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Therapist's interventions and therapeutic alliance: A single case study
No full textTherapist's interventions and therapeutic alliance: A single case study
Daniela Gentile, Sapienza University of Rome, Italy; Veronica Di Donato; Antonello Colli;
Vittorio Lingiardi; Mark Hilsenroth
As reviewed by Hilsenroth, Cromer and Ackerman (2012), there are specific therapist's
interventions that can improve or deteriorate therapeutic alliance. However, few studies
have examined the association between specific therapist's interventions and within session
collaboration level. This study, that represents an extension of a previous research by
Mayotte-Blum et al. (2012), examines the relationship between therapist's interventions with
therapeutic alliance ruptures and resolution processes in a long-term case of psychodynamic
psychotherapy, The sample consisted of 16 sessions over 4 years of treatment (first 4
sessions, 4 sessions from year 1, 4 sessions from year 3, the last 4 sessions). Prior to
treatment the client signed a consent form to participate in research. All sessions from
treatment were videotaped and conducted at a university-based clinic. Patient. Ann, was a
25 year-old single White female enrolled in a master's of arts program for Social Work. She
originally entered psychotherapy experiencing four acute stressors within the same month:
the death of her grandmother, the end of a long-term relationship with a boyfriend,
problems in her graduate program, and difficulties with her externship supervisor. Therapist.
Dr. M was a 35-year-old married White male at the beginning of treatment with Ann. He was
a licensed and board-certified clinical Ph.D. psychologist with (at that time) 9 years of
postdoctoral experience. Raters. Two groups of independent raters evaluated the sessions.
The raters are Clinical PhD graduate students with excellent reliability in the use of the CPPS
(ICC = .78) and CIS-R (ICC = .83).Measures The Brief Symptom Inventory (BSI; Derogatis,
1993) was used for the assessment of symptoms distress, at the beginning and at the end of
treatment. The Social Adjustment Scale (SAS; Weissman & Bothwell, 1976) was used as an
outcome indicator of social/occupational functioning and the Inventory of Interpersonal
Problems (IIP; Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988) for the assessment ofinterpersonal functioning. The Collaborative Interactions Scale (Colli & Lingiardi, 2009) was
used for the evaluation of therapeutic alliance ruptures and resolution processes and
therapist's interventions have been evaluated with the Comparative Psychotherapy Process
Scale (Blagys & Hilsenroth, 2000, 2005).Results. Ann had demonstrated clinically significant
change (Jacobson et al., 1999) in overall symptomatology, interpersonal functioning, social
and occupational functioning. Dyadic analysis of data showed the association between
patient's collaboration level and therapist's techniques and underlined the mutual and
reciprocal influence between patient and therapist. Clinical utility of these results will be
discussed
Attachment and mentalization in Intimate Partner Violence
No full textIntimate partner violence (IPV) is one of the most common forms of violence against women (WHO, 2012). IPV has been examined from a range of theoretical perspectives, one of those being attachment theory, identified as a way to assess several psychosocial risk factors for violence (Mahalik et al., 2005). In the previous literature, the child`s exposure to violence in the family resulted as a major predictor of subsequent exposure to IPV victimization (Widom, et al., 2008). Research on abused and traumatized samples has shown high frequencies of unresolved/disorganized attachment in adults. Attachment disorganization is associated with major problems of affect regulation and mentalizing deficits (Lyons Ruth & Jacobvitz, 2016). This study has two aims: To analyze the relationship between childhood trauma and victimization in adulthood; To investigate attachment and mentalization ability in order to identify specific mentalizing and attachment profiles of women IPV victims. A sample of forty women, recruited through anti-violence centers, were administered the Adult Attachment Interview (AAI, George et al., 1984) and completed the Reflective Functioning Questionnaire (RFQ, Fonagy et al., 2016). The hostile/helpless coding system (Lyons-Ruth & Melnick, 2004), the Complex Trauma Questionnaire (ComplexTQ, Vergano et al., 2015), and the Reflective Functioning Scale (RFS, Fonagy et al., 1998) were applied to AAI transcripts. The interviews were audiotaped and transcribed verbatim. Coding was conducted by two trained coders, and certified as reliable in the use of the AAI. The protocols were double coded for RFQ, ComplexTQ and RFS. Results will be discussed in terms of clinical and theoretical implications
The Collaborative Interactions Scale: A new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in psychotherapy
No full textThe authors present a new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in
psychotherapy - the Collaborative Interaction Scale (CIS) - and discuss the structure and theoretical background of the
scale and the rating procedure. To assess interrater reliability, three raters independently evaluated 32 psychotherapy
sessions (2,984 patient utterances and 2,984 therapist utterances) using the CIS, which demonstrated good interrater reliability (average k = .66 - .81). In evaluating the relationship between therapist interventions and patient alliance rupture
and collaborative processes, the authors found significant correlations between therapist negative interventions and patient alliance ruptures and among therapist positive interventions, patient collaborative processes, and indirect rupture markers. Results indicate that the CIS is a reliable rating system, useful in both empirical research and clinical assessments
La personalità e i suoi disturbi
No full textContributi di: Vittorio Lingiardi, Luigi Abbate, Laura Buonarrivo, Antonello Colli, Simona Falanga, Francesco Gazzillo, Sandra Girosi, Maria Grazia Manfredonia, Francesca Ortu, Brigitta Starace
Changes in mentalization in patients with personality disorders during sequential brief-Adlerian psychodynamic psychotherapy: The role of therapists' technique and countertransference
No full textMentalization, that is the capacity to understand our and others' behaviors in terms of intentional mental states, represents one of the core features of personality disorders (PDs) and can be related to therapists' countertransference (CT) and interventions.
