Yves de Roten

• Ph.D.
• Research Director at University of Lausanne

Improvement in interpersonal and defensive functioning are considered central transtheoretical mechanisms that drive symptomatic change in clients with BPD. The current case study illustrates the treatment process and symptom changes in relation to interpersonal functioning, operationalized as the pervasiveness of conflictual relationship themes, a...

Background Borderline Personality Disorder (BPD) is one of the most frequent, severe, mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy. In addition and in order to improve access to care, psychiatric treatments are available. So far, it remains unclear if brief p...

The aims of this study were: (a) to explore the relationships between adaptive defense mechanisms (ADMs), maladaptive defense mechanisms (MADMs), stress, recovery, resilience, and sport burnout; and (b) to examine resilience, stress, and recovery as mediators of the relationship between defense mechanisms and burnout. One hundred and seventy-five a...

Background The focus of this case study was to explore the development of the therapeutic alliance in relation to alliance rupture and resolution and the effect of motive‐focussed psychotherapeutic techniques on this process in the treatment of borderline personality disorder (BPD). Methods Therapeutic alliance rupture and resolution processes wer...

Introduction: Psychotherapy added to usual hospital care is beneficial. This study reports on two contrasting cases, one responder and one nonresponder, from a randomized controlled trial on the effectiveness of intensive and brief psychodynamic psychotherapy (IBPP) for depressed inpatients, in which reduction in depressive severity was maintained...

Statistics is involved in sport curricula, due to its importance in science in general and in sport sciences in particular (see for example the development of specific disciplines such as saber-metrics in baseball). The aim of this study is to investigate attitudes toward the first statistics course − the most relevant predictor for achievement − a...

Background GPs are on the front line for the identification and management of chronic depression but not much is known of their representations and management of chronic depression. Objectives To analyze GPs’ representations of chronic depression and to explore how they manage it. Methods Three focus groups were conducted with 22 French-speaking...

Purpose: Previous population-based studies have partially provided inconsistent results regarding the co-variates of chronic depression, which were likely to be attributable to methodological limitations. The present paper that compared people with chronic major depressive disorder (MDD), non-chronic MDD and no mood disorder in the community focus...

Chercheurs et cliniciens vivent dans des mondes de plus en plus séparés, précipitant la psychothérapie dans une crise de légitimité. Cet article fait l’hypothèse que l’alliance thérapeutique, en tant que variable intégrative par excellence, est un élément à même de réduire ce fossé, en considérant en particulier que l’alliance entre chercheur et cl...

This study aimed to compare the effectiveness of the Integrative Brief Systemic Intervention (IBSI), combining therapeutic work on marital and coparenting relationships with brief systemic therapy (BST‐as‐usual) for parent couples. Couples were randomly assigned to the IBSI (n = 51) or BST (n = 50). Both treatments were six‐session interventions an...

Background: Individuals with borderline personality disorder (BPD) present insecure internalized object representations which distort the way they perceive and respond to interpersonal situations (Fonagy, Gergely, & Jurist, 2018). Such distortions bring hypersensitivity to stressful relational contexts along with the frequent activation of immature...

The ways in which therapeutic interventions for personality disorders bring change requires in-depth investigation (Kramer, Beuchat, Grandjean, & Pascual-Leone, 2020). Psychotherapy research aims to discover change processes and to establish the links between the process factors and outcome in treatment. When mental representations are insecurely...

This article describes the treatment framework and core therapeutic principles of the integrative brief systemic intervention (IBSI), a manualized six‐session intervention intended for parents seeking couple therapy. IBSI aims to work on the couple's presenting problem, considering its specific impact in the marital and coparenting domains. The bas...

La relation entre science empirique et pratique clinique est complexe et difficile. Bien que les organismes qui contrôlent la pratique psychothérapeutique demandent que les connaissances et les savoir-être des thérapeutes soient scientifiquement et empiriquement fondés, force est de constater que ce n’est pas – ou peu – le cas actuellement. Deux él...

