Arnold Winston

Continuum Health Partners | CHP · Department of Psychiatry and Behavioral Health

This study aimed to determine how control charts ‐ a form of time‐series line graphs ‐ can be implemented in psychotherapy research to indirectly identify probable rupture‐repair episodes that are associated with psychotherapy outcome. There is no current standard in psychotherapy research with regard to how to use control charts to identify ruptur...

The working alliance is one of the most consistent predictors of outcome. Yet, little empirical knowledge exists on how therapists can use this association to maximize the outcome of cognitive behavioral therapy (CBT) for individual clients. The present study aimed to examine pre-treatment client interpersonal characteristics that determine what fu...

Objective: It has been demonstrated that patient perspective on alliance can predict subsequent treatment outcome as reported by the therapist, but not the other way around. This study aimed to investigate the circumstances in which therapists can provide estimations of alliance capable of predicting patient perceptions of subsequent session outcom...

Objective: Better alliance is known to predict better psychotherapy outcomes, but the interdependent and interactive effects of both therapist- and patient-reported alliance levels have yet to be systematically investigated. Method: Using actor-partner interdependence model analysis the authors estimated actor, partner, and 2 types of interactiv...

Objectives: The Adult Attachment Interview (AAI) has been the gold standard of attachment assessment, but requires special training. The Relationship Scales Questionnaire (RSQ) is a widely used self-report measure. We investigate how each correlates with brain activity during appraisal of subjects’ mothers. Methods: Twenty-eight women were scored o...

In two National Institute of Mental Health (NIMH)-funded studies, our program has developed alliance-focused treatment and training (AFT) protocols and has demonstrated their beneficial effect on treatment resistance and interpersonal process in psychotherapy. AFT is founded on relational principles derived from research on cognitive, affective, an...

Objective: In this article we present preliminary findings from a research program designed to investigate the value of alliance-focused training (AFT), a supervision approach designed to enhance therapists' ability to work constructively with negative therapeutic process. Method: In the context of a multiple baseline design, all therapists bega...

Abstract This study examined the relationship of pre-treatment personality disorder diagnosis to the quality of early therapeutic alliance in 145 patients randomly assigned to either cognitive behavioral therapy or brief relational therapy. The pre-treatment diagnosis was established by DSM-IV (SCID) and Wisconsin Personality Inventory. Quality of...

Objective measurement of depression remains elusive. Depression has been associated with insecure attachment, and both have been associated with changes in brain reactivity in response to viewing standard emotional and neutral faces. In this study, we developed a method to calculate predicted scores for the Beck Depression Inventory II (BDI-II) usi...

Insecure attachment has been linked to depression and to outcome in psychotherapy. The neural mechanisms subserving the relationship between attachment security and depression are not well understood. We have developed a method to examine attachment-related brain activity in depression. Twenty-eight women, half depressed, viewed images of their mot...

Background / Purpose: Objective measurement of depression remains elusive. Depression has been associated with insecure attachment, and both have been associated with changes in brain reactivity in response to viewing emotionally significant faces. Non-linear methods are limited by need for large samples versus risk of over-fitting the data as we...

Background / Purpose: Insecure attachment has been linked to depression and to outcome in psychotherapy, but the neural mechanisms subserving the relationship between attachment security and depression are not well understood.Depression and insecure attachment are subserved by overlapping components of circuits previously identified in studies of...

This study examined the relationship of early alliance ruptures and their resolution to process and outcome in a sample of 128 patients randomly assigned to 1 of 3 time-limited psychotherapies for personality disorders: cognitive-behavioral therapy, brief relational therapy, or short-term dynamic psychotherapy. Rupture intensity and resolution were...

The aim of the study described in this paper was to develop a method for measuring the therapeutic alliance from an intersubjective perspective and to evaluate the efficacy of the measure in predicting psychotherapy outcome. We conducted the study using data from 22 patient-therapist dyads engaged in a 30-session protocol of a brief relational ther...

The aim of this study was to investigate the interrelationships of three measures of the therapeutic relationship and their validity in predicting treatment outcome, including the early identification of two treatment-failure conditions. Forty-eight patient-therapist dyads, in 30-session therapies for personality-disordered patients, were classifie...

