Science topic

Psychotherapeutic Processes - Science topic

Experiential, attitudinal, emotional, or behavioral phenomena occurring during the course of treatment. They apply to the patient or therapist (i.e., nurse, doctor, etc.) individually or to their interaction. (American Psychological Association: Thesaurus of Psychological Index Terms, 1994)
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Does anybody have some articles concerning Resilience? Please, send some!
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I would also look at mental toughness and other non-cognitive skills.
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The client's perception of psychological intervention which sometimes act as obstacle in starting and/or staying in psychotherapeutic intervention..so my question is what could be the obstacles ??
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The perceptual barriers vary from one person to another. Here are some possible obstacles:
  • Stigma of mental illnesses/disorders. For some people, due to their cultural background, the stigma of mental disorders is a major deterrent to mental health services.
  • Lack of awareness/insight of the disorder(s) in the person.
  • Lack of knowledge and understanding of psychotherapeutic interventions and processes.
  • Lack of access to services, etc.
  • Lack of support of the person's intimates to seek treatment, etc.
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The question reflects the hypothesis that beside psychological factors biological patterns also have a significant effect on patients response to psychotherapeutic interventions (e.g. increased stress vulnerability may change effectivness of psychological interventions). The biological markers should be suitable as predictor parameters for prognosis of therapeutic outcome success and also for represeting psychotherapeutic effects on a biological level.
In addition we assume that epigentic effects can already be achieved by inpatient psychotherapy within a duration of 4-6 weeks. We are looking for suitable biological test designs to prove this hypothesis.
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epigenetic markers of the HPA axis, morning cortisol, high sensitive CRP as marker of inflammation.
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I want to continue my Post doc in ISTDP (Intensive short-term dynamic psychotherapy), would you please help me to find positions or grants related to? Thanks
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Dear Dr. Frank Barton Evans
Thank you so much for sending the website of Dr. Allan Abbas. It was useful.
Regards.
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Hello! 
I can't seem to find the information. For e.g., a participant selected the « Difficult » and the « Very Difficult » options for the same question in a 4 option Likert scale question (« How easy or difficult is it to obtain services for clients suffering from depressive symptoms ? »). 
So far, in this thread, people seem to say to treat those answers like missing values, or to create a separate question for the second answer. But this does not apply specifically to Likert-type questions. https://www.researchgate.net/post/How_do_you_handle_survey_questions_where_participants_select_more_than_one_response/1
I've also heard from researches and students to re-code and choose the selected response that has the highest value (in the e.g. above I would choose « Very Difficult »). 
Any literature reference would be welcome!
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Depending on what analyses you are running, another option could be to run separate analyses for 1) treating the data as missing, 2) taking the lower score, 3) taking the higher score, 4) taking the average score, 5) replacing the value with the mean for the scale of the item. If you get the same results with all methods then it doesn't really matter what you do; you can just report what you did and that results were the same either way. It's less clear what to do when you get different results! That kind of procedure is often used when dealing with outliers; consider searching the literature for references on how to handle outliers and then apply the same logic to your situation.
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In many studies on psychotherapy for psychosis the effect seems not be sustained after stopping the treatment. This can be explained by that the relationship with the therapist is the most crucial factor. However I came upon some studies where there was a difference not after 2 years but in the long term 5 years or so with TAU. or befriending. Could there be a 'sleeping' effect ? This can be in accordance with the findings of Strauss e a. : in their qualitative study they discovered that in recovery there are times where apparently nothing happens but where the patient is ''woodshedding'' he gathers skills which he uses in ''changepoints '' periods where there are major changes in his life like a new job or a new relationship.(Strauss e.a.Am Journal of psych 1985)
Do you know qualitative studies which confirm the finding of Straus e.a.
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Thank you Beatrice, I will study the articles. 
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I am closely associated with the oil and gas industry. Price fall since 1014 caused a lot of redundancies in this industry. One estimate says it is over 300,000 skilled professionals.  Somebody suggested to me Elisabeth Kübler-Ross has done a useful study. She is a Swiss psychiatrist who explored the understanding of grief and emotions in terminally ill patients. Her work has subsequently applied in cases such as dealing with unpleasant changes.
I love to hear what you think?
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Dear all,
 I like Miss Boyd's life story and the way she managed to re-invent herself.  My life story is similar but had more ups and downs.  I can detect traces of her advice in your posts too; of course in addition to other things  you have mentioned.
Performing artists are also subject to redundancy, in the form of  public withdrawing their patronage and sending the artist to oblivion.  You don't need me to tell you how the majority of them cope. However, the best example of  re-invention is Madonna. You need  both hands to count the number of times she re- surfaced again triumphant. Good for her.  
I have seen people in industry followed the path which Miss Boyd has sketched  with success. In between redundancy and   re-surfacing one must follow Hazim's  pearl of wisdom.  We would do well to keep in mind what  Lilliana and Harshvardhan  have said, before the ship sinks. The conclusion is don't try to salvage the sinking ship.
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A success story is one in which a significant number of people's daily lives were improved by a treatment or practice developed by clinical psychologists.
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Any good history of clinical psychology will be filled with stories that do not place Beck at the center. I wouldn't be too literal about what constitutes clinical psychology, but do find it odd that there are so many responses focused on Beck, as though others therapies didn't help a lot of people:
A History Of Clinical Psychology (Series in Death Education, Aging, and Health Care,) 2nd Edition by John M. Reisman Publisher: Taylor & Francis; 2 edition (February 3, 1991) Language: English ISBN-10: 1560321881 ISBN-13: 978-1560321880
Ellenberger, H. (1970). The discovery of the unconscious. New York: Basic Books.
Fine, R. (1979). A history of psychoanalysis. New York: Columbia University Press.
You might find some good references in the classic Seligman paper on the Consumer Reports study---there area a lot of critiques, which you should be able to find easily, but in general I'd say clinical psychology in general is a success story:
The effectiveness of psychotherapy: The Consumer Reports study.
By Seligman, Martin E. P.
American Psychologist, Vol 50(12), Dec 1995, 965-974.
Consumer Reports (1995, November) published an article which concluded that patients benefitted very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features of these two methods can be combined into a more ideal method that will best provide empirical validation of psychotherapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved
I also wonder what's the "question behind the question". Do you need to frame it in a different way?
