Clinical Psychology in Europe (E-Journal)
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Case Conceptualization in Clinical Practice and Training
No full textCase conceptualization is central to the success of the therapeutic process. However, integrative case conceptualization research has lagged behind research on integrating therapeutic intervention techniques. A successful case conceptualization provides (a) a dynamic, context-sensitive, yet parsimonious model of the client’s functioning; (b) relevant treatment targets and associated assessment procedures; and (c) a treatment plan including intervention phases and potential obstacles. Success in case conceptualization is a core clinical competency goal for trainees in clinical psychology and a career-long learning goal even for expert clinicians. Emerging technological trends and the formation of adversarial collaborative teams may assist research on the utility of well-constructed case conceptualizations
Between-Session Homework in Clinical Training and Practice: A Transtheoretical Perspective
No full textBackground: This paper defines and illustrates the ways in which Between-Session Homework (BSH) may be integrated into clinical work with clients across various treatment approaches. In line with the focus of this special issue, we explore how clinical training and supervision can enhance therapist skills and competence in the use of BSH. Method: After providing a brief historical overview and an integrative perspective on BSH, along with a review of empirical research supporting its efficacy, we delve into the discussion of BSH as a transtheoretical clinical method with heuristic value across different treatment approaches, such as cognitive-behavioral, psychodynamic, and humanistic-experiential therapies. Results: There exists diversity in how BSH is incorporated into distinct treatment approaches. Furthermore, we emphasize the significance of therapist skills and competence in utilizing BSH to facilitate client engagement and achieve positive treatment outcomes. Finally, we address how clinical training and supervision contribute to the development of these essential skills and competence. Conclusions: Our findings highlight three main points: (1) substantial empirical support for the integration of BSH within cognitive-behavioral therapies, (2) the potential of BSH as a promising transtheoretical clinical method, even though research beyond cognitive-behavioral therapies remains limited, and (3) the imperative need for further research into how clinical training and supervision can effectively enhance therapist skills and competence in implementing BSH
Competence-Based Trainings for Psychological Treatments – A Transtheoretical Perspective
No full textBackground: Although in most countries psychotherapy trainings focus on one treatment orientation, such an approach is associated with systematic shortcomings. The priorities from teaching one theoretical framework should be moved to a more rigorous orientation in science and evidence-based practice, and to the needs of patients, even if strategies of different theoretical approaches need to be combined. Method: We discuss whether competence-based trainings in psychological treatments offer a better framework to facilitate the progress of psychological treatments to a professional academic discipline with transtheoretical exchange, and we provide an example of a transtheoretical education in the basic competences of psychological treatments. A transtheoretical education program requires an umbrella model for case formulation and a transtheoretical definition of intervention goals. Results: We provide an adaptation of the traditional model distinguishing vulnerability/resilience, exacerbation, and maintenance of clinical problems for case conceptualization. Dynamic network models offer a further perspective for developing modern, transtheoretical case formulations. Treatment methods should be better classified according to their transtheoretical goals, which offers opportunities to better compare or combine them. We report a case example of how to transform a general competence-based approach in the training of psychological treatments in the academic education system, which found exceptional acceptance from participating students. Conclusion: Thus, a rigorous competence-based approach to training early clinicians in applying psychological treatments helps to bridge the artificial divide between psychotherapeutic traditions. It also supports the evolution of psychological treatments into an academically robust and highly professional, integrative discipline
Needs, Modes, and Stances: Three Cardinal Questions for Psychotherapy Practice and Training
No full textBackground: Advances in motivational science (Dweck, 2017), personality dynamics (Lazarus & Rafaeli, 2023), and process-based psychotherapy (Hofmann & Hayes, 2019) converge into a pragmatic, integrative, and transtheoretical model of practice and training. Method: The model comprises three elements: a formulation centered on clients’ psychological needs which provides guidance regarding the goals and processes most profitable to pursue; a recognition that such pursuit frequently requires contending with a multiplicity of clients’ internal self-states (i.e., modes); and an enumeration of pragmatic therapeutic stances likely to help address clients’ need-related goals in light of their modes. Results: We distill these elements into three cardinal questions: What needs does this client have that are not currently met, and what are the most profitable ways of remedying that frustration? What mode or modes does this client manifest – both generally and at this very moment? and What stance should I adopt in response to the client’s current mode? We suggest that clinicians should be trained to continually pose these questions and seek to answer them collaboratively with their clients. Conclusion: This model – illustrated here using schema therapy terms – offers a process-based approach which serves as a theoretically integrative starting point but is general enough to provide an assimilative integration roadmap for therapists anchored in most primary orientations. Integrative or assimilative therapists trained to attend to needs, modes, and stances are likely to be (and be perceived as) particularly responsive, and thus, to enact “common factor” practices known to be conducive to therapeutic alliance and gains