We examined the relevance of the level and pattern of the therapeutic alliance in 44 cases of three different, manualized 30-session treatments using patient ratings of the Working Alliance Inventory after each session. It was hypothesized that both high-alliance level and either a linear increase in alliance rating or a series of brief rupture-and...

This study assessed introject and attachment styles of patients and therapists, and the match of these styles in patient/therapist dyads, to determine their relation to various psychotherapy process and outcome measures. The INTREX was used to measure introject style (affiliation and autonomy) and the Relationship Scale Questionaire to measure atta...

This article describes a pilot study evaluating the feasibility of an ap-proach developed to test the efficacy of a therapeutic intervention (brief rela-tional therapy) for patients with whom it is difficult to establish a therapeutic alliance. In the first phase of the study, 60 patients were randomly assigned to either short-term dynamic therapy...

This paper presents a study with the aim of evaluating the relative efficacy of an alliance-focused treatment, brief relational therapy, in comparison to a short-term dynamic therapy and a cognitive-behavioral therapy on a sample of highly comorbid personality disordered patients. Results indicated that the three treatments were equally effective o...

Psychotherapy and psychopharmacology should be considered as 2 alternative or complementary treatment approaches, not as antithetical to each other. Studies of potential negative interactions of these 2 techniques have demonstrated none. A number of positive benefits have, however, been found. Studies that look at combined treatments have generally...

The authors argue for an integrated model of brief psychotherapy that includes psychoanalytic and cognitive-behavioral approaches, as well as pharmacotherapy when necessary. The use of such a model gives the clinician the opportunity to tailor the treatment to the individual patient using differential therapeutics. In implementing a differential th...

This article presents an integrated conception of the self based on cognitive and interpersonal theories. Implications for clinical practice are outlined, which include understanding the therapeutic relationship as a laboratory and change as involving self-expansion. Implications for clinical research are also presented and exemplified by two strat...

Patients with dysthymia have been shown to respond to treatment with antidepressant medications, and to some degree to psychotherapy. Even patients successfully treated with medication often have residual symptoms and impaired psychosocial functioning. The authors describe a prospective randomized 36-week study of dysthymic patients, comparing cont...

As a substudy of a manual-based outcome study of the Beth Israel Brief Psychotherapy Program, the authors studied the efficacy of supportive psychotherapy in personality change, with particular attention to changes that outlast the period of treatment. They examined results from the Inventory of Interpersonal Problems (IIP) at intake, 40th-session...

Interpersonal Scenarios involve the construction and use of idiographic vignettes to assess the self in an interpersonal context. Constructed from a semistructured clinical interview, these scenarios represent prototypical patterns of how individuals interact with others when at their best and worst. They can be rated by patients on seven parameter...

Early sessions of patients categorized as dropouts (n = 25), good outcome (n = 28), and poor outcome (n = 20) completers of a 40-session protocol of short-term psychotherapy were compared to determine predictive validity of in-session measures of therapeutic alliance and interpersonal behavior (Working Alliance Inventory, Session Evaluation Questio...

The authors report preliminary results of Brief Supportive Psychotherapy (BSP) in the Beth Israel Brief Psychotherapy Program for a sample with primarily Cluster C Axis II disorders. This study compares 24 patients treated with BSP with 25 patients treated with Short-Term Dynamic Psychotherapy (STDP). STDP was chosen because its confrontational met...

The scale was developed with support from the National Institute of Mental Health (MH50246). It is a 44-item observer-based measure of therapist adherence to three time-limited psychotherapies in the Beth Israel Brief Psychotherapy Research Program: a integrative relational, a short-term dynamic, and a cognitive-behavioral model. It also includes a...

Based on increasing recognition that the therapeutic relationship is critical in psychotherapy, the goal of this study was to establish the psychometric properties of a suboutcome strategy that could identify important in-session events involving patient-therapist interactions. Ten third-party observers were calibrated on a circumplex measure of su...

Anxiety disorders are among the most frequently diagnosed group of psychiatric disorders in the general population. Although anxiety disorders are often comorbid with depression and personality disorders, they rarely culminate in psychosis. Having observed psychosis in the course of a severe panic attack, the authors prospectively identified four p...