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Is it possible to investigate the role of psychological factors in dyadic practice? Please help me to find literature
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Dear Béatrice Marianne Ewalds-Kvist
thanks a lot
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both Piaget and Vygotsky are considered as exponents of Constructivism, but still they differ in their emphasis that i need to get clarification
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Piaget concerned with the cognitive structure, to start from known to unknown and to find relevant connections between knowledge inside classrooms and its applications outside the school. Vygotsky has two main domain of the concept, the first is the cognitive constructivism which very closed to Piaget and the second is the social constructivism which investigate the importance of building concepts and acquiring skills in a social context that gives the learner proper help in the right time which so-called scaffolding process and it suppose that the learner can obtain knowledge and skills from the teacher and class-mate better than depending only on himself without hints. Vygotsky and others referred to one reaction when student receive proper hint in the right time which called Aha reaction and then he/she can build on that hint to reach the targeted goals step by step (Scaffolding).
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I'm looking for previous research using the System for Observing Family Therapy Alliances (Friedlander et al, 2006) stablishing a cut-off point for SOFTA-o results in order to distinguish cases or sessions with "good enough" from others with "insufficient" expanded therapeuthic alliance.
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Thank you very much, Béatrice and María Fernanda, for this articles, manual, and www describing SOFTA developtment, use and rating. Nevertheless, I'm afraid the answer to my question is not included in that documents. I'm not looking for SOFTA dimensions rating procedure, but for stablished criteria about SOFTA dimension rates in order to classify cases in two clearly different groups: good vs. insufficient expanded therapeutic alliance.
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treatment of depression/anxiety/addiction etc, what is NLP best for?
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Could you further explain the methodology with respect to how the number of studies was reduced to 12? After removing 350 studies that were not relevant, there would be (125 - oops ... arithmetic error (I thought it had said 475) .... there would be 75 left. It is difficult to determine the extent to which the meta-analysis is meaningful without being able to re-assure oneself that lack of results didn't lead to removal from the meta-analysis in the first place. 
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As an example: Should someone whose delusional content is about a certain conspiracy theory from a therapeutic viewpoint be allowed to read books about it? 
Is there any research into possible therapeutic outcomes, chronification (of delusions), ...?
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Some resources:
Using the back door: Metacognitive training for psychosis.
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.
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)
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I am planning a study about psychotherapy research in my country. My aim is to describe the themes that have been researched, but also to evaluate the methods, designs, techniques and analysis that researchers have used. It would be helpful if there is an established framework to use in this evaluation.
Otherwise, my plan is to compile a framework based on literature about methods of psychotherapy research. It would also be helpful if you can recommend such literature.
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Common sense in designing and viewing research in the context of the real world is not always captured in some of the technical specifications. One of these is sample size. In doing outcome evaluations, we have found that stable numbers are not achieved with samples much under 200. However, you will find many studies with much smaller numbers. The problem with that is that a few outliers can skew findings. For example in a study with 50 people in each of two cells, as few as three individuals can make a difference of 6% in positive vs. negative outcomes in a cell. On the other hand, studies with very large numbers can achieve statistical significance that is essentially meaningless. For example, I recently read a study with thousands of subjects. The reported differences were statistically significant beyond p = .001, but the absolute differences were just a fraction of a percent in outcome - identical for all practical purposes.
Another area is the assumption that randomization achieves equality. I once assisted a physician with a study in which the baseline differences on key variables were significantly different beyond p = .05 at baseline even though randomization was rigorously done. That level of difference would be expected on average for one out of every 20 similar studies.
Consideration of sample size, verifying equality of cells at baseline, objective measures to the extent possible, and accounting for potential influencing factors are essential for rigor.
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Can anyone help me. I am writing a paper on Hate crime and trying to locate information on coping stragedies and coping mechanisms victims employ both prior and after a incident of hate crime ?
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These are patients in nursing homes that have mild to moderate dementia and/or Alzheimer's.  Cognitive and supportive therapy approaches are used to maintain condition or prevent further decline (prevent hospitalization). 
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Hi David-
To me, there is no way to answer your question in a broad way unless you are asking “Is it EVER acceptable…” to which the answer is “Yes.” But I don’t think that’s a helpful answer: I think the answer always has to be asked with regard to the specific circumstances. For example, does the patient find it helpful or supportive? What are their treatment goals? If the patient is losing their capacity to continue to consent are there others (e.g., with power-of-attorney) who can assess the helpfulness and appropriateness of the therapy?
For years? Yes, possibly. It depends what the purpose is. You said “to maintain condition or prevent…decline.” It's not clear to me in what sense this is meant: To prevent the decline of Alzheimer’s? Of course not. To slow decompensation, reduce stress and confusion, increase support in a way that may prevent an acceleration of distress and disturbance? Sure.  For example, there is empirical research supporting psychotherapeutic interventions having a sustained impact on Alzheimer’s patients’ depression and aggression. A Google or ResearchGate search of “psychotherapy effect on dementia” will give you a quick overview. But on a more ‘human’ level, I might ask: what kind of family or social support do these patients have, and might the long-term psychotherapy be serving this kind of social support function?
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I am doing some research on the recovery model in mental illness and have become a little fascinated with this intervention for schizophenia.
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family education to reduced high expressed emotionality (EE) was known to be effective: serendipitously, Bill McFarlane found additional benefit when the education was done with multiple families--his subsequent work elucidating why multi family groups + psychoeducation decreased relapses is spelled out in his writings
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I'm developing a basic psychotherapy skills course for psychiatry residents, and would appreciate recommendations for readings to assign, videos to watch in class etc.
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Hi Sumru,
I recommend having them read some of the case studies in the book "Case studies in Abnormal Psychology." (http://ca.wiley.com/WileyCDA/WileyTitle/productCd-EHEP001999.html) It will really give them an idea of what they might face with their own patients in the future. It's also just interesting to read case studies in general I find! Even if you don't use it as assigned reading, you can take examples and ask them how they would go about treating these individuals.
Hope that helps,
Gerri
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This rare disease can cause a high impairment of the the quality of life. To my knowledge there is no sufficient therapy.
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This was an unexspected number of articles of a rare syndrome. I have requested theses articles and hope to find an answer. Thank You!
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Simple questionnaire that you may recommend.
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The Symptoms of Trauma Scale (SOTS) is a 12 item symptom severity scale, as described by Ford et al., Journal of Psychiatric Practice, in press
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We all may having some sort of traumatic events in our life. Some of them are man made meanwhile some are natural. But every people who faced trauma are not developing PTSD(Post Traumatic Stress Disorder) or accute stress disorder as result of the Trauma. Their emotional Intelligence and Resilience skills play a role in this circumstances.
I kindly expect your idea to develop my research background!
