admission and discharge, effect
sizes were equally low for all three groups (d = 0.4); symptom load differed extremely
between the groups and sustainability of effects was low. Differences between monodiagnosed and comorbid patients exceeded the differences between pre- and postmeasurement.In Austria, not only psychotherapeutic methods but also the clientele is
heterogeneous. Apart from similar outcome, the examined groups reported a similar degree
of contentment with the therapeutic relationships, whereas contentment with treatment
outcome was lower in comorbid patients.Discussion: It remains a resume: "Everybody has
won the prize" (Schüßler, 2009), as the therapeutic relationship explains a
considerable 30% amount of the variance of outcome (Asy & Lambert, 2001). Does this
mean that explicit guidelines are not needed in Austria? From our experience further
research is needed with respect to the necessary and/or optimal dosage and setting in order
to reach the aim of individualized therapy and rehabilitation.
25.
Friday | 5:00 PM-6:30 PM | HS 9
New structures in SPR Europe
SPR Europe
Moderators: Stig Poulsen,
Denmark; Henning
Schauenburg,
UniversitätsKlinikum
Heidelberg, Germany
26.
Panel
Linguistic
Moderators: Anssi Peräkylä,
University of Helsinki; Peter
Muntigl, Ghent University,
Belgium
Friday | 5:00 PM-6:30 PM | HS 5
Conversation analytical psychotherapy research II
Conversation analytical (CA) psychotherapy research brings the theoretical and methodical
resources of social scientific interaction research, to the service of the understanding of
psychotherapy process. Sequential structure of interaction, and the organization of
openings and closings of encounters, are among the classical CA themes that can also inform
the study of psychotherapy. Interactional projects -- goal-orientations that span overs
several sequences and even over several encounters -- are among the more recent themes
53
of CA research that can equally inform research on psychotherapy.
This panel session will follow seamlessly the panel "Conversation analytical psychotherapy
research I". Using classical and more recent notions of conversation analytical research, the
papers in the panel will explore some key facets of psychotherapeutic interaction: attention
to referents, emotion and empathy, as well as the closings of therapeutic sessions. The data
presented in the papers come from cognitive and psychodynamic therapies as well as from a
psychological call-in radio programme. At different stages of their careers, the presenters are
experts from the international conversation analytical research community.
Empathy and therapeutic projects in interaction
Liisa Voutilainen, University of Helsinki; Elina Weiste
Therapist's empathy is crucial for a successful therapeutic process (e.g. Elliott et al. 2011). As
social action, empathy is usually realized through reflecting and mirroring the client's
emotion through verbal and nonverbal means. The presentation is based on our
conversation analytical research on empathy in cognitive psychotherapy and psychoanalysis.
We will describe interactional means through which empathetic reflections and mirroring are
done, focusing especially on their syntactic and prosodic characteristics. Our basic argument
is that the way in which empathy is delivered is connected to a broader therapeutic project.
In other words, the syntactic and prosodical means of the empathetic responses serve not
only the purposes of empathy as such, but also purposes of interpreting and even
challenging the client's ways to describe and relate to their experiences. Through data
examples we will illustrate two practices of empathy that are connected to a broader
therapeutic project: 1) empathy builds grounds for interpretation and 2) prosody of empathy
anticipates either validating or challenging trajectory in the further interaction. We will
discuss these practices in terms of epistemic work that is needed for justifying therapist's
knowledge claims about the client's inner experience. The findings are also discussed in
relation to two sides of empathy (e.g. Bohart & Greenberg 1997): the cognitive side of
understanding the client´s experiences, and the more direct emotional process of simulating
the client´s feelings. ReferencesBohart, A., & Greenberg, L. (1997). Empathy and
psychotherapy: an introductory overview. In A. Bohart, & L. Greenberg (Eds), Empathy
reconsidered (pp. 3-32). Washington DC: American Psychological Association.Elliott, R.,
Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48(1), 43-49.
Project-related Empathy - Data from a short-term therapy with an obsessive compulsive
patient
Michael B. Buchholz, International Psychoanalytic University (IPU), Berlin
I want to present conversational data from a study on empathy in a psychodynamic oriented
German Short-Term Therapy with an obsessive compulsive patient. Both participants share
54
several "projects" as e.g. "symptom removal" or "confession" or "seeking causes" . My
naming of these projects is provisional. It seems to make sense to speak of mutual "projectrelated empathy". Participants organize their contributions as related to the "project" and to
the other participant. It is a type of hearer/speaker, demonstrator/onlooker, feeding/being
fed etc. cooperation analyzed by CA. Open questions are: a) is there a more generic kind of
serial order in which projects are organized?, b) what kind of activities are used to manage
the transformation from one "project" to the next?, c) does it make sense to differentiate a
"project-related empathy" from a "process-related empathy", whereby process be here
understood as sequentiality of projects one after the next?
"What do you take away with you from this conversation?": closing psychotherapeutic
encounter on the radio
Nataliya Thell, Lund University
The data for this paper is recordings of a psychological radio program, called Radio
Psychologist and broadcasted once a week on a Swedish state radio channel. The program is
a 30 minutes telephone conversation between a psychologist and a person seeking help for a
particular psychological problem. In the conversation the psychologist and the program
participant face a number of communicative challenges such as how to formulate the
problem and find a solution within a short period of time, and how to make the conversation
interesting for radio listeners. One particular challenge is to close this single short helpintended conversation meaningfully. Using the methodology of conversation analysis, this
paper identifies and describes conversational organization of a communicative practice used
to negotiate the closure of the psychotherapeutic conversation on the radio. The analysed
practice is frequently initiated by the psychologist's question "What do you take away with
you from this conversation?", and re-invokes those materials talked of earlier in the
conversation, which are seen as useful for the solution of the problem. The analysis shows
how in the closing section of the encounter the psychologist and the program participant are
constructing the meaning of the conversation as helpful. The analysed communicative
practice is discussed with regard to its psychotherapeutic implications, as well as in the
context of the educating and entertaining tasks of the radio program.
Psychotherapeutic process and action sequences
Anssi Peräkylä, University of Helsinki
At the heart of conversation analysis (CA), there is a theory of sequential organization of
social action (Schegloff 2007). According to this theory, adjacent utterances are closely
connected. They convey actions that are organized in initiatory moves, responses, and third
position actions that follow the responses. In this paper, I will outline a conceptualization of
55
psychotherapeutic process based on this three-step understanding of action. Synthetizing the
existing CA studies, I suggest that in the course of this three-step structure, participants of
psychotherapeutic sessions transform their shared, momentary experience. The key
dimensions of the shared experience-in-transformation involve (1) the referents the
participants attend to, (2) their emotional stance to these referents, and (3) their momentary
inter-personal relation. Empirical examples of sequences where such transformations take
place will be presented. Finally, it will be argued that the overall psychotherapeutic goals of
the psychotherapists and their clients are realized in and through action sequences that
involve this transformation of shared experience. Schegloff, E.A. (2007) Sequence
Organization in Interaction: A Primer in Conversation Analysis. Cambridge University Press
27.
Panel
Couple
Moderators: Evrinomy Avdi,
Aristotle University of
Thessaloniki; Virpi-Liisa Kykyri,
University of Jyväskylä
Friday | 5:00 PM-6:30 PM | HS 6
Relational Mind: Exploring embodied responsive actions and attunement in
couple therapy
Recently, there has been increasing interest in the embodied aspects of psychotherapy
interaction. Several recent studies have focused on the mutual attunement and
synchronization between clients and therapists, including emotional attunement, facial
expressions and body movements. Initial studies have shown that synchronization of body
movement may increase the experience of good working alliance and contribute to better
outcome. The Relational Mind research project is a part of the Finnish Academy`s
Programme "Human mind"; it is headed by Jaakko Seikkula and is conducted at the
University of Jyväskylä in collaboration with four other European universities. In this project,
couple therapy interaction is used as a natural laboratory to study the human mind in action:
more specifically, we explore questions regarding how emotions are communicated and
negotiated, how empathy, mirroring and compassion are performed and how this may lead
to affective regulation, exploration, and mutual change over the course of therapy. The
sessions are analyzed on several different yet interrelated levels, which constitute the
processes of couple therapy, namely social (verbal and non-verbal) interaction between the
therapists and the couple, participants` inner thoughts and feelings during specific events of
change, and participants` autonomic nervous system responses during interaction. In this
panel, there are four presentations from the Relational Mind project which explore different
aspects of the therapeutic interaction. Presentations are from three countries and authors
represent several academic career stages.
56
Exploring attunement: verbal, affective and corporeal aspects
Evrinomy Avdi, Aristotle University of Thessaloniki; Theodora Karamba; Anna Mylona;
Vasileia Lerou; Evangelos Paraskevopoulos
Aims: Attunement between clients and therapists is explored as a key aspect of the
therapeutic relationship. In this paper we present findings from one case of couple therapy,
carried out in the context of the Relational Mind project in Greece, and discuss the ways in
which we have attempted to examine attunement by combining verbal, affective and
psychophysiological aspects of the therapeutic interaction. Method: The material consists of
split screen video-recordings of all sessions, as well as Stimulated Recall interviews and heart
rate measurements for all participants in two sessions, one early and one late in the therapy.
The verbal aspects of attunement were studied through discursive analysis. The emotional
expressions of each participant were coded using the circumplex model of affect and
attunement was investigated through studying the correlations between the affective
expressions of different participants throughout the sessions. Attunement on an embodied
level was explored through the concept of Partial Directed Coherence between measures
derived from the heart rate variability of each participant. Results and discussion: The
analysis focuses on the different levels of attunement, as expressed on an affective and
embodied level of interaction and in relation to the spoken dialogue, at key moments of the
session. Moreover, comparisons in the degree and 'quality' of attunement are made between
early and late sessions. Findings are discussed in relation to methodological and clinical
implications.
Soft prosody and silences in interaction in moments of change in couple therapy
Virpi-Liisa Kykyri, University of Jyväskylä; Valeri Tsatsishvili; Anu Karvonen; Markku
Penttonen; Jukka Kaartinen; Jaakko Seikkula
Aims: Initial observations indicate that vocal synchrony is an important element in emotional
attunement and can have a role in bringing about change in psychotherapy. We studied this
by focusing on moments of soft prosody, i.e. the participants' use of shorter or longer
pauses, lower volume, slower rhythm and softer intonation than in surrounding speech in
psychotherapy interaction. It was assumed that soft prosody and silences are useful in
locating significant moments from therapy sessions and in deepening the understanding
about how they emerge and what is their role in embodied interaction. It was assumed that
both moments of attunement and therapeutic change and moments of disengagement and
therapeutic ruptures are found in silent moments of therapy. Methods: Silent moments were
computationally extracted from audio recordings of the sessions using window-based
estimation of root-mean-square (RMS) energy and peak detection, as implemented in
MIRToolbox software under MATLAB environment. A multi-method analysis consisting of
analyses of 1) the social interaction, 2) the autonomic nervous system responses and 3) the
57
participants' experiences as reported in individual interviews was conducted. Results and
discussion: In two pilot cases, there were several silent moments with soft prosody. Some of
these were noticed to be moments of emotional sharing and/or moments of therapeutic
change, whilst some were characterized as moments of disengagement between two or
more of the participants. Findings are discussed against the tradition of psychotherapy
change process research.
Emotional Synchrony Analysis: a Cross-Cultural and Longitudinal comparison through the
Joystick Coding Method.
Berta Vall, Universitat Autònoma de Barcelona; Evrinomy Avdi; Anna Symeonidou; Anna
Mylona
Aim: Synchrony is a construct that analyses the temporal coordination of non-verbal
behaviors, and it has been suggested as a model for intersubjectivity (Feldman, 2007). In this
paper we present findings from one case of couple therapy, carried out in the context of the
Relational Mind project in Spain and Greece, in which emotional synchrony is studied with
the joystick method. Within this method we aim at comparing emotional valence and arousal
results of participants in the psychotherapeutic context. Results of each participant will be
aligned in a time-line and, thus emotional synchrony among participants will be established.
Moreover, comparison of data with verbal and non-verbal information will be included, as
both, researchers that master the language of psychotherapy and researchers who don't
understand it will analyze the results. With this method, emotional cultural influences and
differences will be analyzed and identified. Finally, results on synchrony will be analyzed
longitudinally, at the beginning of the psychotherapeutic process and at the end of it.
Therefore, changes on emotional synchrony within the psychotherapeutic process will be
analyzed. Methods: Data was collected from one couple therapy, in which two sessions were
coded (beginning session and final session). Sessions were video-recorded and then coded
with the Sadler's Joystick tracking device. Results: Results reflected that indeed some cultural
differences in emotional analysis could be detected. However, when focusing on valence and
arousal those differences were reduced. Moreover, differences were also detected in the prepost analysis of emotional synchrony through therapy. Discussion: Clinical and research
implications of results are reviewed and discussed.
Attributions of blame and autonomous nervous system responses in couple therapy for
intimate partner violence
Helena Päivinen, University of Jyväskylä, Finland; Juha Holma; Anu Karvonen; Virpi-Liisa
Kykyri; Jukka Kaartinen; Markku Penttonen; Jaakko Seikkula
Aim: Couple therapy has been criticized for leaving the victim of intimate partner violence
(IPV) unheard and, further, blaming her/him for the violence. Earlier research on
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physiological responses in argument-provoking conversations with one's partner has led to
the hypothesis that attributions of blame induce autonomous nervous system (ANS)
responses in IPV perpetrators and victims. The research design of the project Relational mind
in events of change in multiactor therapeutic dialogues enables us to study not only psychological and social, but also physiological aspects of interaction. In this paper we look at how
blaming the other takes place in conjoint therapy for IPV and how participants respond, both
conversationally and physically, when invited to occupy a position of accountability. Method:
Video-recorded couple therapy sessions with three couples, whose reason for seeking treatment involved IPV, were analyzed qualitatively using both discursive psychology and the narrative approach. The ANS responses of the participants were measured during the analyzed
therapy sessions. Results: Various accusations, criticisms and wishes put the other person
into a position of accountability. Attributions of blaming can focus on either behavior or
character, or both, and thus elicit distinct emotions and reactions on the verbal and physiological levels. Further details of these findings will be given in the presentation. Discussion:
The implications of the findings for clinical practice and research will be discussed.
Discussant: Jarl Wahlström, University of Jyväskylä
28.
Panel
Process-Outcome
Moderator: Sigal Zilcha-Mano,
Haifa University, Israel
Friday | 5:00 PM-6:30 PM | HS 7
What drives alliance effect on outcome?
Alliance is one of the most studied constructs in the field of psychotherapy, with three
decades of research examining its effect on outcome. The quality of the therapeutic alliance
found to be a consistent predictor of outcomes in psychotherapy, with stronger alliances
being associated with better therapeutic outcomes. Recent studies on psychotherapy in
individual treatment have suggested that this association may be significant even when
accounting for the temporal precedence between alliance and symptoms. The first study in
this panel will focus on group psychotherapy and will examine whether the association
between alliance and outcome in multimodal psychotherapy for depression may be
significant even when accounting for the temporal precedence between alliance and
symptoms.
The two other studies in this panel will focus on moderators of the alliance-outcome
association. Meta-analyses report high variability in the strength of the alliance-outcome
association. This variability underscores the importance of identifying significant moderators
of the alliance-outcome association, which can then be utilized to improve treatment.
The second study in this panel will seek to identify potential moderators of the allianceoutcome association in a cohort of patients from a randomized clinical trial of interpersonal
and cognitive behavioral therapy in a psychiatric clinic in Sweden. The third study will
examine moderators for the alliance-outcome association in a cohort of patients from a
randomized clinical trial comparing several feedback conditions in Chile.
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Reciprocal effects of Group Cohesion and Symptoms in Multimodal Psychotherapy for
Depression: Disentangling Within from Between Effects
Ulrike Dinger, Heidelberg University, Germany; Sigal Zilcha-Mano; Henning Schauenburg
Cohesion is an important aspect of therapeutic relationships in groups. Previous scholars
suggested that cohesion is a therapeutic factor in group therapy, assuming a causal
relationship between cohesion and symptomatic change. Although earlier studies
demonstrated the empirical correlation between cohesion and outcome, there is a lack of
studies accounting for the correct temporal sequence in the cohesion-outcome association.
The current study aims to disentangle the reciprocal effects of cohesion and outcome.
Furthermore, we aimed to differentiate within- and between-patient effects in the
longitudinal design. A sample of 40 depressed patients were recruited in the context of a
multimodal, hospital based psychotherapy setting and treated with either day-clinic or
inpatient psychotherapy. Using multilevel modelling techniques, we found indications for
reciprocal causality. Cohesion was a significant predictor of subsequent symptoms, even
when previous symptoms were controlled. Likewise, previous symptoms predicted
subsequent cohesion, even when previous cohesion was controlled. While both withinpatient effects were significant, we found only a between-patient effect for the prediction of
cohesion through earlier symptoms. Patients with high cohesion generally had lower
symptoms. The study demonstrates the usefulness of longitudinal designs in the empirical
investigation of cohesion as therapeutic factor in group psychotherapy.
Moderators of within-patient alliance effect on symptom change
Fredrik Falkenström, Linköping University, Stockholm, Sweden; Annika Ekeblad; Robert
Vestberg
Aim: The Working Alliance has recently been studied using a within-patient design. Our
previous study on primary care psychotherapy showed a statistically significant but on
average very small within-patient effect of the alliance on next session symptom reduction,
although this effect varied greatly among patients. Patients with personality problems,
informally assessed by the treating clinicians, had much stronger alliance effects. Using data
from a randomized clinical trial of Interpersonal and Cognitive Behavioral therapy in a
psychiatric clinic in Sweden, we explore moderators of the session-to-session effects of the
alliance. Methods: The Working Alliance will be assessed using the WAI-SR, and
symptoms/wellbeing with the BDI-II. Using cross-lagged random effects and finite mixture
models, the following variables are hypothesized to moderate the alliance effect: DSM-IV
comorbid Axis II pathology, Reflective Functioning, number of prior episodes of depression,
and dependency/self-criticism measured by the Depressive Experiences Questionnaire. The
following variables are hypothesized not to moderate the alliance effect: demographics (sex,
age, education level), therapy type, concurrent medication, initial symptom level, and
60
general alliance level. Results: Analyses will be made during the spring of 2015, and
presented at the European SPR meeting in September. Discussion: Little is known about the
within-patient alliance effect, and knowledge of the kinds of patients who are sensitive to
fluctuations in the alliance is important because of the risk that alliance ruptures ruin
treatment, while repaired ruptures may be a source of extra therapeutic benefit.
Examining heterogeneity and identifying moderators of the alliance-outcome association.
Sigal Zilcha-Mano, Haifa University, Israel; Paula Errázuriz
Background: Although the alliance-outcome association is one of the most consistent
findings in psychotherapy research, it is also highly heterogenic. Little is known about the
factors explaining this heterogeneity, and consequently there is a lack of adequate
knowledge about how to utilize this association to improve treatment. Objective: (a) examine
the associations among between- and within-individual variability in alliance and outcome,
controlling for previous symptomatic levels; and (b) examine potential moderators of the
alliance-outcome association. Method: five hundred and forty-seven patients treated in a
primary care psychotherapy setting were randomly assigned to five treatment conditions.
The effect of alliance on treatment outcome was analyzed using multilevel models,
disentangling changes in alliance within-individuals from alliance between-individuals.
Patient and therapist characteristics were examined as potential moderators. Results:
Patients who generally reported on a better alliance also reported a better outcome.
Furthermore, patients reporting improvement in alliance throughout treatment also
reported a greater reduction in symptoms throughout treatment. Patients with more severe
symptoms benefited more from a good alliance. Additionally, therapists identifying
themselves as more integrative in their treatment orientation were able to better utilize
good alliances for treatment success. Conclusions: The present study identified significant
sources of heterogeneity in the alliance-outcome association, facilitating the use of this
association to improve treatment.
Discussant: Orya Tishby, Hebrew University, Jerusalem, Israel
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29.
Panel
Child/Adolescent
Moderator: Nick Midgley, Anna
Freud Centre
Friday | 5:00 PM-6:30 PM | HS 8
Treatment of children and adolescents
The 'mentalization' of the children and the dynamics of the parental couple as variables in
the therapeutic process of children and adolescents
Licia Lea Reatto, Italian Psychoanalytic Society; Valentina Tobia; Giulia Scarpellini
This study analyzed changes following psychoanalytic treatment in a group of children who
had carried out a therapy for different types of disorders.The purpose was to verify 1) the
changes observed in children in relation to the different areas involved by development,
through the comparison with a control group; 2) the relationship between the characteristics
of the parental function and the changes observed in their children. We referred to the
concepts of 'mirroring' and 'reflective functioning' developed by Fonagy, assuming that in the
state of mental distress these functions, essential for conscious subjectivity, are
compromised and could be reactivated through the psychodynamic therapeutic process.The
study focused on a sample of 54 boys/girls, interviewed individually at least two years after
completing the treatment, and involved their parents and therapists, by the administration
of questionnaires prepared on-purpose (modeled on the CORE-OM by Evans, adapted for the
developmental age). Correlations' results showed that: 1) the relationship between the 'expt' and their parents improved when the parents had a better 'self-representation', and
worsened when ' parental risk' was higher (p < .05); 2) there was a high correlation between
parents' relationship with the ex-pt and the 'representation' they had of him/her (p > 0.01);
3) the role of the father was relevant for the treatment's outcomes, 4) maternal discomfort
(anxiety and depression) was related to lower father's functioning, especially in the case of
Eating Disorders; 5) 'representation of the son' by parents was highly influential for the
therapy's outcome and was weaker in case of teenage patients. Data provided by therapists
have confirmed these results. To conclude, in our study we found that for a good therapeutic
outcome are influential: the development of the relational function; subjective well-being of
parents; markedly, the 'mentalization' of the child by the parents; the paternal function; the
emotional balance in the parental couple, particularly in the case of teenage children, in
which we found lower capacity for mirroring by the parents, and considering Eating
Disorders, cases in which the conflictuality in the parental couple was higher. We discussed
the relevance of these findings for the clinical practice, and for the development of further
studies on the internal dynamics of the couple and its interference in the child's therapeutic
process. Key words: psychodynamic treatment of children / adolescents; parental
mentalization; mirroring, reflective function; dynamics of the couple; risk elements.
62
Do we do what we think we do? - An exploration of manualizing psychotherapy
Alex Desatnik, UCL - University College London UK
Aim: There is significant evidence to suggest that improvement in parenting quality and
parent-adolescent relationship often closely corresponds with improvement in adolescent
behaviour, as well as with a decrease in internalising and externalising symptoms (Baruch,
Vrouva & Wells, 2011). The Approach to Parenting Teenagers (APT) is a therapeutic approach
to individual work with parents of adolescents, informed mainly by psychoanalytic theory. It
has been developed by the Open Door service for adolescents and their parents, in
collaboration with UCL and the Anna Freud Centre. The APT was evaluated through several
outcome studies, all demonstrating significantly positive outcomes (Jarvis, Trevatt &
Drinkwater, 2004; Jarvis & Drinkwater; 2004; Desatnik, Jarvis, Tohme & Trevatt, under
review) The aim of the present study is the manualization of the APT. Methods: 10
completed APT interventions were audio recorded and transcribed. The transcripts were
analysed using thematic analysis. Results: Two "zones" of focus of the therapeutic work were
identified. The perceptual -- dealing with the parental perception of the adolescent, and of
him/herself as a parent; and the behavioural - dealing with quality of communication and
parental authority. Furthermore, the analysis isolated seven key interpretation categories
forming the core of the approach (e.g. promoting ego functioning, Therapist as an auxiliary
ego, promoting adolescent autonomy). Discussion: It is suggested that, contrary to common
practice where the clinicians attempt to manualise their work based on their explicit
understanding of what they do, an in depth session by session analysis of the implicit
processes can yield significantly richer and more accurate clinical material that is more
representative of the clinical process taking place. The manual developed is now used to
inform the design of a multi-site RCT aimed at further evaluating the effectiveness of the
approach.
The ProYouth online platform for prevention and early intervention in eating disorders:
Relationship between participants' impairment and program utilization
Sally Sophie Kindermann, Center for Psychotherapy Research, University Hospital Heidelberg;
Markus Moessner; Stephanie Bauer
Current healthcare fails to significantly alleviate the burden of illness associated with eating
disorders (ED; e.g. due to limited availability, barriers to service uptake and effectiveness of
treatments). Internet-based interventions have been moved in the centre of attention as a
means to address these challenges and to enhance the prevention and (early) treatment of
ED. ProYouth is a flexible online program combining automated modules (screening,
supportive monitoring, psychoeducation, news section) and personalized modules
(moderated forums, counselling via chat) that can be used by participants depending on their
individual needs. The overall aims are to educate about ED and treatment, to counteract the
development of ED, and to facilitate timely access to professional support. Based on the
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underlying stepped-care approach of ProYouth, it is assumed that utilization of the various
modules is associated with participants' level of impairment. In the present study, this
assumption was tested using data from approx. 3900 registered users. Specifically,
relationships between participants' individual impairment and their utilization of the
ProYouth portal (e.g. number of logins, forums posts, utilization of chats, and monitoring
participation) were analyzed. As expected, we found a huge variation in participants'
impairment and higher impairment was associated with a higher frequency and intensity of
program utilization. The findings confirm that the flexible approach of ProYouth matches
participants' individual needs for support. The combination of automated and personalized
modules allows to address a large number of users in light of limited resources.
Pilot study on establishing a training group to promote mentalisation
Agnieszka Katarzyna Unger, Universität Kassel, Germany; Silja Kotte
This research paper focuses on trainees at the vocational training centre (VTC) in Nordhessen
and the Staatliche Berufsschule (State Vocational College) at the VTC in Kassel. The
vocational training centre provides initial training and vocational preparation for young
people with physical disabilities, psychological impairments and fewer opportunities. The
trainees are provided with support from so-called rehabilitation teams throughout their
whole vocational training and assisted in gaining the highest possible vocational qualification
depending on their individual strengths and weaknesses as well as developing their
personalities. The state vocational college at the Nordhessen vocational training centre in
Kassel approached the University of Kassel with a research project with the aim of improving
the effectiveness of vocational rehabilitation in vocational training. The background for this
are the trainees' destructive tendencies in terms of their motivation for vocational
rehabilitation aims, their learning and social behaviour as well as an increase in cognitive
impairments, psychological problems and social disadvantages. There is a threat of overload
that may lead to resignation and burnout due to the vocational training centre staff's main
impression being that they are now less effective with trainees who are becoming
increasingly more problematic. Successful vocational rehabilitation requires more intensive
supervision of the trainees by staff as well as them working together with a whole range of
different professional groups to be able to keep the placement rate constant on the primary
labour market. The "Mentalising vocational training" evaluation project was designed from
the Nordhessen VTC's research assignment and began in August 2013. The evaluation project
is led by Prof. Dr. Svenja Taubner (Alpen-Adria-University Klagenfurt). The evaluation project's
aim is to establish a climate that promotes mentalisation or reflexive components of
mentalisation by involving as many members of the Nordhessen VTC in Kassel as possible in
the process. In this research paper one assumption is that the destructive tendencies of the
trainees at the Nordhessen vocational training centre in Kassel is due to the significant
limitations of their mentalisation capacity. Based on the "Peaceful schools" project by
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Twemlow et al. (cf. Twemlow & Fonagy 2011), the "training group to promote mentalisation"
pilot project starts directly with the trainees in order to break down destructive tendencies
and social stereotypes. The trainees should be involved in setting up the groups to actively
consider and question internal working models together. The pilot project was designed for
the whole year of vocational training.
30.
Brief Paper Session
Practice Research
Moderators: Jana Volkert,
University Medical Center
Hamburg-Eppendorf, Germany;
Sheila Butler, UKCP and The
Open University
Friday | 5:00 PM-6:30 PM | HS 10
Practice Research
The DPG-Practice-Study -- Study Design, Sample Description and Preliminary Results
Miriam Hans, University of Kassel, Germany; Johannes Zimmermann; Cord Benecke;
Dorothea Huber; Svenja Taubner
The DPG-Practice-Study (Benecke et al., 2011) is a naturalistic, long-term prospective study
that investigates effectiveness, sustainability and economic aspects of psychoanalytic and
psychodynamic psychotherapy in Germany. The eleven participating psychoanalytic
outpatient centers collected basic routine data of over 5,500 patients. Of these, 850 patients
were recruited for the study; 550 actually started therapy with one of the participating
therapists. The study design is as follows: After informed consent, patients are administered
the SCID-interview (axis I and axis II) at the beginning and termination of treatment.
Additionally, patients and therapists complete questionnaires at these two stages as well as
once a year during treatment. Patients also complete follow-up-questionnaires up to six
years after the beginning of treatment. Patients' questionnaires include basic sociodemographic information as well as instruments such as the Symptom-Check-List, the
Inventory of Interpersonal Problems, and the Inventory of Personality Organization.
Therapists give information about frequency and setting of therapy, applied interventions as
well as ratings of improvement of their patients' condition. Having started in 2009, the data
collection is still running. Nevertheless, preliminary results - including the description of the
sample and first results of patients' improvement or deterioration - can already be
presented. Especially, changes in symptomatology, interpersonal problems and personality
organization will be reported.
The effectiveness of psychotherapy in healthcare-practice: A pilot-study for an "Austrian
Consumer Survey of Psychotherapy"
Theresa Ferstl, University of Salzburg, Austria; Jörg Sommerfeld; Anton-Rupert Laireiter
Aim: Efficacy of psychotherapy is well recorded; however, its effectiveness under regular
healthcare conditions is still a buzzle with many open spots. Many methods to explore
65
effectiveness of psychotherapy are available meanwhile. One is to conduct patient surveys
using a retrospective catamnestic design. Methods: In a pilot-study to establish an "Austrian
Consumer Survey on Psychotherapy" the authors developed a questionnaire registering data
on psychological and social functioning, mental symptoms, well-being etc. retrospectively at
the beginning of therapy, its end and the actual date of study. Additionally, subjective
perception of change as well as goal attainment and satisfaction with therapy are recorded
together with data on the therapy itself. In the mentioned study effectiveness of CBT and
Systemic Therapy (ST) were explored and compared. Results: 54 patients having undergone
either CBT (n=32) or ST (n=22) in the past filled in the questionnaire electronically. The
sample consists mostly of women (79%) in their mid-thirties, higher educated, suffering most
often from depression, anxiety disorders and psychosomatic complaints. Both methods
resulted into big reliable changes (ES's > 1.00) and high stability over the catamnestic period
(M=20 months); they did not differ in their effects. Additionally, subjects evaluated their
therapies as highly effective and satisfying and reported good goal-attainment. Discussion:
Retrospective catamnestic designs can be applied well to study effectiveness of
psychotherapy in healthcare. Additionally, psychotherapy was found to be highly effective
under these conditions. This strategy can be adopted to study effectiveness of psychotherapy
in general in Austria.
Three in one-clinician, psychotherapist and psychotherapy researcher in transitional
country- mission impossible or not?
Ljiljana Samardzic, Clinic for Mental Health, Clinical Center Nis, Serbia
Psychotherapy research in the field of psychodynamic psychotherapy encounters many
difficulties worldwide- from methodological to financial ones, as well as those associated
with variable influence of psychodynamic and psychoanalytic thought in academic and
mental health institutions during last decade. On the other side, psychodynamic
psychotherapy research in Eastern European (transitional) countries did not have the chance
to develop itself because of many obstacles and insufficiencies. In this brief paper, the author
reviews the process and outcome of the one of a pioneering carried-out researches in
transitional country, elaborating methodological "shortcuts" and other deviations from
proper psychotherapy research, determined by the fact that the researcher was at the same
time the psychotherapist and clinician. In the conclusion, the author reflects on limited value
of the results of this kind of research, but also on possible, also limited benefits arising from
pioneering and individual research endeavors of this kind.
66
Economic evaluation of concise cognitive behavioural therapy and/or pharmacotherapy for
depression and anxiety disorders; a pragmatic randomised controlled equivalence trial in
routine secondary care
Denise Meuldijk, Leiden University Medical Centre, Netherlands
Background: Depression and anxiety disorders cause great suffering and disability and are
associated with high health care costs. In a previous conducted pragmatic randomized
controlled trial, we have shown that a concise format of cognitive behavioural- and/or
pharmacotherapy is as effective as longer standard care in reducing anxiety and depression
symptoms and in improving general health and quality of life in secondary care psychiatric
outpatients. The present study is intended as an extension of our previous study. In a
economic evaluation, we examined whether a favorable cost-utility of concise care compared
to standard care was attained. Methods: This economic evaluation was performed alongside
a pragmatic randomised controlled trial. Health- related Quality of life was measured using
the Short-Form (SF-36) questionnaire, outcomes were cost per Quality-Adjusted Life Year
(QALY). Cost of healthcare utilization and productivity loss (absenteeism and presenteeism)
were assessed using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric
Illness (TiC-P). A cost-utility analysis, using cost-effectiveness acceptability curves, comparing
differences in societal costs with quality-adjusted life-years (QALYs) at 1 year was performed.
Results: At one year after study entry, the difference in mean cost of the two primary
treatments was not significant between the two groups. No significant differences in other
healthcare and non- healthcare costs could be detected between patients receiving concise
care and standard care. Also, QALYs were not statistically different between groups during
the study period. From both the societal and healthcare perspective, the probability that
concise care is more cost-effective compared to standard care remains below the turning
point of 0.5 for all acceptable values of the willingness to pay for a QALY. Discussion: The
study suggest that concise care is unlikely to be cost-effective compared to standard care in
the treatment for depressive- and anxiety disorders at 1 year. Replication of our economic
evaluation might benefit from an extended follow-up period and strict adherence to the
study protocol. If concise care will be found to be cost-effective in the long term, this would
have major implications for recommendations how to optimize secondary mental health care
in the treatment of anxiety- and depressive disorders.
