The accuracy of therapists' interpretation and the outcome of dynamic therapy

Temple University, Filadelfia, Pennsylvania, United States
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 09/1988; 56(4):490-5. DOI: 10.1037/0022-006x.56.4.490
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This study developed a measure of the accuracy of therapists' interpretations based on the core conflictual relationship theme method and examined the relation of accuracy to the outcome of dynamic psychotherapy. Accuracy was assessed on therapists' interpretations from two early-in-treatment sessions of 43 patients receiving moderate-length dynamic therapy. The results indicated that accuracy about the main wishes and responses from others that were expressed in the relationship themes was significantly related to outcome, even after the effects of general errors in treatment techniques and the quality of the helping alliance had been controlled for. Our hypothesis that accurate interpretations would have their greatest impact in the context of a positive helping alliance was not confirmed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

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Available from: Paul Crits-Christoph
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    • "(Crits-Christoph, Luborsky, et al., 1988; Eells et al., 1995; Perry et al., 1989; Curtis et al., 1988; Dahl & Teller, 1994 "
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    ABSTRACT: We present an analysis of the reliability and base rates of the interpersonal contents of narratives told by patients in psychotherapy. Trained judges rated two samples, including 60 opiate-dependent patients in cognitive or psychodynamic therapy and 72 depressed patients in cognitive or interpersonal therapy. Using a comprehensive system based upon a circumplex model and involving 104 separate categories, we found that most categories of interpersonal behavior could be rated reliably. Potential problem categories were identified and strategies for increasing reliability are discussed. In particular, categories related to the concept of the introject (what the self does to the self) had low reliability. An analysis of the base rates of interpersonal themes revealed that issues related to autonomy/ assertion were most prevalent, although some differences between the two samples were evident. The implications of the results for research on narratives and models of psychotherapy are discussed.
    Full-text · Article · Oct 1999 · Journal of Clinical Psychology
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    • "In psychotherapy research, there is a tradition of studying the working alliance from one selected perspective at a time: the patient's, the therapist's, or the independent observer's. Several metastudies (Crits-Christoph et al., 1988; Horvath & Symonds, 1991) showed that regardless of the method of measurement, the patient's ratings of therapeutic alliance are the best predictor of different types of outcome, and the therapist's ratings are the worst. The observer's ratings proved to be the most sensitive to changes over time in the level of the therapeutic alliance. "
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    ABSTRACT: The original psychoanalytic research situation is the two-person dialogue. However, clinical practice in itself is still not an application of systematic case study methodology. In order to approach the question why we need systematic psychoanalytic research, three types of dialectical tensions are described. Psychoanalysis, like other scientific disciplines, is involved in a dialectics of (1) rationalism versus empiricism, i.e., theory construction and observation; (2) the perspective from within and from without, i.e., subjective self-knowledge versus expert knowledge; (3) continuity or discontinuity between psychoanalysis and adjacent fields of knowledge, as well as realism versus essentialism. The tension between the scientific and the clinical attitudes is discussed. Finally the question of scientific and private theories is approached. Some of the methodological and epistemological pitfalls in psychoanalysis are seen as a consequence of the close affinity between private explanatory systems and psychoanalytical theories. Rules of evidence are necessary as a control for the unavoidable uncertainty.
    Full-text · Article · Jan 1999 · Scandinavian Psychoanalytic Review
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    • "Studies of the role of interpretation in psychoanalysis, psychoanalytic psychotherapy, and brief dynamic psychotherapy have been in the following areas: (1) depth of interpretation (Dittman, 1952; Harway et aI., 1955; Rausch et aI., 1956. Speisman, 1959; Howe, 1962); (2) process studies of the immediate in-session responses of patients to interpretations (Garduk and Haggard, 1972; Luborsky, 1977); (3) outcome studies relating interpretation to treatment progress (Malan, 1976; Marziali and Sullivan, 1980; Marziali, 1984; Piper et aI., 1986); and (4) accuracy of interpretation (Silberschatz et aI., '1986; Crits-Christoph et aI., 1988). "
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    ABSTRACT: Statement of the Research Problem Interpretation is generally held to be the major curative factor in psychoanalysis, psychoanalytic psychotherapy, and short-term dynamic psychotherapy. (Freud, 1912; Strachey, 1934; Luborsky, 1984; Arlow, 1987). Described by Bibring (1954) as the "supreme agent in the hierarchy of therapeutic principles" (p. 763), interpretation is regarded as a central activity of the therapist, around which other aspects of treatment are organized to maximize its effectiveness. Despite the consensus of its clinical import, there is no universally accepted definition of an interpretation. The concept of interpretation has evolved, as has its relationship to the therapeutic process. For Freud (1900, 1912, 1914), interpretation referred to the translation of the manifest into the latent content, whether this involved dreams, associations, symptoms, or behaviors of the neurotic patient. As the scope of psychoanalysis broadened to include patients with preoedipal and narcissistic pathology (referred to in this study as lower functioning), interpretation also acquired new dimensions. With lower functioning patients, the intent of interpretation shifted in relation to resistance, transference, and reconstruction. In a revised developmental and relational psychoanalytic framework, some authors (Ornstein and Ornstein, 1975; Pine, 1986a, 1986b, 1990) view interpretation primarily as a contact rather than a content or an insight promoting agent. In sharp contrast to traditional psychoanalysis of higher functioning (primarily neurotic) patients, with lower functioning patients, the transference neurosis is avoided in favor of providing a "holding environment" (non-interpretive intervention) (Winnicott, 1965). Such therapy is typically more active and supportive, as well as less intense and interpretive. In actual practice, however, most clinicians are reported to use a mixture of interpretive (expressive) and holding (supportive) techniques early in treatment and throughout its course (Luborsky, 1984; Waldinger, 1987).
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