Best regards
Asanka
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I agree with all of the comments posted here. I would add and emphasize that a priori long-term and enduring vulnerabilities (as touched on by Dinesh) may set boundaries for resilience across individuals and that although related to resilience, vulnerabilities are independent factors that begin before and after birth and continue to be influenced by early negative experiences/trauma. Even later in life, comorbidities (diseases, illnesses) and dispositional variables (hostility, etc.) make it more difficult to "bounce back" in the face of stressors. Resilience needs to be considered in the context of a person's vulnerability. If a person is born with physical, economic and social hardships, she/he will  find it more difficult to be resilient e.g., when one becomes a professor at a major university and has parents who never went to school, this is reflective of much greater resilience than someone who becomes a professor, but has parents who were doctors or engineers.
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Improving collaboration, improving working alliance
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Hi Egon.  As promised, our website on alliance-focused training (with clinical tools): http://alliancerupture.weebly.com/    Still under revision, but very close to going live (probably in a week or two).  Best regards, Chris
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I'm interested on anything current or seminal on "self-agency" from various schools within the psychoanalytic, cognitive-behavioral & humanistic traditions. Anything from conceptual treatises to empirical investigations. I'm interested in how relevant self-agency is considered for well-being and how change in self-agency is effected from various perspectives.  Anything on method & measurement in addition to clinical theory.
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Chris
Not quite clear what you are looking for but I will tell you what I know. First, regarding “agency.” Are you interested in clients’ experience of agency? Or in the fact that they act agentically? They could act agentically without explicitly perceiving or experiencing themselves as being agentic. For instance, I have considered David Rennie’s qualitative studies as having demonstrated client agency in terms of action (so did David). But there was no explicit attempt to measure or even to ask clients if they were feeling agentic at the time. Second, I’m not sure if you mean something different by self-agency from agency per se.
            I’ve summarized evidence suggesting that clients act agentically in therapy. Most of it is qualitative and does not explicitly link to outcome, although I think you can infer a link. I will attach two chapters that summarize evidence. Both are page proofs so probably you shouldn’t quote directly, but the content is the same as is what is in the final chapters. The Bohart & Wade chapter is in the recent Handbook of Psychotherapy and Behavior Change. The Bohart & Tallman is in M. Cooper, J. C. Watson, & D. Hölldampf (Eds.), Person-centered and experiential therapy work: A review of the research on counseling, psychotherapy and related practices (pp. 91-133). Ross-on-Wye: PCCS Books.
            As far as the experience of agency, there is less. One study I know of is Hoener, Stiles, Luka, & Gordon, (2012). That is cited in both chapters, although mis-cited in Bohart & Tallman (2010) as “Hoerner” (I mis-spelled her name; it is Hoener, and in that chapter it is her conference presentation that is cited).
Art
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Any data on therapist actual use of the CST manual and whether it was found to be beneficial or useful by clinicians?  I'm interested in data beyond the value of feedback regarding progress on the OQ (Outcome Questionnaire) and regarding reasons for poor progress on the ASC (Assessment for Signal Clients: alliance, motivation, social support, life events).
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My  experience is somewhat tangential using an adapted CST as part of a feedback system that used different outcome measures but used the ASC routinely.
I am convinced that the overall clinical setting and the mindset of clinicians and managers are vital variables here as is the patient population. I think that in the UK, at least there has been a drift away from clinical psychologists seeing themselves individually as active researchers but this does not mean that they have necessarily become good users of research even such eminently practical research as exemplified by Mike's work. Furthermore there has been a cultural dilution with the advent of psychological therapists without a scientific background.
While our forthcoming paper (Lucock et al.) and indeed the Pychotherapy Research Special issue (2016?) should give you some hard data, my belief is that the way ahead is more about developing cultures (where therapists are receptive to feedback and accept that when things are not going well they need to stop think and go in another direction) [I have just been moving my rather large van in a rather confined space!] rather than systems. Systems are great but they can only function in the right culture. lambert himself spoke on this at SPR Barcelona but I am not sure how much the negative data gets published.
If the CST is to work it probably needs to be an interactive device that pulls and pushes the therapist into changing direction trying new tactics getting help and advice and using other resources. Of course good supervision or the combination of CST supervision and outcome data could do this. We also need therapists who are prepared to carry on working when they are out of their comfort zone and statistically are more likely to produce less results than if they abandon the client and move onto someone else who is easier to work with. ie a system that rewards persistence and flexibility.
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I'm looking for a text about self-esteem and psychopatology and group psychotherapy. I want to use self-esteem as a measure for effectiveness of group psychotherapy. 
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 Hello Zbigniew Wajda
Some papers that might help:
Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of social and clinical psychology, 25(8), 875-884.
The fulltext is available from the author’s publication page on ResearchGate:
In study 2 of this paper, measures of self-esteem are discussed, and referenced to the paper below, which used the Rosenberg Self-esteem Scale (1965):
Torrey, W. C., Mueser, K. T., McHugo, G. H., & Drake, R. E. (2000). Self-esteem as an outcome measure in studies of vocational rehabilitation for adults with severe mental illness. Psychiatric Services, 51, 229-233.
The following paper also records the use of the Rosenberg Self-esteem Scale:
Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E., ... & Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59(8), 713-721.
The paper below records the use of the Index of Self-Esteem (Hudson, W. W. (1982). The Clinical Measurement Package: a field manual. Homewood: Dorsey Press.).
Knight, M. T., Wykes, T., & Hayward, P. (2006). Group treatment of perceived stigma and self-esteem in schizophrenia: a waiting list trial of efficacy. Behavioural and Cognitive Psychotherapy, 34(03), 305-318.
The paper below does not relate to group psychotherapy:
Zeigler–Hill, V., & Abraham, J. (2006). Borderline personality features: Instability of self–esteem and affect. Journal of Social and Clinical Psychology, 25(6), 668-687.
Regarding the following paper - you may think that self-esteem was inferred rather than frequently mentioned per se:
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self‐criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353-379.
The below reference relates to Ch. 6 but the book is available on Google to sample:
 O’Brien, E. J., Bartoletti, M., & Leitzel, J. D. (2006). Self-esteem, psychopathology, and psychotherapy. Self-esteem issues and answers: A sourcebook of current perspectives, 306-315.
Hope these help
Mary
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A college counseling center administers assessment measures on a repeated basis (interval) to clients who use mental health services. Students complete a 62-item measure (baseline) at intake, and a brief version of the measure 34-item) at the third, sixth and ninth session (three times). Treatment ranges anywhere from three sessions to ten sessions - so, the same participants are measured over several time periods or waves, but not every participant will have the same number of observations.
Also, I want to compare three interventions (IVs): Counseling only, Psychiatric Medication only, Counseling and Psychiatric medication
By looking at the scores on the clinical assessment measure (DV).
Will the mismatch in time or waves cause me problems?