Engaging in and with research as an integral part of professional practice -- a PRN initiative
in UK
Sheila Butler, UKCP and The Open University
There has been considerable discussion concerning the impact of evidence-based debate on
policy and practice in psychotherapy. This has included the importance of developing a
different model of research which is linked to both practice and development, the need to
develop research capacity amongst all contributors and beneficiaries of psychotherapy
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research, and the importance of two-way communication strategies that link research to
practice and vice versa. Practitioner Research Networks (PRN) are an essential tool in this
process and the UKCP Research Committee has set up its network and is running several PRN
research projects which will be discussed during the presentation. We are exploring and
developing a range of initiatives at local and international levels to develop strategies for
supporting practitioners' research and looking at what types of research potentially provide a
widening of our understanding of psychotherapy. The UKCP PRN is committed to engaging
the membership in maintaining professional excellence and offering the potential for
cultivating a research culture in a professional organization. Opportunities for effective
collaboration and ongoing activities between those who produce, participate in, and use
practice-based research will be discussed and, more dialogue and debate will ensure that
future research connects more closely with practitioners' needs and achieves a greater
impact.
Use of Mental Health Services in the Elderly: Results from the MentDis_ICF65+ study
Jana Volkert, University Medical Center Hamburg-Eppendorf, Germany; Sylke Andreas;
Martin Härter; Berta Ausin; Alessandra Canuto; Mike Crawford; Maria Dehoust; Chiara Da
Ronch; Luigi Grassi; Yael Hershkovitz; Manuel Munoz; Alan Quirk; Ora Rotenstein; Ana-Belen
Santos-Olmo; Susanne Sehner; Arieh Shalev; Jens Strehle; Anna Suling; Kerstin Weber; Karl
Wegscheider; Hans-Ulrich Wittchen; Holger Schulz
Background/ Objectives: Given the on-going demographic changes in western societies,
mental health of older people has become increasingly important in recent years. However,
little is known about their use of mental health services, especially for those suffering from
diagnosed as well as undiagnosed mental disorders. The aim of this study was to identify
predictors and barriers of adequate mental health service utilization in the elderly population
(between 65 and 85 years) in six different European and Associated countries using
standardised interview techniques. Methods: As part of the MentDis_ICF65+ study N = 3,136
community-dwelling elderly at the six study sites were interviewed with the age-sensitive
CIDI65+ to assess mental disorders. Service utilization was assessed with the adapted service
use section in the CIDI65+, which assesses the use of mental health services in the last 12
months and the types of received treatment (e.g. individual or group therapy sessions or
medication). Furthermore, a list of items on self-perceived barriers to mental health service
use, including attitudinal and structural barriers was given to participants. Participants also
provided additional information on activities and participation and quality of life. Descriptive,
bivariate, and multivariate analyses were conducted. In line with Andersen´s (2008)
Behavioural Model, predisposing, enabling, and need factors were analysed as predictors by
multiple linear regression and multinomial logistic regression, respectively. Results: Of those
with a one year prevalence of any mental disorder (without dependence/abuse), 11.1% used
any mental health service in the last 12 month compared to 5.5% in the group without a
68
clinical diagnosis in the last year. Pharmacotherapy and individual therapy sessions (20mins
or longer with a doctor or therapists) are the most frequent types of intervention. Significant
predictors of underuse are male sex, a bad financial situation, a low symptom severity, and
living in the London catchment area. Discussion/ Conclusions: Underutilization of mental
health services of older people is very common and interventions are needed to improve an
adequate use of services.
31.
Poster session
Friday | 6:30 PM-8:00 PM | Foyer at HS A (Auditorium)
Posters, Drinks and Nibbles
A Naturalistic Outcome Study on Katathym Imaginative Psychotherapy and Hypnosis
Psychotherapy: Results after the first Year
Christian Sell, University of Kassel; Heidi Möller; Svenja Taubner
In a prospective naturalistic longitudinal study the therapeutic effectiveness of depthpsychological methods Katathym Imaginative Psychotherapy (KIP) and Hypnosis
Psychotherapy (HY) was investigated within the Austrian health system. The sample consists
of 300 outpatients at T1, 183 outpatients after 6 months and 150 outpatients after 1 year. At
T1, these patients have significantly higher symptom-related distress (BSI/BSCL) and lower
life satisfaction (FLZ) than the respective norm samples. For interpersonal problems (IIP) and
personality organization (IPO-16), however, no significant differences to the norm samples
have been found. A mixed-model ANOVA (ML) revealed a significant decrease in symptomrelated distress over the course of one year. The effect size is d = .58. There were no
significant differences in effectiveness between KIP and HY. Whether the patients had a
personality disorder (ADP-IV) as well as their level of psychological mindedness (PMS) did
both predict changes in effectiveness. The relationship between points of measurement and
symptom-related distress showed significant variance in intercepts across patients. These
results suggest that under the conditions of the Austrian health care system, KIP and HY have
a good level of effectiveness with regards to symptom-related distress.
Anaclitic and introjective patients respond differently to therapeutic techniques
Ingrid Erhardt, University of Kassel; Wolfgang Mertens; Raymond A. Levy; Stuart J. Ablon;
John M. Kelley; Carolina Seybert; Susanne Hörz-Sagstetter
Aim: A naturalistic process-outcome study investigates differential differences in patients'
reactions to therapeutic techniques in psychoanalytic and psychodynamic long-term
psychotherapy (n = 29 patients from three psychotherapy archives). The hypothesis says that
69
therapy processes of anaclitic (dependent) and introjective (self-critical) patients differ in
respect of therapists' techniques. Methods: The Psychotherapy Process Q-Set (Jones 2000;
Ablon et al. 2012) is applied on four sessions of each treatment to identify in-process
variables. Measure points cover chronologically intervals over the process. The sample is
distinguished by criteria and procedure based on Blatt & Ford (1994) into anaclitic and
introjective patients. Factor analysis is used to investigate the differences between both
subgroups overall as well as over each measure point. Results: Three factors are identified:
"patient mistrusts", "therapist uncovers", "therapist avoids advices". Results show that
anaclitic patients respond differently to therapists' techniques than introjective patients.
There is a significant mean difference at the second measure point (after first third of
treatment process). Patients' readiness to trust is reduced in anaclitic patients when
therapists uncover their unconscious feelings and patterns while being more directive. This is
not true for introjective patients. Discussion: Presumably, anaclitic patients are more anxious
in relation to others what is intensified and they pull back when therapist use interpretations
and confrontations. Whereas, introjective patients seem to be comfortable with those
techniques. Clinical implications and limitations of the study will be discussed.
Changes in describing the family and defining reported problems in family therapy process
Barbara Józefik, Jagiellonian University, Kraków, Poland; Feliks Matusiak; Bartosz Treger
Aim: The aim of the poster is to present the results of the qualitative analysis of the manner
in which members of families referred to family therapy to the Family Therapy Outpatient
Unit of the University Hospital in Krakow between 2010-2014 describe their families and
problems they experience. The presentation focuses on two main questions: 1. If and how
does the narration of the family members on functioning of the family, experienced
problems and symptoms of the index patients change in the family therapy process? 2. Does
the content of family narrations have any significance in terms of willingness to enter therapy
and drop-out phenomenon? Methods: The research was conducted with SCORE 15 tool that
was developed to monitor changes occurring in family therapy process. The analysis was
based on the grounded theory methodology in which empirical data was subjected to open
coding and selective coding. Next, quantitative data was attributed to the category tree,
obtained at the previous phase, based on the frequency of occurrence of a given category in
empirical data. Finally, thematic analysis was also used to interpret and comment on the
results. Results: The results are still being analysed however, a preliminary assessment has
shown that families, that have completed long-lasting therapy, formulated a simple and
positive description of a family as a whole. Meanwhile, critical descriptions of the
relationships between family members were also relatively frequently observed. It may be
assumed that a positive narrative expresses experiences, which make up the families
resources, enabling family members to cope with illness, motivating them to continue
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therapy. A positive description of a family as whole may make it easier for the family
members to openly confront the difficult aspects of relationships.
Clinical and psychodynamic diagnosis and early alliance prediction
Ljiljana Samardzic, Clinic for Mental Health, Clinical Center Nis, Serbia; Gordana Nikolic
The aim of our study was to assess predictive validity of the criteria of clinical and
operationalized psychodynamic diagnosis (OPD) for the quality of early therapeutic alliance
in psychodynamic psychotherapy. For the purposes of this study, 63 outpatients from
different non-psychotic ICD-10 diagnostic categories, assigned to psychodynamic
psychotherapeutic treatment, were assessed using clinical parameters and OPD (2nd Edition)
criteria (five axes), before they have started regular treatment. After the fifth session, early
working alliance was estimated using Working Alliance Inventory (WAI). The patients who
have stopped their treatment before the fifth session were considered as dropout group.
Statistical analysis- logistic regression was conducted in order to determine predictive validity
of individual patient's clinical and OPD characteristics for the quality of working alliance. Our
results show that characteristics of patient's interpersonal relations and structural
deficiencies are statistically significant for the prediction of working alliance quality in the
early phase of psychotherapy.
Clinician's adjustment at the interface of common and specific factors
Jean-Michel Thurin, National Institute for Health and Medical Research; Monique Thurin
Aim: As part of a clinical naturalistic process-outcomes research, based on one year
systematized observational psychotherapy case studies, we present the analysis of the
psychotherapeutic process of 60 autistic children. Methods: Each case study is initiated by a
structured case formulation and an ICD-10 diagnosis that complement the previous
assessments and tests. Changes are evaluated from three kinds of indicators: Autistic
Behaviours (BSE-R), Autism Psychodynamic Changes (APEC) and Psychological state (CPQ).
The Child's and Therapist's attitudes, functioning and interactions during the therapy are
observed from the 100 items of Child Psychotherapy Process Q Set (CPQ). It is from CPQ that
we focus on process and mechanisms of change, with an innovative associated methodology.
Among therapists, 51 are psychoanalytically oriented, 5 of cognitive behavioural orientation,
3 of psychomotor and 1 of play therapy reference. Results: This research shows that
psychotherapy for autistic children requires a significant experience and qualities of the
therapist, with different techniques taking in account specificities of emotional,
developmental and psychosocial context for each child. The common factor is specific and
specific factors are adjusted to the behavioural problems and developmental level of each
patient. Discussion: This quantitative and qualitative research combines an intensive study of
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each case with that of aggregated cases. Moderators are taken in account and can play an
important role in the choice of technical ingredients to apply. Internal validity is analysed for
each case and for aggregated cases with the quasi-experimental studies criteria.
Disability Culture: Practice to Evidence in Therapeutic Modifications for Intellectual
Disabilities
Judith English Tischler, University of San Francisco
The efficacy of psychotherapy approaches in counseling individuals with intellectual
disabilities (ID) has been largely unaddressed in the empirical literature until recently.
Numerous reasons for this can be seen to draw close parallels to the notion of cultural
competency with regard to other underserved and marginalized populations who lack access
to mental health services, including: perceptions of maladaptive behaviors as being an
intrinsic pathologic factor of intellectual disability (Fletcher, 2011); the belief that
psychotherapy is ineffective with this population (Sturmey, 2005); a paucity of research and
training to guide effective practice (Beail, 2003; Willner, 2005); and a paucity of professional
modifications to existing theoretical approaches that have been demonstrated to be effective
with this population (Tarver-Behring, & Spagna, 2004); Prout & Browning,
2011).This poster presents a comparative review of empirical and case studies that have
employed therapeutic processes for individuals with disabilities across an array of theoretical
models. Disability identity, from intrapersonal and interpersonal status through community
membership, is examined as a therapeutic construct. Two research questions are: a).What
modifications to extant theoretical models of psychotherapy have demonstrated promising
outcomes for individuals with ID; and b) what common factors among published studies have
produced outcomes that inform future evidenced based practices (process-product) for
research on interventions forindividuals with ID? Two descriptor variables: adaptations to
therapy techniques (Hurley et al., 1998), and common factors of therapeutic change
processes (Grencavage & Norcross, 1990) were coded for each of the primary studies.
This comparative review expands upon the method employed by Whitehouse et al. (2006) in
which studies were examined for the presence/absence of adaptations in either CBT or
psychoanalytic primary studies. The analysis sought to apply a dual coding scheme to extant
empirical studies that reported qualitative and quasi-experimental design. Adaptations to
existing recognized therapeutic models revealed that replication efforts of existing studies
remain a methodological challenge. Pre-requisite therapeutic skills were often cited as a
target for future studies examining treatment outcomes. Common factors across treatment
paradigms, along with well-defined adaptation strategies offer promise in providing therapy
for people with intellectual disabilities. In this poster, process and outcome variables of
therapist assumptions and behavior are summarized with a visual comparison of theoretical
methods employed. Future directions for research addressing psychotherapy for individuals
with disabilities are suggested.
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Does interpersonal behaviour of psychotherapy trainees differ in private and professional
relationships?
Janna Ida Fincke, University Klagenfurt; Heidi Möller; Svenja Taubner
Aim: Currently, little is known about the impact of psychotherapy trainees' interpersonal
behaviour on their therapeutic development. The present study aimed to evaluate the effect
of trainees' interpersonal behaviour on Work Involvement (WI) and compared their social
behaviour within professional and private relationships as well as between different
psychotherapeutic orientations. Methods: The interpersonal scales of the Intrex short-form
questionnaire and the Work Involvement Scale (WIS) were used to evaluate two samples of
German psychotherapy trainees in psychoanalytic (PA), psychodynamic (PD) and cognitive
behavioural therapy (CBT) training. Trainees from sample 1 (N = 184) were asked to describe
their interpersonal behaviour in relation to their patients when filling out the Intrex, whereas
trainees from sample 2 (N = 135) were asked to describe the private relationship with a
significant other. Results: Interpersonal affiliation in professional relationships significantly
predicted the level of Healing Involvement (HI), while Stress Involvement (SI) was predicted
by interpersonal affiliation and interdependence in trainees' relationships with their patients.
Social behaviour within professional relationships provided higher correlations with WI than
private interpersonal behaviour. Significant differences were found between private and
professional relation settings in trainees' interpersonal behaviour with higher levels of
affiliation and interdependence with significant others. Differences between therapeutic
orientation and social behaviour could only be found when comparing trainees' level of
interdependence with the particular relationship setting. Conclusion: Trainees' interpersonal
level of affiliation in professional relationships is a predictor for a successful
psychotherapeutic development. Vice versa, controlling behaviour in professional settings
can be understood as a risk factor against psychotherapeutic growth. Both results strengthen
an evidence-based approach for competence development during psychotherapy training.
Interpersonal behaviour in private relationships seems to be of less relevance for trainee
development, which should influence selection criteria at training institutions.
Does the family „need" depression? A pilot study of family consultations
Bernadetta Janusz, Jagiellonian University, Kraków, Poland; Bogdan de Barbaro; Mariusz
Furgał; Martyna Chwal; Jakub Bobrzynski
The aim of the presented study was to analyze associations between drug-resistant
depression and the way the illness is referred to by patients and members of their families. In
particular, a hypothesis to be verified was that being ill may be a factor stabilizing the family
system, and consequently the treatment of this type of depression may encounter additional
difficulties. The study included 20 patients and their families. Consultations that were
conducted with each family constituted data for qualitative (thematic analysis) and
quantitative (models of regression) analysis. Initial results indicate an explicit association
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between the way patients and their families define the circumstances of the illness
(inerpersonal, intrapsychic, medical discourse), and the type of interactions between them,
manifested verbally and nonverbally. Results of the qualitative analysis indicate that if a
patient during family consultation actively reflects on how to describe his or her situation
and precipitating factors of his or her illness, it usually takes place in opposition to other
members of his or her family of origin. On the other hand, if a patient manifests depressive
symptoms, he/she enters a dependent role, while the rest of the family express an attitude
of warmth towards him or her.
EAP Project to Establish the Professional Competencies of a European Psychotherapist
Courtenay Young, European Association of Psychotherapy; Peter Schulthess; Traudl
Szyszkowitz; Renée Oudijk; Ansis Stabingis
This presentation outlines some of the work that has been done (to date) on the EAP's
project to establish the "professional competencies" of a European Psychotherapist. The 1st
Phase of this project was completed in 2012, with the establishing of a set of Core
Competencies. The 2nd & 3rd phases - currently in process - are to establish the "Specific
Competencies" of the various different modalities in psychotherapy, or those required by a
specific country; and the "Specialist Competencies" required by special client groups
(children, prisoners, refugees, etc.) or required in training, supervision, management or
research.
Effectiveness and sustainability of Katathym Imaginative Psychotherapie (KIP) with
adolescents
Brigitte Fiala-Baumann, Institute of Psychology, Innsbruck, Austria; Eva Baenninger-Huber
KIP is a proved psychotherapy method working with imagination. Up to now, there are no
empirical studies about the effectiveness of this psychotherapeutic approach in
psychotherapies with adolescents. In order to fill this gap, we started a study in which 30
adolescent patients having a clinical DSM IV or ICD 10 diagnosis are compared with a nontreatment control group. The patients are between 12 and 18 years old. All therapists are
graduated with five to ten years of active practice working at different places in Austria.
Starting from the assumption that psychotherapeutic success is depending on the patients'
relationship to their parents, both perspectives are compared. At the beginning of the
treatment the following instruments were administered to the patients: Symptom Checklist
(SCL-90), Elternbildfragebogen (EBF-KJ) and Youth Self-Report (YSR 11-18). For the parents
we use the Child Behavior Checklist (CBCL 4-18), a parallel version of the YSR 11-18. In order
to capture the patients' subjective attitude towards psychotherapy more deeply, semistructured interviews are conducted with the patients, the non-treatment group, and the
parents. These measures are repeated during treatment every six month. A follow-up
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measurement takes place six months after the end of treatment. Up to now, all 30 patients
finished the first measurement. First results will be presented and discussed in this poster.
Effectiveness of the psychoorganic analysis: the possibility to reduce the level of anxiety
and general psychological symptoms
Inta Poudziunas, Baltic Psychoorganic Analysis Center; Armands Brants; Inga Kartupele
Baltic Centre of Psychoorganic Analysis, in cooperation with the Latvian Association of
Psychotherapists of Psychoorganic Analysis carried out long-term research about the
effectiveness of the psychoorganic analysis as a method of psychotherapy. The study aims to
determine the possibility to reduce the level of anxiety and general psychological symptoms
as interpersonal sensitivity, somatic, obscesive compulsive, depressive, paranoid symptoms
and other symptoms. Until now the pilot study is completed - 5 months long
psychotherapeutic group. 2 psychoorganic analysis psychotherapists used the POA concepts
as 3 functional form (unary, dual, ternary), regression and progression, triads (situationfeelings-expression, the primary impulse-the secondary reaction-compromise, etc.). Group
leaders also relied on the vegetative nervous system principles to encourage positive
emotional changes. Group members rated their emotional state at the beginning of group
and every 7 weeks with State-Trait Anxiety Inventory (STAI, Spielberger, 1973) and Symptoms
checklist SCL-90R (Derogatis, 1977, 1994). The pilot study results show that there is the
situational anxiety statistically significant differences in various stages of psychotherapy
(F=4.32, p<0.05). Comparing the arithmetical average with the Post Hoc test, it must be
concluded that statistically significant differences are between the first and each subsequent
results, so the level of the anxiety of study participants in the time of psychotherapy has
become significantly lower (p<0.05). During psychotherapy has identified a number of
positive changes in the emotional sphere for participants, but the change rate is highly
individual - from small to statistically significant. The study will continue in two two-year
groups.
Emotion regulation and recovery from anorexia nervosa - applying lessons from adults to
treat youth and families
Karolina Rozworska, University of British Columbia, Vancouver, Canada; Marilyn Fitzpatrick;
Howard Steiger; Richard Young
Anorexia nervosa (AN) is a challenging disorder to treat and a growing body of research
shows that there is a link between AN symptomatology and impaired processing of emotions
(EP) across age groups. For example, experimental research suggests that symptoms of AN
increase after the induction of negative affect. Several studies have shown that individuals
with eating disorders have more difficulties with emotional expression, regulation, and
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awareness than healthy controls. Research also shows that long-term treatment outcome is
predicted by difficulties in EP, suggesting a need to place more focus on emotional
functioning in therapy. The aim of this presentation is two-fold: first, it will present the
results of a longitudinal study that explored if a change in three aspects of EP (unawareness,
expression of negative emotions, and suppression) predicts improvement in AN symptoms in
the course of specialized day treatment for eating disorders. Regression analysis showed
that, among the three, suppression was the only significant predictor (F = 3.22, Adj R2= .24 p
< .05) and remained significant after controlling for the effect of depression and the BMI (F =
11.79, Adj R2 =.61, p < .001). Second, the authors will discuss how these results can inform
the treatment of not only adults but also adolescents and their families. Developmentally,
children learn emotion regulation skills from their caregivers' responses to emotions.
Engaging families in therapies focused on emotion regulation is a natural extension of this
developmental process. It is also best practice in treating eating disorders in children and
adolescents to engage families. Studies showed that when caregivers' responses to their
children are invalidating and critical, these children have poorer outcomes in family-based
therapy for eating disorders. This suggests the need to intervene with parents to enhance
their skills in responding in a manner that validates and regulates emotions. Effective
interventions, however, require an exploration of ways in which caregivers "teach" emotion
regulation to their children with eating disorders. The direction for first and fourth authors'
future research on this topic will be discussed.
How I choose my theoretical lens: Therapist voices from India
Chetna Duggal, Tata Institute of Social Sciences, Mumbai
The therapeutic work of a therapist is through the lens of a theoretical model or framework.
The theoretical orientation determines how the therapist views the client concerns,
conceptualizes them and structures the treatment. A qualitative study was conducted to
explore factors that influenced therapists' adherence to a specific theoretical framework. The
interviews revealed that therapist choice of therapeutic model was guided by a range of
factors, such as personal fit, effectiveness experienced through personal therapy, good
therapeutic outcomes with clients, comprehensiveness of the model in understanding client
concerns, and consonance with religious values held by the therapist. The choice of the
model fit with the therapists personal beliefs of what a therapeutic framework was needed
for, and led to greater conviction in the therapist about their therapeutic work and the
model. Findings are discussed in the context of Indian psychotherapy practice.
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Identification of tests based on the Control Mastery Theory - A single case study
Irina Flaig, Alpen-Adria-Universität Klagenfurt; Sylke Andreas
This single case study "Eisbaer" is based on the assumption of the Control Mastery Theory by
J. Weiss (1987), which states that patients try to overcome their pathogenic beliefs by
"testing" those within the therapist-patient relationship. The main purpose of this qualitative
study is to identify tests of a patient in short-term psychodynamic psychotherapy. Thereby
trying to contribute to the constantly increasing necessity of psychotherapy research,
especially regarding psychotherapy outcome and determination of process variables. The
transcripts with a total of 35-session, regarding a 33-year old patient with somatoform
disorder and depression, were analyzed. The first 4 sessions of the therapy were used to
formulate an analysis plan according to the central goals, obstructions, anticipated tests and
insights to perform a plan analysis based on the Control Mastery Theory. Plan formulation
resulted in three categories of tests: patient’s need to emphasize his own needs, patient’s
need to control others and patient’s need to separate from others. Those were expressed
through variations of transference tests and turning-passive-into-active tests. The results
show, that 70 test-situations were isolated in total, following the formulated analysis plan.
Test-differentiation was possible, so that 8 out of the 70 isolated tests were identified as
passive-into-active tests. All the three categories of the plan formulation were relevant
throughout the therapy process and appeared in a pattern. Thereby a category was tested in
therapy, testing progressed, the frequency of tests regarding this category increased till
reaching a peak, then slowly decreased and finally stopped as another category became
more relevant. A broad variety of applied tests and behavior surrounding test-situations
became apparent.
Individual paths of becoming a psychotherapist
Birgitta Schiller, Sigmund Freud University, Vienna, Austria; Erzsébet Fanni Tóth; Kathrin Mörtl
Nine narrative interviews have been held with students of the Sigmund Freud University
Vienna, with the initial question: "Why are you studying psychotherapy?" Within all
interviews, four different main themes emerged through the analysis using the Grounded
Theory Method: influences, own experiences, field of psychotherapy and coping strategies.
All participants talked of course about their biographical past, how their decision-making
processes looked like, including the decision to become a psychotherapist. But they also
talked a lot about being a student, how they think about psychotherapy in the beginning of
their training, about their way of choosing a specific therapy modality, how they developed
skills and personality throughout time, and how specific expectations and attitudes were
changing throughout the training. This is a rich pot of information, which can be viewed from
different angles. Each of these topics is worth to have a deeper look, but for the challenge of
creating a poster I decided to present the whole picture. Imagining someone's path of life
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like a river, birth would be the source and going on would be the river itself, until in the end it
flows into the gigantic ocean of "being a psychotherapist". This ocean has an individual depth
and colour for each therapist relating to their very individual experiences, their chosen
therapy modality, and their distinct view on life. The poster should illustrate the different
stages of such a possible path, concluded from the information gathered in the statements of
current psychotherapy students.
Integration of an experience of spiritual emergency into a client´s worldview. A grounded
theory.
Tomas Rihacek, Masaryk University in Brno; Hana Sedláková
The study is focused on the process of constructing the meaning of the spiritual emergency
experience. Spiritual emergency is understood as an experience of psychotic nature, defined
by criteria such as good pre-episode functioning, non-ordinary states of consciousness,
awareness of the intrapsychic nature of the process, or preserved ability to cooperate. The
research question was formulated as follows: "How is the construction of the meaning of an
spiritual emergency experience happening?" In-depth interviews with 13 clients were
analyzed using the grounded theory method. The analysis yielded a core category named
"The integration of an experience transcending ordinary states of consciousness into a
client's world view." The process of integration was conceptualized by two complementary
processes: (1) Suppression, i.e. an effort to mitigate or eliminate symptoms and to return to a
previous state of functioning, and (2) Facilitation, i.e. an acceptance of symptoms and their
unfolding meaning, leading to a new perspective. The results are discussed in relation to
different therapeutic practice with psychotic patients.
Is the structural level of psychic integration in adolescence a predictor for the persistence
of personality disorder symptoms in young adulthood? Preliminary results of an ongoing
longitudinal study.
Astrid Bock, Medical University Innsbruck; Eva Huber; Elke Wieser; Maria SteinmayrGensluckner; Cord Benecke
It is a major challenge to draw a clear distinction between the symptoms going along with a
crisis in adolescence and the manifestation of an early onset personality disorder. Previous
longitudinal studies showed mixed results considering the persistence of personality
disorders from adolescence into adulthood. The structural level of psychic integration as
conceptualized in the Operationalized Psychodynamic Diagnosis for Children and Adolescents
(OPD-CA task force, 2007) is similar to the now proposed Level of Personality Functioning
Scale as introduced in DSM-5. We assume that a closer look into the sub-dimensions of the
levels of integration of psychic structure in adolescence allows a differential diagnosis of the
precursor of personality disorder in adulthood. In this longitudinal study 60 adolescents (T1:
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2007-2009; mean age = 15,58; SD = 0,94) with and without psychic disorders were diagnosed
with the OPD-CA, SCID-II-Interviews and questionnaires. The second data collection (T2:
2014-2015) is still ongoing and will be finished in July 2015. The participants, now in their
early twenties, are assessed with SCID-I-interviews, SCID-II-interviews, and questionnaires.
We assume that we will find specific characteristics in the sub-dimensions of psychic
structure that will be connected to the course of personality disorder symptoms.
Motivation and instruction: how do we try to increase the odds of client compliance.
Ricardo de Pascual Verdú, Autonomous University of Madrid, Spain; Nerea Galván
Domínguez; Carlos Marchena Giráldez; Darío Moreno; María Xesús Froján Parga
Aim: To find out what kind of motivational utterances are most often used by along the
instructions that the therapist issues in therapy. Method: Out of a sample of 88 recorded
sessions (by 9 different therapists and all of them pertaining to individual treatments) that
had been coded using the SISC-INTER-CVT and SISC-MOT-T coding systems, 12 pairs of
consecutive, instruction-heavy sessions were selected. In these pairs, 33 different
instructions had been issued. These instructions were reviewed in order to find whether
motivational utterances had been issued along them or not, and what kind of motivational
utterances were being used. Frequency analyses were performed. Results: Out of the 33
instructions that were studied, 13 didn't include motivational utterances. Out of the 20 that
did, 1 of them was accompanied by a colloquial motivational utterance, 18 by chain
motivational utterances and 1 by both chain and colloquial motivational utterances. Out of
the 18 chain motivational utterances, 10 anticipated an apetitive consequence for the client
if he complied, 8 anticipated apetitive consequences of compliance along with aversive
consequences of non-compliance, and none used the anticipation of aversive consequences
alone. Discussion: In line with previous results, it appears that the therapist, when trying to
encourage the client to follow instructions, uses motivational utterances more often than
not. Also, the therapist most often tries to help the client anticipate the apetitive
consequences of complying with the instruction, instead of simply issuing vague encouraging
verbalizations.
Myths of the psychotherapy. The multiplicity of theoretical approaches and its reliability
proved by efficacy
Jerzy Witold Aleksandrowicz, Jagiellonian University Medical College
Multiplicity of theoretical approaches and psychotherapy modalities express rather
backwardness of the knowledge and ambitions of their authors and "school" leaders than
diversity of the observations being the basis of assumptions. The convictions in their basic
differences, utility and effectiveness are a myths, probably sustained for socio-economic
purposes. Results of the efficacy research are incredible due to its sins of the methodology:
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neither the groups with the same diagnosis in the terms of ICD or DSM are really
homogeneous nor therapeutic actions steered by the theoretical assumptions are really
identical. So, nor conclusions of the equal effectiveness, nor of some modalities particular
indications in chosen disorders seems really proved. It seems that as a matter of fact we have
to do not with the multiplicity, but with two kinds of psychotherapy. One of them is a form of
psychosocial help for healthy people or persons needing support at in the case of illness
(counseling), based mainly on the psychological and anthropological theories. While it is not
a therapy stricto sensu, its usefulness in current social conditions is great and confirmed by
their widespread dissemination. EBM procedures seem to be inappropriate in the proof of
their verification. They could be based on different theories however their multiplicity could
be limited by current efforts to integrate them. Second kind of psychotherapy is a treatment
of some disorders of mainly psychogenic nature. Being based on the concepts of
psychopathology, the theories of these psychotherapies should be dependent on the
knowledge of the circumstances of treated disorders. This kind of psychotherapy is at the
moment poorly developed, perhaps mainly due to the limited usefulness of current
psychopathology. Key words: psychotherapy theories, reliability, research methodology.
Network meta-analysis of psychological, pharmacological and combined treatments for
Borderline Personality Disorder (BORDERNET) - study protocol
Sven Rabung, Alpen-Adria-Universität Klagenfurt; Alessa von Wolff; Sarah Liebherz; Falk
Leichsenring; Levente Kriston
Borderline personality disorder (BPD) is a common mental disorder which is characterized by
severe functional impairments, a high suicidal risk, a negative impact on the course of
depressive disorders, extensive treatment utilization, and high societal costs. For
psychological treatment, evidence suggests that specific forms of psychotherapy are helpful
for at least some of the problems frequently found in patients with BPD. At present, there is
no evidence to suggest that one specific form of psychotherapy is superior to another in BPD.
For pharmacotherapy, results are heterogeneous and evidence is not yet robust. A broader
knowledge base is needed concerning relative effectiveness and constraints of available
treatment options to help practitioners form judgments based on the circumstances of
individual cases. The present review summarises the existing evidence on the comparative
effectiveness and safety of psychological, pharmacological and combined treatments for
people with BPD by means of a network meta-analysis. Thereby, it does not only update the
existing evidence synthesis, which -- at least for psychological treatments -- is lacking
timeliness, but also for the first time statistically integrates all the available direct and
indirect evidence on comparative effectiveness of psychological, pharmacological and
combined treatments that is available in a network of treatments and comparisons. Since
network meta-analysis suggests a ranking of interventions according to their relative
effectiveness, the results may be of high relevance for clinical decision making.
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Neural correlates of empathy in couples: A study of peripheral and central nervous system
measures during an ecological interaction task
Marta Barbosa, Universidade do Minho, Braga, Portugal; Patrícia Oliveira-Silva; Jean Decety;
Kristin Perrone; Joana Coutinho
Empathy is a psychological construct broadly studied in psychotherapy field. The context of
intimate relationship is one of the main contexts where empathy appears to be critical.
Empathy is a crucial component of successful and stable interpersonal relationships including
romantic relationships. Perceived empathy is positively associated with relationship
satisfaction and negatively associated with interpersonal conflict (Duncan C. & Jowett S.,
2010). Recently, neurosciences have been contributing for explaining empathic processes by
shedding light on their neurobiological correlates. This research project aims to contribute to
a better understanding of the neurobiological correlates of empathic processes. Thus the
main goal of this study is to analyze the neural correlates of empathy in couples both at the
peripheral and central nervous system level. Our sample is composed by 30 couples (60
participants) that live in an intimate relationship with a minimum duration of one year. In
Study I both elements of the couple perform a structured interaction task in the lab, in which
they discuss postive and problematic topics in their relationship. This interaction is
videotaped and during the task the simultaneous recording of psychophysiological measures
(electrodermal activity, interbeat interval, heart rate and respiratory frequency) using the
Biopac MP-150 is performed. We hypothesize higher levels of global autonomic arousal
during negative communication, a relationship between heart rate variability and regulatory
dimensions of empathy. We also hypothesize that the degree of physiological linkage or
synchrony between both elements of the couple will be higher in moments in which the
elements of the couple behave in a more empathic way. In the Study II excerpts of the
previously videotaped interaction (positive; negative and neutral affect communications) will
be used to construct a functional magnetic resonance imaging (fMRI) task. During the fMRI
task each element of the couple watches to the video of his/her partner expressing negative
and positive communications and is asked to elaborate on what his/her spouse is thinking
(cognitive empathy) and feeling (emotional empathy). We will assess which areas of the
brain have an increased activation in the different empathy conditions. We expect that that
cognitive empathy (What is your wife/husband thinking?") will be associated with the
activation of brain areas involved in social perception such as the medial pre frontal and
orbitofrontal cortex and temporal parietal junction. We expect that the emotional empathy
conditon ("what was your wife/husband feeling?") to engage emotional networks
particularly insula, amygdala and parahippocampal gyrus. In this poster we will present the
experimental design of the research project, the interaction task performed by the
participants in the lab and the research hypothesis for study I and II.
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Objectives, Interventions and Challenges in Parent-Child Art Psychotherapy
Dafna Regev, University of Haifa, Israel; Sharon Snir
Aim: In recent years there has been growing interest in parent-child art psychotherapy (e. g.