1. The objective was to assess long-term efficacy of antidepressant medications in dysthymia. 2. In a naturalistic study, patients with DSMIII-R dysthymia who had participated in previous antidepressant trials with fluoxetine and trazodone were evaluated at a mean of 40.0 weeks of follow-up to assess whether medication response persisted over time....

To better understand the mechanisms of change in psychotherapy, it is important to validate suboutcome measures that represent intermediate links between more molecular in-session changes and ultimate outcome. The present study involved the collection of pre- and postsession ratings from 53 patients in a 20-session protocol of cognitive therapy, wh...

This article investigated the mechanisms underlying associations between patients' contribution to the alliance and outcome by examining relations between change in the alliance over the course of treatment and improvement in Short-Term Dynamic Psychotherapy (STDP) and Brief Adaptive Psychotherapy (BAP). Findings for STDP were consistent with 1 mod...

To better understand the mechanisms of change in psychotherapy, it is important to validate suboutcome measures that represent intermediate links between more molecular in-session changes and ultimate outcome. The present study involved the collection of pre- and postsession ratings from 53 patients in a 20-session protocol of cognitive therapy, wh...

Studied patient defensive behavior and therapist addressing defense (TAD) in short-term dynamic psychotherapy and brief adaptive psychotherapy in 28 adult patients with personality disorders. Three levels of patient defense (immature, intermediate, and mature) were coded. Only intermediate defensive behavior such as intellectualization and rational...

The efficacy of short-term psychotherapy has become an area of increasing interest. The primary objective of this study was to assess the results of two forms of short-term psychotherapy in patients with personality disorders. Eighty-one patients with personality disorders were randomly assigned to brief adaptive psychotherapy, short-term dynamic p...

1. There is increasing evidence that many patients with major depression also have coexisting dysthymia, and that antidepressant treatment may alleviate both conditions. 2. Open-label study of fluoxetine and trazodone for 18 patients meeting DSM-III-R criteria for concurrent dysthymia and major depression. 3. Fourteen patients completed three-month...

The purpose of this study was to assess the efficacy of fluoxetine, a selective serotonergic antidepressant, in the treatment of dysthymia. Thirty-five patients who met criteria for dysthymia, but not major depression, began randomized, double-blind 8-week trials of fluoxetine or placebo. Of 32 patients who completed the study, 10 (62.5%) of the 16...

The study of immediate in-session processes and outcomes as possible change events as they vary across context has become an important research focus. In this paper we examined transference and nontransference interpretations, as well as clarifications (in-session processes) followed by patient affect or defensive behavior (in-session outcomes). Tr...

A number of medications have been reported to induce psoriasis. We report two cases of fluoxetine-related psoriasis and discuss similarities between lithium-, trazodone hydrochloride-, and fluoxetine-induced psoriasis. Two women being treated for depression with fluoxetine developed psoriasis after 6 and 12 months' exposure. This time frame is clin...

There is increasing evidence that antidepressants may alleviate symptoms of dysthymia, but few prior studies on selective serotonergic agents. Twenty patients meeting criteria for dysthymia, but not meeting criteria for major depression, received open label trials of a serotonergic antidepressant, either fluoxetine or trazodone. Seventeen (85%) com...

This study examined the effects of therapist confrontations and clarifications on patient defensive and affective responding in short-term dynamic psychotherapy. Four videotaped therapy sessions from each of 16 patients were coded on a per-minute basis for the occurrence of selected patient and therapist variables. Contrary to prediction, no signif...

Examined therapist–patient interactions in 16 cases of brief psychotherapy. Three types of therapist intervention (patient–therapist interpretations, patient–significant other interpretations, and clarifications) were compared in terms of the frequency of patient affective or defensive behavior that occurred in the 3 min following each. Therapist-i...

Thirty-two patients with personality disorder diagnoses were randomly assigned to two treatment conditions that vary on several techniques of brief dynamic psychotherapy. Seventeen patients constituted a waiting list control group. The two brief psychotherapies showed significant improvement on target complaints, SCL-90, and Social Adjustment Scale...

Ten outpatients meeting DSM-III-R criteria for obsessive-compulsive disorder completed a 32-week, open-label study with fluoxetine, a selective serotonin reuptake blocker. The patients were evaluated every four weeks for obsessive-compulsive symptomatology, anxiety, and depression. Significant improvement of obsessive-compulsive and anxiety measure...