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Every participant should have the same number of observations or assessment to draw substantive conclusions in a macro sense. The main concerns I have, assuming the assessment measures are valid and reliable, are subjective bias, demand characteristics, and maturation. Then also, are the measures taken before or after the treatment sessions in each testing interval. I prefer the latter for the previous concerns. Check out xpainstress.com for a mental health services questionnaire in use with chronic pain/stress of single subject/group repeated measures over time.
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As many of you know, we (psychotherapy researchers) have often focused on symptoms measures as measures of outcome. My students and I are trying to develop a more comprehensive measure that will include items about coherence, freedom to choose to mention just a few aspects of this new measure that have not always been included in past studies. My question is what aspects of psychotherapy outcome do you think a comprehensive (but short) measure of therapeutic outcome should include besides symptoms? The most helpful answers will be phrased very clearly and not include jargon. Thanks
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What I hear from my patients is not that their symptoms or problems disappear but that their functioning has improved. That they can do more, listen more to their family, do things at home, go out for shopping, eventually start working again, et cetera. Most of them still have the same fears, nightmares, bad sleep, which appear in the symptom check lists, but when asked they say they feel better because they can do more.
My suggestion would be to include a general functioning list, although it stays important to listen to their own opinion about it.
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Papers on Early responders to CBT for children and adolescents with OCD or Anxiety
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Dear Nor,
Some papers:
Predictors of treatment response to intensive cognitive-behavioral therapy for pediatric obsessive-compulsive disorder. Rudy BM, Lewin AB, Geffken GR, Murphy TK, Storch EA. Psychiatry Res. 2014 Dec 15;220(1-2):433-40.
The prediction of treatment outcomes by early maladaptive schemas and schema modes in obsessive-compulsive disorder. Thiel N, Tuschen-Caffier B, Herbst N, Külz A, Nissen C, Hertenstein E, Gross E, Voderholzer U. BMC Psychiatry. 2014 Dec 25;14(1):1689.
Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial. Külz A, Landmann S, Cludius B, Hottenrott B, Rose N, Heidenreich T, Hertenstein E, Voderholzer U, Moritz S. BMC Psychiatry. 2014 Nov 18;14(1):314.
Cognitive behavior therapy for obsessive-compulsive and related disorders.Lewin AB, Wu MS, McGuire JF, Storch EA.nPsychiatr Clin North Am. 2014 Sep;37(3):415-45.
Integrating Real-Time Feedback of Outcome Assessment for Individual Patients in an Inpatient Psychiatric Setting: A Case Study of Personalized Psychiatric Medicine.
Confer JR, White M, Groat MM, Madan A, Allen JG, Fowler JC, Kahn DA.
J Psychiatr Pract. 2015 Jan;21(1):72-78.
Self-Affirmation Breaks the Link Between the Behavioral Inhibition System and the Threat-Potentiated Startle Response.
Crowell A, Page-Gould E, Schmeichel BJ.
Emotion. 2015 Jan 19
Test of an hypothesized structural model of the relationships between cognitive style and social anxiety: A 12-month prospective study.
González-Díez Z, Calvete E, Riskind JH, Orue I.
J Anxiety Disord. 2015 Jan 9;30C:59-65.
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I need comparison of CALPAS, WAI, Haq, VTAS, VPPS, TARS, TBS. 
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You're welcome.  Let me know if you need anything more as I (& know others who) have some experience with many of these measures.
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I'm wanting to use the Working Alliance Inventory - short (12 item) observer version, as part of a research study we are conducting here in the UK. I'm looking for a rating manual - I've got the 4th edition (2000), but am looking for one of the earlier versions, as the rating system was changed from the 4th version onwards, and we're needing to use an earlier version... This is part of our work on an RCT examining treatment of adolescent depression. Thanks!
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And here is an observer-based measured of alliance rupture events & resolution processes in case it may be of any use.
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I am currently advising and working with the NHS National IAPT programme. In the past year I have reviewed many services. A frequent factor to emerge has been the less than necessary referrals to achieve the 15% access goal set by the NHS for CMHD.  Given the high prevalence of these disorders why are we not overwhelmed by demand?
I have been looking at help seeking research and mental health literacy.
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Great postings. I work with eating disorders and the percentage of people suffering from anorexia nervosa (AN) and bulimia nervosa (BN) specifically are very low. BN because people are embarrassed of symptoms and often function well despite them and much suffering that they hide. AN because the disorder is egosytonic. If they want to lose weight and know that therapy will involve weight gain, they're not going to "undo all their hard work". Mostly people with AN are referred by worried family members or school counsellors and actively resist at least at the beginning.
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There may be many barriers which hamper people from using effective psychotherapy services: form cultural ones ("psychotherapy is useless", or "all forms of psychotherapy are equally effective", or "effectiveness of psychotherapy cannot be assessed"), to economic ones (costs for individuals or for organisations), or organisational ones (too few professionals or too few public services), or lack of advertising. I'm asking this question because the time seems ripe to launch an initiative for favouring the access to effective psychotherapy (which we actually did in Italy). Knowing what the situation is abroad about these barriers may be helpful. 
Hundreds of thousands of people in need of mental health services may not be helped not because of low effectiveness of treatments, but rather for little access to them!
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The almost total lack of trained personnel. The problem is exacerbated by the highly variable quality of clinical psychologists, who range from the well-qualified and motivated to the utterly inept. Get any of my clinical colleagues talking on the subject to hear some horror stories!
And behind this, the utter neglect of mental health in the Irish health services. Ten years ago we had the lowest proportion of health spending on mental health in the EU, and this proportion has declined ever since. Irish graduates will not apply for jobs in Ireland because of the appalling working conditions, as a response to which the Health Services Executive spent millions recruiting Pakistani psychiatrists from unaccredited medical schools to work in Irish psychiatry. 
Apart from that, things look great for mental health in ireland. 
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I am doing my thesis on the therapeutic relation between Art Therapist and patient within a pediatric acute medical children's hospital setting comparing two groups one with the assistance of a therapy dog and one without. Due to the Institutional Review Board of the Hospital I had to disclosed the possibility of the therapy dog within the title of the study to all participants, so there was an immediate response from my pediatric participants from the moment I disclosed the title. The verbal and bodily reaction, from the participants, have been noted and accounted for in my data collection, as 18 out of 20 participants were completely non-responsive to my presence in the room until they heard the word dog. What I have come to realize in my data collection and what I found the most intriguing aspect that has presented itself is the apparent inclusion of object relations, object permanence, and the therapy dog acting as a secure base throughout the sessions in both groups. The question I am inquiring about is has anyone done work surrounding these aspects within their own practice and/or research, or have you read any articles/research done in regards to these theories and the inclusion of an animal within the therapeutic relationship?