Plante & Berneche, 2008). The present study aimed to establish an accepted definition of the
process and practice of parent-child art psychotherapy. Methods: A total of 20 parent-child
art therapists aged 36 to 61 took part in the study. In the first stage of the study fifteen of the
20 participants were asked to participate in a semi-structured interview regarding their
practical experience. In the second stage the interviewees provided feedback on the findings.
Grounded Theory methodology was used to analyze the data (Charmaz, 2006). Results and
Discussion: The results show that most therapists define the main objective of parent-child
art psychotherapy to be creating a change or improving the child's mental well-being,
behavior, and functioning. The interviews also revealed four intermediate objectives: (1)
Creating the time and space for spending time together; (2) Creating a play space within the
therapy room; (3) Observing and learning from the interaction; (4) Providing the parents with
information and support. Interventions related to each objective are discussed. This study
may assist mental health therapists who work with children, art therapy students, and novice
art therapists in familiarizing themselves with this unique treatment area, its therapeutic
objectives, and art-based work methods. The information may also serve practicing
therapists as a means to voice their opinions and as a source of reference, grounding and
organization.
PQS-D-Sup. A New Q-sort in supervision research
Andreas Hamburger, International Psychoanalytic University; Ingrid Erhardt
Psychotherapy Q-Sort (PQS, E. E. Jones 2000) has already been translated to German as PQSD by Albani et al. (2008). It has been widely used and validated as a reliable research
instrument to quantify process variables in psychotherapeutic sessions. PQS is suitable to
track process variables over time. It was used to identify items which are associated with
outcome, as well to determine the degree which specific (process) items contribute to
outcome. It can by used to capture clinically useful concepts by assessing associations with
other (process/outcome....) instruments. Prototypes of ideal treatment (e.g. psychoanalytic
or CBT) were developed to measure treatment adherence (cf. Ablon et al., 2011). Our study is
part of the research project PSASUP on supervision in youth services at IPU Berlin. For the
present substudy, we use audiotaped group supervisory sessions to develop a new
assessment instrument for supervision, PQS-D-Sup, adapting the PQS-D from psychotherapy
to supervision research. Items were reformulated to adapt them from single session
psychotherapy to the supervisory group context, the coding manual was refined accordingly.
Construction and validitation of a prototype for psychoanalytic supervision is in process.
Interrater-reliability is tested regularly. Further research on psychometric properties such as
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convergent validity is in process. References: Ablon, S. & E.E. Jones (1998): How Expert
Clinicians' Prototypes of an Ideal Treatment Correlate with Outcome in Psychodynamic and
Cognitive-Behavioral Therapy, Psychotherapy Research, 8, 71--83 Ablon, S. J.; Levy, R. A.;
Smith-Hansen, L. (2011). The contributions of Psychotherapy Process Q-set to Psychotherapy
Research. Psychotherapy Research 14 (1); 14-48Albani, C; Ablon, J.S. Levy, R. A. Mertens, W.
& Kächele, H.: Der „Psychotherapie Prozess Q-Set" von Enrico C. Jones. Ulm: Ulmer Textbank
2008 Erhardt, Ingrid (2014): Bezogenheit und Differenzierung in der therapeutischen Dyade.
Gießen: Psychosozial.
Process Outcome Mindfulness Effects in Trainees (PrOMET)
Paula Kröger, Heidelberg University, Germany; Thomas Heidenreich; Hinrich Bents; Wolfgang
Lutz; Christoph Flückiger; Johannes Mander
Mindfulness - a specific form of attention that is non-judgmental, purposeful, and focused on
the present moment - received a growing interest within psychotherapy research and
practice in the past two decades. Although the efficacy of mindfulness-based interventions
could be demonstrated for specific manualized forms of mindfulness-based approaches that
are carried out in group settings, little is known about the underlying mechanisms. One
plausible yet underexplored mechanism is patients’ motivation to change. Additionally,
studies investigating the effects of mindfulness experiences of both patients and therapists
on therapeutic processes and outcome in individual psychotherapy have been requested.
Consequently, the main purpose of this study is to identify whether exercises with
mindfulness elements help to improve the therapeutic process. More specifically, we are
examine the effects of a brief, session introducing intervention with mindfulness elements,
as practiced by both the outpatient and trainee therapist at the beginning of every therapy
sessions, on motivation to change and treatment outcome under effectiveness conditions.
Thereby, 150 outpatients are randomized after five sessions of diagnostics either to a
mindfulness intervention group (MIG), a control group (CG) practicing a short form of
progressive muscle relaxation (PMR), or a treatment as usual (TAU) group. The most
important outcome variable will be the Short Version of University of Rhode Island Change
Assessment (URICA-S), which measures treatment motivation based on the transtheoretical
model of behavior change. In our contribution we will present the study design and the
progress of data collection as well as first preliminary results.
Productive function of PAMs in the context of verbal interaction
Günther Kainz, Universität Innsbruck, Austria; Eva Baenninger-Huber
In our research project we are investigating the role of verbal and nonverbal interactive
behavior for productive psychotherapeutic change. Specifically, we are interested in the
relation between processes of affective regulation on a micro-level of verbal and nonverbal
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behavior and a productive psychotherapeutic process. One type of interactive relationship
pattern we identified are the so-called Prototypical Affective Micro-sequences (PAMs),
characterized by smiling and laughing, which have the function to regulate negative
emotions interactively. Several studies have shown that PAMs play an important role in
establishing a productive balance between secure working alliance and conflictive tension.
Starting from these considerations, this research work focuses on the questions, in which
emotional and relational context the different types of PAMs (successful, unsuccessful,
plus/minus, participation) do occur and in which contexts they may be viewed as fruitful. To
this end, we are relating the different types of PAMs to relationship patterns gained by the
help of the CCRT-LU Method (Albani et.al, 2008). Additionally, we are investigating
transference patterns in which the patients' wishes, needs and intentions towards the
therapist and the therapist's reaction on them in the hic-et-nunc of the psychotherapeutic
interaction will be categorized. This method should allow to trace changes in these
categories in the course of a successful psychotherapy. In this poster, the method will be
explained more deeply and illustrated by examples.
Psychodynamic Therapy as a Process of Objective Hermeneutics
Goetz Egloff, Practice for Psychoanalysis; affil., Heidelberg University, Germany
Aim: Ulrich Oevermann´s research method, Objective Hermeneutics (OH) originally stems
from sociological qualitative research. Through overcoming subjective interpretive modes,
OH aims at a development of meaning as a process of reconstruction that is actually
falsifiable. As it is a theory and research method presuming constitutive features to structure
the world by meaning, psychodynamic therapy can be viewed as a corresponding process of
gaining access to patients´ experiencing of themselves, of their surroundings, and of their
symptom. Methods: Originally stemming from text analysis, OH consists foremost of
sequential analysis which is adapted to the process of development of meaning in the
therapy session. In a non-subsumptive, non- hierarchical but dialectical logic by way of OH
the symptom in the patient is immanently examined -- together with the patient. The patient
undergoes experiential analysis; her experiencing is mediated by speech. Similar to
biographical research in sociology, meaning is examined in terms of social category at the
intersection of nature and culture. However, what is seen as universal structure is neither
examined nor questioned. Only historical aspects of the subject´s personal experiencing are
taken into account. Results: Through the therapist´s elaborating on the patient´s symptom,
the symptom´s meaning is abductively objectified. In an immanently critical perspective the
symptom will not only reflect the patient´s personal, biographic experiencing but her social
relations and the societal super-structure and predispositions she has grown up in. The
approach differentiates universal from historical structures, aiming at some generative
grammar of the symptom. In intentionally omitting topics that might not be falsifiable within
the therapeutic dyad the patient feels free to speak her mind without the therapeutic
process remaining in mere behavioral modes. The therapist makes suggestions of
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interpreting as well as the patient does. Inducing of self-reflection and transferring results
into everyday life is strongly supported. Discussion: Viewed in OPD-2 axes terms, OH focuses
on working through only of conflict and relational axes, emphasizing OPD-2 treatment
preconditions and adding of a structural-genetic, psychohistoric approach, conceptualizing
structure merging into societal aspects. Subjectivity is conceptualized as subjectivity from
crisis in historical context; this is where the latencies to be disclosed are. Only abductive
reasoning is focused at -- as well as definitely a limitation of transferencecountertransference interpretation. The approach might not be for severe disorders only. At
any rate, a general, integrative theory of socialization is required.
Qualitative research on relationship between mentalization skills in parents and
psychosocial functioning of children in latency stage of development.
Karolina Dejko, Jagiellonian University, Kraków, Poland; Bernadetta Janusz; Bartosz Treger
Objectives: The aim of the presented project was to establish the mentalization skills in
parents of children with difficulties in realizing developmental objectives of the latency stage.
The research was exploratory in nature - according to our knowledge this project was the
first application of mentalization concept in research in polish sociocultural context.
Methods: The research was held within qualitative methodology. We collected and analyzed
9 interviews with participants of Multi-family Therapy project carried out in University
Hospital in Kraków. The structured Adult Attachment Interview was used as the main tool for
the research. The analysis was performed with the Reflective Functioning Scale. Results: The
conducted analysis showed that parents of children with difficulties in realizing
developmental objectives of the latency stage are characterized by reduced mentalization
skills. The typical mentalization pattern encompasses the tendency towards idealization,
generalization and lack of coherence. Conclusions: Observed disturbance in mentalization
may strongly influence quality of relationship between parents and their children. It may
result in difficulties in reflecting and containing child's emotional experience, and therefore
influence his regulatory skills. As a consequence, disturbances in child's emotional and social
development might occur. In conclusion, it can be stated that implementation of therapeutic
techniques oriented at development of parents' mentalization skills might be very beneficial
for treatment of child.
Regulation of Guilt Feelings in Psychotherapeutic Interactions
Sabine Monsberger, Institute of Psychology, University of Innsbruck, Austria; Eva BaenningerHuber
Pathological and inadequate guilt feelings often are subject of psychotherapeutic treatment.
They are crucial for the understanding of a patients' conflicts and productive change during
therapy. Accordingly, a lot of literature exists that describes guilt feelings from a clinical
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perspective. Studies, which are investigating the elicitation and regulation of guilt feelings in
psychotherapeutic interactions on an observational level however, are still rare. As a result,
we conducted a series of studies in which processes of affective regulation in the context of
guilt feelings were examined. Psychoanalytic psychotherapies were videotaped and the
interactive behavior of the patients and the therapists were analyzed using FACS for coding
facial behavior. Following this methodological approach so-called "traps" could be identified
(Bänninger-Huber & Widmer, 1999). These short interactive relationship patterns are
characterized by specific verbal and nonverbal behavior and fulfill the function to regulate a
patient's guilt feelings involving the therapist. The goal of the study presented here, is not
only to identify different types of traps but to have a closer look at patients' more individual
regulation strategies such as "self-reproaches" or "justifications" and the therapists reactions
on these behaviors. Following a single case design, five successive sessions in which guilt
feelings are discussed will be analyzed. The patient is a 28 years old student that sought
therapeutic help because of experiencing a loyalty conflict between his girlfriend and his
male friend. In our poster, preliminary quantitative results will be presented and the
regulation strategies identified will be illustrated by examples.
Self-regulation as a predictor of improvement in depressive symptoms and suicidality in
adolescents treated for depression in primary care
Marianela Hoffmann, Pontificia Universidad Católica de Chile, Santiago; Vania Martínez;
Graciela Rojas; Patricio Cumsille
It is now recognized that depressive disorders are a public health problem of high
importance worldwide, being recognized depression as a serious psychiatric illness that is
associated with extensive acute and chronic illnesses, and mortality (Birmaher & Brent,
2007). But despite the seriousness of this disease and its high prevalence, most depressed
adolescents are undiagnosed, remaining untreated (USPSTF, 2009). Therefore, clinicians and
research teams in the area of mental health we should invest resources to address this
situation. Investigate and implement appropriate and timely treatment could reduce
morbidity and mortality associated with this disease, preventing its recurrence and
chronicity. Although self-regulation has long been a fundamental concept in developmental
psychology (eg, Kopp, 1982), Rothbart was one of the first to explicitly link these skills to
temperament, becoming a central concept of his theory (Putnam & Stifter, 2008). The selfregulation skills operationalized a multidimensional construct called effortful control, defined
as the ability to inhibit dominant responses to activate subdominant responses, to detect
errors and to plan (Rothbart & Bates, 2006). While in recent years has been widely studied
self-regulation and its relationship to internalizing and externalizing problems of children and
adolescents, few studies investigating this ability from the implementation of the treatment
of these problems. That is why in the present investigation the role of this temperamental
ability is addressed on improving affective disorders, specifically self-regulation in relation to
major depressive disorders and suicidality in adolescent primary care users. The objective of
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this research is to determine the relationship between the ability of self-regulation and
decreased depressive symptoms and suicidality in adolescents treated for depression in
primary care in Santiago de Chile. This research uses quantitative methodology with a
correlational design, longitudinal type, in which features are described and analyzed in an
adolescent population ( 15-19 years) having a major depressive episode and attends
treatment in primary care. Relationships between different variables of self-regulation
(attention control, inhibitory control and activational control) and the presence of depressive
symptoms and suicidality were studied. Study participants to date are 75 adolescents 15 to
19 years of age, consult one of the four primary care clinics chosen for the study in the
municipality of Puente Alto de Santiago de Chile.
Significant events in the context of therapeutic change: A pilot study
Petr Dolezal, Masaryk University Brno Czech republic; Hana Tomicová; Lucia Ukropova;
Michal Cevelicek; Tomas Rihacek
Objective: The aim of the study is to identify and explore significant in-session events from
both a client's and a therapist's perspectives and to connect them to the process of
therapeutic change. Method: In a single case study format, rich data from an individual
therapy with a depressive client will be collected and then analyzed, using both qualitative
and quantitative methods. Interpersonal Process Recall Interview and Helpful Aspects of
Therapy form will be used to identify significant events, a set of quantitative instruments will
be used to track client change. Results: Convergences, as well as divergences in the client's
and therapist's perspectives on significant events will be described. The identified events will
then be connected to the process of change. Conclusions: A proposal will be made for a
systematic multiple-case study research program addressing the relationship between
significant events and the process of change.
Significant events in the therapeutic collaboration: A successful therapy case
Andriza Saraiva Corrêa, Universidade do Minho, Braga, Portugal; Eugénia Ribeiro; Débora
Rodrigues; Sara Costa
Qualitative research on significant events enable a detailed description of the processes that
lead to a significant impact on therapy, and thus may be particularly informative regarding
clinical practice. Therefore, the present study is based on the paradigm of significant events
and on the model of therapeutic collaboration to understand the process of change. Aims:
The current study aims to analyze the therapeutic collaboration throughout a successful
case, concerning significant events identified by the client and therapist as important for the
process. Method: We used the Therapeutic Collaboration Coding System and we coded the
impact of significant events using an analysis grid based on literature. Results: The analysis
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process is still in progress. We expect to characterize the specificity of therapeutic
collaboration on significant events with different impacts.
The beginning and ending of a psychotherapeutic session
Reto Bergauer, Universität Innsbruck, Austria; Eva Huber; Eva Baenninger-Huber
The beginning as well as the ending of a psychotherapeutic session are important yet
unexplored moments that fulfil different functions within the therapeutic process. The
beginning of the session can be seen as the phase where a positive affective relationship
between the patient and the therapist is established. This relationship is used to advance
into the emotionally challenging therapeutic process within the actual "working phase" of
the therapeutic session. The function of the session's ending phase is to re-establish the
positive affective relationship after the "working phase" and to engage the patient into
further continuing his or her therapeutic process. Beside the influence on the positive
affective relationship between patient and therapist, beginning and ending also offer a "good
start" and a "good separation" to facilitate the transition between the emotional challenging
process of the "working phase" and everyday life. In the present study we examined
nonverbal processes within the patient-therapist relationship with respect to the following
question: Which affective and regulatory processes occur at the beginning and end of a
therapy session? Videotaped psychoanalytic therapy sessions were analyzed for interactive
phenomena such as Prototypical Affective Microsequences (PAM, Bänninger-Huber 1991),
mutual smiling and gazing towards each other, as well as for patient's and therapist's
attempts of self-regulation (e.g. adaptors, clearing the throat, repetitions of words).
Beginning was defined as the phase from get-together to the introduction of the actual
therapeutic topic (between approximately 7 minutes and 16 seconds); Ending was defined as
the phase from withdrawal from therapeutic topic to leave-taking (between approximately 7
minutes and 10 seconds). Sessions 2, 10, 20, 30, 40 and 50 of two psychotherapies were
examined. Results of this study showed occurrences of different affective regulations. Selfregulatory laughter often occurred with attempts of self-regulations (e.g., adaptors, clearing
the throat, straighten up in the seat), simultaneous laughter appears often in beginnings and
endings to facilitate the transition non-verbally and PAMs occurred more frequently at the
earlier sessions of the therapy. Implications of these findings will be elaborated and
discussed.
The diversity of religious experience: How religious therapists relate towards
religiousness/non-religiousness of their clients
Katarina Motalova, Masaryk University
Various authors and literature (Crosby a Bossley, 2012; Martinez, Smith a Barlow, 2007;
Vandenbergh et al., 2012) report that religious clients prefer a religious psychotherapist, but
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there is little research on psychotherapist's preferences concerning clients. This qualitative
study concerns with how Czech religious psychotherapists relate towards religiosity/nonreligiosity of their client. Eleven Roman-Catholic therapists working in Czech republic were
interviewed and the transcriptions were subjected to thematic analysis. Results show that a.)
therapists divide and refer to the clients according to their religiousness/non-religiousness
and b.) they tend to perceive working with the religious client more positively than with the
non-religious, especially because of broader set of interventions and resources (e. g prayer,
holy communion etc.).The discussion concerns with if and in what way might the option of
diversity of psychotherapeutic approaches (even religious therapies or religious
modifications of traditional approaches) be important in relation to the diversity of
psychotherapists and the diversity of clients and their religious experiences.
The Impact of Adverse Childhood Experiences on Healing Involvement with respect to
Attachment and Introject Affiliation: A Study on the Competence Development of
Psychotherapy Trainees
Daniela Michaelis, Alpen-Adria-University Klagenfurt, Austria; Svenja Taubner
Aim: Empirical studies show that in comparison to other professional groups, clinical
psychologists experienced adverse childhood experiences (ACE) frequently. The type and
extent of the potential impact of ACEs on the therapeutic expertise are of great importance.
The present study examines the impact of ACEs on healing involvement (HI) as therapist
moderated by current attachment representations. Method: 90 trainees were interviewed
with the Adult Attachment Interview (AAI). From transcripts ACEs were coded with high
interrater reliability. Furthermore, participants filled out the Work Involvement Scales to
assess HI and the INTREX Short Form to capture the introject affiliation. In addition, the
Experience in Close Relationships-Revised Questionnaire was employed to assess attachment
anxiety and avoidance. Results: There were no significant effects of ACE on levels of HI after
controlling for the effects of age and sex. Introject affiliation and attachment avoidance had
no moderating effect on the relation between ACE and HI. However, lower levels of
attachment anxiety are associated with higher HI in the presence of ACE. Discussion:
Addressing attachment anxiety especially in trainees with a personal history of ACE could be
crucial in personal therapy and supervision for therapeutic competence development.
The impact of Psychodrama in adolescents' life
Nuno Pires, Universidade do Minho, Braga, Portugal; Margarida R. Henriques
Aim: Psychodrama is a group therapy guided by dramatic action to explore individual
problems or issues, looking for the integration of clients' inner experiences at cognitive,
affective and behavioral level. The therapeutic work is based on dramatic representation,
group dynamics, sociometry and role-playing. Although the studies of its effectiveness, little
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is known about the impact of this approach. To fill this gap, we intended to investigate the
impact of psychodrama, in a group of teenagers, through the clients' perspectives and their
parents. Methods: We study a psychodrama group with 5 adolescents aged between 14 and
18 years, with weekly sessions in a psychological university service of children and
adolescent. To analyze the therapy impact in clients' daily life and their relationships within
the psychodrama group, we used: psychodrama social atom -- to analyze the social relations;
interviews -- to assess the impact of psychodrama; autobiographical narrative task about a
significant event lived in-session -- to analyze emotions and the meanings constructed in the
situation; WAI_C and YSR questionnaires. With parents we used the CBCL questionnaire and
an interview about son's motivation toward therapy and its impact on behavior and wellbeing. With therapist we used the WAI_T and an open-question questionnaire about the
involvement and evolution of each element. The data will be analyzed following case studies
methodology, exploring common factors among cases. Results: The data collection is still in
process. Discussion: Findings will be discussed in order to identify important dimensions to
be explored in a next study focusing the change process in psychodrama context.
The Research of Drawing Therapy Promoting College Excellent Freshmen's Positive
Psychological Adaptation
Xuyang Deng, Southeast University; Zhang Shuo; Xiaofei Qu; Jing Zhang; Linlin Sun; Jinlin
Guo; Wei Tong
Objective: To help college excellent freshmen to make self-exploration, know and understand
themselves, learn to manage emotion positively, improve their interpersonal skills, master
the reasonable method of study, so as to adapt to college life in a better way through the
integrated drawing therapy. Methods: To carry out group counseling using drawing therapy,
drawing after music imagination and interesting psychological activity for the excellent
freshmen in a natural class. At the same time, this paper adopted questionnaire as an
evaluation method before and after the test, and to compare with the control group. Results:
1. The experimental group's scores in adaptability (including problem solving, confidence and
competency, value judgment), self acceptance and self evaluation, social support (objective
support and subjective support), positive coping dimensions in post-test were significantly
higher than pre-test (p < 0.05, p < 0.01, p < 0.05, p < 0.05, p < 0.01, p < 0.01, p < 0.01, p <
0.05, p < 0.05). 2.The control group's scores in self-acceptance of effect evaluation in posttest were significantly higher than pre-test(p < 0.05). 3. There were significant heterogeneous
differences between experimental group and control group before the group counseling. The
experimental group's scores of total adaptation, family and interpersonal relationship,
emotion and study adaptation, self-acceptance, life directional dimensions were significantly
higher than control group in post-test (p < 0.01, p < 0.01, p < 0.01, p < 0.01, p < 0.01, p <
0.01). 4. It can be seen that the increasing scores of three dimensions including life
adaptation, self-acceptance and life directional dimensions were due to the effect of group
counseling for experimental group by covariance analysis. (p < 0.05, p < 0.01, p < 0.01).
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Conclusion: Integrated drawing therapy is helpful to improve college excellent freshmen's
family and interpersonal relationship, ability of emotion and study adaptation, to promote
the self-acceptance, to cultivate optimistic attitude towards life, so as to promote college
excellent freshmen's positive psychological adaptation effectively.
The University of British Columbia Perfectionism Treatment Study: Evaluation of
Psychodynamic/Interpersonal Group Psychotherapy for Perfectionism
Paul L. Hewitt, University of British Columbia; Samuel F. Mikail; Gordon L. Flett
Over the past 25 years, perfectionistic behavior has been shown to be a pernicious
personality style with many deleterious outcomes including unipolar depression, anorexia
nervosa, physical health concerns, and suicidal behavior (Flett & Hewitt, 2002). Although
described as a core personality vulnerability factor (Hewitt et al., 2008; in press) there has
been relatively little attention to the development of appropriate treatments for
perfectionism. We (Hewitt, Flett, & Mikail, in press) developed a
psychodynamic/interpersonal treatment for perfectionism and the current study sought to
determine whether clinically significant improvement, based on our comprehensive
conceptualization of perfectionism, could be obtained using this group treatment approach.
A sample of 71 community-recruited perfectionistic individuals participated in the University
of British Columbia Perfectionism Treatment Study. Eighteen of these participants were
initially non-randomly assigned to a waitlist control condition. All participants completed
measures of perfectionism traits, perfectionistic self-presentation, and automatic
perfectionistic thoughts, as well as measures of distress including depression, anxiety, and
interpersonal problems at pre-treatment, post-treatment, and at a 4-month follow-up.
Multilevel modeling demonstrated that perfectionism levels decreased with large effect sizes
and that these decreases were associated with reductions in distress measures. Clinically
significant decreases were found in all perfectionism components and post-treatment scores
on most variables were significantly lower in the treatment condition versus the waitlist
control condition. The findings suggest that psychodynamic/interpersonal group treatment is
effective in treating components of perfectionism.
Therapeutic Agency Inventory: Questionnaire Development
Julia Huber, University Hospital, Heidelberg, Germany; Christoph Nikendei; Henning
Schauenburg; Ulrike Dinger
Therapy treatment success is assumed to be mainly determined by the quality of patients'
participation in therapy. However, the operationalization of patient participation is often
indirect and the underlying constructs remain vague. Agency, defined as the patient's degree
of active influence on the therapy process, has been emphasized in qualitative studies as
highly relevant from the patient's point of view. Until now, measurements of agency and
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prospective studies investigating the relationship between agency and therapy process and
outcome measures are lacking. The aim of the study is to develop a self-report questionnaire
of Therapeutic Agency and to evaluate its psychometric properties in a sample of
psychotherapy patients. Based on qualitative studies and discussion with 8 psychotherapists
we generated a pool of 39 items. The preliminary version of the questionnaire will be given
together with established process and symptom measures to an intended sample consisting
of 200 psychotherapy out- and in-patients with various mental disorders. Based on reliability
analysis the item number will be reduced. Factor structure, construct validity, and reliability
will be reported. For factor analysis a one-dimensional structure of the Therapeutic Agency
Inventory is expected. High positive correlations with self-efficacy and mastery, but negative
correlations with symptom measures would indicate good convergent and discriminant
validity. Reliabilities will be calculated based on the sample distribution. For the discussion,
we aim to differentiate agency from related patient variables.
Therapist's interventions and therapeutic alliance: A single case study
Daniela Gentile, Sapienza University of Rome, Italy; Veronica Di Donato; Antonello Colli;
Vittorio Lingiardi; Mark Hilsenroth
As reviewed by Hilsenroth, Cromer and Ackerman (2012), there are specific therapist's
interventions that can improve or deteriorate therapeutic alliance. However, few studies
have examined the association between specific therapist's interventions and within session
collaboration level. This study, that represents an extension of a previous research by
Mayotte-Blum et al. (2012), examines the relationship between therapist's interventions with
therapeutic alliance ruptures and resolution processes in a long-term case of psychodynamic
psychotherapy, The sample consisted of 16 sessions over 4 years of treatment (first 4
sessions, 4 sessions from year 1, 4 sessions from year 3, the last 4 sessions). Prior to
treatment the client signed a consent form to participate in research. All sessions from
treatment were videotaped and conducted at a university-based clinic. Patient. Ann, was a
25 year-old single White female enrolled in a master's of arts program for Social Work. She
originally entered psychotherapy experiencing four acute stressors within the same month:
the death of her grandmother, the end of a long-term relationship with a boyfriend,
problems in her graduate program, and difficulties with her externship supervisor. Therapist.
Dr. M was a 35-year-old married White male at the beginning of treatment with Ann. He was
a licensed and board-certified clinical Ph.D. psychologist with (at that time) 9 years of
postdoctoral experience. Raters. Two groups of independent raters evaluated the sessions.
The raters are Clinical PhD graduate students with excellent reliability in the use of the CPPS
(ICC = .78) and CIS-R (ICC = .83).Measures The Brief Symptom Inventory (BSI; Derogatis,
1993) was used for the assessment of symptoms distress, at the beginning and at the end of
treatment. The Social Adjustment Scale (SAS; Weissman & Bothwell, 1976) was used as an
outcome indicator of social/occupational functioning and the Inventory of Interpersonal
Problems (IIP; Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988) for the assessment of
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interpersonal functioning. The Collaborative Interactions Scale (Colli & Lingiardi, 2009) was
used for the evaluation of therapeutic alliance ruptures and resolution processes and
therapist's interventions have been evaluated with the Comparative Psychotherapy Process
Scale (Blagys & Hilsenroth, 2000, 2005).Results. Ann had demonstrated clinically significant
change (Jacobson et al., 1999) in overall symptomatology, interpersonal functioning, social
and occupational functioning. Dyadic analysis of data showed the association between
patient's collaboration level and therapist's techniques and underlined the mutual and
reciprocal influence between patient and therapist. Clinical utility of these results will be
discussed.
Therapists' Self-Perception, Attachment, and Relationship: The Role of Selfobject Needs
Limor Goldner, University of Haifa, Israel
The associations between therapists' narcissistic vulnerability as manifested in their hunger
for selfobject needs and attachment orientation, self-esteem, and authenticity were explored
in a sample of 200 Israeli therapists, along with the quality of the therapeutic relationship, as
they perceived it, with their clients. In addition, the mediating role of therapist's attachment
anxiety and sense of self-esteem and authenticity on the associations between hunger for
mirroring and the therapist-client bond were explored. The findings indicated that hunger for
selfobject needs was associated with anxious attachment orientation while hunger for
selfobject need for mirroring was associated with low levels of self-esteem, authenticity, and
the quality of the therapist-client bond. The therapists' needs for mirroring mediated the
association between therapists' anxious attachment orientation and their self-perception,
whereas therapists' negative self-perception mediated the contribution of need for mirroring
to the quality of the therapeutic relationship.
Towards a psychodynamic evidence-based manual for depression: A proposal for a
clinically adapted manual of the UPP-Depression.
Liat Leibovich, Haifa University, Israel; Sigal Zilcha-Mano
Psychodynamic therapy for depression received considerable empirical support in recent
years. Nevertheless, no one specific version of dynamic therapy for depression meets full,
formal APA Division 12 criteria to be designated a well-established EST. The main reason for
that is that there has not been a replication by a separate research group of any effective,
manualized form of dynamic therapy for depression. In an effort to address this problem,
Leichsenring and Schauenburg (2014) held a meta-analysis based on 14 randomized
controlled trials (RCTs) of dynamic therapies receiving empirical support. An integration of
the principles of these therapies brought out seven therapeutic modules, which found to be
consistent across effective psychodynamic treatments (UPP-Depression). The current project
suggests a more clinically refined version of the modules, set up as a manual and
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demonstrated by three case studies. We used the concepts of therapeutic alliance and CCRT
as organizing concepts that link the different modules. Our purpose it to use this manual as a
basis for single case analyses and after receiving enough support for the revised manual to
further examine it in RCTs.
Tree and dream tree. Validity of relationship patterns with projective objects.
Slobodan Stojanovic, Ulm University, Germany; Helga Andrejkovits; Hanna Andrejkovits;
Robert Kulisek; Michael Stigler; Ludvik Betak; Dan Pokorny
AIM. The projective open procedure "tree and dream tree" (Betak) is freely inspired by the
classical Baumtest of Koch; it enhances it by the activation of the psychodynamic dimension
substantially. Participants are being consequently asked to draw two different tree pictures.
Whereas into the first tree, rather "conventional" issues are being projected, within the
second "dream tree", traces of deeper substantial problems are visible. This opens the space
for a therapeutic dialog close to imaginative techniques and dream elaboration. The
projective procedure provide valuable diagnostic hints for a broad spectrum of clients, both
adults and children. The theory was clinically tested by its author in more than 3000 cases.
The aim of the current study is to investigate his qualitative clinical findings in an empirical
research study. Methods: 21 daily patients in the psychosomatic hospital and 21 control
persons are being asked to draw two tree pictures with the following elaboration in a
therapist-client dialog. After the dialog, the participants are asked for freely associated
adjectives expressing relationship qualities of close relationship persons and of two drawn
trees. Moreover, some standard psychometric instruments are administrated. Evaluation:
Drawings are being judged by experts blind with respect to the study group and drawing
order. The successfulness of the blind rating will be examined by the exact binomial test. The
transcribed dialogs will be investigated lexically w.r.t. to the emotional content and primary
process. The adjectives will be coded by the CCRT-LU category system (core conflictual
relationship theme, Leipzig-Ulm). Results: We will present the study overview. The
procedure, study hypotheses and analysis steps will be explained in a qualitative detail on a
selected case. The project continues with summarizing quantitative analyses intended for a
next presentation. Discussion: We expect to reach two goals of the study: (a) from the point
of psychotherapy, to confirm Betak's theory of access to the deeper psychodynamic issues,
(b) from the point of methodology, to show a possible approach how to analyze a casuistic
material and clinical conjectures both by qualitative and statistically quantitative methods.
What are the characteristics of a good therapist? Patients' and therapists' perspectives
Alban Hirmer, University of Salzburg, Austria; Anton-Rupert Laireiter
Aim: Although randomized controlled studies try to minimize the share of the individual
therapist in the outcome of psychotherapy it is found regularly that this variable explains at
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least 5% of outcome variance, naturalistic studies resulting even into higher estimations (cf.
Willutzki et al., 2013: up to 18%). Several studies have tried to explore the features of a good
therapist ("supershrink"); however therapists' as well as patients' perspectives have not yet
been considered systematically. Therefore a study was conducted to explore important
features of a good therapist and to relate them to one's own therapist (patient's perspective)
and to the therapist by him-/herself (therapist's perspective). Additionally, the relation of the
personal therapist's qualities to the subjectively perceived therapy outcome from patient's
perspective was investigated. Methods: In an online survey 102 psychotherapy outpatients
and 94 psychotherapists of different orientations filled in a questionnaire containing 31
personal characteristics of a good therapist (oriented in Jennings and Skovholt, 1999) and
rated them for a good therapist in general as well as for their own (therapist). Patients rated
perceived effects of their therapies in addition. Results: The study is in progress at the
moment and data are not yet analysed. Therefore results cannot be presented in this
abstract. However data analysis will be finished till end of May. So, results can be presented
at the conference. Discussion: The results will be discussed related to their importance for
establishing knowledge about good therapists and their relation to subjectively perceived
therapy outcome.
What happens in therapy when a patient who has a diagnosis of a seemingly severe and
long-lasting mental illness expresses anti-therapeutic verbalisations?
Alejandra Álvarez, Autonomous University of Madrid; Carlos Marchena Giráldez; Nerea
Galván Domínguez; Aitana Segovia; María Xesús Froján Parga
Aim: This study has been carried out from a functional analytical perspective and its purpose
is to analyse what influence the interaction between therapist and patient in sessions has on
the patient's expression of anti-therapeutic verbalisations. Method: The data has been
analysed following an observational methodology. The Observer XT was the software tool
used to view and study 20 video recordings from psycotherapy sessions. The verbal
behaviour of psychotherapist and patient during these sessions was classified using the prevalidated categorisation system, 'Therapist and Patient Categorisation System of Verbal
Behaviour'. The survey data was collected from various centres belonging to the public
network of social healthcare to individuals with a degree of disability associated with a
severe and long-lasting mental illness from The Community of Madrid. Results: The
frequency of the patient's anti-therapeutic verbalisations varies in relation to the type of
therapist's verbalisations expressed before and after them. Discussion: The results of this
study allow us to analyse the role of the therapist in the appearance of these behaviours in
session. Certain aspects such as the therapist's directivity or the reinforcement or
punishment appear to be fundamental.
