Mattias Desmet

Ghent University | UGhent · Department of Psychoanalysis and Clinical Consulting

Introduction: Different types of psychotherapy are effective for treating major depressive disorder across groups yet show large within-group differences. Patient personality style is considered a potentially useful variable for treatment matching. Objective: This study is the first experimental test of the interaction between therapeutic approa...

In this paper, we argue (1) that self-report measurement is meaningful. ‘John’, a patient-participant in psychotherapy research, is presented to illustrate meaning-making processes in self-report measurement. We show that neglecting individual scoring processes might lead to invalidation of data. Therefore, (2) we argue that it is vital to actively...

Personality and psychopathology are highly relevant and easily relatable constructs. The current study investigated the relationships between dependency and self-criticism, sociotropy and autonomy depressive personality traits, and Cloninger's temperament and character personality traits postulated as vulnerability factors for depression, in relati...

In this paper, we argue (1) that self-report measurement is meaningful. Case 'John', a patient-participant in psychotherapy research, is used to illustrate meaning making processes in self-report measurement. We show that neglecting individual scoring processed might lead to invalidation of data. Therefore, (2) we argue that it is vital to actively...

In the evidence-based paradigm, measurement is considered the cornerstone of psychological research. Self-report measurement is advocated as reliable means to assess personal experiences, as the standardized items and response scales provide numerical data that are comparable over people. As these measures limit response variation, individual diffe...

Objective: This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliably symptom increase pre-to-post treatment. Method: An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre-post outcome evaluation of self-reported depression symptoms a...

Self-critical perfectionism has been linked to alliance impairments due to patients’ distancing attitudes. However, systematic research on therapists’ emotional experiencing when working with self-critical patients is scarce. This qualitative study explores how therapists perceive, emotionally experience, and react to self-critical patients’ interp...

Case study methods are increasingly recognized as crucial methods to enhance understanding of the complexity of psychotherapy processes and as way to bridge the science-practice gap. The Single Case Archive (SCA) was constructed to facilitate access to the existing field of case study research for academic, clinical, and educational purposes. Cases...

The evaluation and assessment of outcome is an important issue in psychotherapy research and practice. Since the beginning of empirical research, the effectiveness of treatments has been in the focus of interest to optimise mental health care. Despite this importance, the assessment of outcome by pre‐to‐post comparisons of point measures is hampere...

A major challenge in offender therapy is to facilitate clients’ emotional engagement, especially with clients who over-regulate their affect. It has been suggested that treatments that focus on improving clients’ affect regulation (AR) and deepen client’s emotional experience during treatment may enhance treatment outcomes. In this systematic mixed...

In the present paper we examine four cases in which the assumption that “good outcome” necessarily means “good therapy” did not hold. Cases were selected that reported good pre-post outcome (i.e., clinically reliable decrease in symptom severity) but a negative (disappointing) therapy experience, drawn from a randomized controlled trial (the Ghent...

In this theory-building case study, we investigate Blatt’s two-polarity model of personality development according to which psychopathology is a consequence of an unbalance between the two developmental lines of interpersonal relatedness and self-definition. Anaclitic psychopathology, such as schizophrenia, histrionic, dependent, and borderline per...

Quantified symptom measurement by self-report questionnaires is part of the ‘gold standard’ of assessing psychotherapeutic efficacy. In this paper, we report a qualitative case comparison to explore how June and Amy, two patient-participants in a gold standard psychotherapy study, experienced the process of quantitative data collection. The study r...

Objective: To assess the outcome of psychotherapeutic treatments, psychotherapy researchers often compare pre- and post-treatment scores on self-report outcome measures. In this paper, the common assumption is challenged that pre-to-post decreasing and increasing outcome scores are indicative of successful and failed therapies, respectively. Method...

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and...

Research concerning the influence of core interpersonal patterns related to childhood trauma on the therapeutic process is scarce. We investigated interpersonal patterns at the start of treatment, changes in interpersonal patterns as treatment progressed, and the change process in a mixed-methods single case study of a supportive-expressive psychod...

Background: Mental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring me...

Although Blatt's two-polarity model of depression has suggested that patients' interpersonal styles may shape countertransference phenomena in psychotherapy, empirical research on this topic has remained scarce. This article provides an in-depth study of countertransference processes in clinical work with dependent (anaclitic) depressed patients us...

In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon...

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment t...

The conversational actions of reformulating and mirroring constitute some of the core intervention techniques of psychotherapy. The purpose of the present study was to investigate the way in which therapists in cognitive-behavioral (CBT) and psychodynamic therapy (PDT) use reformulating and mirroring strategies to return patients’ prior talk and ho...

Aim: Exploring change processes underlying “good outcome” in psychotherapy for major depression. We examined the perspectives of patients who “recovered” and “improved” (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre–post outcome...

Objective: The current study is part of a multiple case study that investigated the emotional change in individuals who have committed sexual offenses (ISOs). This case study highlights how one client used sex as a maladaptive coping strategy to suppress negative emotions. Method: A mixed-methods design was used to track changes in the client's...