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Thanks for the information—I will definitely search Duke's database for their research. I have been using my English Bulldog Tilly for approximately 8 years in the hematology/oncology outpatient unit (Valerie Fund), The Unterberg's Children's Hospital at Monmouth Medical Center, pediatric in and PICU wards, CCIS (Children's Crisis Intervention Services) at Monmouth Medical Behavioral unit, and I also take her to the Hawkswood School to work with children with differing severity of disabilities, physical, development, and cognitive. I also raised a service dog to be used with individuals with special needs—all of which lead me to go back to school to attain my Masters in Creative Art Therapy and also focus my  thesis on this phenomenon with rapport building, with a focus on the attachment, object relations, object permanence, and secure base theories when I am in session with my patients. It has been really amazing to witness these children being able to open up to me, who is ultimately a stranger, merely because my dog is in the room or in some cases (due to the study parameters and the way I measured rapport) if she was in my office but the kids new she was nearby. Thanks again for your story and for your information leading me down another amazing rabbit hole of research and information.
Happy New Year and all the best for you and your family (furry and skin) for 2015.
Alison Silver
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Any research on patient personality disorder as it impacts patient-therapist interactions or the therapeutic alliance since 2010.
For example: Tufekclioglu, S., Muran, J.C., Safran, J.D., & Winston, A. (2013). Personality disorder and early therapeutic alliance in two time-limited therapies. Psychotherapy Research. 
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Thank you, Adriano, for your thoughtful comments, & best wishes for the new year, Chris
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Namely, management of negative affect or anxiety.
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Thank you!
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Where can I find informations concerning client's willingness to express emotions during psychotherapy as the signal about his readiness to work on the solution of the problem which leads to behaviour change?
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Thanks for your very interesting question, Marta. I appreciated Beatrice's and Michael's excellent input. Along with motivational interviewing (MI) by Miller and Rollnick (2012), I'd recommend the Stages of Change (SOC) of The Transtheoretical Model (TTM) by Prochaska & DiClemente, (1983) and Prochaska, DiClemente, & Norcross (1992) for assessing the client's readiness and motivation to change.
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I have done some research and found a few researches who proved that cognitive behavioral therapy has worked. I would like to know if the researchers: Allen, Woolfolk et. al. and Smith were good researcher for this study.I want to know if there were any other related sources about the use of cognitive therapy treatment and intervention for somatic complaints from patients.
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This does not answer your question, but a similar one: any effective treatment for somatization disorder needs to dissolve the stresses caused by trauma and other overloads of experience and stored in the nervous system.
I am a meditation teacher, not a therapist, but in my experience somatic symptoms begin to dissolve as soon as transcending begins to be practiced. Transcending is an effortless mental process that produces a state of deep rest in which mental alertness is not lost.
Our experience and published research show that transcending gradually eliminates all stored stresses, leaving the nervous system strong and resistant to acquiring new stresses.
Several psychiatrists and psychologists regularly refer some patients to instruction in transcending, which takes several hours spread over several days.
There are two main sources of instruction in transcending, Transcendental Meditation (TM) and Natural Stress Relief (NSR).
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Anyone aware of new research on problems or difficulties in the therapeutic relationship, alliance ruptures, therapeutic impasses, treatment resistance, patient-therapist hostility? Anything since the attached review/meta-analysis (Safran, Muran, & Eubank-Carter, 2011)?
Psychotherapy Relationships That Work: Evidence-Based Responsiveness, 2 edited by J.C. Norcross, 05/2011: chapter Repairing Alliance Ruptures: pages 224-238; Oxford University Press, New York, NY., ISBN: 0199737207
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Hello John,
check these out:
  • Haskayne, D., Larkin, M. and Hirschfeld, R. (2014). What are the Experiences of Therapeutic Rupture and Repair for Clients and Therapists within Long-Term Psychodynamic Therapy?. British Journal of Psychotherapy, 30: 68–86. doi: 10.1111/bjp.12061 http://onlinelibrary.wiley.com/doi/10.1111/bjp.12061/full
  • Gerostathos, A.; de Roten, Y.; Berney, S.; Despland, J-N.; Ambresin, G. (2014). How Does Addressing Patient’s Defenses Help to Repair Alliance Ruptures in Psychodynamic Psychotherapy?: An Exploratory Study. Journal of Nervous & Mental Disease, 202(5), 419-424. doi: 10.1097/NMD.0000000000000112 ...and many more by JN Despland: https://www.researchgate.net/profile/Jean-Nicolas_Despland/publications
  • Cash, S. K., Hardy, G. E., Kellett, S., Parry, G. (2014). Alliance ruptures and resolution during cognitive behaviour therapy with patients with borderline personality disorder. Psychotherapy Research, 24(2), 132-45. doi: 10.1080/10503307.2013.838652
  • Altenstein, D., Krieger, T., Grosse Holtforth, M. (2013). Interpersonal microprocesses predict cognitive-emotional processing and the therapeutic alliance in psychotherapy for depression. Journal of Counseling Psychology, 60(3), 445-452.  doi: 10.1037/a0032800
Also, these two reviews could be of help:
  • Baillargeon, P. , Coté, R. & Douville, L. (2012). Resolution process of therapeutic alliance ruptures: A review of the literature. Psychology, 3, 1049-1058. doi: 10.4236/psych.2012.312156. http://file.scirp.org/Html/25454.html
  • Degnan A., Seymour-Hyde A., Harris A., Berry K. (2014). The role of therapist attachment in alliance and outcome: A systematic literature review. Clinical Psychology & Psychotherapy, doi: 10.1002/cpp.1937.
Edit:
I've just found one more. It's in French though, but has an extended English abstract:
  • Bouvet, C., Cleach, C. (2011). [Early dropout patients in psychiatric psychosocial rehabilitation treatment and their bindings with relational skills, object relation and intensity of psychopathology]. L'Encéphale, 37, Suppl 1, S19-26.
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I'm a newbie, so I hope I am doing this right... I am interested in any information on using Cognitive Behavioral Therapy, Art Therapy & Mindfulness to increase hope in patients with chronic pain.
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I found the recent paper of McCracken & Vowles about CBT, ACT and mindfulness for patient with chronic pain to be quite good, it might help you a little:
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178-187. doi:10.1037/a0035623
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Teachers' emotional burnout seems to be a worldwide phenomenon. As a teacher myself I have experienced it and because quitting is not a solution I have decided to research and find ways to successfully deal with it and if possible prevent it. My main interest is helping the educational community, my colleagues as well as myself.   
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Interventions that promote teacher resiliency, especially those that use mindfulness training (MT) seem to be quite promising.