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What problems bring patients to substance misuse treatment? A preliminary study with
patient-generated vs standardised outcome measures
Paula Alves, ISCTE-IUL; Célia Sales; Mark Ashworth
In general, when entering treatment for substance misuse, patients tend to be evaluated
with brief measures that focus on drug-related aspects (e.g. past and current history of
substance misuse) or risk behaviours (e.g. sharing of drug paraphernalia). These measures,
such as the UK-popular Treatment Outcomes Profile (TOP; Marsden et al., 2008), provide
little information about the psychological status of patients seeking substance misuse
treatment, nor about other aspects of patient's life which are unrelated to drug misuse but
nevertheless may be causing distress. In this poster we will report the preliminary results of a
study that aimed to identify the problems that patients report when entering substance
misuse treatment and are given total freedom to express their concerns, whether these are
drug-related or not. To achieve this, we administered two patient-generated outcome
measures (PGOM), namely, PSYCHLOPS (Asworth et al., 2004) and the Personal
Questionnaire (PQ; Elliott, Mack & Shapiro, 1999), together with TOP, immediately before the
first treatment session. We will present the comparison between the contents reported by
patients in the two PGOMs, as opposed to those included in TOP, discussing the advantages,
setbacks and implications of using them in clinical practice.
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Saturday, 26 September 2015
32.
Training
Moderators: Omar C.G. Gelo,
University of Salento, Lecce,
Italy and Sigmund Freud
University, Vienna, Austria;
Kathrin Mörtl, Sigmund Freud
University, Vienna, Austria
Saturday | 9:00 AM-10:30 AM | HS 9
Studying the development of psychotherapy trainees: The SPRISTAD
international collaborative multisite project
Discussants: Svenja Taubner, Alpen-Adria-Universität Klagenfurt; Sheila Butler, UKCP and The
Open University; Henning Schauenburg, UniversitätsKlinikum Heidelberg, Germany; Irene
Messina, University of Padua; Franz Caspar, University of Bern, Switzerland; Henriette
Loeffler-Stastka, Medical University of Vienna, Austria; Biljana van Rijn, Metanoia Institute;
Michael Wieser, Alpen-Adria-Universität Klagenfurt; Hinrich Bents, Heidelberg University,
Germany; Omar C.G. Gelo, University of Salento, Lecce, Italy and Sigmund Freud University,
Vienna, Austria; Armin Hartmann, University of Freiburg, Germany; Rima Viliuniene,
Lihuanian Society of Psychoanalysis
The SPR Interest Section on Therapist Training and Development (SPRISTAD) is supporting an
international collaborative multi-site longitudinal project to study the development of
psychotherapy trainees. The development of trainees is seen here as the evolution of both
trainee`s role-identity and role-performance. The general aim is to track over time changes in
these constructs and to identify factors that may facilitate and/or impede this development.
To this aim, a series of both quantitative and qualitative data collection instruments have
been developed and translated in several languages. At the moment, several countries are
already involved in this project, both within and outside Europe. The structured discussion
intends to present the general features of the study as well as to collect inputs from those
who are already involved in it (UK, Germany, Italy, etc.), with the aim of opening a broader
discussion with the audience.
33.
Panel
Eating disorders
Moderator: Stig Poulsen,
Denmark
Treatment of eating disorders and obesity
Client experience of psychotherapy for bulimia nervosa: The impact of client attachment
patterns
Stig Poulsen, University of Copenhagen, Denmark; Susanne Lunn; Louise Tækker; Sarah
Daniel
Aim: While the possible impact of client attachment patterns on the process and outcome of
psychotherapy has been discussed extensively, empirical findings on the subject are still
relatively scarce and often inconclusive (Daniel, 2014; Levy et al., 2011). Qualitative studies
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of client experience of therapy might contribute to the understanding of how client
attachment patterns are associated with client preferences and difficulties in relation to
therapy, but only very few studies have been conducted (cf. Hill et al., 2012). This interviewbased study explores to what extent clients' attachment patterns may be reflected in their
experience of psychotherapy. A particular focus is whether attachment patterns appear to be
differentially related to clients' experience of cognitive behavior therapy (CBT) and
psychoanalytic psychotherapy (PPT). Method: 70 adult clients with bulimia nervosa
participated in a randomized controlled trial comparing CBT and PPT. All clients participated
in the Adult Attachment Interview (George et al., 1996) before therapy. 57 of these clients (n,
CBT=33, n, PPT=24) participated in an interview about their experience of the therapy
(Elliott, 1996; Poulsen et al., 2010). Interviews were analyzed following a Grounded Theory
methodology. Subsequently, the clients were organized within groups based on their overall
satisfaction with therapy following the principles of Nilsson et al. (2007). Results and
Discussion: Salient experiences of therapy characteristic of clients with different attachment
patterns will be reported. A particular focus will be whether particular matches between
client attachment pattern and the therapeutic approach are experienced as particularly
productive or challenging by the clients.
Cognitive Strategies for Enhanced Self-regulation: the challenge of regulating eating
behavior.
Eleni Kanellopoulou, University of Athens, Greece; Kevin Ochsner; Walter Mischel; Hedy
Kober
Which ways of thinking can facilitate self-regulation in the domain of health behaviors and
why? In this set of experiments on healthy eating behavior change we first tested two
explicitly instructed cognitive strategies in order to help female US university student
participants regulate their overeating behavior during the Thanksgiving holiday. We found
that thinking of refraining from overeating as an act of care towards oneself was effective in
helping participants limit overeating and dessert consumption, as compared to thinking of
overeating as an act that the individual would later regret. In the next experiment, we
systematically varied the frame-valence (positive vs. negative) and time-focus (present vs.
future) of a goal-directed cognitive strategy in order to investigate the unique contribution
and interaction of these factors in rendering particular cognitive strategies effective in the
context of self-regulation for healthier eating and weight-loss among both male and female
participants. What we found was a time-focus by frame-valence interaction, such that, when
focusing on future outcomes, a positively framed strategy (i.e. thinking of how healthy
choices would eventually lead to reaching one's future goal) resulted in significant weightloss and healthier eating over a two-week period, whereas a negatively framed strategy (i.e.
thinking of how unhealthy choices would lead to failing to reach one's future goal) did not.
On the other hand, when focusing on present progress, a negatively framed cognitive
strategy (i.e. thinking of how an unhealthy choice constitutes taking a step away from one's
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goal) resulted in significant weight-loss and healthier eating, whereas a positively framed
strategy (i.e. thinking of how a healthy choice constitutes taking a step towards one's goal)
did not. Interestingly, this result, supports the hypothesis that goal focused self-regulation
cognitive strategies could be most effective when they point either on gains in the future, or
on losses in the present. Current health communication policy and practice that aim to
motivate people to engage in healthier living practices, focus mainly on the future, negative
consequences of unhealthy behaviors - such as overeating - a strategy that we found to be
ineffective and that previous research has found to be associated with harmful effects such
as reinforcing the stigma against people who apparently engage in the unwanted behavior (in
this case stigmatizing overweight and obese people). This thesis proposes alternative,
effective, cognitive strategies for promoting self-regulation in the domain of eating, as well as
other health-related behaviors.
Helpful Aspects of Telephone-Based Cognitive Behaviour Therapy for Obesity: Qualitative
Outcomes
Bao-Chau Du, University Health Network; Susan Wnuk; Stephanie Cassin; Sanjeev
Sockalingam; Raed Hawa
Objective: The aim of the present study was to examine the feasiblity of a Telephone-Based
Cognitive Behavioural Therapy (Tele-CBT) intervention for the treatment of severe obesity in
a bariatric surgery population and to explore the influence of significant events during
therapy which individuals experienced as being most helpful. Method: Participants (N=62)
were recruited from the Toronto Western Hospital's Bariatric Surgery Program (TWH-BSP),
and had been approved for surgery. Participants were randomly assigned to the preoperative Tele-CBT group (Pre-Op CBT) or the post-operative group (Post-op CBT).
Participants in the Pre-Op CBT group received six Tele-CBT sessions prior to surgery, delivered
weekly and each session lasted 50 to 60 minutes. Participants in the Post-Op CBT group
received the same treatment six months following surgery. Particpants also completed a
questionnaire packet consisting of the outcome measures at baseline, post CBT intervention
and after completing each session. Qualitative feedback regarding the Tele-CBT protocol was
obtained using the Helpful Aspects of Therapy questionnaire and was also solicited from
participants at the end of the final Tele-CBT session by their therapists. Results: Results
indicate that the CBT protocol is feasible to deliver by telephone. Furthermore, participants
found psycho-education about the Cognitive Behavioural Model of Overeating; SelfMonitoring, Behavioural Activation; Self-Care; a good therapeutic relationship and therapist's
validation of difficulties and stigma attached to obesity were most helpful. Conclusions: TeleCBT for the treatment of obesity is feasible for participants receiving bariatric surgery and
highlights the need for psycho-education regarding the CBT model of obesity, selfmonitoring, and behavioural activation.
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34.
Panel
Theory
Moderator: Jerzy Witold
Aleksandrowicz, Jagiellonian
University Medical College
The revision of "functional" disorders psychopathology
I would like to invite to this panel the participants ready to propose some new theoretical
concepts concerning the essence of "functional disorders" and to discuss their reliability as
well as psychotherapeutic consequences. This means -- to looking for the particular,
appropriate to the essence of disturbance forms of "medical", treating psychotherapy. One
of those proposals will be presented in my paper: "Alternative concept of psychopathology of
neurotic disorders and their adequate psychotherapy".
Alternative concept of psychopathology of neurotic disorders and their adequate
psychotherapy.
Jerzy Witold Aleksandrowicz, Jagiellonian University Medical College
Current psychopathology of "functional disorders" as well as DSM and ICD syndromeoriented classifications of those disorders are weakly adequate to the diagnostic and
therapeutic purposes. Categories based mainly on symptoms are artificial, unclear and not
coherent to the reality of disorders. Instability of syndromes makes diagnosis limited to the
moment of interviewing. Effects of diagnostic procedures seem to dependent mainly on the
patient-diagnosing person relation. In alternative approach proposed here functional
disorders are considered a mean of communication (symptoms as "words" and syndromes as
"sentences"), expressing in nonverbal "parole" the content of current state of mind. The
experience of the lack of some other person presence and attention seems to be here of
primary importance. The essence of illness consists on incapability to communicate those
experiences using some common in a given culture verbal or nonverbal language and to
fulfill the need of attachment. The unconsciousness of those psychic processes is one of
possible reasons.This incapacity results from some particular personality traits (deficits)
disturbing opportunity to make needs and feelings conscious, to build relationships, to use
coping mechanisms facing life exigencies, to recognize and overcome faulty cognitive
schemas and so on. Such approach in understanding functional disorders offers a different
meaning of "psychogenesis". It provides also cohesive explanation of the role the
unconsciousness, of "symbolic function" (individual meaning) of symptoms, of the need of
attachment and relationship. It explains the individual variability and instability of neurotic
syndromes, the impact of relation between personality (eg. "ego strength") and life
difficulties ("stressful situations") on the appearance of functional disorders, the role of
"adaptation" and the "triggers", the preventive role of education as well as many other
aspects of their psychopathology. It seems important to differentiate chronic or recurrent
neurotic disorders from short term reactions to stressful situations, effects of conditioning
and from "psychophysiological reactions". While in the "psychophysiological reactions"
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and/or "conditioned disorders", CBT seems to be adequate therapy, in the chronic and
recurrent ones it seems necessary to disrupt the structure of the failure ("neurotic")
communication system, that means to use words in the place of disturbances of function and
to learn (or re-learn) the use of common language. Key words: functional disorders,
attachement, non-verbal communication.
Selected personality traits and their changes in the course of intensive psychodynamic
group psychotherapy evaluated with the use of MMPI-II and STAI questionnaires.
Katarzyna Cyranka, Jagiellonian University Medical College Krakow, Poland; Michal Wojciech
Mielimaka; Krzysztof Rutkowski; Jerzy A. Sobanski; Łukasz Muldner-Nieckowski; Edyta
Dembińska; Bogna Smiatek-Mazgaj; Paweł Rodziński; Katarzyna Klasa
Aim: Analysis of changes of profiles, clusters and single personality traits observed in patients
treated with intensive, psychodynamic group psychotherapy. Material and methods:
Personality profiles and traits have been evaluated with the use of Minnesota Multiphasic
Personality Inventory (MMPI-II-R), State-Trait Anxiety Inventory and Neurotic Personality
Questionnaire (KON-2006) at the beginning and at the end of treatment. 100 patients have
been included in the analysis. Results: Significant changes in various traits of personality have
been observed in the course of treatment. Moreover specific traits connected with some
personality disorders, as well as neurotic personality were identified. Conclusions: Evaluation
of personality functioning reveals significant changes attainable with the use of intensive
psychodynamic group psychotherapy. The results suggest the necessity to conduct further
research on the relationship between personality traits and neurotic disorders. Alternative
conclusion points at inadequacy of contemporary diagnostic criteria of neurotic and
personality disorders to clinically evaluated characteristics of personality functioning.
Critical reflection on contemporary diagnostic criteria from the perspective of
differentiation and dynamics of symptoms in patients with neurotic disorders and
disturbances in personality functioning treated with group psychotherapy.
Michal Wojciech Mielimaka, Jagiellonian University Medical College; Katarzyna Cyranka;
Krzysztof Rutkowski; Jerzy A. Sobanski; Edyta Dembińska; Łukasz Muldner-Nieckowski; Bogna
Smiatek-Mazgaj; Katarzyna Klasa
Aim: Critical reflection on contemporary diagnostic criteria of neurotic disorders (DSM-5,
ICD-10) based on the analysis of distribution and dynamics of symptoms reported by patients
suffering from neurotic and personality disorders in the course of intensive, psychodynamic
group psychotherapy. Material and methods: patients treated with group psychotherapy
filled out the KO "0" Symptoms Checklist before treatment (at the time of diagnosis) and
several times in the process of treatment (at the beginning, in the middle, and at the end).
Symptoms diversity has been evaluated with the use of statistical analysis. Results:
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Considerable diversity and co-occurrence of symptoms have been identified. Moreover, in
the course of treatment severe changes in the intensity and distribution of symptoms have
been observed. Conclusions: Contemporary diagnostic classifications of neurotic and
personality disorders seems to be insufficient and in selected cases inadequate to
symptomatic manifestation in clinical setting. Keywords: neurotic disorders, symptoms
diversity, group psychotherapy.
35.
Panel
Process
Moderator: Eva BaenningerHuber, Institute of Psychology,
University of Innsbruck, Austria
Nonverbal interaction and psychotherapeutic process: An observational
approach
In this panel, data from our research project "Processes of affective regulation in long term
psychoanalytic psychotherapies" will be presented. Our data consists of six psychotherapies
which take place at our psychotherapeutic research unit at the University of Innsbruck. They
were videotaped completely and several outcome and process measures have been applied.
After each session patient and therapist completed the Helping Alliance Questionnaire (HAQ)
(Luborsky et al., 1996). Facial behavior is coded with the Facial Action Coding System (FACS).
In our approach, we are interested in the question what role specific verbal and nonverbal
interactive relationship patterns play in establishing and maintaining a productive
psychotherapeutic process. Specifically, we are interested in the relation between nonverbal
processes on a micro-level and productive psychotherapy.
In the first contribution, Huber et al. compare different types of interactive relationship
patterns (so-called Prototypical Affective Microsequences (PAMs)) in "high HAQ" sessions
with "low HAQ" sessions. The analysis is based on 36 sessions with four different patients in
which totally 704 PAMs have been identified. In the second paper, Bock et al. investigate the
correlation between the frequencies of facial synchronizations such as simultaneously
starting smiles, head turns, nods or mouth movements and the HAQ scores. For this
purpose, twelve sessions of two different therapeutic dyads have been analyzed and coded
with FACS. The third paper by Schiestl et al. describes the phenomenology and function of
different types of crying in psychotherapies and the regulation of crying by patients and their
therapists.
The balancing of conflictive tension and secure relationship: Prototypical Affective
Microsequences in psychotherapy
Eva Huber, Innsbruck University, Austria; Lea Ahrends; Valerie Plosz; Sigrid Götsch; Stephanie
Hausmeister; Eva Baenninger-Huber
Central aspects of psychotherapeutic interactions manifest themselves not only in verbal, but
nonverbal behavior. Processes of interactive affective regulation, for example, are
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phenomena that can be observed within the therapist-client interaction. Prototypical
Affective Microsequences (PAMs; Bänninger-Huber, 1991; Bänninger-Huber & Widmer, 1999)
are a specific form of interactive affective regulation, where one interacting partner "offers"
a smile in the context of an affectively disturbed self- or relationship regulation. Depending
on the reaction of the interacting partner, different types of PAMs can be differentiated:
Within a successful PAM the interacting partner responds with a smile. Thus both smile
simultaneously, thereby regulating the conflictive tension and establishing a secure
relationship. If the PAM is unsuccessful, the interacting partner does not respond to the
smiling, the secure relationship is not established and the conflictive tension remains
activated. In psychotherapeutic interactions both the establishment of a secure relationship,
and the maintaining of conflictive tension are important. In this study, three phases within
each therapeutic session were distinguished: The beginning, the working phase, and the
termination of the session. Types of PAMs were analyzed within these phases. The results
showed that the beginning and the termination were dominated by successful PAMs,
whereas the working phase was dominated by unsuccessful PAMs. These results indicate that
the balancing of conflictive tension and secure relationship is achieved by offering a secure
relationship at the beginning and a "good separation" at the end, but remaining the
conflictive tension in the working phase to enable the processing of conflictive topics.
Nonverbal synchrony in psychotherapy
Astrid Bock, Medical University Innsbruck; Eva Huber; Günther Kainz; Irene Becker; Anna
Mintrop; Eva Baenninger-Huber
Nonverbal synchrony as the coordination of nonverbal behavior between two interacting
partners plays an important role for the quality of the relationship. Originally observed
within mother-child-interactions, nonverbal synchrony is also an important indicator for
relationship quality in interactions of adults. Within psychotherapeutic interactions, previous
findings suggested that nonverbal synchrony is related to symptom reduction and positive
assessment of the therapeutic relationship (e.g. Ramseyer, 2010; Ramseyer & Tschacher,
2014). The present study investigated whether frequency and duration of nonverbal
synchrony within 12 sessions of two psychoanalytic psychotherapies (6 sessions each)
correlated with the clients' and therapists' assessment of therapeutic success and
psychotherapeutic relationship. The results showed that the frequency and duration of
synchronal gazing toward each other correlated positive with the therapists' assessment of
therapeutic success. Duration and frequency of body- and mouth-movements that served
self-regulatory functions correlated negative with therapists' and patients' assessment of
therapeutic success and therapeutic relationship. Implications of these findings will be
elaborated and discussed.
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Interactive regulation of crying in psychotherapy
Michael Sebastian Pöll, Institute of Psychology, Innsbruck, Austria; Cathrin Schiestl; Eva
Baenninger-Huber
Our study deals with the question what role crying does play in affective regulation of
patients and therapists in psychoanalytic treatment. Specifically, we are interested in the
question, what nonverbal behaviors, especially facial expressions do patients show during
crying and how they regulate their emotions. Furthermore, we are interested in the
therapists' nonverbal reactions to the patients' crying and in their verbal interventions.
Crying episodes are very challenging moments for the therapists. According to psychoanalytic
theory they should keep up a balance between a secure relationship and a certain conflictive
tension. Thus, on the one hand therapists should not trap into an everyday pattern by
comforting the patients too early but should stay abstinent. On the other hand, the
therapists should show enough attachment behavior and empathy that allow the patients to
continue talking about negative emotions. In order to learn more about these processes, we
are analyzing crying episodes in an ongoing psychoanalytic psychotherapy with a 31-years old
depressed woman. At the moment, the therapy comprises 188 videotaped sessions. Crying
occurred in 30 sessions. From selected sessions, short crying episodes will be identified. The
patient's facial behavior during these episodes will be coded with FACS as well as the
therapist's nonverbal and verbal reactions to the patient's crying. First results of this study
will be presented and illustrated by a micro-analysis of a selected crying episode.
Discussant: Adam Horvath, Simon Fraser University, Burnaby, Canada
36.
Brief Paper Session
Training
Moderator: Johannes Krall,
University of Klagenfurt,
Austria
Training/Supervision
What are the benefits of a brief alliance-focused training? Preliminary results.
Diana Ortega, Institute of Psychology, University of Lausanne, Switzerland; Pomini Valentino
The alliance plays an important role in psychotherapy. Being able to identify and repair
alliance ruptures appears to be an important skill for psychotherapists. However, current
training programs often do not provide a consistent number of courses focused on alliance
ruptures.This study examines the effects of a brief training course in the Safran & Muran
(2000) model of repairing ruptures of alliance. The participants were 34 trainees in CBT and
psychodynamic psychotherapy who were in their first or second year of postgraduate
training. They were randomized into an experimental group (N=16), who received a two-day
training course and a control group (N=18), who were put on a waiting-list. The participants'
competence in repairing alliance ruptures was assessed through standardized 20-minutes
role-plays with professional actors trained to simulate hostile patients. The role-plays were
104
filmed and the videos were rated with the Rupture Resolution Rating System (EubanksCarter, Muran & Safran, 2009). Repeated measures ANOVAs showed an interaction effect
between time and group condition for both the frequency of resolution strategies used and
the overall resolution score (F(1 (1,32)=15.21; p=.00, Partial Eta Squared =,322 ; F(1
(1,32)=9.08; p=.04, Partial Eta Squared = ,235). At post-test, trained therapists used
significantly more resolution strategies and had a better resolution score, whereas non
trained therapists did not change on both measures. These results tend to support the
implementation of such training. Analyses of the specific resolution skills learned by
participants will offer other insights on its actual effects.
Corrective Experiences of Trainee Therapists' in Individual Psychotherapy as Patients
Himanshu Giri, Sigmund Freud University, Vienna, Austria
Aim: The therapist is usually seen as an expert who points out patients' problems and helps
him recover from it. Therapists have to go through an extensive training in most countries
which includes several number of hours of their own training therapy and firm theoretical
knowledge to get to the point where they can start working with patients. This undoubtedly
makes them experts in the theory and experience of Corrective Experiences. Getting in touch
with their own and their colleagues' corrective experiences in individual and group training
therapy helps them to get to a close understanding of their patients. Methods: Narrative
interviews using the Corrective Experiences Interview Manual (Angus et al 2011) conducted
with the trainee therapists about their corrective experiences in therapy as patients were
audio analyzed using an advanced computer software ATLAS.ti. Grounded theory
methodology was used for analysis. Results & Discussion: A total of 499 codes (1st level)
were grouped into 20 main categories which were then used to draw a picture of the
corrective experiences of the trainee therapists in their own individual therapy. The study
showed that change during/after therapy happens as a result of multiple factors. The
multiple factors could be categorized into major themes, example given: Big moments in
therapy/things that happened only once, Characteristics of the therapist, Interventions by
the therapist, Client's motivation and the Therapeutic alliance. Although the above
mentioned factors represent individual themes, the trainee therapists narrated them as a
'whole process' where each aspect was linked to another. This process concept of how
training therapists narrate their corrective experiences will be presented at the
conference.Overall the research showed that corrective experiences experienced in training
therapy has similarities as well as unique aspects compared to patient's experiences in the
usual setting.
105
Supervision in psychodrama training -- Enactment and experiential learning
Johannes Krall, University of Klagenfurt, Austria
Supervision is an important step in psychodrama training. It aims at learning in the transition
phase from training to professional practice of psychodrama counselling and psychotherapy.
Theoretical and methodological aspects of the training are to be linked by reflecting
psychotherapeutic work of trainees. In the presentation one study of systematic reflection on
supervision in psychodrama training is introduced. The focus is to evaluate how well the
objectives in supervision are met and which methodological factors in supervision are helpful
and supportive in this learning process. The study also shows the level of the trainees´
distress in their psychotherapeutic work, and to what extend it can be reduced in
supervision. In order to investigate the sustainability of these effects the trainees are asked
to give their feedback immediately after each supervision and a second time after about 2-4
weeks. Furthermore interviews with trainees with one group (13 trainees) are conducted two
times a year (one each semester). The outcome of this study depicts, that the objectives in
supervision are met on a high level, and that supervision has positive effects in reducing
distress of trainees. The results also suggest that action methods and dramatization are
helpful for the learning process of trainees.
Synergetic management of personal and professional growth process of students in the
systemic psychotherapy training group (with the support of Synergetic Navigation System)
Miran Možina, Sigmund Freud University, Ljubljana, Slovenia
Teaching / learning which is based on the principles of complex self-organizing systems can
open new possibilities and resources for more effective learning. Of crucial importance are
resonance effects between the dynamics of the student and the dynamics of the teaching
process or other meaningful system environments (outside or even within the student). By
this, teaching is the continuous realization of the boundary conditions for self-organizing
processes of the student's mental and neural systems. Actually, this understanding is not
metaphorical but has a very concrete meaning since internet-based feedback systems are
available to measure and analyze the present states of self-organizing processes (so called
Synergetic Navigation System). This technology has specific benefits to the student as well as
to the teacher. Psychotherapy training becomes an evidence-based and theoretically founded
management process of the student's dynamics. The base of the data driven evidence is the
actual change process, not only the results of controlled outcome studies. First results of the
research in the systemic psychotherapy training group support this "real time monitoring"
approach.
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37.
Brief Paper Session
Theory
Moderator: Dan Pokorny, Ulm
University, Germany
Conceptual/critical
Diversity, creativity and freedom in the psychotherapy practice and seven sins of the
psychotherapy outcome research.
Dan Pokorny, Ulm University, Germany
This contribution presents some naïve observations on the psychotherapy outcome research
related to the top question of the European SPR Meeting in Klagenfurt: "Psychotherapeutic
diversity: How many approaches do we need?" Answers are often predetermined by the
question formulation. Hence, our answer will be given by the question reformulation: "How
much methodical and political regulation do we need?" or, concerning different approaches,
"Why we love to have so many?" We will point to some general paradoxes of the outcome
research and its practical consequences for a clinical practice. On the beginning, there is a
nearly self-evident requirement. (a) The quality of the psychotherapy approach should be
based on scientific evidence. (b) Hence, empirical studies of the efficacy and efficiency of
particular methods for particular disorders are needed. (c) For the sake of a soundly
controlled empirical study, we need to standardize psychotherapeutic approaches. (d)
Thereafter, empirical studies prove successfully the efficacy and efficiency of standardized
procedures. (e) Consequently, the standardized -- i.e. manualized -- procedures only should
be used in the clinical practice. In such a way, the outcome research is influencing and
changing the rules for the psychotherapy practice. This is based on the outlined cyclic
deduction on the necessity of petrified procedures which have -- as far as we know -- no
support by the research. On the contrary, an amazing psychotherapy research indicates that
freely acting therapists were more successful than "manualized" ones. This is the first of the
"seven sins" of outcome research we intend to name. The physics (Heisenberg) and logic
(Gödel) discovered their principal limits in the 20th century proving the existence of
questions which never can be answered. The psychotherapy research -- as well as the
medicine -- seems to be philosophically at the state of nature sciences in the 19th century,
believing we can sooner or later answer all the questions, just if we are industrious enough.
Summarizing our hesitations on the outcome research: It is a very useful and important
branch of the science. However, it cannot overtake our decisions on the psychotherapy
methods and techniques we shall use in general and in the individual psychotherapy case.
The outcome research is "a good servant and a bad master". Hence, we advocate to utilize its
results not as mandatory "instructions" but rather as potentially useful "hints". Going this
way, we can both enlarge our wisdom and preserve our therapeutic freedom.
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"Under pressure?" On the origins and finality of time limited therapy
Rosa Maria De Geest, University of Ghent
Aim: In the nearby future, psychotherapy in Belgium will be refunded by the healthcare
system. Patients and practitioners have long anticipated this evolution. Nevertheless this
change should be carefully surveyed. It is likely that within this new setup the healthcare
insurance system will calculate the number of sessions of therapy for the patient in advance.
In certain practice climates working with a time limit has become a given, though very little is
known about how this procedure influences the psychotherapeutic process. In our study we
would like to investigate how the concept of a time limit and its incentive developed
throughout history. Methods: We plan to investigate different perspectives on time limited
therapy by comparing two cases of time limited psychotherapy. Results: We plan to finalize
our study by August 2015. This research of literature is preparatory for a qualitative study
regarding the effects of a time limit on psychotherapy. Discussion: The outcome of this study
can be of interest for government policy and psychotherapy practice, providing an overview
on the benefits and limitations of a time limit in psychotherapy. How can a time limit be of
use aside from pragmatic and financial motives? And can it be applied within the frame of a
psychotherapeutic treatment, without it becoming part of a "One size fits all" approach to
treatment?
All have won what? On the epistemic value of RCT based evidence in Evidence Based
Treatments
Femke L. Truijens, Ghent University, Belgium; Mattias Desmet
Aim: "All have won, and all must have prizes," - so the dodo bird verdicts the statistical
indifference between 'evidence based' types of psychotherapy. Evidence is understood as the
result of randomized controlled (RCT) efficacy research. This 'golden standard' design
requires samples that are homogeneous with regard to symptom(s) - following from the
statistical assumptions in central tendency statistics. Symptom specific measures are used to
select patients scoring above a cut-off, resulting in samples characterized by tight and simple
symptom patterns. Whereas the external validity of this procedure is heavily critiqued, I
study the internal validity of a priori methodological assumptions in RCT efficacy research. In
this paper, I address the clinical and epistemic plausibility of sample selection by a quantified
symptom measure for depression, the BDI-II, which was found to be a reliable screening
measure for Major Depressive Disorder. Method: In a pilot study on our mixed method
psychotherapy data from depressed adults, we used the BDI-II to select patients eligible to
participate in a strict RCT design. For both the eligible and non-eligible sample, we
scrutinized individual symptom patterns. Results: Analysis showed a 60-40 ratio of depressed
patients to be included or excluded, respectively. 75% of the 'eligible' sample still showed
comorbidity, which would have been reason to exclude them from a RCT. Discussion: The
extraordinary large exclusion percentage indeed inserts doubt on external and ecological
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validity of quantified eligibility screening in RCT efficacy research. More striking however is
that a supposedly 'eligible sample' still harms the assumption of homogeneity. In this paper, I
propose such invalidity of a priori methodological assumptions as an explanation for the
dodo bird effect. I discuss the implications of these preliminary empirical results for the
understanding of 'evidence' from RCTs and the epistemic value of Evidence Based
Treatments.
Do we know how many approaches we have?
Zbynek Vybiral, Masaryk University; Katarina Motalova
In two previous papers called "A Valid List of Recognised Psychotherapies" presented at SPR2009 conferences in Bolzano and in Montreal we showed the results of an attempt to
generate a serious list of psychotherapy modalities, based on criteria interconnecting current
research outcomes, today's practise-based evidence, being included in relevant scientific
literature, and guidelines of influential institutions in the field. Attention had been given to
several similar endeavours. Our up-date 2015 study "Do we know how many psychotherapies
we have?" attempts to discuss further steps incl. difficulties in the course of establishing such
a systematic collected list of psychotherapies. In the 2010 we published the previous List of
recognised psychotherapies in the Czech journal Psychoterapie and in the book Soucasna
psychoterapie (Portal, Prague). Five years after the publications we can present an extended
list as well as new questions and questionings. Klagenfurt's brief paper inform about more
than 250 titles, names and labels of approaches used by professionals, article and book
authors, scholars and researchers for labelling the particular treatments. The questions
about need of diversity, as well as a question whether all psychotherapies are alike have
been emerging during the updating of our list for the last years. We believe continuously that
practice implication of our research lies in providing practitioners with a science-based view
on which treatments are accepted in contemporary scene, and which are not. We emphasize
that criteria for inclusion of which varied treatment modalities have been included must be
widely discussed. In principle, our criteria are as follows: (1) The treatment has been
recognized by influential bodies in EU and USA like the European Association for
Psychotherapy, APA Division for Psychotherapy, APA Society for Clinical Psychology, UKCP and
BACP in the UK and others; 2) The approach has been mentioned in several influential
publications in the field; (3) Articles focusing on the approach have been published in
scientific journals, e.g. Psychotherapy: Theory, Research, Practice, Training and others. We
took into account more than 1400 journal abstracts and full texts. We ponder that knowing
of how many approaches we have is the substantial contribution to the debate whether we
need so many therapies.
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38.
Linguistic
Moderators: Michael B.
Buchholz, International
Psychoanalytic University (IPU),
Berlin; Peter Muntigl, Ghent
University, Belgium; Anssi
Peräkylä, University of Helsinki
Saturday | 11:00 AM-12:30 PM | HS 9
The relationship between Conversation Analysis & Psychotherapy Research:
Benefits and future directions
Discussants: Eva Baenninger-Huber, Institute of Psychology, University of Innsbruck, Austria;
Michael B. Buchholz, International Psychoanalytic University (IPU), Berlin; Adam Horvath,
Simon Fraser University, Burnaby, Canada; Peter Muntigl, Ghent University, Belgium; Anssi
Peräkylä, University of Helsinki; Liisa Voutilainen, University of Helsinki
In recent years, conversation analytical (CA) studies on psychotherapy have proliferated.
Within psychotherapy research, CA is a "newcomer": a new way to describe the microdynamics of the therapy process. Within the tradition of CA, the study of psychotherapy is
also a recent development. For almost 50 years by now, conversation analysts have studied
the structures and processes of social interaction in ordinary conversations and in
institutional settings other than psychotherapy. In this structured discussion organized by
M. Buchholz, P. Muntigl and A. Peräkylä, scholars coming from CA and from other strands of
psychotherapy research will give short statements regarding the benefits and future
directions of CA research on psychotherapy. They will address questions such as: What is the
distinctively new contribution that CA offers to psychotherapy research? What are the
limitations of CA regarding the study of psychotherapy? Are there ways in which the study of
psychotherapy can renew the theory and method of CA?