Nous nous intéressons à la définition et à la prise en charge de la dépression chronique du point de vue du psychiatre, à l’aide d’une démarche qualitative. Si de nombreuses études comparent l’efficacité des traitements de la dépression chronique, on ne sait que peu de choses des pratiques réelles de ceux qui les mettent en œuvre. En analysant troi...

Background Problematic interpersonal patterns, as defined by the core conflictual relationship theme (CCRT) method, are part of the clinical presentation of clients with borderline personality disorder (BPD). So far, we do not know whether the pervasiveness of interpersonal patterns changes and if this change explains therapy outcome. Methods In a...

The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline scor...

Résumé Objectifs: La présente étude a été conçue pour explorer deux questions : 1) l’incidence de la détresse et de la dissociation péri-traumatique dans une population générale algérienne durant les phases initiales de l’épidémie COVID-19 ; 2) les prédicteurs sociodémographiques des réactions péri-traumatiques. L'objectif est de mieux comprendre l...

https://www.revmed.ch/RMS/2020/RMS-N-708/La-medecine-de-famille-face-a-la-depression-chronique Cette étude s’intéresse à la prise en charge de la dépression chronique au cabinet du médecin de famille (MF) et à la collaboration MF-psychiatre. La pratique des MF de notre étude met en évidence deux situations différentes : les patients capables de ve...

This study focuses on the management of chronic depression at the general practitioner's office and the collaboration between general practitioner (GP)-psychiatrist. Our study's highlights two different situations: patients able to verbalize their psychological suffering and who can be directly referred to the psychiatrist and patients expressing t...

This study explored the change that unfolded when parents resolved their coparenting dissatisfaction during an Integrative Brief Systemic Intervention (IBSI) for parent couples. We conducted a task analysis (Greenberg, 2007) to build a model of resolving coparenting dissatisfaction. We compared a postulated model of change (rational model) based on...

Background: Borderline personality disorder (BPD) is one of the most frequent, most debilitating and lethal mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy, and may involve brief psychiatric treatment as first-line intervention. No controlled study has assessed...

Objective This article aims to provide an overview of the efficacy of co‐parenting programs on outcomes related to child's adjustment, parents' well‐being, and quality of the co‐parenting, romantic, and parent–child relationships. Background Numerous co‐parenting programs have been developed, supported by empirical findings associating quality of...

Interpersonal processes are a key target in counselling and psychotherapy. It is of paramount importance to sharpen their assessment using integrated methods. Hence, this methodological paper describes how fields of research in psychotherapy and neuroimaging can be integrated into one novel complementary neurobehavioural paradigm that can be applie...

Background Borderline Personality Disorder (BPD) is one of the most frequent, most debilitating and lethal mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy, and may involve brief psychiatric treatment as first-line intervention. No controlled study has assessed t...

La collaboration des médecins généralistes et des psychiatres dans la prise en charge de la dépression chronique est considérée comme nécessaire, mais qualifiée de suboptimale dans la littérature. Cette étude qualitative vise à mieux cerner les facteurs qui influent sur la décision de référer un patient dépressif chronique au psychiatre. Pour ce fa...

Objective: So far, only a few studies have focused on psychotherapy for Dependent Personality Disorder (DPD). DPD is marked by a repetitive pattern of efforts aiming at maintaining close relationships, which may present as a lack of assertiveness and as a difficulty in making routine decisions. The present study aims at exploring processes of chan...

Résumé Cette revue de littérature synthétise les résultats des études ayant utilisé une mesure empirique de l’attachement du client au thérapeute en psychothérapie. Une recherche systématique dans les bases de données Medline, Embase, Pubmed, PsycInfo, et Web Of Science a débouché sur 25 études publiées. Une approche méta-analytique a également été...

Aim of the study Interpretations are a key technique that distinguishes psychodynamic therapies from many other treatment modalities (1,37). Research has explored elements of interpretations (e.g., accuracy, timing, depth) and their impact on various variables such as patient defensive functioning, the therapeutic alliance and treatment outcome. Ho...