Roeser, R. W., Skinner, E., Beers, J., & Jennings, P. A. (2012). Mindfulness training and teachers' professional development: An emerging area of research and practice. Child Development Perspectives, 6(2), 167-173.
Gold, E., Smith, A., Hopper, I., Herne, D., Tansey, G., & Hulland, C. (2010). Mindfulness-based stress reduction (MBSR) for primary school teachers. Journal of Child and Family Studies, 19(2), 184-189.
Burton, N. W., Pakenham, K. I., & Brown, W. J. (2010). Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program. Psychology, health & medicine, 15(3), 266-277.
Benn, R., Akiva, T., Arel, S., & Roeser, R. W. (2012). Mindfulness training effects for parents and educators of children with special needs. Developmental Psychology, 48(5), 1476.
Fleming, J. L., Mackrain, M., & LeBuffe, P. A. (2013). Caring for the Caregiver: Promoting the Resilience of Teachers. In Handbook of Resilience in Children (pp. 387-397). Springer US.
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Discussion on benefits of therapeutic relationship usually focus on clients' benefits but there are many professional and personal benefits for therapists. A massive, 20-year, multinational study of 11,000 therapists conducted by David Orlinsky and Michael Helge Rønnestad (2005) pointed that 97 % of the therapists reported that learning from clients was a significant influence on their sense of development, with 84 percent rating the influence as “high.” Hence, therapists genuinely believe that clients are the best teachers.
If we look at the personal angle, researchers found (Skyner, 1989; Guy, 1987; Williamson, 1981) that one of the main reasons for psychotherapists entering the profession is due to experience of denied nurturing in the family of origin. These findings can help us understand why positive and nurturing psychotherapy relationships are providing a healing space not just for clients but therapists as well (Charny, 1982; Marovic 2011).
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I learned from my clients a lot about a host of professions, working conditions, family conditions, problematic and pathological behavior, views on life, ways to cope with things, harmful and beneficial conditions of living, etc, and so on. I often admired clients for a number of things. I was more more than once impressed by their strengths than their weaknesses. I did not need them to be healed myself.
This holds for primary psychological care, in which I have been working most of the time. (In 2014 I retired.) 
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I am currently conducting a therapy process understanding study through trial co. and started seeing the therapist missing the clients unsaid needs. Seems like these gaps happen pretty frequently and clients follow the flow which therapists set and to see how their other needs to be understood. I am looking for prior studies or related research or your thoughts!
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John, thank you, I will check and follow Richard Sly, whom I have never known by now. I am a part of the Scott Miller and Barry Duncan's research related with client feedback.
Thank you!
Noriko
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This is an old concept originally developed by Lyman Wynne and Margaret Singer in the sixties that opens interesting possibilities for researchers interested in the social origins of psychosis and cognitive problems.
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Hi Beata, 
Your case study sounds quite interesting I would be very interested in reading it. Is it ready for submission in English?
I'm not sure if I understand what you mean by informal learning within the family but it surely sounds interesting.
I have specific predictions about social isolation but yes, generally speaking, it seems to be a very important factor in psychosis.
My only concerned is that a diagnosis at this late stage is normally associated with organic/medical problems.
Paulo 
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I hope that someone can help me to get a scale of emotional intelligence for children between the age of 6-10.
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Dear Gianluigi,
a very exiting research program! You can find more information on the TEIQUE in the children and adolescent form in the two papers referring to the Italian validation of these two forms of the questionnaire:
  • Russo, P. M., Mancini, G., Trombini, E., Baldaro, B., Mavroveli, S., & Petrides, K. V. (2012). Trait emotional intelligence and the Big Five: A study on Italian children and preadolescents. Journal of Psychoeducational Assessment, 30, 274–283. 
  • Andrei, F., Mancini, G., Trombini, E, Baldaro, B., & Russo, P. M. (2014). Testing the incremental validity of Trait Emotional Intelligence: Evidence from an Italian sample of adolescents. Personality and Individual Differences 64, 24–29.
Moreover, you can find more specific information on the combination of emotion recognition and trait EI in children in a paper we published two years ago:
  • Agnoli, S., Mancini, G., Pozzoli, T., Baldaro, B., Russo, P. M., & Surcinelli, P. (2012). The interaction between emotional intelligence and cognitive ability in predicting scholastic performance in school-aged children. Personality and Individual Differences, 53, 660-665.
With regard to TEIQUE-CF I think you can download the Italian version directly form the Petrides’s web-site, or, alternatively, you can write him asking for the Italian version of the questionnaire.
I wish you good luck with your research,
best
     Sergio
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I am working on a dissertation & one of my chapters is the history of integrating/using psychology & theology in counseling law enforcement personnel
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Hi Nate, I had a scout around for you since your question interested me - I worked for many years in crisis counselling and I remain interested in models and approaches, particularly integrating different discipline groups and their skill sets.
In the early 1990s in Australia we utilised Critical Incident Stress Management (CISM) teams, however there was not a role for theology; it was very much a psychological debriefing procedure, devised by Jeffrey T. Mitchell in 1983. It drew on crisis intervention and group theories. There is quite a bit of writing from him circa 1986.
He uses peer support personnel as debrief staff alongside mental health professionals. He has written about law enforcement personnel also:
Mitchell, J. T. (1991). Law enforcement applications of critical incident stress teams. Critical incidents in policing, 201-211.
The model in the USA has been one of Critical Incident Stress Debriefing (CISD).
The Bohl Law Enforcement model would seem to be the one tailored for the group you are interested in and the USA context, with the inclusion of clergy. There is a 1991 article, drawing on Mitchell's work, and some developments since:
Bohl, N. (1991). The effectiveness of brief psychological interventions in police officers after critical incidents. In J. T. Reese, J. M. Horn, & C. Dunning (Eds.), Critical incidents in policing (pp. 31–38). Washington, DC: U.S. Department of Justice.
Bohl, N. (1995). Professionally administered critical incident debriefing for police officers. In M. I. Kurke & E. M. Schriver (Eds.), Police psychology: Into the 21st century (pp. 169–188). Hillsdale, NJ: Erlbaum.
1991 seems to be the year you are after.
Good luck with your dissertation!
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Ego structural disorders are called "hard to reach". What works for whom? Who works with what? What are the practical experiences you have?
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The strongest literature clearly related to Borderline personality disorder for which there are multiple evidence-based models, recently in fact reviewed at the American Psychiatric Association Meetings last week in New York (see APA website for more).
See references by Bateman and Fonagy on Mentalization-Based Therapy (MBT), Brief Psychodynamic Psychotherapy as further developed by Kernberg and Clarkin into a manualized treatment, Dialectical Behavior Therapy (DBT) as developed by Linehan.