Impulsive Buying and Deferment of Gratification Among Adults With ADHD
No full textBackground: Impulsivity symptoms have been studied thoroughly in adults with ADHD, including hasty actions and decisions without considering possible consequences. The objective of our study was to investigate impulsive buying and deferment of gratification among adults with ADHD and a comparison group. Method: The participants were 225 adults with ADHD and 121 university students who completed the Buying Impulsiveness Scale (BIS), the Deferment of Gratification Questionnaire (DOGQ), the Adult ADHD Rating Scale—IV (ADHD-RS), as well as background questions. Results: Significant differences were found between the two groups on the three scales, the ADHD group showing more ADHD symptoms, more frequent impulsive buying behaviour and less ability to defer gratification. Mediation analyses yielded significant indirect effects in both samples, which suggests that the relationship between ADHD symptoms and impulsive buying is mediated by the ability to defer gratification. Conclusion: The results suggest that placing emphasis on improving the capacity of adults with ADHD to defer gratification might be beneficial in treatment
Effect of Cultural Adaptation of a Smartphone-Based Self-Help Programme on Its Acceptability and Efficacy: Randomized Controlled Trial
No full textBackground: Research on cultural adaptation of psychological interventions indicates that a higher level of adaptation is associated with a higher effect size of the intervention. However, direct comparisons of different levels of adaptations are scarce. Aims: This study used a smartphone-based self-help programme called Step-by-Step (Albanian: Hap-pas-Hapi) for the treatment of psychological distress among Albanian-speaking immigrants in Switzerland and Germany. Two levels of cultural adaptation (i.e., surface vs. deep structure adaptation) were compared. We hypothesised that the deep structure adaptation would enhance the acceptance and efficacy of the intervention. Method: We conducted a two-arm, single-blind randomised controlled trial. Inclusion criteria were good command of the Albanian language, age above 18, and elevated psychological distress (Kessler Psychological Distress Scale score above 15). Primary outcome measures were the total score of the Hopkins Symptom Checklist and the number of participants who completed at least three (out of five) sessions. Secondary outcomes were global functioning, well-being, post-traumatic stress, and self-defined problems. Results: Two-hundred-twenty-two participants were included, of which 18 (8%) completed the post-assessments. The number of participants who completed the third session was equal in both conditions, with N = 5 (5%) and N = 6 (6%) respectively. Discussion: Drop-out rates were high in both conditions, and no group difference was found regarding the acceptance of the intervention. The high drop-out rate stands in contrast with other trials testing Step-by-Step. Future research should examine cultural factors impacting recruitment strategies, as insights could help to reduce participant drop-out rates in clinical trials
Longitudinal Associations of Experiential and Reflective Dimensions of Meaning in Life With Psychopathological Symptoms
No full textBackground: Rather than being rooted in deliberate reflection, the experience of meaning has been shown to evolve from intuitive processes (Heintzelman & King, 2013b, https://doi.org/10.1007/978-94-007-6527-6_7). Accordingly, experiential and reflective dimensions of meaning in life can be distinguished (Hill et al., 2019, https://doi.org/10.1080/09515070.2018.1434483). In this preregistered study, we explored how these dimensions are longitudinally associated with psychopathological symptoms. We expected that experiencing more meaning would predict fewer depressive symptoms and fewer personality functioning impairments six months later, whereas reflecting about meaning would predict more psychopathological symptoms. Method: A German-speaking sample of N = 388 completed self-report measures assessing meaning in life, depression, and personality functioning at baseline and six months later. Results: Controlling for depression at baseline, elevated levels of experiencing meaning in life predicted a decrease in depressive symptoms. Experiencing meaning did not predict personality functioning impairments six months later. However, exploratory analyses with a larger sample tentatively showed that experiencing meaning in life predicted less impairments in personality functioning. Evidence supporting the hypothesized association between reflection and future depression as well as future personality functioning impairments was discerned through exploratory analyses. Generalizability of results to clinical care settings is limited due to the studied non-clinical sample. No causal conclusions can be drawn from the data because the study employed an observational design with two assessment points. Conclusion: Experiencing meaning in life emerged as a potential protective factor against future psychopathological symptoms, whereas exploratory analyses pointed to an opposite relationship for reflection about meaning in life. Results are discussed with regard to clinical implications and directions for future research