Objectives Recognizing and reflecting on one's own and other people's mental states represent a major difficulty for patients with borderline personality disorder (BPD). Only recently have studies begun exploring whether these capacities increase with successful therapies and if such an improvement is linked with outcome. The present study investig...

Les résultats des thérapies de couples de parents peuvent être évalués sur deux dimensions principales : l’ajustement conjugal et l’alliance coparentale, cette dernière étant encore rarement prise en compte. Cet article s’intéresse à l’observation des interactions de couples de parents dans une tâche de résolution de problème coparental, comme plus...

La littérature clinique systémique a beaucoup thématisé l’impact du conflit conjugal sur la coparentalité et sur les problèmes de l’enfant, mais peu l’effet de la coparentalité sur les deux autres sous-systèmes. Cet article présente un modèle d’intervention clinique pour les couples parents développé à Lausanne depuis quelques années, l’interventio...

Starting from the observation that the representations of an illness impact the way physicians treat it, a multidisciplinary research team investigated the representations and treatment of chronic depression by general practitioners (GPs). This was made through a qualitative study by means of focus groups. Firstly, we outline the types of patients...

Aim of the study This study investigated the association between therapist interventions and patient defensive functioning in low-alliance and high-alliance sessions over the course of short-term dynamic psychotherapy (STDP) (n= 22). Subject or material and methods Lag sequential analysis was used to determine if there were predictable sequences o...

Le développement actuel de méthodes statistiques de plus en plus spécialisées et sophistiquées, combiné, entre autres, à ce qui s’apparente à de la frilosité du côté des revues, font que la lecture des statistiques demeure un art compliqué pour le clinicien et se résume trop souvent à « on ne comprend rien, on avale tout ». Dans cet article, nous n...

Changes in emotional processing (EP) and in theory of mind (TOM) are central across treatment approaches for patients with borderline personality disorder (BPD). Although the assessment of EP relies on the observation of a patient's self-criticism in a two-chair dialogue, an individual's TOM assessments is made based on responses to humorous stimul...

Objective: Borderline personality disorder (BPD) is characterized by immature defense mechanisms. Dialectical behavior therapy (DBT) is an effective treatment for BPD. However, understanding the underlying mechanisms of change is still limited. Using a transtheoretical framework, we investigated the effect of DBT skills training on defense mechani...

Biased thinking is a common feature of patients presenting with borderline personality disorder (BPD). For the treatment of BPD, it was shown that the individualizing of the treatment, by using the motive-oriented therapeutic relationship (MOTR), had a beneficial short-term effect on process and outcome. So far, it remains unclear what the role of...

Objective: In cancer care optimal communication between patients and their physicians is, among other things, dependent on physicians' emotion regulation which might be related to physicians' as well as patients' characteristics. In this study we investigated physicians' emotion regulation during communication with advanced cancer patients, in rel...

The purpose of this study was to identify the potentially distinct defense profiles of athletes in order to provide insight into the complex associations that can exist between defenses and other important variables tied to performance in sports (e.g., coping, perceived stress and control) and to further our understanding of the complexity of the a...

The concept of biased thinking – or cognitive biases – is relevant to psychotherapy research and clinical conceptualization, beyond cognitive theories. The present naturalistic study aimed to examine the changes in biased thinking over the course of a short‐term dynamic psychotherapy ( STDP ) and to discover potential links between these changes an...

Objective: The marked impulsivity and instability of clients suffering from borderline personality disorder (BPD) greatly challenge therapists' understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that usi...

Background: Defense mechanisms are a central component of psychodynamic theory [1,2] and their interpretation is key to psychodynamic practice. Over the years, varying perspectives on dealing with patients' defense mechanisms have been outlined [3]. Aim of the study: To examine how psychodynamic therapists deal with patient defenses in their clinic...

There is evidence that a key feature in borderline personality disorder (BPD) is the difficulty to reflect on one’s own as well as on other people’s state of mind. So far, no study has examined the link between metacognition and symptom change presented by BPD patients across treatment. This preliminary pilot study represents a first step in descri...

