Clinical Psychotherapy - Science topic

Respected Researcher

We, as experts in the field of clinical psychology, before we judge the individual as being sick with a certain disease, we prepare an initial interview for him/her to identify his personality through his/her words, appearance, facial features, and behavior, and then conduct him/her after that interview after two or three diagnostic tests in Intelligence, personality and thinking (mental and cognitive tests), and of course we rely on collecting information from some people close to him/her (family, children, brothers, friends, peers, etc.), because we cannot judge an individual who suffers from blindness for example, that he/she is a disabled person as soon as he/she lost his/her eyes, and we cannot judge a healthy person, who does not suffer from any disability, that he/she has several skills.

That is why we have to take proper and correct measures in the diagnosis process first, and this is explained by the published research that you read, and indeed this is what is meant, because if we focus on the individual’s disability, this may affect the loss of his/her important skills remaining, and this increases his feeling that he/she is a helpless person who is useless, and then he/she will make dangerous decisions that lead him/her to a tendency towards suicide or any other serious illness, so it is the responsibility of the psychiatrist or psychologist first and undoubtedly, to pay attention to the development of the skills available to the helpless person, and not to care about the extent feeling the level of disability, because the development of skills leads to the treatment of disability.

I appreciate this great effort, and I hope to join you, but it is possible to know a biography of the work, as well as your presentation of a comprehensive plan on the most important achievements and humanitarian psychological works that serve patients or those who need them, because as you know, we have a duty towards the right of every patient. Therefore, we are obligated to offer our sincerity to work before God Almighty, and before those who need guidance and psychological treatment.

There is a paper written by Brooks & co-authors (2020) with a review and analysis of 24 researches on psychological effects of quarantines. It was a very helpful study for me and for my research.

I follow the question

There is a Single Case Archive at http://singlecasearchive.com/

Rutgers University has a Pragmatic Case Archives at http://pcsp.libraries.rutgers.edu/index.php/pcsp/issue/archive

Hello Niamh,

Influence of preoperative and postoperative pelvic floor muscle training (PFMT) compared with postoperative PFMT on urinary incontinence after radical prostatectomy: a randomized controlled trial.

Geraerts I, Van Poppel H, Devoogdt N, Joniau S, Van Cleynenbreugel B, De Groef A, Van Kampen M 

Eur Urol. 2013;64(5):766. 

BACKGROUNDThe efficacy of preoperative pelvic floor muscle training (PFMT) for urinary incontinence (UI) after open radical prostatectomy (ORP) and robot-assisted laparoscopic radical prostatectomy (RARP) is still unclear.

OBJECTIVETo determine whether patients with additional preoperative PFMT regain urinary continence earlier than patients with only postoperative PFMT after ORP and RARP.

DESIGN, SETTING, AND PARTICIPANTSA randomized controlled trial enrolled 180 men who planned to undergo ORP/RARP.

INTERVENTIONThe experimental group (E, n=91) started PFMT 3 wk before surgery and continued after surgery. The control group (C, n=89) started PFMT after catheter removal.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSISThe primary end point was time to continence. Patients measured urine loss daily (24-h pad test) until total continence (three consecutive days of 0 g of urine loss) was achieved. Secondary end points were 1-h pad test, visual analog scale (VAS), International Prostate Symptom Score (IPSS), and quality of life (King's Health Questionnaire [KHQ]). Kaplan-Meier analysis and Cox regression with correction for two strata (age and type of surgery) compared time and continence. The Fisher exact test was applied for the 1-h pad test and VAS; the Mann-Whitney U test was applied for IPSS and KHQ.

RESULTS AND LIMITATIONSPatients with additional preoperative PFMT had no shorter duration of postoperative UI compared with patients with only postoperative PFMT (p=0.878). Median time to continence was 30 and 31 d, and median amount of first-day incontinence was 108 g and 124 g for groups E and C, respectively. Cox regression did not indicate a significant difference between groups E and C (p=0.773; hazard ratio: 1.047 [0.768-1.425]). The 1-h pad test, VAS, and IPSS were comparable between both groups. However, "incontinence impact" (KHQ) was in favor of group E at 3 mo and 6 mo after surgery.

CONCLUSIONSThree preoperative sessions of PFMT did not improve postoperative duration of incontinence.

Best wishes

Might be worth to have a look at the West Haven-Yale Multidimensional Pain Inventory by Kerns, Turk & Rudy (1985), it includes a section that evaluates patient's perceptions of significant other's responses to displays of pain and suffering.

Some resources:

Using the back door: Metacognitive training for psychosis.

doi: http://dx.doi.org/10.1080/17522439.2014.913073

By Kumar, Devvarta; Menon, Mahesh; Moritz, Steffen; Woodward, Todd S.

Psychosis: Psychological, Social and Integrative Approaches, Vol 7(2), Apr 2015, 166-178.