The short statements will be given by: Eva Bänninger-Huber, Michael Buchholz, Adam
Horvath, Peter Muntigl, Anssi Peräkylä, Liisa Voutilainen.
39.
Panel
Training
Moderator: Hadas Wiseman,
Haifa University, Israel
Saturday | 11:00 AM-12:30 PM | HS 10
Impacts of Supervision and Personal Therapy in Training and Development of
Psychotherapists
Using the CCRT in supervision : exploring client and therapist dynamics and enactments
Orya Tishby, Hebrew University, Jerusalem, Israel; Hadas Wiseman
The training process in psychodynamic therapy (and other therapies) emphasizes therapists'
self- awareness, and exploration of transference countertransference dynamics. The
relational approach in psychotherapy also focuses on enactments: therapy events that recreate clients' interpersonal conflicts in the relationship with the therapist (Aron, 1996).
Understanding and resolving enactments is a complex process, however the resolution
contributes to a corrective emotional experience.
The Core Conflictual
Relationship Theme Method (Crits-Christoph & Luborsky, 1998) is a useful tool to study
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relationship patterns. Traditionally it has been used to identify the clients' relational patterns
and transference. However, it can also be used to identify the therapist's relational "blind
spots" that may hinder the therapeutic process. In this study, we will demonstrate two
relational encounters: One therapist and two clients, described through the lens of the three
participants' basic relational patterns. The different patterns created different alliance
trajectories, leading to different outcomes. When the therapist was able to adjust himself to
address the client's relational needs, while also acknowledging and addressing his own, the
therapeutic alliance was a success. Supervision can help therapists in training identify these
relational patterns, demonstrate ways of managing their countertransference and suggest
personal therapy when needed.
The impact of personal therapy on attachment style, introject affiliation and well-being
Jennifer Klasen, Universität Kassel, Germany; Svenja Taubner; Heidi Möller
Aim: Therapists consider personal therapy as a central ingredient for their development.
However, the empirical impact on trainee development and therapeutic outcome is
controversial and sparse. Orlinsky and colleagues propose indirect effects of personal
therapy on outcome moderated by well-being. In Germany, personal therapy or selfawareness training are mandatory for therapy training but program differ in terms of settings
(individual vs. group) and length (120 hours to up to 1000 hours). In this study, the effects of
different intensities of personal therapy or awareness training respectively on trainees are
analyzed. Methods: 100 trainees from different therapeutic approaches (cognitive
behavioral, psychodynamic and psychoanalytic psychotherapy) from Germany were assessed
at the beginning and after three years of training. Trainees filled out questionnaires about
attachment style (ECR), Introject affiliation (INTREX) and well-being (MLZB) as well as early
aversive childhood experiences (ACE). Furthermore, they were asked about their satisfaction
with, setting and the amount of hours of personal therapy/ self awareness training. Results:
The second data wave is currently assessed. At first timepoint, 65% of participants reported
at least one ACE and a high satisfaction with personal therapy at the beginning of training.
Changes of attachment styles, introject affiliation after three years of training will be
reported. Using a multiple regression analysis, it will be analysed if changes in attachment
and the relation between early aversive experiences and well-being is explained by the
intensity, satisfaction with or setting of personal therapy.
Influences of Personal therapy on Psychotherapists in Training and Beyond
Hadas Wiseman, University of Haifa, Israel; Michael Helge Rønnestad; David E. Orlinsky; Adi
Duchin
The interest in personal therapy as one of the cornerstones in the training of
psychotherapists has a long history that can be traced through the history of the profession.
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In the SPR/CRN International Study of the Development of Psychotherapists that consists
over 11,000 therapists in more than two dozen countries (Orlinsky, Rønnestad & Willutzki,
2010) therapists ranking of the influence of personal therapy on professional development
was investigated across career cohorts. Five career cohorts were defined by years of clinical
practice: Beginning therapists (>0 to 2), Early career therapists (>2 to 7), Established
therapists (>7 to 15), Experienced therapists (>15 to 25), and Senior therapists (>25 to <50).
Across all cohorts, personal therapy was ranked as 2nd or 3rd following direct experiences in
therapy with patients (ranked 1st) and supervision, except for beginning therapists still in
graduate school, for whom the influence of courses and seminars was more salient. This
presentation will focus on the influences of personal therapy on both trainees, as well as
experienced therapists, based on a recent international empirical overview conducted by
Rønnestad, Orlinsky, and Wiseman (in press). In addition, preliminary findings from a study
with advanced trainees (Wiseman & Tishby) will be presented that explored the influence on
process (alliance and session depth and smoothness) of receiving ongoing supervision with
or without current personal therapy. More quantatiative and qualitative research is needed
on the influence of therapists' personal therapy on both client outcomes and process in
order to evaluate it as a potential contributor to differential therapist effects.
Discussant: Thomas Schröder, University of Nottingham, UK
40.
Panel
Attachment
Moderators: Katarina Kompan
Erzar, Study and research
center for family; Tomaž Erzar,
University of Ljubljana; Andreja
Poljanec, Sigmund Freud
University Ljubljana; Tatjana
Rozic, Franciscan family
institute
What is in the core of mindful relationships? Dyadic regulation and
attachment in relational therapy and supervision
In recent years it became clear that psychotherapy process research should include the
notion of affect regulation and mindfulness in order to grasp the basic agency of change
events. In our panel we present the study of therapeutic change as a result of dyadic
regulation processes in therapy, supervision and the application of these findings in working
with group. Since we know that dyadic regulation is the main process in promoting change
and addressing unconscious affective dynamic, we wanted to trace that dynamic in three
different settings and make it "visible". The aim of the study was to connect contemporary
neuroscientific findings about affect regulation and mindfulness (the ability to be in touch, to
be emotionally genuine and present, jet professional) with the process of relational family
therapy, group work and supervision. For the purpose of the study sessions were video
and/or audio taped and transcribed. Self report data were also gathered and independent
coder validated the findings.
The study showed the parallel dynamic between basic process of therapeutic change is
regulation of unregulated dynamic by dyadic affect regulation. We also confirmed the notion
of parallel process in supervision and group work. Supervision thus becoming the
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"laboratory" of dyadic affect regulation which forms the solid base for effective relational
work.
Exploring the connection between change events in supervision and change in therapy
Tatjana Rozic, Franciscan family institute; Tomaž Erzar; Katarina Kompan Erzar; Andreja
Poljanec
We present a study of change events in supervision which is based on the idea of dyadic
regulation of affect. Using task analysis as a method of process research we developed a mini
theory of change events in supervision and explored the association between these events
and change in therapy.For the purpose of the study therapeutic and supervision sessions
were audio taped and transcribed. After each session the client completed the questionnaire
which was specially designed to assess client's perception of the therapeutic process and
change. Change events in supervision were selected, respectively, by the therapist and
supervisor and subsequently analyzed by independent observers with the method of coding
affects. Additionally, the research team used the method of interpersonal process recall with
the therapist and supervisor in order to confirm findings from coding. The results of
matching the process of change in therapy to the change events in supervision showed
common features of what was judged to be the same affective dynamic. We discovered that
unregulated affective dynamic from therapy was resolved by dyadic affect regulation in
supervision. Affects regulated in a more functional way through supervision were used by
the therapist as a powerful tool for modifying interpersonal dynamic in the therapist-patient
dyad which consequently led to change in therapy. Change events in supervision are
sequences of time, within which the dyadic regulation of unregulated affect is happening;
regulated affects in supervision are leading to change in therapy.
The problem of shame in intimate relationships, how to obtain secure attachment in
distressed couples
Tomaž Erzar, University of Ljubljana; Katarina Kompan Erzar; Andreja Poljanec; Tatjana Rozic
The presentation focuses on the dynamic of shame in intimate relationships and presents the
results of a study designed to explore how this emotion was managed by couples when
discussing the events related to how they got together. The study describes eight aspects of
10-min discussions by 11 heterosexual couples: mutual affect, view of self, verbalization,
actuality, expression of vulnerability, avoidance or tolerance of shame, insight, and
usefulness for therapy. In turbulent marriages, not only are accounts of this moment of their
joint history affected by how spouses treat each other in their present relationship, but the
events described show striking affective similarity to presenting the couple's problems and
symptoms. Insight into the couple's inability to establish a minimal level of trust, secure
bonding, and mutual acceptance in the early phases of their relationship's development
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provides a space for therapeutic work to access feelings of shame that might have
intergenerational roots. The findings of this study therefore have implications for
understanding and working with the intergenerational transmission of shame and
interpersonal regulation of shame and showing the importance of developing secure
attachment between spouses and mindful awareness of one's own vulnerability.
Building motherhood, the power of young mothers group
Andreja Poljanec, Sigmund Freud University Ljubljana; Tomaž Erzar; Katarina Kompan Erzar;
Tatjana Rozic
The commitment and physical and emotional availability of parents will from the day their
child is born determine the breadth and depth of the child's social and relational world; after
all, this primary relationship undermines how the newborn will develop. The first three years
of the child's life are fundamental for the development of the child's brain. As the brain is not
yet a fully formed organ at birth, it develops and grows in response to the spontaneous
relationships experienced within the environment. Experiences from the early formative
years of the child's life are the most consequential. The child's primary relationship,
especially with the mother, thus provides the basis for how the circuitry for emotional
processing will draw up in the child's brain; this circuitry will also determine the individual's
greater or lesser capacity to enter into emotional relationships later in life. This is the
essence of why it is crucial for the mother and child to be able to mutually co-create the kind
of connection that will allow this. In this contribution, we will look into the fields recognized
by mothers attending a young mother's group as vital to co-creating a happy and fulfilling
motherhood. In our study we trace the change in connection between mothers and children
through the group process. The results shows us how to understand the process of building a
maternity and its meaning for healthy child development and how to identify the essential
elements of successful motherhood.
Discussant: Katarina Kompan Erzar, Study and research center for family
41.
Panel
Process
Moderators: Günter Schiepek,
Paracelsus Medical University;
Benjamin Aas, University of
Munich
Multi-level Analysis of Psychotherapeutic Pattern Transitions -- Psychological
Time Series, Brain Networks, Biochemical Markers, and Diary Texts
This panel describes the psychotherapeutic process of a single case (obsessive-compulsive
disorder, treated in an in-patient setting) by different methods. In a multi-level approach, we
monitored a broad set of psychological variables, using the Synergetic Navigation System on
a daily basis. The resulting time series and frequent electronic diaries can be referred to each
114
other. The time series are analyzed by dynamic complexity measures (complexity resonance
diagrams), recurrence plots, correlation pattern analysis, and other methods. Diaries were
analyzed by methods of qualitative text analysis, the Therapeutic Cycle Model (TCM), and
Recurrence quantification Analysis (RqA). Five fMRI scans were conducted during three
months of psychotherapy. The stimulation paradigm used pictures from the Maudsley
Obsessive-Compulsive Stimulus Set (MOCSS), as well as neutral, disgusting, and individually
recorded OCD-symptom-provoking pictures to test the changing activation of OCD-relevant
brain networks. For modeling of anatomically based functional connectivity dynamics we
used a resting state sequence combined with Diffusion Tensor Imaging (DTI). It is
hypothesized that a change in synchronicity and dynamical complexity of psychological
variables is a sign of psychotherapeutic improvement, which is in turn linked to changes in
brain-network activation. Brain networks are represented by effective connectivity
(Dynamical Causal Modeling, DCM) and functional connectivity dynamics (FCD).
Furthermore, blood samples were drawn and analyzed for brain-derived neurotrophic factor
(BDNF), cortisol, and oxytocin concentrations.
Time series of daily self-ratings from the Therapy Process Questionnaire: The nonlinear
dynamics of common factors, mood, and therapy-related cognitions
Benjamin Aas, University of Munich; Wolfgang Aichhorn; Günter Schiepek
The conceptual frame of this multi-level approach to human change processes, its
background in the theory of nonlinear, self-organizing systems (complexity science), and the
methods used will be outlined. Some characteristics of the female patient (diagnosed as
obsessive-compulsive disorder) and her clinical course will be introduced. The inpatient
psychotherapy was realized at the Department of Psychosomatics and Psychotherapy,
Christian Doppler University Hospital, Salzburg, Austria. In this case (like in all others)
therapy- and self-related cognitions, emotions, the experienced relationship to the therapists
and to other patients, and the problem severity were assessed by daily self-ratings, using the
Therapy Process Questionnaire presented by the internet-based Synergetic Navigation
System. Time series and their dynamic complexities, complexity resonance diagrams,
correlation pattern analysis, and recurrence plots indicate critical instabilities and pattern
transitions in the course of this therapy.
Dynamics of neural networks: Transitions of effective connectivity (Dynamic Causal
Modeling) in a sequence of fMRI scans
Kathrin Viol, University of Munich, Germany; Benjamin Aas; Günter Schiepek
During the hospital stay of three months five fMRI scans were realized, using a stimulation
paradigm of individualized symptom provoking pictures (taken in the home setting of the
patient), disgust-provoking, and neutral pictures from the IAPS, and pictures from the
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Maudsley Obsessive-Compulsive Stimuli Set. We were interested in the change of brain
activity patterns during psychotherapy and its correspondence to non-stationarities in the
psychological time series (pattern transitions). Beside a localization-focused analysis of
involved brain regions by SPM, a network analysis was realized. Effective connectivity is
portrayed by a hypothesis-driven approach modeling the activating and inhibiting causal
relations between selected brain areas (Dynamic Causal Modeling). Transitions in effective
connecitivty networks during psychotherapy could be identified and were related to
transitions at the psychological level.
Dynamics of neural networks: Transitions of Dynamic Functional Connectivity matrices in a
sequence of fMRI scans
Andreas Spiegler, Aix-Marseille Université; Benjamin Aas; Günter Schiepek; Viktor Jirsa
The stimulation paradigm of the fMRI scans not only included standardized and individualizes
pictures, but also a resting state phase of 10 minutes. Actually, the analysis of resting state
networks and their alterations in psychiatric disorders (e.g., depression, OCD) is one of the
most promising topics in functional neuroimaging. Here we focus on functional connectivity
patterns and their changes during the psychotherapeutic process. The analysis refers to a full
brain model of 66 cortical and subcortical structures and its dynamics during 10 minutes of
resting state activity. The method utilizes structural connectivity data from Diffusion Tensor
Imaging (DTI) and cross-correlates all functional connectivity (FC[t]) matrices produced by a
running window over the resting state period. By using the newly developed method of
Functional Connectivity Dynamics matrizes, the non-stationarity of brain dynamics (pattern
transitions) is reflected at two time scales: within a resting state and between resting states
realized in the five fMRI scans during the course of the therapy under consideration.
Dynamics of biomarkers for neural plasticity (BDNF), stress level (cortisol), and immune
state
Wolfgang Aichhorn, Paracelsus Medical University; Benjamin Aas; Barbara Kofler; Peter
Strasser; Andreas Koller; Günter Schiepek
In the morning immediately before the fMRI scans blood was taken from the patient. Serum
was analyzed for specific biochemical markers of neural plasticity (Brain Derived
Neurotrophic Factor, BDNF) and enduring stress (cortisol). Another parameter is the
attachment hormone oxytocine, and markers of immune activity like specific cytokines and
neopterine (marker of the cellular immune response). Changes in these parameters were
compared with neural dynamics (transitions in effective and functional connectivity) and
psychological time series (SNS-based self ratings).
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Dynamics and transitions of Therapeutic Cycle Model (TCM)-related parameters
Catalin Zaharia, Sigmund Freud University, Vienna, Austria; Omar C.G. Gelo; Benjamin Aas;
Günter Schiepek; Erhard Mergenthaler
Using the Synergetic Navigation System (SNS), the patient not only filled in the TPQ for daily
self-reports, but also wrote short diaries at most days of her hospital stay. The diaries have
been content analyzed by means of the Therapeutic Cycle Model (TCM). This model uses a
dictionary-based, computer-assisted text analysis system. First, three classes of verbal
behavior are assessed: Emotional Tone (ET), Abstraction (AB) and Narrative Style (NS).
Second, ET and AB are used to identify four important distinct modalities of emotionalcognitive regulation in psychotherapy: Relaxing, Reflecting, Experiencing, and Connecting.
The time series of theses parameters are compared with the time series of daily self-ratings
by the TPQ and analyzed by the same complexity measures. It should be demonstrated that
the pattern transitions of the therapeutic self-organization process are reflected in the TCM
results, especially in the emergence of the connecting mode (reflecting emotions and
emotional insight).
Analysis of open-ended texts (diary entries) in psychotherapy with Qualitative Content
Analysis
Philipp Mayring, University of Klagenfurt, Austria; Benjamin Aas; Günter Schiepek
The contribution shows the possibilities of Qualitative Content Analysis for analyzing openended diary entries in psychotherapeutic longitudinal research. The patient wrote short texts
about their feelings, experiences, and health conditions every day over a period of three
months during a psychotherapy. In a first approach every diary entry is coded in the sense of
deductive category assignment, following central therapeutic variables like self-esteem,
stress, and emotional state. A coding guideline defines those variables. In a second step,
process variables in respect to the course of variable values over time are defined and coded.
A newly developed open access software program (www.qcamap.org) supports this content
analytical procedures. The reliability of the procedures can be shown by inter-coder
comparisons. The validity of the results can be estimated in comparison to questionnaire
data in respect to the same variables of the same persons (cross-validation). It has to be
shown how the results of the Qualitative Content Analysis fits to the dynamic patterns
realized at other system and data levels.The contribution shows the possibilities of
Qualitative Content Analysis for analyzing open-ended diary entries in psychotherapeutic
longitudinal research. The patient wrote short texts about their feelings, experiences, and
health conditions every day over a period of three months during a psychotherapy. In a first
approach every diary entry is coded in the sense of deductive category assignment, following
central therapeutic variables like self-esteem, stress, and emotional state. A coding guideline
defines those variables. In a second step, process variables in respect to the course of
variable values over time are defined and coded. A newly developed open access software
117
program (www.qcamap.org) supports this content analytical procedures. The reliability of
the procedures can be shown by inter-coder comparisons. The validity of the results can be
estimated in comparison to questionnaire data in respect to the same variables of the same
persons (cross-validation). It has to be shown how the results of the Qualitative Content
Analysis fits to the dynamic patterns realized at other system and data levels.
Discussants: Franco F. Orsucci, University College London, Cambridge NHS Foundation Trust,
Institute for Complexity Studies of Rome; Günter Schiepek, Paracelsus Medical University
42.
Brief Paper Session
Couple
Moderator: David Hewison,
Tavistock Centre for Couple
Relationships, UK
Couples
Revisiting Physiological Linkage in Couples
Patrícia Oliveira-Silva, Universidade do Minho, Braga, Portugal; Marta Barbosa; André
Oliveira; Ana Beiramar; Carla Silva; Kristin Perrone; Joana Coutinho
The search for psychophysiological correlates of the social functioning often relies on the
individual as the essential unit of observation. With this type of approach it is not always
possible to capture specific patterns of responsivity to others' behaviors, especially between
close relationship partners. However, this obstacle may be overcome by using a dyadic
multivariate approach, which allows to explore the dynamic changes driven by relational
processes at both individual and dyadic level (Butler, Gross & Barnard, 2014). Empirical
research has documented evidence on the importance of the interplay of physiological
responses in the quality of social life and long-term health. This issue is especially critical in
marital research, considering findings from recent studies showing that the behavioral
influence of each partner on the other occurs also through physiological linkage, which is
defined as a coordinated oscillation of the physiological responses between partners (Butler
& Randall, 2013; Saxbe & Repetti, 2010). In order to assess this mechanism more directly, we
used psychophysiological measures, as measured by the cardiac and electrodermal activities,
during a dyadic couple interaction task. In the current study, 30 couples cohabiting together
in a committed relationship, for at least one year, were recruited through a large online
subject pool from the university and the general community. The interaction task consisted
of a minimally structured conversation in the laboratory setting about positive and negative
aspects of their relationship. This ecological laboratory-based interaction was designed to
mimic the couples' daily experiences, which involve transactional emotional processes, or
the reciprocal interaction of emotions, either negative or positive. The cardiac and
electrodermal activities from both spouses were recorded simultaneously using a data
acquisition system coupled to two amplifiers for each physiological modality. For the purpose
of assessing the change scores during the interaction task, a 2-minute minimally demanding
baseline task was performed by both members of the dyad. After the task, self-report
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measures of empathy in the relationship and relationship satisfaction were administered to
both spouses. We predict that differing patterns of physiological linkage will be associated
with the subjective assessment of empathy and relationship satisfaction. The focus of this
communication is to discuss three main points: (1) the results obtained by our group in this
study; (2) what is known about this mechanism, by which two individual can coregulate their
physiological responsivity; and (3) the potential practical and conceptual implications of this
research.
From Competence Frameworks to treatment: the development of a couple therapy to treat
depression in the UK's Improving Access to Psychological Therapies programme
David Hewison, Tavistock Centre for Couple Relationships, UK
Aim: To transform the UK's National Institute for Care and Health Excellence (NICE)
Guidelines based on specific RCT Studies for the use of couple therapy for the treatment of
depression into a behaviourally-based, integrative, 'Couple Therapy for Depression'.
Methods: An Expert Reference Group, including the presenter, agreed what studies should
be drawn upon over and above those identified by NICE. A list of competencies was
developed on the lines of that agreed for CBT, utilizing depression-specific manuals where
they existed, or 'best-statements' of particular couple therapy models. These competencies
were then structured into a coherent 5-day teaching programme plus supervision for existing
couple therapists, based on the specific techniques needed to treat co-existing depression
and relationship distress. Results: A 20-session therapy model was developed that draws
strongly on Jacobsen and Christensen's Integrative Behavioural Couple Therapy, but which
also includes elements of Bodenmann's Coping Oriented Couple Therapy, as well as Cognitive
Behavioural therapy, Emotion Focused Therapy, Systemic Therapy, and Psychodynamic
Therapy. Couple Therapy Practitioners in the UK's Improving Access to Psychological
Therapies programme are now using this model successfully to treat depression. Discussion:
Retaining the characteristics of each approach to couple therapy whilst combining them into
a meaningful and clinically-sound model was a great challenge, as some of the original
competencies were contradictory. A focus on an emotionally-engaged relationship as patient
was the solution.
The role of heart rate variability for the regulatory components of empathy in couples
Joana Coutinho, University of Minho; Marta Barbosa; Jean Decety; Paulo Silva; Natalia
Antunes; Patrícia Oliveira-Silva
Empathy plays a crucial role in the maintenance of close bonds in general social
relationships, but it's particularly important in the context of romantic relationships, in which
partners heavily rely on each other's support and validation (Péloquin & Lafontaine, 2010).
Empathic processes include different dimensions such as emotional contagion, cognitive,
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affective and regulatory abilities. These different dimensions have been associated with
important neural biomarkers, namely at the level of the autonomic nervous system (ANS)
(Coutinho, Oliveira-Silva & Decety, 2014). The majority of the studies about the autonomic
correlates of empathy have focused on the sympathetic branch of the ANS, but this study is
focused on its parasympathetic branch due to the importance of regulatory skills for
empathy. Due to its inhibitory effect on the sympathetic system, the vagal tone has been
shown to be important for the physiological and emotional regulation and prosocial behavior.
Vagal tone exerts an important influence in the respiratory sinus arrhythmia and
consequently in the heart rate variability (HRV). Thus the main aim of our study is to analyze
the association between HRV and empathy. More specifically, this study aims to analyze 1)
the relationship between HRV and self-reported empathy and 2) the relationship between
HRV and the arousal growth rate during an empathic task when compared to the baseline.
Our sample is composed by 30 couples (N=60), married or living together for at least 1 year
before the participation in the study. Both elements of the couple perform a videotaped
structured interaction task in the lab. In this task each element is required to talk about
problems and strengths of their relationship. The other spouse is instructed to pay careful
attention and is asked to paraphrase what their partner has just said. During this interaction
task the simultaneous recording of psychophysiological measures (interbeat interval, heart
rate) using the Biopac MP-150 data acquisition system (BIOPAC SYSTEM, Santa Barbara, CA) is
performed. After the task self-report measures of empathy (Interpersonal Reactivity Index
and Interpersonal Reactivity Index for Couples) and relationship satisfaction (Revised Dyadic
Adjustment Scale) are administered to both spouses. We hypothesize that participants' level
of HRV will be positively associated with perceived empathy as assessed by self-report
measures. In addition, we hypothesize that HRV will be negatively associated with the
arousal growth rate (measured by HR) between baseline and empathic task. The analysis of
the data already collected which is currently in progress will be presented. Therefore we will
show how these data on the physiological correlates of empathy can contribute to a better
understanding of empathic processes and its different dimensions. The clinical implications
of these results for the understanding of dyadic interactions and for couple´s therapy will
also be discussed.
Mentalisation of the relationship with the dead child in a process of couple therapy.
Bernadetta Janusz, Jagiellonian University, Kraków, Poland
The main aim of this research is to answer the question: 'To what extent is the level and style
of menalisation of relation with the dead child changed during couple therapy sessions?'
According to the main assumption of the research, in the course of increasing parental
mentalisation, the physical bond with the child should transform into psychological bond.
Three processes of couple therapy were investigated. The reasons of the dead were suicide,
accident and an illness. All three couples started therapy within the first half year after child's
death and continued throughout a year. All couples have one more child except the lost
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one.The Reflective Functioning Manual-Version 5,( Fonagy, Target, Stele, Stele, 1998),
modified for the research purposes, was used to analyze the transcripts of the sessions. The
aim of using this method was scoring the level and mentalising style of both parents. The
questions of the therapists were categorized into two groups: 'demand questions', that
require mentalisation and 'permit questions', that do not require mentalisation. In answers
to the "permit questions" only high and very low codes (>3code and<1) were allocated),
whereas all appropriate codes (>3code, <-3code) were given to answers to 'demand
questions'. Spontaneous utterances were coded in the same way as permit questions.
Additionally all subjects were investigated by the use of AAI in order to establish their general
mentalising capacity.
Couple Therapy Practice in India
Chetna Duggal, Tata Institute of Social Sciences, Mumbai
Couple therapy practice in India is rapidly evolving, but there exists very little documentation
by practitioners on developing themes in this area. The author will present, through cases
seen in couple therapy practice, the nature of concerns that couples present in therapy in
urban India. Using case narratives and vignettes, the author will outline presentation of
concerns related to sexual issues, extra marital involvement, and incompatibility on
emotional engagement, across couples of different age groups. The changing options
exercised by couples in therapy, such as reconstruction of the marital narrative, suspended
marriages, and open marriages will also be discussed. Interventions in couple therapy will be
outlined in a narrative format to present how treatment actually unfolded. Several of the
options being exercised by couples to deal with the concerns presented, are still considered
new / modern in the Indian context, and the case narratives and vignettes will also describe
how these solutions were negotiated in the therapeutic process. Dattilio (2006) recommends
the use of case studies to present the concerns and intervention in couple therapy as it
allows for more effective engagement with the content and as it is easier to integrate the
information into existing frameworks of knowledge. Implications for therapeutic intervention
in the Indian socio-cultural context will also be explored.
43.
Brief Paper Session
Trauma
Moderator: Walter Renner,
Pan-European University
Trauma
Body Psychotherapy in the treatment of social and emotional isolation
Maurizio Stupiggia, University of Genova, Italy
RESEARCH CONDUCTED WITHIN THE OPERATION IN THE COUNCIL : EARTHQUAKE 20TH MAY
2012, Emilia Romagna , ItalyThe earth trembles and devastates: 7 deaths, 3.000 displaced,
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dozens of homes got destroyed. The Italian School of Biosystemics decides to be present and
sends a psychological task force on site to produce a preventive action of second level ( this
kind of prevention provides psychological support and deep listening, immediately after the
earthquake, to support people affected by stress, avoiding the transformation in a PTSD.) The
research, an empirical one, is about the effect of some body techniques on the process of
gradual socialization, where the trauma created a sense of fear, increased vigilance and
emotional isolation. The therapeutical work we did in the camp was not directly on the
trauma, but on the capacity to rebuild relationships, and the results showed the connection
between the decreasing sense of loneliness and the change of some physiological and
psychological parameters. We used specific techniques of Body Psychotherapy with people
who were victims of the earthquake, and they will be described.
Assessing the degree of severity of attachment trauma in the Adult Attachment Interview:
A comparison between patients with borderline personality disorder, anxiety disorders and
healthy controls.
Simon Kindl, Institute of Psychology, Innsbruck, Austria; Dan Pokorny; Jana-Theresa
Jurkowitsch; Katharina Hüther; Carol George; Anna Buchheim
Aim: Several epidemiological studies report high rates of childhood traumatization among
patients with borderline personality disorder (BPD) and patients with anxiety disorders. In
attachment research, both groups show a predominance of the category „unresolved
trauma" in the Adult Attachment Interview (AAI). The aim of our study was to compare
specific characteristics of traumatization between female patients with BPD, anxiety
disorders and healthy controls. Method: On the basis of a comprehensive literature research,
a category system was developed to analyse distinct features (e.g. age, frequency, severity,
content) of traumatic childhood events evaluated in the AAI narratives. The system will be
applied to n = 143 AAIs (56 diagnosed with BPD, 57 diagnosed with anxiety disorders, 30
healthy controls). Results: Our measure revealed high inter-rater reliability of two
independent raters and high convergence between the AAI trauma scales and the category
"unresolved trauma", which proved external validity. Among borderline patients, we found
positive correlations between the degree of severity of traumatization and the severity of
psychopathology. In general, we expect higher rates of general traumatization and sexual
abuse among BPD patients and higher rates of separation and loss among patients with
anxiety disorders. Moreover we expect several distinctive features with respect to severity of
trauma in the two clinical groups. Discussion: First results indicate that the category system is
feasible to be used in studies investigating the differential relevance of attachment and
trauma for clinical groups. For psychotherapy research, this might be relevant for treatment
plans including trauma focused interventions.
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Effects of lay intervention on post-traumatic symptomatology in refugees: Conclusions on
possibilities and limitations of unspecific factors in psychotherapy
Walter Renner, Pan-European University
Unspecific factors in psychotherapy will be discussed on the basis of three randomized
controlled studies on the effects of lay help on clinical symptoms in migrants. Study 1, with a
total of N = 94 (44 female) refugees and asylum seekers from Chechnya, established guided
self-help groups over 15 weeks and found them to be equally effective in traumatized
participants as Cognitive Behavior Behavior Therapy in a Control Group. Effect sizes were d =
0.94 for post-traumatic and d = 0.62 for depressive symptoms as compared to a Wait-List
condition. Similarly, Study 2, in a randomized controlled design, assessed the effectiveness of
sponsorships provided to N = 63 (38 of them female) adult refugees and asylum seekers over
six months. Again, the intervention was highly effective by reducing clinical symptoms in
traumatized individuals. Study 3, in an attempt to replicate the results of Study 1 with a total
of N = 66 female working migrants from Turkey with recurrent depression, however, found
non significant changes brought about by guided self-help groups as compared to
randomized controls. From the qualitative results obtained in Studies 1 and 2 in addition to
the quantitative data, unspecific factors of therapeutic change conveyed by the lay
interventions will be identified and discussed in a culturally sensitive context. From Study 3,
the limitations of such factors will be highlighted. It will be concluded that unspecific factors
constitute an important asset to interventions especially in a cultural context, but do not
suffice to bring about reliable therapeutic change.
The Core Conflictual Relationship Theme in trauma: A single-case study.
Kimberly Lucienne Helga Danny Van Nieuwenhove, Ghent University, Belgium
Aim: From different perspectives (e.g., developmental, cognitive-behavioral, and
psychoanalytic), interpersonal aspects are considered fundamental in the development of
trauma-related disorders. However, in therapy research, these interpersonal aspects have
received little attention. Psychodynamic psychotherapy focuses on changing the Core
Conflictual Relationship Theme (CCRT), i. e., the way in which people interact in a habitual
way with significant others and how conflicts herein may arise. In this brief paper it is argued
that the CCRT could be introduced as a means to study interactional patterns in a systematic
way. Method: The CCRT is operationalized in three dimensions: the subjective wishes with
which one enters interpersonal relations, one's own personal appraisal of how the other
responds to these wishes, and the characteristic reactions of the self to this other. Using an
adaptation of the Consensual Qualitative Research for Case Studies method, we will examine
change in the CCRT in a pilot single case. Results: We hypothesize that at the beginning of
treatment the CCRT will contain feelings of helplessness towards a controlling other and the
wish to oppose and control this other. We further expect that changes will be observed
throughout therapy in terms of the subject perceiving the other as more predictable and
123
reliable, and feeling himself as more socially connected. This research is still in progress, but
will be finalized by the time the conference takes place. Discussion: I will provide rich clinical
descriptions and case illustrations to support the results.
Memories of conflictive relationships with parents: The effects of subjective experience on
coping in second semester students
Fiorenza Piraccini, Center for Psychology and Education Meilen (Zürich); Fabian Schambron;
Martha Koukkou
The physio- and pathogeneses of the many different human conflictive relationships will be
discussed based on the proposals of an integrative, living systems theory-oriented model of
the brain functions that underlie the bio-psychosocial healthy or deviant psychosocial
development of individuals (Koukkou, M., Lehmann, D.: In: E. Zacharacopoulou (ed)
Psychoanalyse and the humane body: Beyond the Mind-Body-Dualism pp: 45-52.
Amsterdam, Elsevier 2006). Empirical findings from human sciences and social neuroscience
support the following thesis: the human brain is a self-organizing system that creates
individual thoughts, emotions, decisions, coping strategies and actions using its biography.
Biography is created by the brain's personal meaning-extraction functions, the experience
dependent plasticity. Biography includes internalized socio-cultural and scientific beliefs of
the individual's social realities. Such beliefs influence the individual's behaviour in a nonconscious way. We present empirical findings from a study with second semester-students in
the University of Zurich and ETH Zurich. The subjects answered the WHO questionnaire of
Quality of Life (WHO QOL-100) and questions assessoring memories of parental educational
style (ESI). This study is part of a large-scale research program that addresses the question (1)
How and Why the brain functions that create biography lead to intra-psychic conflicts and
their effects on the man different conflicting relationship, and (2) How and Why internalized
socio-cultural and scientific assumptions about human nature (that are discussed in the
dichotomies, biology-psychology, etc.) limit the researchers potential to understand the
impact of socio-cultural realities on psycho-social development and to contribute to more
effective psychotherapies and primary prevention.