Other personality disorders such as Narcissistic, Histrionic (Cluster B of DSM) do also respond to the first 2 of these treatments. Less is evidence-based for the anxious-avoidant PDs,, antisocial PD of course and the schizotypal/schizoid and paranoid PDs. However, in my experience the particular constellation of comorbidity, personality characteristics including competencies (ego strengths), culture, and relationship-contexts shape what kind of intervention works for whom. This is also not to neglect the patient-therapist match, as it is within this relational context that the process takes place of course.
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When should we use observationally measured ratings of the working alliances (therapist and observer) in psychotherapy research, and when should we use patients’ self-reporting?
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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.
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I've been struggling to find it online. I'm extremely interested in using it but cannot find it anywhere. I would appreciate anyone e-mailing it to me.
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Is it the depression index mentioned in this paper? http://www.ncbi.nlm.nih.gov/pubmed/3595512
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I have been engaged in several outcome research studies wherein we had the typical control/experimental group and looked at results from pre to post.
Now I am interested in perhaps doing some studies about trying to break down the individual factors that may be contributing to the change (e.g. the specific factors/interventions outlined in the treatment manuals).
Does anyone have any ideas or articles they're aware of that do this well?
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here is a current paper that has broken down the dialect between client and therapist to determine thresholds between safety and risk... attempting to measure change via therapeutic collaboration.
Ribero,E., Ribero., A.P., Goncalves, M. M., Horvath, A. O., & Stiles, W. B. (2013). How collaboration in therapy becomes therapeutic: The therapeutic collaboration coding system, Psychology and Psychotherpy: Theory, Research and Practice, 86, 294-314
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Historical reasons really - curious how he progressed from Ego, Hunger and Aggression (1947) to Gestalt Therapy (1951).
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Hi Adam, Thank you so very much! I really do appreciate it (I didn't get a message so sorry I'm getting back to you a month later). I am tracking down Ego and now I think it would be worth it just to compare PHG and whether there was a kernel or a few kernels of ideas for the experiential exercises so this helps (and I will stop procrastinating and get to working on it finally...:). It may be that the experiential portion of PHG really came from synthesizing the ideas in the air at the time in the US rather than EGO as there were a number of therapeutic, body work, self-actualizing groups at the time in the US. Thanks again!
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I'm interested in comparing the intensity of therapist emotional reaction elicited by different modalities, but the countertransference questionnaire seems like it may not serve the purpose well.
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I think what you are asking about is a general tool to measure countertransference. I think the following is pretty good and freely available for download on line:
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It appears that the highest level of integration thus far has involved using psychodynamic, humanistic/experiential, behavioral/cognitive-behavioral, or systems models, and "borrowing" techniques from other approaches. Is it possible to build upon those models beyond the current level, or will it take a brain-based approach to reach the next level?
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I gave a response to a similar question in a LinkedIn group to which i belong and thought this would be of interest to this questions followers. Bob
Eric, the neurophysiological common language is the correct level of interpretation in relation to what allows the brain to achieve “higher cortical functions.” Whether referring to abilities to have language, problem solve, use verbal schemas, or form emotional schemas, the common denominator in my proposed model is the cortical column. From a neuroscience standpoint this gives the level at which to look for future research. Other current levels are molecular, neurotransmitter/receptor, modular, probabilistic or frequency coding, and large structure circuits. Methods of measurement involve single cell recordings up to imaging techniques and EEG/MEG. If the correct level of the “code” is the column, then findings from all research at these other levels should be explicable by the columnar model. For example, I reviewed studies that indicate increased fMRI activity during initial learning only. This means that once a permanent long-term memory exists in relation to a stimulus, imaging is not expected to show increased cortical activity in the location of the columns involved with that memory. In relation to intense emotional memories, there would be increased activity at the subcortical level, such as the amygdala on the side where the memory is stored. In a clinically relevant study I mentioned in the 2013 paper, fMRI showed increased right frontal activity during exposure to decrease anxiety to spiders. At 6 month follow up, treatment gains were maintained but the right frontal activity was no longer observed. The study authors suggested the right frontal region was not involved in the maintained benefits. I suggested the columns in this region are still involved and are the ones that allow the decreased anxiety, but show no increased metabolic activity since the columnar circuits are consolidated and require no generalized activity that was necessary for initial memory consolidation. A radical difference in my model and the one that has been predominate since the 1980’s relates to the hippocampus. The current view is that initial storage of memory occurs in the hippocampus and is somehow later transferred to other areas, such as the cortex. The columnar theory says the memories are stored cortically from the outset in the same circuit involved in initial processing, and the hippocampus serves as the pacemaker to allow gamma frequency oscillations and dynamic column formation to strengthen the synaptic connections among the columns. I discuss this and other aspects (such as related to Alzheimer’s and schizophrenia) in a brief article in the Speculation section of the upcoming Neuropsychotherapist magazine on October 1.
More relevant to the current discussion, the common language relates to the Clinical Biopsychological Model in which there are 3 cortical aspects (right hemisphere, left hemisphere, interhemispheric congruence) being addressed as related to negative emotional memories (e.g., trauma, relationship problem memories), current factors (e.g., pain, stressful work environment, marital arguments), and loss positive stimuli (e.g., loss of relationship, loss of job). As I hope I have been able to communicate in my articles, I believe it is possible to use the model to assist in identifying all areas to be addressed in an efficient manner (typically one session) followed by a detailed explanation (conceptualization) being given to the client that explains how the presenting problems developed and how treatment will address each. The conceptualization gives a common language between the therapist and the client, with an understanding of how therapy will proceed. This also allows a way to see how issues addressed in one manner influences issues in a different area. An example of this relates to the distinction I made in the article published (in the International Journal of Neuropsychotherapy, available at Neuropsychotherapist.com) last week on Type-G (Giver) and Type-T (Taker) interpersonal behavior patterns. A description based on this model is an integral part of the emotional restructuring session used to deal with relationship negative emotional memories. In that procedure, the description allows the client’s verbal interpreter (left hemisphere) to gain an understanding (a new schema) of the exact behavior patterns of the target individual (i.e., the person who is the focus of the session, such as a parent, a boss, a spouse, etc.). In the session, this allows interhemispheric congruence since the client better verbally understands the actions of the target individual with better acceptance of the right hemisphere-based emotional reactions of the client (i.e., the client both thinks and feels his/her emotional reactions are reasonable). The same Giver/Taker conceptual framework provides the rationale for how to deal most effectively with individuals in current relationships as I have discussed in my treatment manual and included in the article as an appendix. The concept further serves to insulate the client from developing future detrimental negative emotional memories in relationships since it allows the client to comprehend an individual’s behaviors are a function of how that person has learned to interact in relationships. This externalization prevents perceptions of personal inadequacy and loss of control by the client.