Objective: There is little research on short-term treatments for borderline personality disorder (BPD). While the core changes may occur only in long-term treatments, short-term treatments may enable the study of early generic processes of engagement in therapy and thus inform about effective treatment components. It was shown that a 10-session ve...

Background: Difficulty in emotion regulation is a hallmark feature of patients with borderline personality disorder (BPD). Therefore, change in the frequency of certain patients' coping strategies-aiming at emotion regulation-are among the most promising mechanisms of change in treatments for BPD. In parallel, it was highlighted that therapist res...

The purpose of the present study was to develop and evaluate a measure of defense mechanisms: the short Defense Style Questionnaire (DSQ-26). A total of 296 competitive athletes completed the DSQ-26 and other self-report questionnaires both before and after a sport competition. Results of Principal Component Analyses (PCA) on the pre-competitive da...

Adaptación de La Relación Terapéutica orientada/centrada sobre los motivos orientada a un contexto de grupo en la terapia dialéctica-conductual para el trastorno límite de la personalidad La relación terapéutica es estudiada como un proceso frecuentemente en la terapia individual y menos en la terapia de grupo. Una razón para la escasez de este tip...

One of the key technical guidelines outlined by psychodynamic theorists and clinicians is for therapists to interpret a patient's most prominent defenses (Greenson, 1967; Langs, 1973). However, a debate exists about what constitutes a patient's most prominent defense and which defenses therapists actually choose to interpret in-session. This study...

Interpersonal defense theory is an interpersonal conceptualization of defense processes. It is especially helpful for addressing issues about the therapeutic relationship. This qualitative, theory-building case study investigated whether the theory offers a framework for augmenting our understanding of rupture-resolution phenomena. The case involve...

Background: For severe and chronic depression, inpatient treatment may be necessary. Current guidelines recommend combined psychological and pharmacological treatments for moderate to severe depression. Results for positive effects of combined treatment for depressed inpatients are still ambiguous. Methods: This randomised controlled trial exami...

Objective: To investigate which characteristics of the physician and of the consultation are related to patient satisfaction with communication and working alliance. Methods: Real-life consultations (n = 134) between patients (n = 134) and their physicians (n = 24) were audio taped. All of the patients were aware of their cancer diagnosis and co...

Key practitioner message: A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting an...

Therapist adherence describes the quality of interventions according to the imperatives of a treatment model. We examined the relationship between therapist adherence and symptom change in the context of a short-term treatment with respect good psychiatric management (GPM) principles. Based on a parent trial, borderline personality disorder patient...

The present study aimed to investigate the association between treatment outcome and the assimilation of problematic experiences during psychotherapy. The assimilation process is described in an eight-level sequence, the Assimilation of Problematic Experiences Scale (APES); insight is conceived as one level in this developmental sequence. This leve...

Un cas exemplaire, un cas d'école, un beau cas, un cas de figure, un cas extrême, un cas particulier, un cas épineux, un cas limite… Les modalités de l'étude de cas sont multiples et expriment le fait que tout raisonnement suivi, toute explication, toute théorie bute une fois ou l'autre sur la nécessité d’explorer et d’approfondir les propriétés d’...

The marked impulsivity and affective instability of clients suffering from Borderline Personality Disorder (BPD) greatly challenge therapists’ understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that using...

Rationale: The majority of primary care patients presenting with mild to moderate depression receive an antidepressive drug as the principal agent of treatment. However, their efficacy is currently challenged and patients prefer psychological treatment to drug treatment. Objectives: Current article first reviews models of collaboration between prim...

The present study examined the relationship between depth of defense interpretations by therapists, and patient defensive functioning, on the therapeutic alliance in a sample of 36 patients undergoing short-term dynamic psychotherapy. Defense interpretation depth was defined as the degree to which therapist interpretations contained information reg...

Introduction A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. Our one-month randomized controlled trial of very brief psychotherapeutic treatment (12 sessions/4 weeks) showed especially medium to large between effect sizes (BES ranging from .53 to .89) at 3...