The role of negative cognitions in the process and outcome of psychotherapy for PTSD
Vera Bekes, McGill University, Montreal, Canada; Dominic Beaulieu-Prévost; André
Marchand; Stéphane Guay; Geneviève Belleville
Background: Although several forms of psychotherapy have been found to be effective to
treat posttraumatic stress disorder (PTSD), many patients struggle with residual symptoms
after treatment. The cognitive-vulnerability theory hypothesizes that negative cognitions
about the self and world play key role in the development and maintenance of PTSD
124
symptoms. In contrast, the scarring theory posits that PTSD symptoms have a deteriorating
effect on personality, including the increase in negative trauma-related cognitions. In order
to develop more effective interventions, understanding the nature of inter-relationship
between cognitions and PTSD symptoms throughout the therapy process would be crucial.
Aim: We aimed to investigate the relationship between negative cognitions and PTSD
symptoms during by testing both models. Method: 71 patients with PTSD were assessed for
negative cognitions and PTSD symptoms at 5 timepoints during cognitive-behavior
psychotherapy (at baseline, twice during therapy, at the completion of therapy, and at
follow-up six months later). Longitudinal lagged regression modeling was used for data
analyses. Results: PTSD symptom reduction between times predicted subsequent reduction
in trauma-related negative cognitions about the world (but not about the self), providing
support for the scarring model. The reverse effect of change in cognitions about the
world/self predicting symptom change was nonsignificant. However, consistent with the
cognitive-vulnerability model, negative cognitions about the self at baseline predicted
increasing amounts of variance in PTSD symptoms by time. Conclusion: We found evidence
for both models. Effective therapies should focus both on symptom reduction and negative
trauma-related cognitions.
44.
Process
Moderators: Franco F. Orsucci,
University College London,
Cambridge NHS Foundation
Trust, Institute for Complexity
Studies of Rome; Günter
Schiepek, Paracelsus Medical
University; Wolfgang
Tschacher, Universität Bern
Saturday | 1:30 PM-3:00 PM | HS 9
Complexity Science for Human Change
Discussants: Michael B. Buchholz, International Psychoanalytic University (IPU), Berlin; Giulio
de Felice, Sapienza University of Rome & Institute for Complexity Studies; Günter Schiepek,
Paracelsus Medical University; Andrea Seganti, Società Psicoanalitica Italiana; Wolfgang
Tschacher, Universität Bern; Pier Christian Verde, Fondazione Pensiero e Linguaggio - Roma -;
Franco F. Orsucci, University College London, Cambridge NHS Foundation Trust, Institute for
Complexity Studies of Rome
Complexity Science for Human Change is deeply rooted on principles and methods growing
beyond established schools of psychotherapy as a new, and probably revolutionary,
methodology for facilitating minds to change themselves. The focus here is on form,
structure, coupling, co-evolution and dynamics as the real deep common factors. In order to
understand common factors as psycho-bio-physical dynamics we can now use the most
advanced non-linear statistics tools and sophisticated non-determinist mathematical models.
These new lines of clinical research are generating a new meta-praxis, meta-theory, and
meta-models, transcending established technical differences. The multiplicity, plurality and
polysemy of Complexity Science respect the natural ecology of language and neuroscience by
ensuring appropriate degrees of freedom and personalised care for clients and therapists.
Language in its different forms of life and semiotic games is unlimited and naturally complex
while constantly reflexing in brain dynamics as in a Mobius band.
125
Complexity Science for Human Change is a toolbox where we can find methodologies and
inspirations to facilitate the self-organization of other human beings, and our own. It can
expand creativity, whilst self-organising the complex curves and singularities of interactive
processes. Its openness enhances the degree of information, the degree of contravention to
established techniques and the degree of purposeful ambiguity. It is the companion for
human change explorers of the 21st century.
Beyond cultural scripts - Talk-in-Interaction as a topic for process research
Michael B. Buchholz, International Psychoanalytic University (IPU), Berlin
The most complex thing in psychotherapy is language or, less abstract, speaking, or, more
precisely: talk-in-interaction (Heritage 1984). The most important tool in psychotherapy is
talk, however talking is under-researched. I want to propose some ideas about the micromacro-relationship that is built-in here. Mostly, therapists and researchers use a type of
cultural script about what works in psychotherapy (e.g. "insight" or "emotional abreaction"),
however, these concepts are too inclusive. We should - with a predominance of talk observe in single case studies the degree of micro-coordination by voice rhythms, body
movements and emotional expressions in order to find the threshold beyond which feedback
loops intensify the mutual focus of attention and shared emotion bringing to birth feelings of
emotional energy, morality and human solidarity. What happens when, at which place in
time, is widely relevant question. Some ideas will be presented how this could be conducted.
Multi-Level Methodology and Mind-Brain Dynamics in Psychotherapy
Günter Schiepek, Paracelsus Medical University
Self-Organization and its most prominent theory -- synergetics -- has proven to be an
inspiring research paradigm for investigating and modelling complexity and dynamics of
mental, behavioural, and social phenomena. The evolution of human systems is
characterized by features as circular causality, the emergence and dynamics of order
parameters, order transitions, and critical instabilities. Psychotherapy research was one of
the most productive fields for empirical research on self-organization in psychology. Referring
to several studies on psychotherapy processes we will demonstrate that human development
and learning generate some kind of order. They are chaotic in a strict sense, i.e., they can be
characterized by low-dimensional, complex, and changing dynamics. Other studies using
different data sources, coding methods, and time scales focus on synchronization, nonstationarity, and local instabilities of psychotherapeutic processes. By this way and referring
to the concept of order transitions, synergetics offers an explanation to what is called
"sudden changes" in psychotherapy. Empirical evidence also exists for coordinated order
transitions in the dynamics of subjective experiences and brain activity, measured by
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repeated fMRI scans. During the treatment of patients with obsessive-compulsive disorder
(OCD), transitions started by the destabilization of current patterns and hence by critical
fluctuations. The most important change rates of neural activity in different brain areas
occurred during cognitive-affective order transitions.
Co-evolution and criticality in therapeutic couplings.
Complexity Studies of Rome
The stance produced by Complexity Science in human change can be ground-breaking. It
considers the Subject from a system and networks point of view, mapping internal and
external attractors, their organization, their couplings and resulting dynamics. Well-tuned,
harmonic, systems have at the same time a certain degree of randomness and creativity,
robustness and stability, making them flexible and strong through environmental
fluctuations. From this structural point of view, symptoms are indicators of dynamic
imbalances to be treated in co-evolutionary dynamic therapeutics. Dynamic analysis and
structural coupling can allow reconsidering the path of change as a co-evolutionary journey
toward optimal forms of complexity for self-organization and self-realization. This journey
goes through perturbations, critical states and self-organized criticality, preliminary to new
self-organizations. Therapy, in this way has firm grounding in nonlinear statistics and
advanced mathematical modelling. Traditional therapeutic approaches can be deconstructed to the common factors and those can finally get firm foundation in complexity
science. Higher degrees of freedom create spaces for personalized care and autonomy, to
ensure bio-ethical self-determination and openness.
Clinical and theoretical consequences of mother-infant research: from the idea of the good
enough mother to the idea of a realistically fallacious mother.
Andrea Seganti, Società Psicoanalitica Italiana; Pier Christian Verde
Which are the clinical consequences of mother infant research? The point has been
addressed through a harsh epistemological debate (Green & Stern, 2000) focusing on the
legitimacy of inferring subjective experiences from observed behaviours. The authors express
their consideration that a central issue was left apart by the debate: the existence, from the
beginning of life, of a robust and smart capacity of eleboration of the relational misfits. The
authors propose that present psychodynamic theories did not integrate the observational
data showing the newborns are able to foresee and to prevent the inevitable fallacy of their
mothers and to give important contributions to the functioning of their interpersonal
relationships. They also suggest that the psychodynamic theories that maintained the idea of
a completely dependent infant in respect of a good enough mother do have a negative
interference with the clinical work.
127
Structural modeling of alliance
Wolfgang Tschacher, Universität Bern
There is a broad consensus that the therapeutic alliance constitutes a core common factor
for all modalities of psychotherapy. Alliance is commonly conceptualized either from the
experiential (first-person) perspective or the behavioral (third-person) perspective. I propose
this conventional duality should be amended by a 'structural approach' of dynamical systems
theory. Systems theory provides concepts, tools, and hypotheses for the modelling of
alliance processes. In the discussion, I wish to exemplify this by the empirical-behavioral
phenomenon of nonverbal synchrony, and the modelling of the therapeutic alliance as a
phase space whose potential minima (attractors) can be shifted by the therapist to
approximate therapy goals. A mathematical formulation can be derived from probability
theory and synergetics.
How is the shape of change in the psychotherapeutic complex system? Towards a deeper
understanding of the analytic field.
Giulio de Felice, Sapienza University of Rome & Institute for Complexity Studies; Silvia
Andreassi
The paper will highlight the dynamics of change over the process of psychoanalytic
psychotherapy. The authors will mainly take into consideration three variables: a) Patterns of
transference-countertransference; b) Physiological changes; c) Linguistic use of emotional
and abstract words. They will present results coming from the empirical literature on how
those variables interact and evolve over time. The paper will show the path from a
problematic pattern of transference-countertransference (brought to the therapy by the
patient), through its deconstruction, to a new relational structure. Furthermore, the paper
will make a comparison between the shown trajectories of change and the psychoanalytic
literature consistent with them. The paper rounds off by highlighting the theoretical and
empirical findings on what the shape of change in psychotherapy looks like, narrowing the
gap between the clinical and research aspects of our work, and by giving clearer shape to
what complexity science can bring to psychotherapy research.
128
45.
Panel
Personality disorders
Moderator: Johannes C.
Ehrenthal, University of
Heidelberg, Germany
Treatment of Patients with Borderline and other Cluster B Personality
Disorders
Predictive value of ambulatory assessment and self-report on outcome in depressed
patients with vs. without BPD
Johannes C. Ehrenthal, University of Heidelberg, Germany; Johanna Koehling; Henning
Schauenburg; Stephanie Bauer; Markus Moessner; Ulrike Dinger
Some contemporary theories on Borderline Personality Disorder (BPD) propose that affective
instability and difficulties in affect regulation are its defining features. However, recent
results from ambulatory assessment studies using clinical comparison groups indicate that
affective instability may be less specific for BPD. Furthermore, there is a lack of studies on the
predictive validity of affective instability for symptom course or outcome of BPD. And last,
but not least, most studies that use aspects of affective dysregulation as predictive variables
rely on retrospective self-report data, which may be less reliable given that mental states
tend to vacillate in BPD. To test the predictive validity of affective instability for treatment
outcome, we assessed affective states over seven consecutive days using ambulatory
assessment devices in a sample of female patients at the beginning of intensive inpatient
psychotherapy. We recruited 20 patients with current major depressive disorder (MDD) and
comorbid BPD, and 21 patients with current MDD but no personality disorder as a
comparison group. Diagnostic status was assessed by SCID-I and II, depression severity by
expert rating (HRSD) and self-report (BDI, Brief Symptom Inventory). Inpatient treatment
lasted about eight weeks and consisted of a standardized program of individual and group
psychotherapies. Compliance rates for the ambulatory assessment were high (>94%). We will
use indices of positive and negative affectivity, affective instability over time, and affective
reactivity to assess the predictive validity of emotional dysregulation for treatment outcome.
We will furthermore compare the predictive power of ambulatory assessment with selfreport data on general affectivity. The results will be discussed against a background of levels
of personality functioning and object-relations approaches to BPD.
The interpersonal context surrounding the occurence of alliance rupture-repair episodes
during dialectical behavior therapy for borderline personality disorder
Jamie David Bedics, California Lutheran University; David C. Atkins; Marsha Linehan
The therapeutic alliance and the therapeutic relationship are considered essential to the
effectiveness of dialectical behavior therapy for the treatment of borderline personality
disorder. The goal of the present study is to extend prior work on the alliance and
therapeutic relationship in DBT by focusing on the occurrence of alliance rupture-repair
129
episodes in a randomized controlled trial of DBT versus community-nominated treatment by
experts for BPD. A total of 92 clients (46 = DBT; 46 Community-Nominated Experts) rated the
therapeutic alliance and also rated the quality of the therapeutic relationship at four timepoints during treatment. Based on DBT theory, it was expected that a lack of balance in
autonomy-control in the therapeutic relationship would be associated with the occurrence of
an alliance rupture in DBT. It was also predicted that the perception of less affiliation in the
therapeutic relationship would be associated with the occurrence of an alliance-rupture.
Preliminary results supported the association between less perceived therapist affiliation and
the occurrence of an alliance rupture, regardless of treatment intervention. Clientperceptions of autonomy-control in the therapeutic relationship were not related to the
overall occurrence of an alliance-rupture in either treatment. Results will be discussed in the
context of treatment strategies for the effective detection and resolution of alliance ruptures
in DBT.
Psychoanalytic-interactional therapy versus psychodynamic therapy by experts for
personality disorders: A randomized controlled trial comparing manualized and nonmanualized treatments in Cluster B personality disorders
Sven Rabung, Alpen-Adria-Universität Klagenfurt; Ulrich Jaeger; Oliver Masuhr; Andreas
Dally; Michael Dümpelmann; Christian Fricke-Neef; Christiane Steinert; Ulrich Streeck; Falk
Leichsenring
Objectives: With regard to Cluster B personality disorders most psychotherapeutic
treatments focus on borderline personality disorder. Evidence-based treatments for patients
suffering from other Cluster B personality disorders are not yet available. Psychoanalyticinteractional therapy (PIT) represents a transdiagnostic treatment for severe personality
disorders. PIT has been applied in clinical practice for many years and proven effective in
open studies. In a randomized controlled trial we compared a manual-guided form of PIT to
non-manualized psychodynamic therapy by experts in personality disorders (E-PDT) in
patients with Cluster B personality disorders. Methods: In an inpatient setting, patients were
randomly assigned to manual-guided PIT (N=64) or non-manualized E-PDT (N=58). In
addition, a quasi-experimental control condition was used (TAU, N=46) including primarily
patients continuing their outpatient treatment (80%) and a smaller proportion of waiting list
patients (20%). Primary outcomes were level of personality organization and overall
psychological distress. As secondary outcomes depression, anxiety and interpersonal
problems were examined. Results: No significant improvements were found in the TAU
patients. Both PIT and E-PDT achieved significant improvements in all outcome measures and
were superior to TAU. No differences were found between PIT and E-PDT in any outcome
measure at the end of treatment. Type of Cluster B personality disorder did not affect the
results. Conclusions: In an inpatient setting both PIT and E-PDT proved to be efficacious in
Cluster B personality disorders. In a head-to-head comparison, both treatments appeared to
130
be equally effective. Further research on the treatment of Cluster B personality disorders is
required.
Personality functioning as predictor of catamnestic outcome: An examination of depressed
patients with and without Borderline Personality Disorder after 6 months of
psychodynamic multimodal inpatient psychotherapy
Henning Schauenburg, UniversitätsKlinikum Heidelberg, Germany; Johanna Koehling;
Johannes C. Ehrenthal; Ulrike Dinger
The experience of depressed patients with Borderline Personality Disorder (BPD) differs from
the depression experience of patients without personality pathology. In case of a current
depressive disorder in addition to BPD, patients are more severely depressed and report a
greater range of affective disturbances. In addition, BPD patients show more anger/hostility
as well as more pronounced self-criticism than patients with depressive disorders only
(Köhling et al., in press). The current study aims to explore the prognostic value of BPD status
and personality functioning for the therapeutic outcome as measured in a 6-month follow up
assessment after psychodynamic multimodal inpatient therapy. A sample of 60 depressed
inpatients was recruited at the beginning of an 8-week psychodynamic multimodal program.
All patients had a Major Depressive Episode (MDE), and 29 (48%) were diagnosed with BPD.
The remaining 31 patients had no personality disorder according do DSM-IV. Diagnostic
status of patients was confirmed with standardized interviews (SCID-I and II for DSM-IV). In
addition, patients answered questionnaires on their level of structural integration and
personality functioning (OPD-SF), depression severity (BDI-II) and self-worth (Rosenberg SelfEsteem Scale). Patients were treated with 8 weeks of inpatient psychotherapy including
psychodynamic group and individual therapy and left the program with a recommendation to
continue individual outpatient therapy. After a period of 6 months, patients were contacted
again and asked to return follow-up questionnaires (OPD-SF, BDI and Rosenberg Self-Esteem
Scale). Multiple regression analyses will be conducted in order to evaluate the prognostic
validity of patients' initial clinical variables for long-term outcome after 6 months. The
discussion will concentrate on the importance of personality pathology for the long-term
outcome of depressed patients. Literature: Köhling, J. Ehrenthal, J. C., Levy, K. N.,
Schauenburg, H., & Dinger, U. (accepted for publication). Quality and severity of depression
in borderline personality disorder: A systematic review and meta-analysis. Clinical Psychology
Review
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46.
Panel
Training
Moderators: Michal Cevelicek,
Masaryk University, Brno;
Roman Hytych, Masaryk
University, Brno; Tomas
Rihacek, Masaryk University in
Brno
Personal Therapeutic Approach and competency development in beginning
therapists
The present panel focuses on the development of Personal Therapeutic Approach (PTA) and
competency in beginning integrative and cognitive-behavioral therapists. PTA stands for the
unique configurations of concepts and practices that therapists adopt and adapt to their
needs and personal qualities. Addressing the development of PTA from various perspectives,
using qualitative methods of analysis, the authors explore: individual developmental
trajectories in two case studies of trainees of an integrative training; experience of being a
student in an integrative training in 25 trainees; development of self-confidence in eight
beginning CBT therapists in the context of various professional and personal influences.
Although therapists may differ in the ways they perceive and practice psychotherapy, there
needs to be some common ground, which satisfies the demand on professional
accountability and evidence-based practice. That demand may be met by competency-based
approach to psychotherapy training, which will be elaborated in the concluding presentation.
Integrative therapists' development: Two case studies
Michal Cevelicek, Masaryk University, Brno; Zuzana Silhanova; Roman Hytych; Tomas Rihacek
Aggregation of psychotherapy process and outcome data has been challenged as potentially
ignoring the specific effects of therapists on outcome. The focus on individual change
trajectories has been proposed. Therapist development research may draw from this
turnaround by focusing on individual developmental trajectories. The authors used a
multiple-case study design to analyse the Personal Therapeutic Approach (PTA) development
in beginning integrative therapists. As the core aspect of the PTA, the development of case
formulation skills was studied. Two trainees provided a series of in-depth interviews, as well
as written case formulations. The data was analysed using qualitative methods. Case
summaries and a cross-analysis of the two sets of data will be presented. Furthermore, the
case study approach will be evaluated as a method to study trainees' professional
development, which facilitates an assessment of aspects that may be difficult to study in
other ways.
An experience of beginning trainees in an integrative training: A phenomenological
analysis
Monika Štěrbová, Masaryk University, Czech Republic; Tomas Rihacek
Given the popularity of psychotherapy integration, it is crucial to study the development of
trainees who endorse an integrative perspective from the beginning of their careers.
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Approaching the problem from a phenomenological point of view, this study explores an
experience of being a student in an integrative psychotherapy training. Reflexive accounts
written by 25 trainees at the end of their first and second years in training were analysed
using interpretative phenomenological analysis. The analysis yielded several themes
including curiosity about training, expectations of personal growth, looking forward to new
people and sharing with the group, fear of the training, sense of belonging to a group,
confidence in the process, personal development, better understanding of others, trying out
new ways of interacting in the group, learning by reflecting one's own feelings and thoughts,
feelings of conscious incompetence, finding one's personal topics, perception of the
usefulness of the training. The results are discussed in relation to the existing literature on
beginning therapist development, with particular emphasis on psychotherapy integration.
Professional development of beginning cognitive-behavioral therapists: From gaining
confidence in CBT to therapists' self-confidence
Lenka Maruniakova, Masaryk University, Faculty of Social Studies, Czech Republic; Tomas
Rihacek
This study is focused on the development of self-confidence in beginning CBT therapists. The
aim of the study was to explore how beginning CBT therapists develop, considering various
professional, as well as personal influences. Eight in-depth interviews with beginning
therapists were conducted; grounded theory was used for data analysis. The analysis led to
the conceptualization of three phases beginning CBT therapists go through when gaining selfconfidence: 1) Externally built confidence in CBT methods; 2) Internalized confidence in CBT
methods; and 3) Therapists' self-confidence. Each phase is described in terms of its sources
and consequences for therapists' practice. The results provide deeper description of the
process how beginning CB therapists gain their self-confidence. The findings suggest that for
beginning CB therapists relying on CBT methods, especially in the beginning phases of their
professional development, plays an important role. However, for gaining their selfconfidence, other sources were also identified (other professional sources and personal
sources such as personal experiences and characteristics).
Competency model of Integrative Training: Current version
Jana Kostinkova, Masaryk University
Psychotherapy competencies reflect the demand on professional accountability and
evidence-based practice in psychotherapy field in general. Competency-based approach
might inform psychotherapy training usefully in many ways. Particularly integrative trainings
can benefit from competency-based approach which brings comprehensible focus within the
breadth of psychotherapy integration for both trainees and trainers. The paper introduces
the process of building of Competency model of psychotherapy training which was
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developed within the Training in psychotherapy integration and describes the Competency
model as a tool for educational and evaluative purposes in integrative training.
Discussant: Thomas Schröder, University of Nottingham, UK
47.
Panel
Psychodynamic
Moderators: Fredrik
Falkenström, Linköping
University, Stockholm, Sweden;
Björn Philips, Center for
Dependency Disorders,
Stockholm, Sweden; Peter
Lilliengren, Stockholm
University, Sweden
The efficacy of affect-focused and relational psychotherapies: some recent
findings
Empirical support is growing for psychotherapy methods that focus on relations and affects.
Evidence is gathering that such treatments are effective for patients with severe psychiatric
disorders, and not only for "the worried well". The aim of this panel is to present evidence
for three types of therapies focusing on relations and affects, in the hope that this will help
broadening the range of treatments that can be offered in clinical practice.
In the panel, one meta-analysis of Experiential Dynamic Therapy is presented; summarizing
the results from 28 independent studies that together show promising results for this
particular version of Psychodynamic therapy. The second presentation is a comparative
clinical trial, testing the effects of Interpersonal Psychotherapy (IPT) against CBT in the
treatment of Major Depressive Disorder in a psychiatric clinic in Sweden. The results of this
trial showed that IPT was not inferior, and close to significantly superior, to CBT. In addition,
IPT had fewer dropouts than CBT. Finally, the first preliminary results of a controlled trial of
Mentalization Based Treatment for patients with Borderline Personality Disorder and
comorbid substance dependence are presented.
Experiential Dynamic Therapy for psychiatric disorders: A meta-analysis of randomised
controlled trials
Peter Lilliengren, Stockholm University, Sweden; Robert Johansson; Karin Lindqvist; Jakob
Mechler; Gerhard Andersson
There is growing empirical support for the efficacy of Short-Term Psychodynamic
Psychotherapy (STPP) in treating adults suffering from common psychiatric conditions.
However, STPP represents a family of treatment models that share several key features, but
also have different emphasis in theory and technique. Thus, the growing evidence-base for
STPP may not be generalizable to all subgroups of STPP. One such subgroup is Experiential
Dynamic Therapy (EDT), which encompasses STPP-models directly based on or derived from
the work of Malan (1963, 1976, 1979) and/or Davaloo (1990, 2000, 2005). EDTs place a
strong emphasis on helping patients directly experience previously warded-off affects and
use the "Triangle of Conflict" and "Triangle of Persons" as conceptual guides for the moment-
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to-moment assessment of patient responses, as well as choice of therapist interventions. In
order to evaluate the efficacy of EDT for psychiatric conditions, we conducted a metaanalysis of randomized controlled trials. Twenty-eight studies published between 1978 and
2014 were included, encompassing 1782 adult patients with mood, anxiety, personality or
mixed disorders. Across outcome domains, medium size between-group effects (Cohen's d
ranging from 0.39 to 0.65) favored EDT over inactive controls at post-treatment, as well as in
symptom measures at follow-up. We found no differences between EDT and active
treatments (e.g., medication, CBT, manualized supportive therapy) at post-treatment, but
EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of within-group effect
sizes, EDT was associated with large improvements in general psychiatric symptoms (d =
1.11), depression (d = 1.33) and anxiety (d = 1.09), as well as small to moderate gains in
interpersonal problems (d = 0.55) and global functioning (d = 0.86). Small but significant
effects suggested continued improvement between post-treatment and follow-up.
Heterogeneity in pre-post effects was explored in subgroup analyses, which indicated that
EDT may be most effective in depressive disorders and that individual EDT had larger effects
compared to group treatment. Additionally, EDT performed better in higher quality studies.
We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further
high quality studies evaluating contemporary versions of EDT in specific psychiatric
conditions are warranted.
Interpersonal Psychotherapy and Cognitive Behavioral Therapy in the treatment of Major
Depression in regular psychiatric care
Annika Ekeblad, Linköping University, Stockholm, Sweden; Fredrik Falkenström; Robert
Vestberg; Gerhard Andersson; Rolf Holmqvist
Background: Interpersonal Psychotherapy (IPT) and Cognitive Behavioral Therapy (CBT) are
empirically supported treatments for Major Depressive Disorder; nevertheless there are few
direct comparisons in specialist psychiatric care of the two forms of therapy, and CBT has a
stronger research base in that it has been tested in more studies. Method: A total of 96
psychiatric patients with DSM-IV Major Depressive Disorder were randomized to 14 sessions
of either CBT (n=48) or IPT (n=48). Main outcome measures were reduction of depression
severity and recovery, as assessed by the Beck Depression Inventory-II (BDI-II). IPT was
hypothesized to be non-inferior to CBT. Results: In the ITT analysis, IPT seemed superior to
CBT in reducing depression symptoms after treatment, although the post-treatment
difference did not quite reach statistical significance (p =.08). IPT clearly passed the noninferiority test. The drop-out rate was significantly higher in CBT. There was no statistically
significant difference in recovery rates. Results were unaffected by statistical control for use
of antidepressants. Discussion: The major strength of this study is its ecological validity, since
all treatments were carried out as part of regular psychiatric care by the usual clinic
therapists. Limitations include fewer therapists each treating more patients in the IPT
condition, which may have led to greater learning effects for IPT therapists. There may have
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been a researcher allegiance effect favoring IPT. In conclusion, the results indicate that IPT is
not inferior to CBT in the treatment of depression and there seem to be fewer dropouts from
IPT. IPT should be considered a viable alternative to CBT in the treatment of depression in
psychiatric care.
Mentalization-Based Treatment for Dual Diagnosis: First Results from a Randomized
Controlled Trial
Björn Philips, Center for Dependency Disorders, Stockholm, Sweden
Aim: To study the efficacy and effectiveness of Mentalization-Based Treatment (MBT) in
combination with treatment as usual (TAU) for substance dependence compared to TAU
alone in patients with Borderline Personality Disorder (BDP) and concomitant substance
dependence. Methods: The study was designed as a randomized, parallel-group, observerblinded clinical trial (N=46). Patients were primarily recruited within the large public
addiction clinic the Center for Dependency Disorders, Stockholm County Council. Patients
were randomized to one of two treatment arms, both lasting 18 months: 1) 24 patients
subjected to psychotherapeutic treatment with MBT as a complement to treatment as usual
(TAU) or 2) 22 patients receiving TAU alone. MBT in accordance to a manual (Bateman &
Fonagy, 2006) consisted of individual and group psychotherapy, one session of each per week
for 18 months. The primary outcome variable was severity of BDP, as measured by the
Borderline Personality Disorder Severity Index (BPDSI-IV). Secondary outcome variables
included measures for alcohol and drug use, suicidal and self-harming acts, retention in
treatment, psychiatric symptoms, interpersonal problems, and social adjustment. Results:
First preliminary outcome results are presented. Discussion: Patients with dual diagnosis
constitute a challenge for health care providers because of the severity and complexity of
their problems, and the increased risk for destructive and self-destructive behavior. There is
a shortage of research on psychotherapy for this group. The present study provides data on
both efficacy and effectiveness of MBT for dual diagnosis, as it was conducted in an ordinary
clinical setting.
Can psychoanalytic theories be "proved"?
Per Høglend, University of Oslo, Norway
Psychotherapy research needs to identify the active treatment components, for whom they
are effective (moderators), mechanisms of long-term changes (mediators). Mainstream
psychodynamic theories state that interpretation of transference leads to increased insight
which again leads to long-term improvement of interpersonal functioning. However insight
may not be sufficient. Clinical theory indicate that working through is necessary which lead
to the integration of cognitive insight and emotional understanding. In this presentation
cognitive insight and emotional understanding will be analyzed in a two-mediator model of
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the long-term effects of transference interpretation, using structural equation modelling
(SEM). The analyses uses data from the FEST-study (First Experimental Study of Transferenceinterpretation). This dismantling randomized clinical trial is specifically designed to study the
long-term effects of transference work. One hundred patients were randomized to one year
of therapy with transference interpretations (transference group) and without transference
interpretations (comparison group). They were followed up one and three years after
treatment termination.
Discussant: Mark Hilsenroth, Adelphi University, New York, USA
48.
Panel
Methods
Moderator: Dan Pokorny, Ulm
University, Germany
Dynamic side effects of self-report measures
In this panel, we will present the progress in four running projects localizing or developing
questionnaires for the sake of psychotherapeutic screening and testing. We have realized
how much the administration of a questionnaire triggers the test person to reflect own
problems, resources and existentially substantial issues. Measurement theory and
psychometry try for methodological reasons to minimalize any effects of measurements on
the investigated subject. On the other side, the common client-therapist dialog in the first
therapy session has already considerable therapeutic effects experienced by the client, in the
most case positive ones. We are convinced that, analogously, we need not to neglect the
impact and side effects of psychometric measurements. Rather, we can try to understand
them, control them and used them for therapy benefits.
Blerta Bodinaku (Tirana) will share her experiences from the representative study, concerning
willingness and defenses of participants to disclose information on their own problems and
on relationship persons. Elvisa Sokoli (Tirana) will present the representative study in which
participants` problems are judged by themselves and by close persons and she will discuss
how the judgments are influences by the relationship type. Milena Karlinska-Nehrebecka
(Krakow) will report on the naturalistic outcome study performed in the frame of the
MetaSystemic theory. Andrzej Nehrebecki (Krakow) has developed his questionnaire
WisdOM (Wisdom Outcome Measure) guided by principles of a good therapist-client dialog.
He will present these principles and summarize spontaneous feedbacks from numerous
users.
Self-reports and reports on close relationship persons in a population study.
Blerta Bodinaku, University of Tirana, Albania; Dan Pokorny
Aim: In a representative study in Tirana, selected translated psychometric instruments as
well an open questionnaire on close relationship persons were administrated. As we
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reported earlier, satisfactory and fully comparable values for reliability and validity of
psychometric measures were found and an impact of historical and cultural circumstances
was observed. In this contribution, we will present the first time the results on relationship
patterns in Albanian population as well demonstrate the effects of the questioning process
on study participants. Method:. Representative samples of 501 Tirana inhabitants and 209
patients in mental health service centers were investigated. A re-test study for the standard
psychometric instruments was performed on subsamples. Four standard questionnaires (SCL90-R, CORE-OM, BDI-II, CES-D) and an open instrument AIR (Adjective Interview on
Relationship) were administrated. In the latter instrument, participants were asked to name
spontaneously up to five adjectives describing the relationship for each of the six close
persons (friend, father, mother, partner, child, self). The 6375 descriptions were analyzed by
the CCRT-LU (Core Conflictual Relationship Theme -- Leipzig, Ulm) category system translated
into Albanian by Eni Qirjako. The categorizations were summarized to the general harmony
index and to 13 category clusters allowing to present relationship profiles of the six
considered persons. Results of standard methods and relationship instruments were
analyzed and compared statistically. The analyses will focus the psychological impact of
instruments and administration on study participants. Results: The complete results will be
presented at the conference. Preliminary findings are as follows. (a) As reported earlier, the
values of the SCL global scales, subscales and items were considerably higher in Albania than
in Germany or USA; the structure of these psychometric differences corresponded soundly to
the historical and cultural contexts. (b) We will complete the results from the re-tests: The
SCL values of symptom severity decreased significantly in both samples by the second
measurements. (c) The acceptance -- willingness or ability -- to complete the adjective
instrument AIR was lower than by standard instruments. (d) However, in comparison to the
studies in other countries, the other persons, particularly the parents are being described in
a strongly harmonious way. Discussion: We will discuss the possible reasons for critical
tendencies found by study participants in self-administrated questionnaires. On the other
hand, the harmonious descriptions of parents can be well understood on the background of
traditional behavior patterns, rules and taboos, which are still consciously or unconsciously
strongly present in the Albanian society. Finally, significant improvements in standard
instruments can be understood as an effect of reflection, triggered by the questionnaire
answering.
My problems seen by myself and by my close person. A representative study using the
ASEBA instrument.
Elvisa Sokoli, University of Tirana, Albania; Dan Pokorny
Aim: The first aim of the presented study was to validate and standardize the Albanian
version of the screening instrument ASEBA (Achenbach System of Empirically Based
Assessment) for adults. In the frame of the international ASEBA project, the Albanian results
were compared to numerous other countries worldwide. The symptomatology of the test
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person rated from two perspectives: from the self-report and from the report of selected
close person. The second research aim of the presented study was to compare these two
perspectives. Methods: The psychometric core of the used form of ASEBA instrument, the
Adult Behavior Checklist for Ages 18-59, consists of 132 dichotomously scaled items. Item
responses are summarized to global scales and diagnostically meaningful subscales. The
parallel form for the report of the close person consists from items corresponding to the selfreport items as far as possible. In the study, a representative sample of N=750 persons from
the Albania was assessed. The selected close person was a spouse / partner (39%), friend
(21%), sibling (15%), child (11%), parent (9%) or other relationship person (6%). Hence, there
were 750 matched pairs of answered questionnaires divided into groups by the kind of the
relationship. Results: The psychometric qualities of the translated ASEBA were comparable to
other international studies. (a) Reliability. The values for corrected item-scales correlations
and Cronbach alpha showed a satisfying inner consistence of all investigated scales. (b) The
external validity was operationalized by agreement between self-reports and reports of close
persons. High correlations were observed both for the global scale (0.84) and for all seven
main subscales (0.56 -- 0.81). (c) There were no significant difference by paired t-test
between the means of the global scale in self-reports and reports (t(749)=0.87, p=.385). (d)
However, the perceived symptom structures differed significantly. In the self-report
questionnaire, internal problem attributions scored higher (subscales anxious/depressive,
though problems, somatic complaints); in reports of close persons, the external attribution
of problems prevailed (rule-breaking, aggressive and intrusive behavior). (e) Differentiating
the finding on the global scale by close persons groups, significant differences between
reports and self-report were found within one group only. The children as judges estimated
the problems of their parents significantly lower than parents did by themselves. Discussion:
The study has confirmed the ASEBA as an instrument suitable for the practice in Albania. A
high correspondence between self-estimation and reports of close persons was
demonstrated. However, it seems, both parties perceive more their own discomfort and
suffering than of the other ones. The milder judgments of children on their parents can
among other be connected to the traditional behavioral rules in the Albanian society.