Cognitive and behavioral treatment programs for individuals who have committed sexual offenses (ISOs) have shown significant but small effect sizes. A growing body of research points toward the importance of difficulties in affect regulation (AR) as a risk factor for sexual recidivism. On this basis, it seems important to target difficulties in AR...

This study explored the meaning of "good outcome" within and beyond the much-used statistical indices of clinical significance in standard outcome research as developed by Jacobson and Truax (1991). Specifically, we examined the experiences of patients marked as "recovered" and "improved" following cognitive-behavioral therapy and psychodynamic the...

Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore...

Drawing on Blatt's theory about personality styles, we examined therapists' affective experiences toward depressed patients with dependent (anaclitic) and self-critical (introjective) personality styles. In addition, we investigated the relationship between therapists' responses, symptom severity, and therapeutic change. Therapists (N = 8) complete...

In psychotherapy research, “validity” is canonically understood as the capacity of a test to measure what is purported to measure. However, we argue that this psychometric understanding of validity prohibits working researchers from considering the validity of their research. Psychotherapy researchers often use measures with a different epistemic g...

In psychotherapy research, treatment efficacy is commonly studied by means of self-report questionnaires to gain quantitative data on symptom development. The data serve as input for statistical analyses up to the level of evidence-based treatment. We analyzed how a patient in a psychotherapy study experienced the translation of her story into quan...

Objective: Adult interpersonal difficulties are considered 1 of the core consequences of childhood trauma exposure. However, research concerning the nature of interpersonal patterns associated with childhood trauma is scarce. The aim of this case study of a supportive-expressive psychodynamic therapy with a woman with a traumatic background, is to...

Affect regulation problems have been found to play an important role in the onset of problematic behavior, such as sexual abuse. The role of emotion and maladaptive coping has become relevant in both research and treatment interventions. Forensic treatments have been strongly influenced by conceptualizations of affect regulation that emphasize the...

Dysfunctional interpersonal patterns constitute one of the core features of complex trauma. Supportive-expressive psychodynamic theory operationalises these interpersonal patterns via the core conflictual relationship theme (CCRT), by defining the main wish, response of other and response of self in patients’ habitual ways of interacting with other...

Research and theory over the past 15 years indicate that affect regulation problems may play a role in the onset of sexual abuse. Affect regulation is often described as a developmental task that can be disturbed by attachment problems or traumatic experiences, potentially leading up to different psychological and behavioral problems. This review i...

Transference implies the actualization of the analyst in the analytic encounter. Lacan developed this idea through the syntagm presence of the analyst. In the course of his seminars, however, two completely different presences emerge, with major implications for how the treatment is directed. In the light of Lacan’s idea that the transference is co...

According to the WHO (2012), the prevalence of unipolar depressive disorders is rising, even in those places where mental health treatments are widely available. The WHO predicts that these disorders will be the leading contributor to the global burden of disease by 2030. This sobering projection fits poorly with how psychological treatments for de...

The classical symptom specificity hypothesis (Blatt, 1974) particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; s...

Background Major depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, t...

Transference in perversion is characterized by specific problems such as a defiant and polemic attitude, erotic transference, projections, and aggression. Such transference poses particular problems in the treatment of perversion and might render analytical work with these patients impossible. We propose that Lacan’s L-schema can contribute to sepa...

Sex offenders demonstrate heightened levels of negative emotions, traumatic experiences, mental health issues, and emotion disregulation. This study presents a qualitative analysis of interviews with sex offenders concerning helpful experiences in experiential group psychotherapy. Experiential group psychotherapy aims to increase emotional awarenes...

Background and introduction: In psychotherapeutic research on Evidence-based Treatments (EBTs), treatment efficacy is operationalized as the numerical mean of individual treatment successes. In psychotherapy research, efficacy numbers are derived in randomized controlled trials by symptom measurement with validated symptom measures . ‘Validity’ re...

Both classical and contemporary psychoanalytic theories stress the importance of interpersonal dynamics in treating neurotic symptoms. Associations between the symptomatic and interpersonal level were formally represented in the symptom specificity hypothesis (Blatt, 1974, 2004), which linked obsessional symptoms to an autonomous interpersonal stan...

Dit artikel is een schriftelijke uitwerking van een lezing op de studiedag ‘Psychoanalyse, oude dromen, nieuwe wegen’, die in oktober 2015 georganiseerd werd door het Tijdschrift voor Psychoanalyse. Het thema van de studiedag betrof onder meer de verhouding van de psychoanalyse tot de maatschappelijke vraag om haar praktijk empirisch te onderbouwen...

The aim of this study is to provide an overview of the scientific activity of different psychoanalytic schools of thought in terms of the content and production of case studies published on ISI Web of Knowledge. Between March 2013 and November 2013, we contacted all case study authors included in the online archive of psychoanalytic and psychodynam...