Exploring Characteristics of Preoccupation and Failure to Adapt Among Patients Suffering From Adjustment Disorder: A Qualitative Study
No full textBackground: Adjustment Disorder (AjD) is a frequent diagnosis in psychological and psychiatric consultations. Recently, the ICD-11 has introduced preoccupation and failure to adapt as core symptoms of AjD. However, empirical research that explores the various possible manifestations of preoccupation and failure to adapt in AjD patients is sparse. Therefore, the study aimed to explore patients’ experiences of the core symptoms of AjD in a qualitative study. Method: We recruited 16 patients suffering from ICD-11 AjD who filled in self-report questionnaires to assess sociodemographic information, adjustment disorder symptoms, anxiety and depression. Then, they participated in a semi-structured interview with a trained psychologist to explore the determinants and characteristics of their preoccupation and failure to adapt symptoms. Thematic analysis was applied to analyze the responses. Results: Six themes were identified in our analysis 1) Preoccupation triggers, 2) Preoccupations and negative emotions, 3) Strategies to stop preoccupation, 4) Consequences of preoccupation, 5) Manifestation of difficulties/failure to adapt and 6) Strategies to address difficulties/failure to adapt. Conclusion: We found partial congruence between our data and previous conceptualizations of AjD. Preoccupations seem to be time-consuming, center around stressors and their consequences, and be associated with negative emotions. Some preoccupations reported by the patients could also be labeled as ruminations or worries. The failure to adapt symptoms seemed to be broader than the exemplary symptoms highlighted in current measures of AjD
Mental Flexibility and Epistemic Trust Through Implicit Social Learning – A Meta-Model of Change Processes in Psychotherapy With Personality Disorders
No full textThis position paper follows the call for transtheoretical meta-models of general clinical change by concentrating on severe mental illness such as Personality Disorders (PDs). We have identified a core process of change related to mental flexibility through implicit learning and propose recommendations for stance and technique that are informed by research on Mentalization-Based-Treatment (MBT) and the learning components as represented in the Mediational Intervention for Sensitizing Caregivers (MISC). While the idea of corrective emotional experience as a general change mechanism involves discriminating between an old and new relationship to update relationship knowledge, the capacity to understand and process corrective emotional experiences may be limited and even iatrogenic in patients with PDs. By integrating MBT and MISC, a meta-model of change is created that allows training in and observation of the granular-level, behaviorally anchored, actions taken by the therapist to open up social learning. Here, social learning is conceptualized as epistemic trust, increasing the client’s reflective functioning during sessions to ultimately enhance cognitive flexibility outside the therapy room. This opens the possibility to implement and observe micro changes in what should be termed now implicit cognitive and emotional corrective experiences. Thus, we propose to shift towards implicit learning within professional relationships; that is, internalizing a new way of thinking about any life-event that requires adaption thereby creating adaptive capacities via mental flexibility as the general change mechanism of Personality Disorder (PD) treatment
Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway
No full textBackground: Universities worldwide are witnessing a surge in mental health problems among students, particularly in anxiety and depression. The Hopkins Symptom Checklist (HSCL) is a popular screening tool, but its reliability in identifying mental disorders remains debated. The aim of this study was to evaluate the criterion validity of the HSCL-25, HSCL-10, and HSCL-5 using 30-day prevalence of major depressive episode (MDE) and generalized anxiety disorder (GAD) from a self-administered electronic version of the Composite International Diagnostic Interview, fifth version (CIDI 5.0), as the benchmark. Method: Data stem from a national survey targeting students in higher education in Norway. In a 2023 follow-up study on mental disorders, 5,568 participants completed both the HSCL-25 and the CIDI. Sex-specific optimal thresholds for all HSCL versions in relation to MDE and GAD (from CIDI) were determined using the Youden Index maximization. Results: The optimal cut-off values for detecting MDE or GAD with the HSCL-25 were 1.96 for males and 2.20 for females, displaying a good balance between sensitivity and specificity. Similar high and balanced sensitivity and specificity patterns were found for both the HSCL-10 and HSCL-5. However, all HSCL versions overestimated prevalence rates compared to the self-administered CIDI. Conclusions: All three HSCL versions showed high criterion validity. The data indicate that HSCL may be better as a screening tool than for precise estimation of MDE and GAD prevalence. For improved diagnostic accuracy, future HSCL versions should incorporate functional impairment assessment. This update would bring the HSCL into closer alignment with clinical diagnostic standards