Psychotherapy directed on close relationships works - naturalistic study of effects of
MetaSystemic approach.
Milena Karlinska-Nehrebecka, Polish Institute for Integrative Psychotherapy, Krakow; Andrzej
Nehrebecki; Omar C.G. Gelo
Aim: MetaSystemic psychotherapy is an integrative approach established by Andrzej
Nehrebecki, and further developed by him, Milena Karlinska-Nehrebecka and co-workers.
The main areas of interest in this approach are close relationships between self and
members of the family system and sometimes -- other objects, as homeland or death. The
aim of this study was to investigate effectiveness of the MetaSystemic approach in clinical
settings. Methods: Observational, non-controlled study was conducted on sample N=187
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persons, age ranging 18-73 years, with mental disorders such as depressions, personality,
eating, anxiety disorders, and nonclinical problems, mainly in close relationships. The
psychotherapy format was group, individual, couple and family. Mean psychotherapy
duration was 29 weeks. 19 psychotherapists were trainees and certified MetaSystemic
psychotherapists. Polish version of CORE-OM and SCL-90 were used as an outcome measure.
The changes within four CORE-OM domains will be presented together with symptomatic
scales comprising in SCL-90. Results: The pre-post differences in CORE-OM and SCL-90 were
significant. Effect size Cohen's d of global CORE-OM was 0.94, effect sizes by its scales varied
from 0.41 to 1.10. 67 % patients exceeded clinical cut-off threshold before treatment,
compared to 33% post-therapy. Over 56% patients showed clinically reliable improvement,
less than 3% - worsening. Effect size of GSI SCL-90 was 0.70; higher improvements were
reached rather by women than by men. By both instruments, the items concerning the close
relationships showed the most impressive improvements. Discussion: MetaSystemic
psychotherapy seems to be an effective psychotherapeutic approach in clinical settings, at
level comparable to other approaches. Improvements in the field of close relationships
correspond to the focus of MetaSystemic psychotherapy. Relationship and existential issues
are of central interest by elaboration of diagnostic finding gained both by questionnaires and
by non-verbal bodily configurations. The general results will be illustrated by individual cases.
A question is an intervention. Feedbacks from participants in the WisdOM study.
Andrzej Nehrebecki, Polish Institute for Integrative Psychotherapy, Krakow, Poland; Dan
Pokorny
Aim: Constructing the WisdOM questionnaire of Nehrebecki (reported earlier), we realized
problems of outcome measures occurring often by their application in the clinical practice: 1.
The aim of the asked items are hidden against the respondent. This infantilises him and
undermine the therapeutic alliance. 2. Medicalization of outcome tools focusses the patient's
attention on clinical signs rather on his substantial wishes to be happy, fulfilled at work and
love, find the meaning of life and to pursue it. Focusing on symptoms -- often masking the
crucial problems -- can be a therapeutic pitfall. 3. Questionnaires with the hidden content are
often tiring for patients not feeling a direct benefit. 4. Scale fragmentation. Patient responses
during jumping from one scale to another does allow any meaningful experience. 5. Item
values. Verbose descriptions can block emotional experience. The neutral midpoint offers a
possibility to defence the potential reflection. 6. Focusing on deficits. Items on diseases,
symptoms and problems increase the experience of negative emotional states and transfers
the message that positive experiences are not important. 7. In patients with instable identity
structure, lack of the test structure can preserve experience of chaos and helplessness
towards inner experiences. Our intention was to base the construction more directly on the
clinical and training experience. Methods: In the sake to remedy the discussed problems, the
construction of the WisdOM instrument consisting of 70 items grouped into 7 successive
domains followed the following principles: 1. The test intention is transparent. Respondent is
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aware of the current topic. 2. The test is focused on significant, existentially meaningful, nonsymptomatic issues. Symptoms are treated marginally. Nevertheless, test scales are highly
correlated with symptom oriented measures. 3. According to the feedbacks, WisdOM items
stimulate emotional experience, exploration and insight, and supports the therapeutic
process. 4. All 10 questions from one scale are presented contiguously. It facilitates focusing
on the experience explored by the scale. 5. The response to the six-grade scales (YES-Yes-yesno-No-NO) is given at the basis of body reactions. 6. WisdOM explores alternately both
positive and negative experiences and the same is a kind of mindfulness practices. 7. The
inspiration for the questionnaire was a model of the constructive therapeutic session.
Results: The instrument was finally validated in a study with N=2675 Polish respondents.
After the study, numerous respondents provided spontaneously a feedback on their
experience during and after the administration. We will present examples and the summary
of their opinions. Discussion: The construction of the -- anyway quantitative -- questionnaire
kept in balance psychometric rules and principles of the client-therapist dialog. This
increased the therapeutic impact as a side-effect of the administration.
49.
Brief Paper Session
Treatment
Moderator: Guillem Feixas,
University of Barcelona, Spain
Therapeutic approaches
Buddhist wisdom and practice in psychotherapy - Where we are and where can we go?
Alon Raz, Haifa University, Israel; The Max Stern Yezreel valley college
In recent years Buddhist wisdom has gained increasing familiarity among westerners. At the
same time more and more therapists become familiar with and enthusiastic about Buddhist
wisdom and practice, and try to find a way to combine it in their therapeutic work. However,
so far there is no acceptable or leading conceptualization regarding the ways the Buddhist
path may or should be integrated into psychotherapy. Currently we only have personal and
individual attempts to interpret and integrate Buddhism into psychotherapy, along with welldeveloped therapeutic methods that focus on specific aspects of Buddhist practice in the
framework of Mindfulness. On my lecture I would like to present a general map of the
different paths in which Buddhism is and can be integrated in western psychotherapy. Over
the last 25 years I have been trying to integrate the Buddhist path in my personal life as well
as in my work as a clinical psychologist. Over the last 10 years I have been teaching Buddhist
psychology together with my colleagues, both as part of a 3 years psychotherapy program
and as a standalone Buddhist psychology program at Shiluv - a center that integrates body,
mind and spirit, East and West in psychotherapy teachings. All these years we have tried to
find our way of adapting old wisdom to psychotherapy practice and teachings. the map I will
be introducing is based on insight gained thorough my personal experience as well as
deliberations and insights received in the process of shaping our programs on the basis of
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our accumulative experience.I believe that this can be meaningful both in terms of
shortcomings, challenges and new horizons when trying to integrate the old wisdom of
Buddhism into current common psychotherapy practice and to the way Buddhism might be
combined in the curriculum of psychotherapy schools and teachings.
Integrative Psychotherapy and Mindfulness: A Natural Fit
Mihael Černetič, Faculty of Psychotherapy Science of the Sigmund Freud University in
Ljubljana
In the last two decades, there have been various attempts of integrating the theory and/or
practice of mindfulness with psychotherapy. The paper presents possibilities for integration
of mindfulness and integrative psychotherapy orientation (Erskine, Moursund, & Trautmann,
1998) on a theoretical level, beyond what Norcross (2005) termed technical eclecticism in
psychotherapy integration. The focus of presentation is on the exploration of how processes
of integrative psychotherapy and mindfulness intertwine and how they mutually enhance
each other. Although mindfulness is not an explicit constituent of integrative psychotherapy,
the two seem to be a natural fit. Parallels are drawn between mindfulness and three core
elements of integrative psychotherapy: contact, ego states, and script. Mindfulness of a
client has the potential to enhance his or her internal and external contact, as well as
strengthen client's Adult ego state. Furthermore, with its emphasize on the here-and-now,
client's mindfulness may facilitate overcoming his or her script patterns (i.e. script cure). In
addition, mindfulness of a therapist may be helpful in implementing the core integrative
psychotherapy methods (Erskine et al., 1998): attunement, inquiry, and involvement.
Therefore, explicit incorporation of mindfulness theory and practice into integrative
psychotherapy may enhance the process and outcome in this psychotherapy orientation.
From death to life: promoting resilience in a polluted area
Fanny Guglielmucci, University of Turin; Adriano Schimmenti; Andrea Seganti; Isabella Giulia
Franzoi; Antonella Granieri
Aim: Asbestos is an environmental toxic agent leading to mesothelioma and death. Over the
years thousands people died all over the world because of its production or inhalation. The
aim of our research is to evaluate the process of a multifamily group (MG) in an Italian
community exposed to it with more than 3.500 victims. Method: One-year sessions of MG
were audio-reordered and assessed thought Prototypical Variation Model (PVM). Twentytwo patients participated: mesothelioma patients (MP) and their caregivers (C). Time-series
analysis was administrated to the main frequencies speakers in order to understand the
change of the language in narratives. Results: Both narratives of MP and C were
characterized by the prevalence of proposition sustained by asymmetric demanding verbs in
1st person (S+/O-). Time-series analysis shows an increasing in the dialogue of state verbs in
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1st person where the positive states prevail (S+) and a decreasing of proposition sustained by
demanding or oblative 1st and 2nd/3rd person verbs. Discussion: MP and C show a
persecutory object representation: they seem to claim a credit assigning to the extern world
a debt respect to their losses and pain. The analytic work has led them to a minor subjective
perception of conflicts and to the arising of resilient aspects of the Self: they seem to assume
a more assertive position, a sort of "direct and aggressive response" for living in an
environment where death is always present.
Personal dilemmas as an innovative focus for psychotherapy: a randomized clinical trial
Guillem Feixas, University of Barcelona, Spain; Adrián Montesano; Arturo Bados; Eugeni
García; Clara Paz
Aim: Cognitive models have contributed significantly to the understanding of depression and
its psychological treatment. However, success is only partial and many authors claim the
need to improve those models of psychopathology and psychotherapy. Our research group
has been working on the notion of cognitive conflict viewed as personal dilemmas according
to personal construct theory. We use a novel method for identifying those conflicts using the
repertory grid technique. Research on prevalence of conflicts showed that up to 90% of
depressive patients presented with such internal conflicts. This study explores the efficacy of
a cognitive therapy for depression using dilemmas for case formulation. Methods: A
randomized clinical trial was carried out with 106 depressed participants comparing the
outcome of two treatment conditions: group CBT plus individual dilemma-focused
intervention versus CBT alone. The BDI-II is the primary outcome measure, collected at
baseline, at the end of therapy, and at 3- month follow-up; other secondary measures are
also used such as CORE-OM and some rep grid indexes. Results: The dilemma-focused
intervention was at least as effective as cognitive-behavioral therapy. In both groups,
symptom improvement was associated with the resolution of conflicts. Discussion: Dilemmafocused has proved its usefulness for case formulation. However, more process-outcome
research in needed to better understand the nature of the process of change and recurrence
in depression.
Single Case, Timed Series (SCTS) Design Efficacy Studies of Psychotherapy of Depression:
the Experience of the International Project on Gestalt therapy
Pablo Herrera Salinas, Universidad Católica de Chile; Philip Brownell; Jan Roubal; Jörg
Bergmann; Illia Mstibovskyi; Otto Glanzer; Stefan Pfleiderer
Currently, a number of researchers recognize that the SCTS design is logical equivalent to RCT
in proving the efficacy of psychotherapy. In fact, for process-oriented approaches it has a
number of advantages, among which the experience of real sessions, the combination of
quantitative and qualitative methods in process-outcome studies, pronounced clarity of
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evidence. Aims of the presented project: (1) Assess the results of Gestalt therapy working
with depressed patients; (2) Identify characteristics of the process of Gestalt therapy
influenced on the achievement of results; (3) Develop and test the format of research
suitable for wide use in private Gestalt therapists practice and clinical work. Methods: Before
working with the client and after its completion the following instruments are used: MiniInternational Neuropsychiatric Interview, Outcome Questionnaire, Beck Depression
Inventory, Working Alliance Inventory. The therapeutic outcome is checked by processing
time series Target Complaints, measured in three time periods: before therapy, during and
after it daily. For analysis of the process of therapy used video followed by the identification
of the characteristics of the therapeutic relationship, applied techniques and patients factors.
Results: The project is currently ongoing. The formation of the research methodology was
completed, working groups in seven countries were organized, pilot studies in Chile and
Germany were conducted, analysis of cases started. Conclusion: SCTS design seems to be
optimal for studies on the efficacy of Gestalt therapy.
50.
Therapist factors
Moderator: Courtenay Young,
European Association of
Psychotherapy
51.
Panel
Psychodynamic
Moderators: Susanne HörzSagstetter, Psychologische
Hochschule Berlin; Antje Gumz,
Berlin Psychological University
& University Medical Center
Hamburg-Eppendorf
Twenty Different Definitions of Psychotherapy
This presentation is based on an article published by the presenter in the International
Journal of Psychotherapy (Vol. 15, No. 1, March 2011, pp. 23-41) and came out of the EAP`s
Project to Establish the Professional Competencies of a European Psychotherapist. It seemed
necessary / essential to establish what we actually mean by "psychotherapy" and this is/was
an attempt to define it more precisely. The presentation here is to get feedback on the
concepts in the article and initiate a discussion on these points. Free access to (copies of) the
article will be provided to all participants.
Factors Contributing to Change in Psychodynamic Psychotherapies
Various factors have been shown to contribute to change in psychodynamic psychotherapies.
In this panel, we want to illustrate how new research approaches and particular the
therapists` perspective can contribute to a better understanding of process and outcome in
psychodynamic psychotherapies. The first paper presents an empirical systematization of
psychodynamic techniques and shows the effect of specific techniques on outcome. The
second paper demonstrates the application of the reflective functioning scale (Fonagy et al.
1991) both as process and outcome measure in two long-term psychoanalytic therapies. The
third paper discusses the predictive value of attachment (AAI), level of structural integration
(OPD-structure), maladaptive narcissistic regulation (Narcissism Inventory) and symptomatic
144
distress (SCL-90) for the measurement of therapeutic success (Heidelberg Structure Change
Scale). The fourth paper examines how therapists’ conceptual patterns based on session
notes can promote the understanding of the therapeutic process and how these patterns are
related to outcome in psychodynamic psychotherapies.
Empirical systematization of verbal psychodynamic techniques and the effect of specific
techniques on session quality and therapy outcome
Antje Gumz, Berlin Psychological University & University Medical Center HamburgEppendorf; Carina Schlipfenbacher; Anne Daubmann; Rainer Erices
Aims: Verbal utterances account for a large part of therapist´s in-session activities. However,
it remains unclear what defines a good therapeutic statement. To date, the knowledge of
specific verbal techniques utilized by therapists and the therapeutic effects of these
techniques is limited. Psychodynamic techniques are generally described inconsistently and
in an abstract, complex and ambiguous manner. Methods: The Psychodynamic Interventions
List (PIL) is a classification system which was developed on the basis of transcribed therapy
sessions using Qualitative Content Analysis. Verbal statements were classified into 37
categories and allocated to three dimensions (form, content, temporal focus). Using PIL, the
transcripts of 60 psychodynamic therapy sessions were analyzed (4 sessions from 15 patients
and 9 therapists, with a mean of 235 verbal statements per session). It was examined
whether the used techniques had an effect on theoretically relevant common factors
(insight; problem solving; therapeutic support) as perceived by patients and therapists, as
well as whether they had an effect on therapy outcome (GSI, SCL-90-R). Results: The
categories „validation", „parallel regarding others and significant carers", „father",
„unspecified significant carer" and „other significant carer" were positively associated with at
least one common factor from patient´s or therapist´s perspective. The categories
„exploring", „conveying professional knowledge", „repeating, paraphrasing, summarizing",
"implicitly indicating a parallel" and "present" were negatively associated with at least one
common factor from patient´s or therapist´s perspective. The category "validation" was
positively related to therapy outcome. Discussion: The results are discussed in the
presentation.
Reflective Functioning as Process and Outcome Measure in Psychoanalytic Psychotherapies
Susanne Hörz-Sagstetter, Psychologische Hochschule Berlin; Wolfgang Mertens; Sybille
Isphording; Anna Buchheim; Svenja Taubner
Aim. This study examines the question of how reflective functioning (RF) can be assessed in
analytic sessions and throughout psychoanalytic psychotherapy. Methods. The goals are to
replicate in part a study by Josephs and colleagues (2004) by applying the RF Scale to analytic
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sessions and to study fluctuations of RF within each session. Additionally, RF based on
sessions was compared with the RF-ratings based on the Adult Attachment Interview (AAI)
during the course of two psychoanalytic psychotherapies with a duration of 240 hours. RF
changes based on 10 sessions per patient − assessed throughout therapy, and RF changes
based on AAI ratings − measured at baseline and aier 240 hours of therapy, and in one case
at follow-up, were related to changes of symptom severity (SCL-90-R), and of attachment
classifications over the course of time. Results. Results showed that in both cases the RF
within sessions fluctuated. The average RF-rating per session increased over the course of
the treatment, while the AAI-based RF rating needed longer to increase. Rather good
correspondence was found between session-based RF-ratings and independent AAI-based
RF-ratings. In both cases, changes in RF were compared to changes in attachment
classification based on the AAI and to symptomatic change. Better correspondence between
symptomatic and attachment changes was found with the AAI-based RF rating. Discussion.
The findings were tentatively interpreted that session-based RF ratings may represent a state
of RF that is strongly influenced by the therapist-patient interaction, whereas AAI-based RF
could be considered to have more trait characteristics.
Prediction of structural change operationalized by the Heidelberg Structural Change Scale
in long-term psychoanalytic psychotherapies
Anna-Rahel Minow, Ludwig-Maximilians-Universität, Munich, Germany; Susanne HörzSagstetter; Anna Buchheim; Ingrid Erhardt; Claudia Denscherz; Wolfgang Mertens
Aim: This study examines how attachment classification, level of structural integration,
symptom severity, and a subscale from the Narcissism Inventory can predict structural
change operationalized by the Heidelberg Structural Change Scale. Methods: A sample of 17
psychoanalytic patients was studied before, during and after at least 240 hours of
psychoanalytic psychotherapy. The patients were rated regarding their perception and
accessibility of mental representations of specific problem foci (HSCS), attachment
classification (AAI), symptomatic distress (SCL-90/GSI), narcissistic regulation (narcissism
inventory NI) and level of structural integration (OPD). AAI, GSI, NI, and OPD level at therapy
onset were used as predictors and therapeutic success was operationalized using the HSCS at
the end of therapy. The 7-point Heidelberg Structural Change Scale (HSCS; Rudolf et al.,
2000) allows to measure structural change, defined as a basic form of personality
modification in the realm of relationship patterns, unconscious conflicts, and patients'
structural features according to the OPD system. Bivariate correlations and a L1-penalized
regression model were applied as statistical methods. Results: Level of structural integration,
a NI-subscale and GSI at therapy onset showed significant moderate to strong correlations
with the HSCS at the end of treatment. Attachment had no predictive value. The L1-penalized
regression model confirmed the important influence of the GSI for the prediction of
structural change. Discussion: The different predictive values of the measures and their
intercorrelations are discussed with regard to practical implications. The findings implicate
146
both - different levels of change in psychotherapy and a high correlation of symptomatic and
structural change.
Therapists' conceptual patterns of interactions and change processes in psychodynamic
psychotherapies
Dorothea Jäckel, Universitäre Psychiatrische Dienste UPD, Bern, Schweiz; Puspa Argawalla;
Joachim Küchenhoff
Aim: Writing session notes constitutes a everyday practice in psychodynamic psychotherapy.
In the presented study which is part of the FIPP study on psychoanalytic therapy processes,
we demonstrate how therapists structure and organize the therapeutic process in session
notes and commentaries. Methods: The study is naturalistic, drawing on mixed-methods.
Session notes of 31 treatments over the first year of psychodynamic psychotherapies are
studied. Data collection is performed upon entry, and subsequently every three months (t1t5). We focus on notes and commentaries of sessions which were considered by the
therapists as turning points or typical. We performed a modified constructivist grounded
theory methodology supplemented by a positioning analysis. Additional instruments are
used: Heidelberg Scale of Structural Change (HSCS), Working alliance (TAB-T, TAB-P). For
categorical variables (HSCS) chi square test and for longitudinal data (TAB), repeatedmeasures analyses of variance were used. Results: Analysis of the session notes revealed
three conceptual patterns: 1. One-person-psychology - observation; 2. Two-Personpsychology - participant observation; 3. Perspective of intersubjectivity - observant
participation. Furthermore they contained descriptions of changes after an intervention
(proximal) and progress markers (distal). Early change (t1) predicts structural change (HSCS)
at t5. The repeated-measures analysis of variance reveals group effects for TAB-P only.
Discussion: The conceptual patterns of the therapists' session notes open up a further
perspective on the therapeutic process. They point to a particular construct of therapeutic
interaction, both proximal and distal changes. From a methodological point of view social
science approaches are fruitful to investigate new perspectives on interaction and change
processes in psychotherapy.
52.
Brief Paper Session
Process
Moderator: Tomas Rihacek,
Masaryk University in Brno
Therapist-Patient-Interactions
Therapeutic Interaction Structures and Referential Process: A Single Case Study
Laura Bonalume, University of Milan-Bicocca, Italy; Ingrid Erhardt; Attà Negri
Aim: According to a constructionist approach for psychotherapy research, the complex
phenomena of therapeutic relationship should be analyzed with a combination of process
147
research and micro level analysis of the sessions. The present single-case study was designed
to show the usefulness of a process analysis with the Psychotherapy Process Q-Set (PQS;
Jones 2000; Ablon et al. 2012) and the Italian Weighted Referential Activity Dictionary
(IWRAD; Bucci, Maskit & Mariani 2013). The aims were to assess the interaction structures of
therapeutic dyads, as defined by Jones' theory of therapeutic action, and the three phases Arousal, Symbolizing and Reorganizing -- of the referential process, described by Bucci. The
main hypothesis is that each phases of the referential process is characterized by specific and
typical interaction structures. Methods: The analysis focused on the transcripts of 8 sessions,
two for each of the a four years of face-to-face psychodynamic-oriented psychotherapy. All
transcripts were rated with PQS items and processed by the Italian Discourse Attributes
Analysis Program, obtaining the following computerized linguistic measures of the referential
process: Positive Affects, Negative Affects, Neutral Affects, Reflection, Disfluency, Referential
Activity. Both qualitative and quantitative analyses were conducted. Results: The data
analysis is in process. Results will be presented. Discussion: The results will be discussed.
Therapists under influence - Patient strategies and therapist reactions
Franz Caspar, University of Bern, Switzerland; Sarah Frühauf
Therapists having a positive influence on patients is a common view of psychotherapy. There
is, however, an influence of patients on therapists too, which has received less attention. The
more restricted and rigid patients are, the more limited the interpersonal behavior of others
with which the get along well. In line with social psychological, interpersonal and clinical
models they try to bring the therapist into an interpersonal position which suits them well.
With 60 patients, common strategies have been rated: Good mood, Positive feedback,
Negative feedback, Agenda set¬ting, Provoking a response from the therapist, Negative
reports about third per¬sons, Fait accompli, Supplication, Self-promotion, Avoidance of
contents, und Emo¬tional avoidance. The rating procedure, frequencies, and therapist
reactions upon these patient strategies will be reported.
How Therapists Experience Psychotherapy with Depressive Patients: A Grounded Theory
and Future Research Possibilities
Jan Roubal, Masaryk University in Brno, Czech Republic; Tomas Rihacek
Psychotherapeutic work with depressive patients presents a significant load for therapists.
Thorough knowledge of characteristics of this load and of possible coping strategies can
contribute to the self-care of therapists, to the prevention of a burnout syndrome and
consequently to the enhancement of the therapeutic relationship with this specific
population of patients. The presented research explores at a micro level changes of the
process of psychotherapist´s experiences with a depressive patient during a psychotherapy
session. Research results provide a detailed description of how psychotherapists experience
148
a relationship with depressive patients and identify coping strategies for psychotherapists
when working with depressive patients. Data were collected from 30 therapists, Grounded
Theory Method was used for the analysis. Results of this research enable to deduce alliance
optimizing strategies to enhance the relationship for these particular, depressive, patients.
Future research possibilities will be presented.
Specificity and Pace Variability of Therapists' Interventions Under Naturalistic Conditions
Margit Koemeda, Swiss Charta for Psychotherapy; Aureliano Crameri; Peter Schulthess;
Agnes von Wyl; Volker Tschuschke
Aim: As part of a larger naturalistic process-outcome study (PAP-S), 422 audio-recorded
sessions were analyzed to determine common and specific elements of eight different types
of psychotherapy: Art and Expression Oriented Psychotherapy, Bioenergetic Analysis,
Existential Analysis and Logotherapy, Gestalt Therapy, Integrative Body Psychotherapy,
Process Oriented Psychotherapy, Psychoanalysis/Analytical Psychology, and Transactional
Analysis. In addition, temporal aspects of therapists' interventional behavior were
investigated. Method: We coded 42 therapists' verbal interventions from 422 sessions with
92 patients using a specially developed multi-method rating manual with 100 different
intervention categories. Descriptive analyses of these observational data were
complemented by mixed model analyses. Results: Therapists worked eclectically and used
different types of intervention: techniques from their own type of psychotherapy (13.9%),
from other types of psychotherapy (20.1%), and non-specific, common techniques (66.0%).
Therapists' affiliation with types of psychotherapy under naturalistic conditions did not
predict the high variability of interventional behavior in different sessions. For some
intervention categories the factor therapist did. The most informative concerning the
variability of intervention types was the factor patient. Therapists also worked at varying
interventional paces. Certain types of interventions were followed by time intervals of which
the duration significantly exceeded that of others. Discussion: More than two-thirds of
psychotherapists' interventions -- under naturalistic conditions -- were common techniques.
About 30% of the interventions were techniques specific to different types of psychotherapy.
Among these, we found some interventions to engage patients in activities of a longer
duration. The varying pace of therapists' interventional behavior and its connection to
specific techniques from different types of psychotherapy seems worthy of further
exploration.
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53.
Brief Paper Session
Psychodrama
Moderator: Michael Wieser,
Klagenfurt
Psychodrama
Patient-Informed Principles in Morenian Psychodrama
Ana Luísa Oliveira, Universidade de Évora, Portugal; Célia Sales; Heidi Levitt; Ana Cruz
We know that a great deal of change in psychotherapy is due to factors related to the
patient, and not so much due to the therapeutic model used or even the therapist.
Therefore, it is relevant to consider the patient experience in therapy, and learn from it about
how to deliver psychological treatments. This study aims to identify practice-guidance
principles driven from patient-identified significant events in a Morenian Psychodrama
Group. During 1 year, 9 patients filled in the Helpful Aspects of Therapy (HAT; Elliott, 1993)
after each session. Their narratives were analysed according to Grounded Theory
procedures, replicating Levitt, Buttler and Hill's (2006) analysis methodology. Results will be
discussed focusing on the implications for clinical practice.
Impasse - How to provoke change? Two cases demonstrating the use of psychodrama in
the process of integrative psychotherapy
Krzysztof Mariusz Ciepliński, The John Paul II Catholic University of Lublin
Diagnosis and analysis of the processes and determinants of personal change is one of the
main areas of research in psychotherapy (Kazdin, 2007; Prochaska & Norcross, 2013). It is an
important premise to continue working on the integration of psychotherapy, too. According
to Czabała (2006), this change should be associated with the presence of the treatment
factors, which include: a positive therapeutic relationship (or its equivalent), the acquisition
by patients of new emotional experiences, new ways of learning about each other, the
environment and training in making differences from their existing ways of acting.
Psychodrama as a method of psychotherapy is invested in the wider mainstream of
humanities, particularly among the approaches based on experience (Greenberg, Watson &
Lietaer, 1998; Kipper, 2007; Krall, Fürst & Fontaine, 2013). Some authors indicate its
relationship with psychodynamic and cognitive behavioural therapies (Bielańska &
Gliszczyński, 2009; Hammond, 2014). This presentation will explore the particular impact of
psychodrama on patients who are caught in an impasse. The term 'impasse' will be defined
from a generic therapeutic understanding and from a psychodramatic perspective. Some of
the theoretical and practical aspects of using psychodramatic elements during the process of
integrative psychotherapy, will be described and discussed. Past and current case examples
will be analysed in a systematic way explicating the potential of psychodrama techniques to
stimulate significant changes. Case material is drawn from the experiences of including
psychodrama within integrative psychotherapy practice.
150
Process and outcome in a slow-open Psychodrama group psychotherapy
Maurizio Gasseau, University of Valle d'Aosta (Italy); Cinzia Guarnaccia
Introduction: The most important researches on effectiveness of Psychodrama
Psychotherapy consider it an effective technique in changing many aspects of the self and
personality of patients (even with severe diseases). However, the main limitation of much
research is that empirical data have been generated infrequently and have often been based
on qualitative designs (Kipper & Ritchie, 2003) The four most important reviews on
Psychodrama (D'Amato & Dean, 1988; Kellermann, 1982; Kipper, 1978; Rawlinson, 2000)
came to a similar conclusion that the initial empirical research on the effectiveness of
psychodrama revealed some encouraging results but the data were insufficient and often
lacked methodological rigor. Aim: Our study aim to verify the effectiveness of the treatment
in two long-term Psychodrama group, slow-open, with severe patients and to understand the
connections between the therapeutic process and treatment outcomes. Method: We
analyzed data collected on 14 patients in treatment with Psychodrama, assessed for 6
months during a long term psychotherapy process. The mean age of the sample is 49 years
(range 27-60), and 50% are women. To outcome evaluation we administered the self-report:
IIP-32, R-SES, ASQ, OQ-45, SCL-90, to process evaluation we used the Group Questionnaire.
Results: The first exploratory analyzes showed some significant changes in outcome
measures analyzed and different correlations with the group process. Discussion: The results
of this study are an interesting deepening about the specificity of the technique
psychodrama than other psychotherapeutic models that allows you to develop some
thoughts about its use in the clinical setting.
The Analysis of the Effects of Psycho-scene-drama Promoting College Poor Freshmen's
Psychological Capital
Xuyang Deng, Southeast University; Zhang Shuo; Xiaofei Qu
Objective: To promote the psychological capital level of college poor freshmen through the
psycho-scene-drama group counseling. Methods: Integrated psycho-scene-drama, including
warming-up, music, painting, performing, discussing, sharing and other specific methods
were used. At the same time, this paper adopted questionnaire as an evaluation method
before and after the test, and to compare with the control group. Results: 1. The
experimental group's total scores and four dimensions of psychological capital in post-test
were significantly higher than pre-test (p<0.001, p<0.01, p<0.01, p<0.001, p<0.05). 2. The
differences in total scores of psychological capital and the scores of self-efficiency, hope, and
optimism dimensions between pre-test and post-test of the control group were not
significant(p>0.05, p>0.05, p>0.05, p>0.05) . But the difference in resilience was to some
extent significant (p<0.05). 3. The differences in total scores and four dimensions of
psychological capital between experimental group's and control group's pre-test were not
significant (p>0.05). 4. The experimental group's total scores of psychological capital and the
151
scores of self-efficiency, hope and optimism dimensions in post-test were significantly higher
than control group (p<0.01, p<0.01, p<0.05, p<0.05). But the difference in resilience was not
significant (p>0.05). Conclusion: The effect of psycho-scene-drama promoting the level of
poor college freshmen's psychological capital is remarkable.
Is Psychodrama Effective for patients with anxiety disorders -- preliminary results of a
research
Galabina Petrova Tarashoeva, Mental Health Center prof. N. Shipkovenski
Psychodrama is becoming a popular method for psychological treatment in Bulgaria in the
last 20 years. However there are no scientific evidences of its effectiveness in Bulgarian
public system for Mental Health Care. The main goal of the project is to conduct an
experimental study that researches the effectiveness of Psychodrama for patients with
anxiety disorders. Two psychodrama groups with patients with anxiety disorders / Neurotic,
stress-related and somatoform disorders (F40-F48) consecutively run in City Mental health
Center "Prof. Dr Nikola Shipkovensky", Sofia, Bulgaria. The psychodrama groups are directed
by a team of 2 certified psychodramatists, in 3 hours session once weekly. Each group starts
with 10 -- 12 patients with anxiety disorders and works 6 months -- 25 group sessions. In
parallel with each one psychodrama group we have control group with the same number of
patients -- 10 -- 12, with anxiety disorders receiving pharmacotherapy Every one of the
patients - in the therapy group and in the control group continue to receive his/her
pharmacotherapy and regular treatment from his/her psychiatrist
54.
Brief Paper Session
Process
Moderator: Ottilia Klipsch,
University Hospital, Heidelberg,
Germany
Etiological/change mechanisms
Symbolization and reprocessing of suicidal ideation in young adult women with attempted
suicide on the basis of their participation in a process of psychotherapy
Xochitl Vazquez, Instituto Tecnólógico de Estudios Superiores de Occidente (ITESO A.C.)
Objective: To obtain systematic information about the process of symbolization and
elaboration of the suicidal ideation in young adult women with attempted suicide on the
basis of their participation in a psychotherapeutic process, to identify risk factors, protective
factors and prevention related to suicide attempts in this population.Subjects: Women
between 21 and 29 years old who have had attempted suicide in the past two years and are
looking to engage in a psychotherapeutic process.Methodology: From the framework of the
qualitative methodology a triangulation will be done from a inductive approach based on:
the observation, comprehension and interpretation with a systematic, deductive and
152
abstract approach of the representation of reality. From Action Research 10
psychotherapeutic session of 6 subjects will be analysed. The psychotherapies will be
conducted by 6 psychotherapists. From analysis of the speech the following methodologies
will be used: The algorithm of David Liberman in its modality for the systemization of the
narratives from the psychoanalytic approach following Maldavsky. Analysis of the speech and
the speech acts. Phenomenological-existential Analysis. Hermeneutical analysis. Construction
of case from a clinical point of view.Expected Results: Characterization of the process of
symbolization and reprocessing in the basis of participation in a psychotherapeutic process .