Delusions have traditionally been considered impervious to counter-arguments and thus not amenable to psychotherapy. However, a growing body of evidence from Cognitive Behavior Therapy for psychosis (CBT-p) has indicated that challenging the delusional beliefs may be effective in reducing their severity. Metacognitive Training/Therapy (MCT) for psychosis also targets delusions, using a back door approach by helping clients gain insight into the cognitive biases behind delusions, followed by attempts to plant the seeds of doubt, and weaken delusional beliefs. There are two variants of MCT, the group format MCT and the individual therapy format MCT (i.e. MCT +). The MCT intervention has three components: (a) normalization, (b) facilitating insight into the relationship between cognitive biases and delusions, and (c) sowing the seeds of doubt in delusional beliefs. Among these, the first two components are common to both MCT and MCT +, whereas the third is specific to MCT +. Initial findings about the effects of MCT in reducing the delusional convictions are encouraging. The present article elaborates on the theoretical background, process, clinical implications, empirical status, and the advantages and limitations of this intervention. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Delusions, action, and insight.

By Buchanan, Alec; Wessely, Simon

Amador, Xavier F. (Ed); David, Anthony S. (Ed), (1998). Insight and psychosis. , (pp. 241-268). New York, NY, US: Oxford University Press, xviii, 366 pp.

We have recently been part of a team that undertook a study of acting on delusions in a general psychiatric population. The study investigated the prevalence and phenomenological correlates of acting on delusional beliefs. The purpose of this chapter is to discuss some theoretical aspects of acting on delusions, to review the results of the study, and to discuss the relationship between delusional action and insight.

What form might this relationship take? One possibility is that the level of delusional action falls as the degree of insight increases. If I have a suspicion that my persecutory ideas are the result of illness, I may be less likely to defend myself. On the other hand, it may be that some delusional actions have the effect of challenging the veracity of the delusion itself, as when a jealous man rifles through his wife's handbag and finds nothing incriminating. In such cases delusional action might be expected to be associated with increased levels of insight. Our group's research sheds some light on these issues. First, however, an attempt is made to outline some theoretical aspects of the relationships among abnormal beliefs, action, and insight. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Delusions in the transference: Psychotherapy with the paranoid patient.

By Altman, Abby; Selzer, Michael A.

Psychiatric Clinics of North America, Vol 18(2), Jun 1995, 407-425.

Attempts to combine a theoretical and practical approach to the challenge presented in psychotherapy of paranoid and delusional patients. The psychotherapy of paranoid patients and management of delusions in the transference are difficult and challenging but common clinical presentations that deserve further attention. Clinicians need to know themselves well and need to be prepared to use this knowledge toward enabling patients to get acquainted with themselves, accepting rather than disowning pieces of self as projections. This is accomplished by relentless attention to prevailing transference and countertransference responses occurring within a reliable treatment frame and therapeutic alliance. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The Effect of Different Components of Psychological Therapy on People with Delusions: Five Experimental Single Cases.

doi: http://dx.doi.org/10.1002/cpp.373

By Jakes, Simon C.; Rhodes, John E.

Clinical Psychology & Psychotherapy, Vol 10(5), Sep-Oct 2003, 302-315.

This study is a contribution to the investigation of the active ingredient in psychological therapy for psychosis. Five people with chronic delusions were treated using a single-case experiment design. The treatment was broken down into components that were administered sequentially. A baseline phase was followed by three different treatment conditions (An A-B-C-D design). The treatments were (1) Solution-focused Therapy (2) Schema-focused cognitive therapy (3) Cognitive therapy focused on modification of the delusion. Three of the five clients responded to treatment with a large change in degree of belief in their delusion. Two clients improved during solution-focused therapy, one client improved during cognitive challenging of the delusion and one client changed during baseline. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

The only explanation for the presented case is an Accomodative astenopia in other words, if the patient has really a mild Myopia 2.0 and had an excessive near work -cell phone, computer, etc. and nervous system instability the power of Myopia increased due to contraction of the cilliary body adding Diopters and Phychotherapy intended to relax the nervous system neutralise  ciliary body contraction decreasing diopters till the Objective power of Myopia, which was equal to 2.0D for this patient.

Cognitive Analytic Therapy could interest you

It is not appropriate for infants less than 2 years, especially for less than six months. Because antihistamines also are potent muscarinic receptor antagonists that can lead to serious anticholinergic side effects, such as sinus tachycardia, dry skin, hyperthermia, dry mucous membranes, dilated pupils, constipation, ileus, urinary retention, and agitation.

I would like to second Dr. Silberschatz's recommendation about the importance of Wampold and Imel's The Great Psychotherapy Debate (2nd ed.; 2015). I think Wampold's contextual model is particularly important, emphasizing the complementary significance of both common and specific factors across bona fide psychotherapies and how those factors combine to contribute to desired outcomes. Another recent reference would be:

Budge, S. L., & Wampold, B. E. (2015). The relationship: How it works. In O. C. G. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy research: Foundations, process, and outcomes (pp. 213–228). Dordrecht, the Netherlands: Springer.

For all practical purposes, mindfulness can be considered a cognitive intervention: by becoming more aware of thoughts and their influence on mood and behavior, you have an avenue to challenge those thoughts, and replace them with different thoughts.

Additionally, it can be considered to have a behavioral influence, similar to Jacobsonian relaxation strategies, usually identified as "systematic relaxation." Taking a deep breath, and exercising would be similar behavioral interventions, each with a presumptive physiological correlate to explain how it helps, psychologically.