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) research. This ‘golden standard’ design requires samples that are homogeneous with regard to symptom(s) - following from the stat...

Transference in perversion is characterized by specific problems such as a defiant and polemic attitude, erotic transference, projections, and aggression. Such transference poses particular problems in the treatment of perversion and might render analytical work with these patients impossible. The authors propose that Lacan's L-schema can contribut...

La transferencia en la perversión se caracteriza por problemas específicos tales como una actitud desafiante y polémica, la transferencia erótica, proyecciones y agresión. Este tipo de transferencia plantea problemas particulares en el tratamiento de la perversión y puede imposibilitar el tratamiento de este tipo de pacientes. Los autores sugieren...

Right from its beginning single case studies on children and adolescents have been an highly esteemed means of communication in psychoanalysis; from the view of treatment research time and again critical arguments are brought forward. As single case studies may provide relevant answers for detailed process aspects, in this study we present a method...

The aim of this study was to evaluate the psychometric properties of the Dutch version of the Toronto Structured Interview for Alexithymia (TSIA) in a clinical sample. The TSIA and the 20-item Toronto Alexithymia Scale (TAS-20) were administered to 85 psychiatric inpatients and to 76 medical outpatients with the symptom of tinnitus. Both internal a...

Psychoanalytic Single Case Studies of Children and Adolescents: Characterisation with the "Inventory of Basic Information in Single Cases" Right from its beginning single case studies on children and adolescents have been an highly esteemed means of communication in psychoanalysis; from the view of treatment research time and again critical argumen...

In the past several empirical studies have examined the relationship between non-suicidal selfinjury (NSSI) and affect inexpressivity, and have provided mixed results. This led us to the hypothesis that there exist two groups of self-harmers (HS and PS) that differ with respect to affective expression. Methods: To test this we divided a sample of s...

A review of the literature indicates that empirical researchers have difficulty translating Freud's theory on depression into appropriate research questions and hypotheses. In their attempt to do so, the level of complexity in Freud's work is often lost. As a result, what is empirically tested is no more than a caricature of the original theory. To...

During the first half of the twentieth century, psychotherapy research was synonymous to single case research. Research and practice were highly integrated in this era, but to be considered full-fledged scientific research, the case descriptions lacked methodological rigor. From 1970 onwards, the experimental Randomized Controlled Trial (RCT) desig...

In this study, associations between alexithymia, interpersonal problems, and cognitive-structural aspects of internal interpersonal representations were examined. Alexithymia was measured using the Toronto Structured Interview for Alexithymia (TSIA) and the 20-item Toronto Alexithymia Scale (TAS-20). To measure interpersonal problems, the dominance...

This study examines the reliability and convergent validity of 2 versions of the Social Cognition and Object Relations Scale (SCORS), one for use with Thematic Apperception Test narratives (SCORS–TAT; Westen, 1990) and one for use with clinical interview data (SCORS–CDI; Westen, Barends, Leigh, Mendel, & Silbert, 199040. Westen , D. , Barends , A...

Introduction The concept of alexithymia refers to difficulties in identifying and verbalizing emotions, an externally oriented thinking style and a paucity of fantasy. Theoretically and clinically we expect typical ways of regulating affect in alexithymic individuals. The few existing studies on this topic mainly rely on self-report methods, which...

Introduction An increasing amount of outcome research supports the efficacy of Short Term Psychodynamic Psychotherapy (STPP) for a wide range of psychological disorders, reporting effect sizes in meta-analyses between 0.50 and 1.40 (for review see Shedler, 2010). Mapping mechanisms of change in the STPP process can be considered the major challenge...

Introduction The concept of alexithymia refers to problems in experiencing and regulating affects; clinical study as well as empirical research suggests that alexithymia is related to cold and socially inhibited interpersonal functioning. However, empirical studies frequently use only self report questionnaires. Objectives/aims This study investig...

The construct of alexithymia is most frequently measured by means of the 20-item Toronto Alexithymia Scale (TAS-20). However a number of other instruments have been developed to compensate for problems with measuring alexithymia through self-report measures. Convergence between the different alexithymia measures is rarely studied. This study invest...

Using lexical content analysis (linguistic inquiry and word count), the hypotheses that social detachment and impaired cognitive processing are typical for alexithymia are investigated. Based on clinical interviews with 32 outpatients (mixed diagnoses), we found support for the hypotheses for the externally oriented thinking facet of alexithymia on...

Abstract. Aims: Traditionally, non-suicidal self-injury (NSSI) is considered to be a mainly feminine phenomenon. The last decade, however, empirical reports of the gender ratio seem to vary extensively. In this study prevalence, gender ratio and methods of non-suicidal self-injury are assessed, and compared to the findings of contemporary literatur...

Clinical observations and controlled studies indicate that the treatment of alexithymic patients is most difficult. Moreover, stronger degrees of alexithymia predict worse therapy outcome. We argue that in order to make therapy for alexithymia-related disorders fruitful, a conceptualization of alexithymia in terms of interpersonally imbedded affect...