Please ask further questions if you have them since I believe this type of dialogue is the best way for me to convey all aspects of the theory and applications. I have an article that is to be published in New Therapist magazine in the next 2 to 4 months since I am trying to reach out to practicing, non-academic therapists. You can also listen to me talk about the model since I am the guest on Shrink Rap Radio in the show that is scheduled to be posted this Thursday afternoon. It is a 50+ minute discussion available as a free podcast at that website.
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Can anyone point me to the best available evidence that compares psychotherapy with no treatment in adult depression?
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One thing that might help would be to stop considering depressive patients as a homogeneous group. Perhaps a minority would profit most from a SSRI or another drug, but most of them would profit from psychotherapy, adjusted to the ins and outs of their problems in living. And do not measure the effectiveness of it by mere symptom reduction. There is more to recovery than that.
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I would like to ask for references/papers about psychotherapy for adolescents with panic disorder. Also, in your experience, which are the best methods?
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We all know that good therapeutic relationship is associated with better psychotherapy outcome. I have a simple question, some theoreticians/clinicians and researchers suggest that the therapeutic relationship is curative on its own. As I have tried to study that question I am interested to hear people thoughts on what about the relationship is curative and how does that work?
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Hi Juergen, Thanks for your useful clarifications. I agree, I think that the distinction that Jacques is posing is between the quality of the therapeutic relationship as important in promoting a process of change or the relationship itself as integral to that change. So one might think that a good alliance between therapist and patient/client would encourage trust, understanding and identification. These qualities might lead the patient to be more open to accept suggestions by the therapist or to be motivated to undertake exercises or study. However, in my work I'm more interested in the way that entering into the relationship itself becomes part of the mechanism of change.
Winnicott has written usefully about this. In 'Fear of breakdown' he describes how the patient's difficulties arise from a fear that something will happen that will destrroy his or her sense of self. In order to prevent this catastrophe, the patient will adopt various defensive strategies to isolate and repudiate the feared thoughts. Winnicott's insight is that this breakdown has in fact already occured. The individual as an infant experienced that catastrophe in the form of a failure of his or her environment to respond in sufficient time to their need. At that time the infant lacked the ability to deal with the failure. A defensive structure was then established, what WInnicott calls a False Self, which lays a pattern for future living and relating.
Winnicott suggests that optimally the patient will experience a similar and inevitable failure in the therapeutic relationship. (As no relationship can be perfect.) However, this time the patient as an adult, and with a facilitative therapist, can re-experience that earlier trauma and grow beyond the earlier defensive structures. An earlier relationship contained a trauma that could not be experienced, was frozen or sealed off and because it was thus timeless, continued to have a limiting effect upon the individual's capacity to relate and to fully live. Re-experiencing, even mildly, in the safer setting of the therapeutic relationship enables that experience to enter into time and then to become past.
So the relationship with the therapist itself is a vehicle for change, not a useful attribute to increase the effectiveness of other tools.
And I totally agree with you, Juergan, that we exist within a social nexus. It is not useful to think of ourselves as existing outside of relationships. Within psychoanalysis there are useful models to describes these processes, projective identification being a major insight into the way inwhich we shape eachother and are shaped by others. Winnicott, again, has useful things to say about this - for example, his statement that there is no such thing as an infant, rather there is always an infant/mother, from which the infant emerges. More recently Christopher Bollas has described the ways in which we use our environment of people, physical objects, ideas to construct our 'character', in the sense of a character in our personal story.
Regards
Geoff
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Pastoral counseling setting
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In addition to the questions of materialism, determinism, and especially positivism as sort of a worldview in empirical psychology and different psychotherpeutic approaches, it would also be good to remember that many of the conflicts are due to the difficulties of interdisciplinary dialogue, starting with adequate mutual listening and attempts at understanding. This is also true for the side of theology.
Please allow me to indicate some bibliographical reference of mine (only available in print, sorry):
* The Birth of Human Sciences, especially Psychology, in: Paul Gilbert (Ed.) L'uomo moderno e la Chiesa - Atti del Congresso (Analecta Gregoriana, 317), Rome: Gregorian & Biblical Press, 391-408.
* Remarks on Religions and Psychiatry/ Psychotherapies, in: Hefti, René/ Bee, Jacqueline (Ed.s) Spiritualität und Gesundheit. Spirituality and Health. Ausgewählte Beiträge im Spannungsfeld zwischen Forschung und Praxis. Selected Contributions on Conflicting Priorities in Research and Practice, Bern u.a.: Peter Lang 99-118.
* Interdisciplinary Dialogue between Theology and Psychology: principles and promising steps, in: Melita Theologica 52 (2001) 135-153.
* The Concept of Human Acts Revisited. St. Thomas and the Unconscious in Freedom, in: Gregorianum 80 (1999) 147-171.
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Couples where violence is present, could be referred from third parties (e.g. court), or self-referred. But sometimes, especially if physical violence is present, it might be risky to get involved in therapeutical interactions that could trigger conflicts/violence. What would help decision making as to accept or not these couples in marital therapy?
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This is a good question, but a controversial one. Many folks working in DV would say couples should never be seen together because it can endanger the victim. However, in the last decade or two scholars have done some good work in identifying types of violence, some of which are amenable to couples work.
In short, where there is a history of coercive control (traditional battering), couples should not be seen together. Most experts agree that for couples therapy to be possible the violence should have been infrequent, minor, and noncontrolling (e.g., free from other tactics common in battering such as monitoring, cutting off from friends, extreme jealousy, etc.). Also, both partners (especially the more powerful one) should be able to admit their role in the problem and take responsibility for abusive behavior. If there are any lethality risk factors (unresolved substance abuse, history of violent crimes, use of weapons, obsession with partner, etc.) couples Tx is contraindicated. However, as has been pointed out, Stith et al have been doing work with couples with non-controlling, more situational violence, and have had good results. When it is appropriate couples work can address several things that individual work cannot, so it is worth a careful assessment to see what will work best.
For more information about violence typologies (situational couple violence vs. intimate terrorism) see Michael Johnson's work [Johnson, M. (2008). A typology of domestic violence: Intimate terrorism, violent resistance, and situational couple violence. Boston: Northeastern University Press.] For more on couples treatments see Stith et al latest [Stith, S. M., McCollum, E. E., Rosen, K.H. (2011). Couples therapy for domestic violence: Finding safe solutions. Washington, D.C.: American Psychological Association.] I have attached another article that I use in a doctoral class for family therapists that addresses this issue in more depth.