There is some evidence that in psychodynamic psychotherapy the quality of the therapist interventions, and especially interpretations, is related to the level of therapeutic alliance and to outcome. This exploratory study follows up this idea by studying the role played by quality of interpretations during sequences of rupture and resolution of all...

Brief systemic therapy for elderly couples The aim of analyzing Viviane and Jacques’ couple therapy was to illustrate the relevance for elderly couples of Brief Systemic Therapy, which is a manualized treatment carried out in a limited timeframe. The pragmatic case study method was followed : concurrent with the therapy, the treatment process and r...

This paper examines the application of the guidelines for evidence-based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two-step approach was taken: (1) The quality...

Aims: Alliance rupture and resolution processes are occasions for the client to have his or her core interpersonal patterns activated in the here and now of the therapy and to negotiate them with the therapist. So far, no studies have been conducted on emotional processing, from a sequential perspective using distinct emotion categories, in allianc...

Objective: Depth of emotional processing has shown to be related to outcome across approaches to psychotherapy. Moreover, a specific emotional sequence has been postulated and tested in several studies on experiential psychotherapy (Pascual-Leone & Greenberg, 2007). This process-outcome study aims at reproducing the sequential model of emotional p...

Of all the variables studied in psychotherapy research, the therapists them selves appear to constitute the strongest predictors of the therapeutic process and results. We currently, however, have very little research data to explain this effect. To date, no research has yet focused specifically on the defenses employed by psychotherapists during t...

Abstract A variation of task analysis was used to build an empirical model of how therapists may facilitate client assimilation process, described in the Assimilation of Problematic Experiences Scale. A rational model was specified and considered in light of an analysis of therapist in-session performances (N = 117) drawn from six inpatient therapi...

Abstract Objective: To study mothers' general anxiety, anxiety about the well-being of the child and psychological stress before prenatal testing by comparing women who conceived through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with women who conceived naturally. Method: Before the first trimester screening test for D...

The Defense Mechanisms Rating Scales (DMRS), one of the most widely used and validated instruments in the study of defense mechanisms, does not include psychotic defenses. The Psychotic-DMRS (P-DMRS) has been developed to include 6 psychotic defense mechanisms: psychotic denial, autistic withdrawal, distortion, delusional projection, fragmentation,...

Background: Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this...

Interpreting or addressing defenses is an important aspect of psychoanalytic technique. Previous research has shown that therapist addressing defenses (TADs) can produce a positive effect on alliance. The potential value of TADs during the process of alliance rupture and resolution has not yet been documented. We selected patients (n = 17) undertak...

The aim of this study was to review the literature on clinician characteristics influencing patient-clinician communication or patient outcome in oncology. Studies investigating the association of clinician characteristics with quality of communication and with outcome for adult cancer patients were systematically searched in MEDLINE, PSYINFO, PUBM...

Objectives: The Assimilation of Problematic Experiences Scale (APES) describes eight levels that a problematic experience passes through en route to becoming part of the person's self. Theoretically, progress along this continuum may be facilitated by therapist interventions that are appropriately responsive to the problem's current APES level, in...

Statistics occupies a prominent role in science and citizens' daily life. This article provides a state-of-the-art of the problems associated with statistics in science and in society, structured along the three paradigms defined by Bauer, Allum and Miller (2007). It explores in more detail medicine and public understanding of science on the one ha...

Cognitive change over the course of psychodynamic psychotherapy has been postulated by several models, but has rarely been studied. Based on the adaptive skills model (Badgio, Halperin, & Barber, 1999), it is reasonable to expect that very brief dynamic psychotherapy may be associated with change in coping patterns and cognitive errors (also known...

Very little research has been conducted so far to study the potential mechanisms of change in long-term active psychological treatments of recurrent depression. The present pilot randomized controlled trial aimed to determine the feasibility of studying the change process occurring in patients during the course of 2-year-long dynamic psychotherapy,...

Brief Systemic Intervention : therapy manual Assessing the effectiveness of psychotherapy should not be limited to studying its impact on several core variables. Manualization of treatment and the use of adherence checks are also key aspects of psychotherapy research : they describe the treatment, ensure that the therapists follow the treatment mod...