Mindfulness meditation, when successful (the person tries and actually has some sustained stretches of time of mindfulness) is recognized to have a range of influences upon brain activity, as measured by EEG or Q-EEG (those terms can be googled). The literature is very heterogeneous on what brain activity changes are seen in those successfully meditating, so I am not confident in making a specific argument one way or the other. But the argument is that the meditation moves the brain into a mental state that is that of a less-distressed state of mind. So, just like taking deep breaths can relax you, possibly due to vagal nerve feedback to the brain, by meditation you deliberately move your brain activity profile to more closely be one of alert relaxation rather than alert alarm or distress.

Further, this can be classically conditioned to some degree, by being associated with deep breathing or a mental focus on the phenomenology of breathing.

My explanation removed the esoteric, or cosmological, or religious, or supernatural nature from meditation. In my view, meditation is not any of these. This is my opinion, and I may be right or wrong. An "Eastern" concept is that meditation upon breathing, the essence of life, can "yoke" you to the essence of life, the infinite or the cosmological.

The impression of losing some sense of yourself is thus explained as losing your self and getting closer to oneness with the universe. "Yoke" shares the same root word with "yoga," hence the term "yoga."

Some may disagree, but yoga is a form of meditation - a very physical form - more physical than slow-walking, meditatively eating a raisin in the well-recognized raisin exercise, etc.

So, if writing a paper or describing your practice, to stand on steady ground it might be safe to say meditation, as a mental health intervention, has aspects of cognitive and behavioral interventions, while some also believe it has unique spiritual or metaphysical aspects. Insurance companies and grant funders will not pay for spiritual interventions, and believers of many religious faiths are not supposed to dabble in practices outside their religion, including the occult, so you have solid ground on two sides for avoiding a portrayal of meditation as spiritual.

A good overview/intro is: "The Calm Technique: Meditation without Magic or Mysticism." The Kabat-Zinn books are good, also.

Genital Muscle Relaxation (GMR) technique was developed by Ganesan (1980). It is a type of muscular relaxation exercise, which helps to reduce emotional arousal and inhibits impulses. It is a popular technique used for managing stress and control sexual impulses.

GMR technique was taught to the adult / married participants, and explained to them clearly. The researcher demonstrated the procedure of GMR Technique.

The participants were instructed to follow the following steps:

It sounds like you might want a chi-square analysis testing whether your groups have gender frequencies (or counts) that are significantly different from one another.  Chi-square tests are used when both variables (independent and dependent) are discrete or categorical.  Any statistical package should be able to do this, and there are some easy-to-use online chi-square calculators as well.

Dear Mathilde,

Check this out:

Lesbian and gay parents and their children: Research on the family life cycle. Division 44: Contemporary perspectives on lesbian, gay, and bisexual psychology.Goldberg, Abbie E.

Washington, DC, US: American Psychological Association. (2010). v 233 pp. http://dx.doi.org/10.1037/12055-000

The previous responses are correct. The BDI II is a questionnaire that gauges symptoms of depression. While it can indicate someone may have major depressive disorder, it is not enough in and of itself to make a formal diagnosis.

As mentioned by the earlier comments, to diagnose depression a person needs to meet a certain number of criteria laid out by a diagnostic manual. The Diagnostic and Statistical Manual of Mental Disorders 5, or DSM-5 as it is commonly known, is used most in the USA. The International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10) is more commonly used internationally. 

These manuals simply offer the diagnostic framework. They only tell you what symptoms to look for in a mental disorder. To actually assess the symptoms one uses the manuals' compendium structured clinical interview booklets. The Structured Clinical Interview for DSM (SCID) goes with the DSM (note, the SCID for DSM-5 has not yet been released as DSM-5 only came out recently. Most people are still using DSM-IV and it's version of the SCID). The World Health Organization World Mental Health Composite International Diagnostic Interview goes with ICD-10, but can also be used for DSM-5. Delivering these clinical interviews requires a great deal of clinical training, and shouldn't be attempted by untrained staff. 

Of course, there are a lot of other handy questionnaires out there if one is looking to quickly screen patients/clients for possible depressive disorders. The Patient Health Questionnaire-9 (PHQ-9) is commonly used in healthcare settings because it is very quick to administer, and very quick to score. 

The purpose of the test is not diagnostic , therefore only reports the magnitude of depressive symptoms that a person compared to a normative group .

Dear Andrea,

For me especially the concept of "interaction structure", about repeated mutually influencing interactions between therapist and patient are a fundamental aspect of therapeutic action. His theory about "interaction structure" is a very important issue and a prominent additional "social issue" in understanding the "working alliance". It is a contribution to a two person psychology.

Egon

There is a recent paper by McEvoy et al. that might be helpful related to therapeutic alliance in individual and group models of CBT. In fact, the largest body of work on this topic with valid measures is related to CBT. One infrequently measured aspect of therapeutic alliance is patient-therapist match, a subject that comes up more in psychoanalytic work. For work on this, read papers by Judy Kantrowitz, a psychoanalyst who has thought about this a great deal.