The current study examined changes in the ratio of patients' affective and defensive behaviors during the course of brief psychodynamic psychotherapy. Treatments of 16 patients were videotaped. For each patient, four sessions were evaluated with a minute-by-minute coding system of process variables. When patients were grouped according to outcome s...

Brief Adaptational Psychotherapy (BAP) is a short-term approach to the treatment of personality disorders that uses as its primary focus the major maladaptive pattern of the patient. Fifteen patients were treated and 16 patients were kept on a waiting-list quasi-control group. Significant differences at termination of therapy were found between the...

NMR water-proton spin-lattice relaxation times were studied as probes of water structure in human red blood cells and red blood cell suspensions. Normal saline had a relaxation time of about 3000 ms while packed red blood cells had a relaxation time of about 500 ms. The relaxation time of a red cell suspension at 50% hematocrit was about 750 ms sho...

Although supportive psychotherapy techniques are more widely used than expressive or insight-oriented techniques, particularly with hospitalized or chronically ill patients, supportive treatment strategies have been underrepresented in the literature and not adequately taught to therapists in training. The authors review the diverse definitions and...

Proton T1 relaxation times of red blood cells were significantly higher in six bipolar depressed patients than in matched normal control subjects before lithium treatment. Times decreased in five of the six patients following 1 week of lithium therapy.

Blood pressure elevation has been reported to be associated with alcoholism and alcohol use. This study assesses changes in blood pressure and risk factors associated with elevated pressures among chronic alcoholics admitted for withdrawal. Blood pressure measurements of 482 patients were analyzed. Both systolic and diastolic pressure decreased sig...

To analyze differences among alcoholics, the authors studied the characteristics of 621 patients admitted to hospital for withdrawal from alcohol in the period October 1979-March 1980. Patients were classified either as using opiates and 'other drugs,' using other, non-opiate drugs only, or using no drugs other than alcohol ('pure' alcoholics). The...

A study was made of the relationship of proton T1 relaxation times and stage of the menstrual cycle. Preliminary data show that these indicators of red blood cell hydration status may be useful as objective markers of premenstrual tension.

Three patients receiving alprazolam developed, within days after beginning treatment, acute excitatory states with features more suggestive of mania than of disinhibition syndrome. The authors suggest a neurochemical link between mania and disinhibitory states.

In response to pressure to assume more responsibility for chronic patients, many general hospitals have asserted that they should limit care to those suitable for voluntary treatment on an open ward. This assertion appears to be based primarily on political and symbolic arguments. The limitation of admission to voluntary patients would serve to exc...

A psychiatric center in Brooklyn provided a socialization program in a community residence for adults discharged from state hospitals and made a study of the program's outcome. Residents on two floors of the home, the experimental group, received an enriched treatment program; those on the other four floors, the control group, received a minimum of...

A residence for adults which primarily houses psychiatric patients who had been hospitalized for many years can be made into a therapeutic living situation. The use of a therapeutic community approach in which patients and staff are encouraged to be open, communicative, and mutually supportive and where problem solving is done in both a relaxed and...

After discussing the problems in teaching clinical psychiatry to medical students, the authors describe the program at the Downstate Medical Center. They pay particular attention to the role of the course coordinator, the priority of medical student education in a department of psychiatry, the value of small group teaching, and the advantages of a...

In their study of the effects of posthospital treatment on psychiatric patients the authors found that those who entered aftercare were rehospitalized less often than those who did not. They found the rehospitalization rate was higher for schizophrenic patients than for patients in other diagnostic groups, and that schizophrenic patients who did no...

Twenty-one paranoid schizophrenics who were being treated in a therapeutic community were divided into groups with grandiose and nongrandiose symptomatology, based on ratings on the Inpatient Multidimensional Psychiatric Scale. The nine nongrandiose patients showed significantly greater improvement during hospitalization. A follow-up of five nongra...

Nineteen black patients were matched with nineteen white patients and treated in individual psychotherapy in an inpatient milieu setting. It was found that black patients did better than white patients during their hospitalization. In addition on a one year follow-up a trend in the same direction was found. Suggested explanations for this were adva...