Methodological guidelines of driving the psychotherapeutic process . Documents that
contain the findings about the particularity of the suicidal act and possible ways to prevent it.
Selective Attention in Patients with Panic Disorder
Ottilia Klipsch, University Hospital, Heidelberg, Germany; Henning Schauenburg; Christoph
Nikendei; Ulrike Dinger
Aim: Selective information processing is supposed to maintain and increase the vulnerability
for anxiety disorders (Van Bockstaele et al., 2014). Although research has consistently
revealed a robust threat-related attentional bias in patients with anxiety disorder (Bar-Haim
et al., 2007), there is empirical ambiguity in determining whether the attentional bias is
comprised of facilitated attention to threat, difficulty in disengagement from threat or both
as well as during which stage of information processing these mechanisms occur (Cisler et
al., 2010). Also, there is a lack of studies examining the influence of patients´ characteristics
on the attentional bias, like attachment security which may function as a protective factor.
This study focuses on the relationship of attachment styles and selective attention to panicand attachment-related words at an early stage of processing in female patients with anxiety
disorder. Method: N=44 female patients with panic disorder and/or agoraphobia filled out
questionnaires on attachment styles (ECR-RD, Ehrenthal et al., 2009), panic-related
symptoms (ACQ, Ehlers & Margraf, 2001), depression (BDI, Hautzinger et al., 2006) and
anxiety (STAI, Laux et al., 1981). Then, the Panic Disorder Severity Scale (PDSS, Shear et al.,
1997) and the Adult Attachment Interview (AAI, George et al., 2002) were administered.
Before concluding the AAI, the patients completed a reaction time based task (Dot Probe
Task, e.g. Dewitte et al., 2007) on a computer. The stimulus material comprised of 4
categories: attachment-negative AN, attachment-positive AP, neutral N and panic-related PR
adjectives. The attentional bias scores indicate attentional orienting and disengagement in
relation to the valence of the stimuli. Results: The manipulation check shows the activation
of the attachment system. Patients vigilantly attend to panic-related words in incongruent
trials. Attachment avoidance is associated with less difficulties in disengaging attention from
panic-related stimuli, attachment anxiety is correlated with more difficulties in disengaging
attention from attachment-positive words. Questionnaire- and observer-based panic
symptoms (ACQ, PDSS) are differently associated to the orienting and disengaging of
attention to panic- and attachment-related stimuli. BDI, STAI and age are controlled for as
153
confounding variables. Discussion: Despite a general attentional bias towards threat,
inconsistent findings on the mechanisms underlying the bias as well as the temporal
description of the characteristics of the attentional bias are reported. Further research
should also test the association of different components of the attentional bias with patients´
characteristics as well as the ability to predict clinically-relevant aspects of emotional
responding.
The cognitive change process in CBT - The analysis of cognitive restructuring and cognitive
errors in two contrasting cases of moderate depression
Nuno Peres Sousa, Maia University Institute - ISMAI; Anita Santos; João Salgado
Cognitive-behavioral therapy (CBT) effectiveness has been studied over the last decades and
its findings are well known. However, studies focusing on the change process are scarce,
especially when compared to experiential and constructivist therapies. Thus, taking into
account the high dissemination of CBT, process research studies seem to be of the most
importance in order to understand how and under which mechanisms CBT works. Our aim is
to develop an observational process coding system that enables researchers to identify the
use of the prime CBT technique, cognitive restructuring (CR), throughout the therapeutic
process. This procedure will help to understand the processes involved in cognitive change in
CBT, as well as to clarify the CR technique for trainees and supervisors. This study aims to
map the CR throughout two contrasting clinical cases of moderate depression, from the
ISMAI Depression Project; to analyze the way CR is adapted to the patients' responses and
the way therapist return to it; to relate CR to the change in cognitive patterns of thinking.
Participants were involved in CBT manualized treatment for depression with supervision. One
was categorized as recovered and the other as unchanged. Cases will be coded with the CR
coding system and with the Cognitive Errors Rating Scales (CERS; Drapeau & Perry, 2010).This
is an ongoing research and authors expect that the use of CR by the patients could be
different in the recovered and in the unchanged case. In the first one we expect that a
significant change will occur in the cognitive errors presented from the beginning to the end
of therapy. Implications for practice and training of CBT therapists will be discussed.
Predictors of remission of suicidal ideation in depressed and/ or anxious outpatients: The
Leiden Routine Outcome Monitoring Study
Anke Schat, Leiden University Medical Centre
Thoughts of suicide frequently occur among patients with mood and anxiety disorders.
Suicidal ideation reflects severe suffering and may lead to suicide attempts, as such it is
targeted in treatment guidelines. Although in some patients, these thoughts subside during
treatment, in others, they persevere. Numerous studies have focussed on predictors of
attempted or completed suicide as well as the predictive value of SI for completed suicide
154
but relatively little attention has been paid to predicting the course of SI. As identifying
patients at risk of sustained SI could aid treatment, this is an important topic. In this study we
used routinely collected data of 777 outpatients diagnosed with depression and/or anxiety
who had suicidal ideation as measured with item 10 of the Montgomery Asberg Depression
Rating Scale (MADRS). Up to 2 years of follow-up data were analysed with univariable and
multivariable survival analysis to identify predictors of remission of suicidal ideation. Results
demonstrated that the course of suicidal ideation is best predicted by a combination of age,
gender, education level, baseline depression scores, self-harm and general health perception.
Patients with low education levels had 14% less chance of achieving remission; a single
standard deviation (SD) increase in baseline depression scores (adjusted MADRS)
corresponded to a 16% decreased chance of remission. One SD increase on the dimensional
assessment of personality pathology- short form (DAPP-SF) self-harm scale corresponded to
a 23% reduced chance of remission of suicidal ideation; finally, one SD increase in short form36 (SF36) general health perception scores corresponded to an 8% reduced chance of
remission of suicidal ideation. Although the overall predictive value of our model was limited
(c=0.6), our results underpin the needs of those patients with suicidal ideation who have low
education levels, more severe depression, who self-harm and who have low general health
perception.
Mentalization in the Framework of Adult Attachment and Interpersonal Behavior
Markus C. Hayden, Alpen-Adria Universität, Klagenfurt; Pia K. Müllauer; Sylke Andreas
Aim: Studies on mentalization have been promoted for the last decades, yet its impact on
different fields of human perception and behavior has not been examined sufficiently. As the
ability to mentalize enables a person to understand and interpret him-/herself as well as
other people, it is conceivable that it plays a key role within close interpersonal contact.
Thus, we hypothesize that mentalization interacts with other factors of human nature that
influence psychological wellbeing, namely attachment patterns as well as patterns of
interpersonal behavior.The aim of our study is, therefore, to further analyze the specific
associations between mentalization, adult attachment, and interpersonal problems in more
detail. Methods: Data was being assessed in two different medical centers and in a
nonclinical population. We surveyed students of different disciplines and patients having
different kinds of mental disorders who were treated in the context of psychosomatic or
psychiatric rehabilitation. Subjects were being examined both by questionnaires
(Mentalizationquestionnaire, Experience in Close Relationships and Inventory of
Interpersonal Problems) and structured interviews (Adult Attachment Interview, Brief Version
of the Reflective Functioning Interview). Results and discussion: We assume specific
associations between the ability to mentalize, attachment patterns, and the types of
interpersonal problems that are experienced. Findings will be discussed at the conference in
the light of mentalization theory and the latest empirical studies.
155
Interactions between interpersonal and symptomatic changes during supportiveexpressive psychodynamic therapy: A systematic case study
Shana Cornelis, Ghent University, Belgium; Mattias Desmet
Aim: In contemporary psychotherapy literature, Blatt's (2004) symptom specificity hypothesis
claims that a patient's personality organization (i.e. predominant anaclithic versus
introjective) determines vulnerability to specific stressors, leading to different
symptomatology. In addition, Luborksy (1984) maintains that personality organization
ultimately boils down to a fixed relationship pattern with a typical "core conflictual
relationship theme" (CCRT). Thus far, studies on specific associations between the
interpersonal and symptomatic level (1) used cross-sectional group designs and (2) yielded
mixed results. Research methods tuned to clinical complexity should be used to further
investigate the symptom specificity hypothesis. Method: This study presents an empirical
case study describing the gradual modification of the CCRT of a patient with severe
obsessional complaints throughout a 26-session expressive-supportive psychodynamic
therapy (Luborsky, 1984) and the associated changes at the symptomatic level. Quantitative
analyses provide graphical evolutions in symptoms, interpersonal functioning, saliva stress
hormones and health care consumption. The CCRT-method (Luborksy & Crits-Christoph,
1998) was used to assess changes at the interpersonal level; subsequently, associations with
changes at the level of symptomatology were studied in a qualitative way. Results: Results
indicate that 1) the patient's symptom was strongly embedded into a disturbing CCRT
primarily characterized by intense ambiguities; 2) significant changes in this CCRT
(predominantly effectuated by supportive interventions) were associated with changes at the
level of obsessional symptoms, emotional suffering, saliva stress-hormones and health care
consumption. Discussion: Results suggest close interactions between the CCRT and
symptomatology in this obsessional patient; no evidence, however, was found for the
symptom specificity hypothesis. Strengths and limitations of the study are discussed.
55.
Brief Paper Session
Alliance
Moderator: Franco F. Orsucci,
University College London,
Cambridge NHS Foundation
Trust, Institute for Complexity
Studies of Rome
Alliance/Relation/Collaboration
Therapeutic collaboration: Impact in alliance development beyond therapies and
outcomes?
Nuno Pires, Universidade do Minho, Braga, Portugal; Eugénia Ribeiro; Luis Janeiro; Inês
Sousa; Helena Azevedo
Aim: Therapeutic alliance has been considered an essential element to treatment outcomes.
Over the last years, the interactional issues have been distinguished as the central core of
alliance, responsible for its quality and strength. We intend to contribute to shed light on the
156
role of the dyadic interactions in alliance development, in Cognitive behavioral therapy and
Narrative therapy. The aims of the study are twofold: (1) to analyze the impact of therapeutic
collaboration in alliance evolution and (2) to understand the dyadic interactions unfolding
during therapeutic session. Method: We study the first four sessions of 10 good outcome and
10 poor outcome cases, of outpatients with depression. All sessions were coded with the
Therapeutic Collaboration Coding System (TCCS) in order to describe therapeutic
collaboration. Using the HLM we depicted the interactions' influence in alliance progression.
Through the GLM we modeled the therapist's interventions in the sequence of the client's
responses and vice versa. Results: We found that only the good outcome group showed a
significant impact of collaboration in alliance development. We also found that the
therapeutic collaboration has a different impact on the alliance evolution, taking into
account the type of therapy. The analysis of the therapeutic interactions is still in progress.
Discussion: We will discuss the findings considering the implications for research and
practice.
Understanding relationship in clinical settings: psychophysiological correlates of
therapeutical interactions
Johann Roland Kleinbub, University of Padova, Italy; Arianna Palmieri; Simone Bianco; Alice
Broggio; Marco Sambin
Aim: The increasing need of empirical evidence in support of psychotherapy models
(Chambless & Hollon, 1998) and therapeutic relationship (Gelso & Carter, 1994) has brought
a sizeable proliferation of validation methods. Current paradigms in psychotherapy research
are beginning to look at these phenomena through a clinical and psychophysiological
integrated approach. In existing literature, skin conductance (SC) synchrony has been
associated to higher levels of empathy (Marci et al., 2007; Kleinbub et al., 2012; Messina et
al., 2013). Nevertheless, other studies argue that dyadic concordance does not necessarily
imply just empathic relation, but also more complex patterns of interaction (Thomsen &
Gilbert, 1998; Hernandez et al., 2014), as well as therapy outcome (Ramseyer & Tschacher,
2014).This study is meant to contribute to the existing literature by providing an insight into
the effects of specific psychotherapy dynamic interactions on therapeutic relationship.
Methods: We simultaneously measured SC levels of a therapist-patient dyad during 8 audio
and video recorded psychodynamic psychotherapy sessions. Two judges analyzed the
recordings referring to the codification system of intra-psychic and inter-personal functioning
(respectively ego states and transactions), as outlined by the transactional analysis model.
Results: Preliminary analyses suggest the existence of specific SC activation patterns within
the interaction, related to different kinds of transactions. Moreover, these patterns seem to
evolve together with the clinical relationship. Discussion: Psychophysiological
synchronization appears related to coherent clinical interactions. Furthermore, the presence
of parallelisms between psychophysiological activation and relational modalities opens up
the opportunity to develop empirically based intervention practices.
157
The overcoming of a severe depression through single and group psychotherapy
Diethelm Raff, Center for Psychology and Education, Meilen, CH; Lilly Merz Raff; Fiorenza
Piraccini; Martha Koukkou
The aim of the single case presentation is to shortly discuss the basic theoretical and
practical concepts of our „Center for psychology and education" (Bildungszentrum
Psychologie und Erziehung). Method: we present short vignetta of a 60 sessions of single
psychotherapy plus 60 sessions of group therapy and other activities with a 40-year-old
woman with a severe depression and generalized anxiety. Results and Discussion: We
propose that the following factors were decisive for the therapeutic success: the therapeutic
alliance, collaboration with the patient in making the treatment plan, supportive
psychotherapy, discovering the unconscious goal of the behaviour, restructuring of the
schema as well as the adult's successful self-management on an outpatient basis. Essential
was that all of this takes place within an equal and trustful sociotherapeutic setting and on a
voluntary basis.
Unique Characteristics of Working Alliance in Relation to the Client's Subjective Evaluation
of the Outcomes of a Separate Session of Gestalt Therapy
Marina Aralova, Southern Federal University; Illia Mstibovskyi
Aim: Study the unique characteristics of the working alliance, the client's subjective
evaluation of the outcomes of a separate Gestalt therapy session and identify the
interconnections between them.Objectives: (1) Methodologically substantiate the
interconnections between the unique characteristics of the working alliance and the
outcomes of a separate Gestalt therapy session; (2) Develop instruments to assess the
working alliance and the client's subjective evaluation of the outcomes of a separate session;
(3) Identify the interconnections between the phenomena in question.Methods: Use of
Working Alliance Inventory (WAI), which we are currently adapting for Russia.Development
and application of a special questionnaire for the working alliance in Gestalt
therapy.Unconstrained self-description by the client of the therapy session outcomes and the
application of content analysis to single out the main parameters for session
evaluation.Procedure of tripartite subjective evaluations of a session (client, therapist and
observer).Testing analysis procedures that will enable to identify the interconnections
between the unique characteristics of the working alliance and the session
outcomes.Results: The project is currently ongoing. At present we are working on the
instruments and putting the proposed procedures to test on 9 groups consisting of Gestalt
therapists, clients and observers.Discussion: Currently, studies of psychotherapeutic efficacy
focus more on the therapy outcomes in general than on the outcomes of a separate session.
This is quite justified, but from the perspective of a practitioner it is a separate therapy
session that more often comes under scrutiny. The client's perception of its outcomes and
the quality of the working alliance seem to be among the most important factors that
158
characterize a successful therapy session. These all determine the relevance of the project
objectives.
Dynamical models of love, a systematic review. Towards a deeper understanding of what
maths can bring to psychotherapy research.
Complexity Studies of Rome; Giulio de Felice
Since the late 80s there has been a gradual increase in the production of scientific literature
on mathematical models of love relations. There has been a gradual evolution in their nature
as well: some are sort of 'mathematical recreations' while others are aiming to 'serious'
psychosocial modelling. However, it is unclear how much of the psychological evidence on
love is considered in its mathematical modelling. This systematic review is aiming to verify
how much dynamical models of love are considering its psychological evidence. Results
support a better integration and synergy between empirical research and mathematical
modelling of love dynamics allowing to explore new methodological tools to understand the
dynamics of change in psychotherapy.
56.
Plenary
Saturday | 5:00 PM-6:30 PM | HS A (Auditorium)
Closing Plenary
“Psychotherapy – The Future of Diversity”,
Visions for SPR-EU
Franz Caspar, University of Bern, Switzerland; Eva Baenninger-Huber, Institute of Psychology,
University of Innsbruck, Austria; Wolfgang Tschacher, Wolfgang Tschacher, Universität Bern;
Henning Schauenburg, UniversitätsKlinikum Heidelberg, Germany; Stig Poulsen, Stig Poulsen,
University of Copenhagen, Denmark
159
Author Index
Participants/Session No.
Aas, Benjamin: 41
Ablon, Stuart J.: 31
Ahrends, Lea: 35
Aichhorn, Wolfgang: 41
Aleksandrowicz, Jerzy Witold: 31,
34
Ãlvarez, Alejandra: 31
Alves, Daniela: 16
Alves, Paula: 31
Andersson, Gerhard: 47
Andreas, Sylke: 4, 13, 17, 24, 30,
31, 54
Andreassi, Silvia: 44
Andrejkovits, Hanna: 31
Andrejkovits, Helga: 31
Angeloni, Federica: 10
Antunes, Natalia: 42
Aralova, Marina: 55
Argawalla, Puspa: 51
Ashworth, Mark: 31
Atkins, David C: 45
Ausin, Berta: 30
Avdi, Evrinomy: 11, 27
Axelrad Levy, Tamar: 23
Azevedo, Helena: 55
Bados, Arturo: 49
Baenninger-Huber, Eva: 8, 22, 31,
35, 38, 56
Barbosa, Marta: 31, 42
Barcelos, Elisabel Soares: 9
Batista, Joao: 16
Bauer, Stephanie: 29, 45
Beaulieu-Prévost, Dominic: 43
Becker, Irene: 35
Bedics, Jamie David: 45
Beiramar, Ana: 42
Bekes, Vera: 43
Belleville, Geneviève: 43
Ben Yehuda, Ariel: 17
Benecke, Cord: 30, 31
Bents, Hinrich: 31, 32
Bergauer, Reto: 31
Bergmann, Jörg: 49
Betak, Ludvik: 31
Bianco, Simone: 55
Bobrzynski, Jakub: 31
Bock, Astrid: 22, 31, 35
Bodinaku, Blerta: 48
Bonalume, Laura: 52
Braga, Cátia: 16
Brakemeier, Eva-Lotta: 24
Brants, Armands: 31
Bremer, Lydia: 13
Broggio, Alice: 55
Brownell, Philip: 49
Buchheim, Anna: 43, 51
Buchholz, Michael B.: 26, 38, 44
Butler, Sheila: 30, 32
Calovska, Nevena Mitko: 15
Canuto, Alessandra: 30
Caspar, Franz: 16, 22, 32, 52, 56
Cassin, Stephanie: 33
Cernetic, Mihael: 49
Cevelicek, Michal: 31, 46
Chwal, Martyna: 31
Ciavolino, Enrico: 22
Cieplinski, Krzysztof Mariusz: 53
Cohen, Esther: 23
Colli, Antonello: 10, 31
Condino, Valeria: 10
160
Cornelis, Shana: 54
Corrêa, Andriza Saraiva: 31
Costa, Sara: 31
Coutinho, Joana: 31, 42
Crameri, Aureliano: 52
Crawford, Mike: 30
Cruz, Ana: 53
Cumsille, Patricio: 31
Cyranka, Katarzyna: 34
Da Ronch, Chiara: 30
Dally, Andreas: 45
Daniel, Sarah: 13, 33
Daubmann, Anne: 51
de Barbaro, Bogdan: 31
de Felice, Giulio: 44, 55
De Geest, Rosa Maria: 37
de Pascual Verdú, Ricardo: 31
De Smet, Melissa Miléna: 17
Decety, Jean: 31, 42
Dehoust, Maria: 13, 30
Dejko, Karolina: 31
Dembinska, Edyta: 34
Deng, Xuyang: 31, 53
Denscherz, Claudia: 51
Desatnik, Alex: 29
Desmet, Mattias: 21, 37, 54
Di Donato, Veronica: 10, 31
Dinger, Ulrike: 28, 31, 45, 54
Dolezal, Petr: 31
Doron, Adiel: 17
Du, Bao-Chau: 3, 33
Duchin, Adi: 39
Duggal, Chetna: 31, 42
Dümpelmann, Michael: 45
Egloff, Goetz: 31
Ehrenthal, Johannes C.: 45
Eisendle, Philipp: 22
Ekeblad, Annika: 28, 47
Erhardt, Ingrid: 31, 51, 52
Erices, Rainer: 51
Errázuriz, Paula: 28
Erzar, Tomaž: 40
Faccini, Filippo: 10
Falkenström, Fredrik: 28, 47
Feixas, Guillem: 49
Ferstl, Theresa: 30
Fiala-Baumann, Brigitte: 31
Fincke, Janna Ida: 31
Finger-Ossinger, Margit: 7
Fitzpatrick, Marilyn: 31
Flaig, Irina: 31
Flett, Gordon L.: 31
Flößer, Kristina: 20
Flückiger, Christoph: 31
Folke, Sofie: 13
Fonseca, Tiago A. G.: 9
Franzoi, Isabella Giulia: 49
Freitas, Sara: 16
Fricke-Neef, Christian: 45
Froján Parga, María Xesús: 31
Frühauf, Sarah: 52
Furgal, Mariusz: 31
Gablonski, Thorsten-Christian: 24
Gahleitner, Silke Birgitta: 14
Gallucci, Marcello: 22
Galván Domínguez, Nerea: 31
Ganor, Ori: 17
García, Eugeni: 49
Gasseau, Maurizio: 53
Gazzillo, Francesco: 10
Gelo, Omar C.G.: 22, 32, 41, 48
Genova, Federica: 10
Gentile, Daniela: 10, 31
George, Carol: 43
Giri, Himanshu: 36
Glanzer, Otto: 49
Goldner, Limor: 31
Gonçalves, Miguel M.: 16
Götsch, Sigrid: 35
Granieri, Antonella: 49
Grassi, Luigi: 30
Grillmeier-Rehder, Ursula: 7
Guarnaccia, Cinzia: 53
Guay, Stéphane: 43
Guglielmucci, Fanny: 49
Gumz, Antje: 51
Guo, Jinlin: 31
Hagg, Ulrich Peter: 1
Hamburger, Andreas: 31
Hans, Miriam: 30
Härter, Martin: 30
Hartmann, Armin: 20, 32
Hausmeister, Stephanie: 35
Hawa, Raed: 33
Hayden, Markus C.: 13, 54
Heath-Tilford, Adelle: 20
Heidenreich, Thomas: 31
Henriques, Margarida R.: 31
Herrera Salinas, Pablo: 49
Hershkovitz, Yael: 30
Hewison, David: 42
Hewitt, Paul L.: 31
Hilsenroth, Mark: 5, 10, 19, 31, 47
Hirmer, Alban: 31
Hoffmann, Marianela: 31
Høglend, Per: 47
Holma, Juha: 27
Holmqvist, Rolf: 8, 47
Horvath, Adam: 8, 35, 38
Hörz-Sagstetter, Susanne: 31, 51
Huber, Dorothea: 10, 13, 30
Huber, Eva: 31, 35
Huber, Julia: 31
Hüther, Katharina: 43
Hytych, Roman: 46
161
Inslegers, Ruth: 21
Isphording, Sybille: 51
Jäckel, Dorothea: 51
Jaeger, Ulrich: 45
Janeiro, Luis: 55
Janusz, Bernadetta: 31, 42
Jirsa, Viktor: 41
Joechler, Nadia: 17
Johansson, Robert: 47
Józefik, Barbara: 31
Jurkowitsch, Jana-Theresa: 43
Kaartinen, Jukka: 27
Kainz, Günther: 31, 35
Kaiser, Tim: 17
Kallenbach, Lisa: 10
Kanellopoulou, Eleni: 33
Karamba, Theodora: 27
Karlinska-Nehrebecka, Milena: 48
Kartupele, Inga: 31
Karvonen, Anu: 27
Katznelson, Hannah: 13
Kaufhold, Johannes: 10
Kelley, John M.: 31
Kindermann, Sally Sophie: 29
Kindl, Simon: 43
Kirnoha, Hanna: 12
Klasa, Katarzyna: 34
Klasen, Jennifer: 39
Kleinbub, Johann Roland: 55
Klipsch, Ottilia: 54
Klott, Rebecca A: 6
Klug, Guenther: 10, 13
Kober, Hedy: 33
Koehling, Johanna: 45
Koemeda, Margit: 52
Kofler, Barbara: 41
Koller, Andreas: 41
Kompan Erzar, Katarina: 40
König, Ralf: 20
Kostinkova, Jana: 46
Kotte, Silja: 29
Koukkou, Martha: 24, 43, 55
Krall, Johannes: 4, 36
Kriston, Levente: 31
Kröger, Paula: 31
Küchenhoff, Joachim: 51
Kulisek, Robert: 31
Kurri, Katja: 11
Kykyri, Virpi-Liisa: 27
Laireiter, Anton-Rupert: 4, 17, 30,
31
Leibovich, Liat: 31
Leichsenring, Falk: 19, 31, 45
Lenz, Gerhard: 24
Leopizzi, Fiorella: 22
Lerou, Vasileia: 27
Leuzinger-Bohleber, Marianne: 10
Levitt, Heidi: 53
Levy, Raymond A.: 31
Liebherz, Sarah: 31
Lilliengren, Peter: 47
Lindqvist, Karin: 47
Linehan, Marsha: 45
Lingiardi, Vittorio: 10, 31
Livneh, Elad: 15
Loeffler-Stastka, Henriette: 7, 32
Lopes, Sofia Vieira: 9
Lunn, Susanne: 13, 33
Lutz, Wolfgang: 31
Machado, Anabela: 16
Macke-Bruck, Brigitte: 7
Maertens, Michael Martin: 14
Malecek, Melanie: 22
Malone, Patrick: 15
Mander, Johannes: 31
Manojlovic, Jelena: 15
Mar’e, Saed: 17
Marchand, André: 43
Marchena Giráldez, Carlos: 31
Martínez, Vania: 31
Maruniakova, Lenka: 46
Masuhr, Oliver: 45
Matusiak, Feliks: 31
Mayring, Philipp: 41
Mechler, Jakob: 47
Meganck, Reitske: 21
Mellone, Valentina: 10
Mendlovic, Shlomo: 17
Mergenthaler, Erhard: 41
Mertens, Wolfgang: 31, 51
Merz Raff, Lilly: 24, 55
Messina, Irene: 32
Meuldijk, Denise: 30
Michaelis, Daniela: 31
Midgley, Nick: 23, 29
Mielimaka, Michal Wojciech: 34
Mikail, Samuel F.: 31
Miller-Bottome, Madeleine: 13
Minow, Anna-Rahel: 51
Mintrop, Anna: 35
Mischel, Walter: 33
Moessner, Markus: 29, 45
Möller, Heidi: 31, 39
Monsberger, Sabine: 31
Montesano, AdriÃ¡n: 16, 49
Moreno, Darío: 31
Mörtl, Kathrin: 31, 32
Mösko, Mike: 15
Motalova, Katarina: 31, 37
Motro, Michal: 23
Možina, Miran: 36
Mstibovskyi, Illia: 49, 55
Muldner-Nieckowski, Lukasz: 34
Müllauer, Pia K.: 13, 54
Munoz, Manuel: 30
Muntigl, Peter: 2, 8, 26, 38
Mylona, Anna: 27
Negri, Attà: 52
Nehrebecki, Andrzej: 48
Nikendei, Christoph: 31, 54
162
Nikolic, Gordana: 31
Ochsner, Kevin: 33
Oliveira, Ana Luísa: 53
Oliveira, André: 42
Oliveira, Joao: 16
Oliveira-Silva, Patrícia: 31, 42
Orlinsky, David E: 39
Orsucci, Franco F.: 41, 44, 55
Ortega, Diana: 36
Oudijk, Renée: 31
Päivinen, Helena: 27
Palmieri, Arianna: 55
Paraskevopoulos, Evangelos: 27
Parth, Karoline: 7
Paz, Clara: 49
Pedersen, Signe Holm: 13
Penttonen, Markku: 27
Peräkylä, Anssi: 2, 8, 26, 38
Pereira, António: 16
Perrone, Kristin: 31, 42
Pfleiderer, Stefan: 49
Philips, Björn: 47
Pinto, Dulce: 8
Piraccini, Fiorenza: 24, 43, 55
Pires, Nuno: 31, 55
Plosz, Valerie: 35
Plümer, Paul: 13
Pokorny, Dan: 31, 37, 43, 48
Poljanec, Andreja: 40
Pöll, Michael Sebastian: 35
Poudziunas, Inta: 31
Poulsen, Stig: 4, 13, 25, 33, 56
Qu, Xiaofei: 31, 53
Quirk, Alan: 30
Rabung, Sven: 19, 31, 45
Raff, Diethelm: 24, 55
Ramseyer, Fabian: 22
Rath, Sophia Kes: 6
Ratzek, Melanie: 10
Raz, Alon: 49
Reatto, Licia Lea: 29
Regev, Dafna: 31
Reichholf, Katharina: 13
Renner, Walter: 43
Ribeiro, Eugénia: 8, 16, 31, 55
Rihacek, Tomas: 31, 46, 52
Ristucci, Chiara: 10
Rodrigues, Débora: 31
Rodzinski, Pawel: 34
Rojas, Graciela: 31
Rønnestad, Michael Helge: 39
Rotenstein, Ora: 30
Roubal, Jan: 49, 52
Rozic, Tatjana: 40
Rozworska, Karolina: 31
Rutkowski, Krzysztof: 34
Sales, Célia: 31, 53
Salgado, João: 54
Samardzic, Ljiljana: 30, 31
Sambin, Marco: 55
Santos, Anita: 54
Santos-Olmo, Ana-Belen: 30
Scarpellini, Giulia: 29
Schambron, Fabian: 43
Schat, Anke: 54
Schauenburg, Henning: 4, 13, 18,
25, 28, 31, 32, 45, 54, 56
Schiepek, Günter: 41, 44
Schiestl, Cathrin: 35
Schigl, Brigitte: 14
Schilcher, Christine: 17
Schiller, Birgitta: 31
Schimmenti, Adriano: 49
Schlipfenbacher, Carina: 51
Schröder, Thomas: 20, 39, 46
Schulthess, Peter: 31, 52
Schulz, Holger: 13, 15, 30
Sedláková, Hana: 31
Seganti, Andrea: 44, 49
Segovia, Aitana: 31
Sehner, Susanne: 30
Seikkula, Jaakko: 27
Seilonen, Minna-Leena: 11
Sell, Christian: 31
Senft, Birgit: 24
Serdtse, Yan: 23
Seybert, Carolina: 13, 31
Shahar, Golan: 15
Shalev, Arieh: 30
Sheets, Jr., Raymond L: 6
Shuo, Zhang: 31, 53
Silhanova, Zuzana: 46
Silva, Carla: 42
Silva, Joana: 16
Silva, Paulo: 42
Smiatek-Mazgaj, Bogna: 34
Snir, Sharon: 31
Sobanski, Jerzy A: 34
Sockalingam, Sanjeev: 33
Sokoli, Elvisa: 48
Sommerfeld, Jörg: 30
Sousa, Inês: 16, 55
Sousa, Nuno Peres: 54
Spiegler, Andreas: 41
Spiel, Georg: 24
Stabingis, Ansis: 31
Steiger, Howard: 31
Steinert, Christiane: 45
Steinmayr-Gensluckner, Maria: 31
Štěrbová, Monika: 46
Stigler, Michael: 31
Stiles, Bill: 8, 16
Stojanovic, Slobodan: 31
Strasser, Peter: 41
Streeck, Ulrich: 45
Strehle, Jens: 30
Stupiggia, Maurizio: 43
Suling, Anna: 30
Sun, Linlin: 31
Symeonidou, Anna: 27
163
Szyszkowitz, Traudl: 31
Tækker, Louise: 33
Talia, Alessandro: 13
Tarashoeva, Galabina Petrova: 53
Taubner, Svenja: 7, 13, 30, 31, 32,
39, 51
Thell, Nataliya: 26
Tholander, Michael: 8
Thurin, Jean-Michel: 31
Thurin, Monique: 31
Tischler, Judith English: 31
Tishby, Orya: 23, 28, 39
Tobia, Valentina: 29
Toivonen, Heidi: 11
Tomicová, Hana: 31
Tong, Wei: 31
Tóth, Erzsébet Fanni: 31
Treger, Bartosz: 31
Tritt, Karin: 17
Truijens, Femke L.: 21, 37
Tsatsishvili, Valeri: 27
Tschacher, Wolfgang: 22, 44, 56
Tschuschke, Volker: 52
Ukropova, Lucia: 31
Unger, Agnieszka Katarzyna: 29
Valentino, Pomini: 36
Vall, Berta: 27
Van Nieuwenhove, Kimberly
Lucienne Helga Danny: 43
van Rijn, Biljana: 32
Vasco, António Branco: 9
Vasconcelos, Cátia Sofia: 8
Vazquez, Xochitl: 54
Verde, Pier Christian: 44
Vestberg, Robert: 28, 47
Viliuniene, Rima: 32
Viol, Kathrin: 41
Volkert, Jana: 4, 30
von Wolff, Alessa: 31
von Wyl, Agnes: 52
Voutilainen, Liisa: 26, 38
Vybiral, Zbynek: 37
Wahlström, Jarl: 11, 27
Waldron, Sherwood: 10
Weber, Kerstin: 30
Wegscheider, Karl: 30
Weiste, Elina: 26
Wieser, Elke: 31
Wieser, Michael: 32, 53
Will, Andreas: 10
Wiseman, Hadas: 20, 39
Wittchen, Hans-Ulrich: 30
Wnuk, Susan: 33
Young, Courtenay: 31, 50
Young, Richard: 31
Zaharia, Catalin: 41
164
Zdenka, Zalokar Divjak: 17
Zeeck, Almut: 20
Zeldovich, Marina: 17
Zhang, Jing: 31
Zilcha-Mano, Sigal: 28, 31
Zimmermann, Johannes: 24, 30
Ziv Beiman, Sharon: 15
Znoj, Hansjoerg: 22

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