Aims: The aim of the present work was to study the relationship between therapists' technique, therapists' CT, and patients' mentalization, in a sample of patients with PDs undergoing a 40-session program of sequential brief-adlerian psychodynamic psychotherapy, a psychodynamic therapeutic model specifically developed for the treatment of PDs in public mental health services.
Method: Eighty-seven patients with PD and their therapists completed ratings of mentalization (mentalization imbalances scale and reflective functioning questionnaire), CT (therapist response questionnaire), and therapists' intervention (comparative psychotherapy process scale) at five different time points (Sessions 5, 10, 20, 30, and 40).
Results: Results showed that patients' mentalizing problematics decreased over time. Moreover, we found a reduction of therapists' disengaged CT, and an increase in positive CT over time. Regarding therapists' techniques, psychodynamic-interpersonal interventions were on average higher than cognitive-behavioral, but both techniques were used increasingly over time. Our results also showed significant and clinically coherent interactions between therapist's CT and techniques and between patient's mentalization imbalance and therapist's response. Our results highlighted the importance of early stages in therapy, since the most significant relationships between the various process variables (patient's mentalizing imbalances, therapist's techniques, and emotional responses) are observed between t1 and t2, corresponding to the initial phases of the treatments. Clinical implications will be discussed
Which kind of therapists' interventions discriminate between rupture and repairing sessions?
No full textTherapeutic alliance (TA) is one of the most important active factor in the psychotherapy
process and outcome (Bordin, 1979; Colli & Lingiardi, 2009; Horvarth, 1994). Even though
several studies have investigated the impact of specific therapist's techniques on TA
(Ackerman & Hilsenroth, 2001, 2003), few researches investigated the association between
therapist's interventions and in-session collaboration level shifts. The aim of the present
study is to identify the therapeutic tech-niques and elements of the psychotherapy process
characterizing sessions with increasing versus decreasing trend of TA. The sample consisted
of 156 audiotaped and transcripted sessions (N=156) of different therapeutic approaches.
Therapeutic alliance and collaboration shifts inside sessions have been evaluated with
Collaborative Interactions Scale (Colli & Lingiardi, 2009), the therapeutic interventions with
the Comparative Psychotherapy Process Scale (Blagys & Hilsenroth, 2000, 2005), the
psychotherapy process with the Psychotherapy Process Q-set (Jones, 1985, 2000). Three
groups, each of three independent raters, evaluated the sessions. Discriminant analysis
(Garson, 2008; Barbaranelli, 2006) identified the distinctive features of the sessions with (a)
increasing and (b) decreasing trends of alliance. Results showed that sessions with TA
increasing trend are characterized mainly by the presence of therapist's interventions
focused on the here and now of the relationship and exploration of affects. The sessions with
TA decreasing trend were characterized by a stance of major rigidity of the therapist, that
were more focused on manualized treatment of his/her therapeutic approaches and not on
the patient's concrete experience. Data will be discussed with attention to everyday clinical
practice
La ricerca in psicoterapia. Modelli e strumenti
No full textIl volume, nato sotto gli auspici della Società italiana e internazionale per la ricerca in psicoterapia (SPR), si propone di raccogliere e organizzare il sapere e lo stato dell'arte relativamente alle diverse aree della ricerca in psicoterapia, e coinvolge i contributi dei principali studiosi del panorama italiano. I temi trattati - aspetti generali della ricerca in psicoterapia, principali costrutti e strumenti di misurazione, modelli di intervento clinico - e una bibliografia aggiornata di oltre 2500 voci fanno di questo volume il testo più completo e aggiornato sull'argomento
Text Analysis within Quantitative and Qualitative Psychotherapy Process Research: Introduction to Special Issue
Full text linkThe present paper introduces the special issue on Text Analysis in Quantitative
and Qualitative Psychotherapy Process Research. The motivation for this special issue
grew out of recognition of the following: (1) both quantitative and qualitative psychotherapy
process research (PPR) make extensive use of text analysis (TA); (2) TA
presents different characteristics that serve different aims in quantitative and qualitative
PPR; and (3) researchers are not always fully aware of these differences in explicit and
systematic ways. The present paper, together with the special issue it introduces, aims at
stimulating a more explicit and systematic methodological reflection on the different
ways in which TA may be used in quantitative and qualitative PPR. We first outline the
general differences between TA in quantitative and qualitative PPR; then, we describe
the extent to which the papers in this special issue illustrate these differences. Finally, we
conclude by stressing that PPR may significantly benefit from researchers becoming
more fully aware of the differences
Countertransference responses mediate the relationship between patients' overall defense functioning and therapists' interventions
Full text linkObjective: The aim of this work was to investigate the relationship between therapists' techniques (supportive/expressive intervention level - ESIL), therapists' countertransference (CT) and patients' defense level of functioning (ODF). We hypothesized that CT could play a mediating role in the relationship between patients' ODF and therapists' ESIL. Method: 65 psychotherapy sessions were rated by two different raters each with the Psychodynamic Interventions Rating Scale and the Defense Mechanisms Rating Scale. Clinicians used the Therapist Response Questionnaire to provide information on their CT. The 65 sessions referred to 65 clinicians (25 = females, 40 = males; 38 = psychodynamic, 27 = cognitive). More than half of the patients (n = 40; 61.5%) had a diagnosis of personality disorder. Among clinical disorders the most frequent were mood (n = 12) and anxiety disorders (n = 11). Five patients had no diagnosis. Results: Four CT responses (parental; positive; criticized; overinvolved) completely mediated the relationship between patients' ODF and therapists' ESIL, while no effect resulted in relation to overwhelmed, helpless, sexualized and disengaged CTs. No effect of theoretical orientations on mediation pathways was found. Conclusion: Both positive and negative CT feelings seemed to play a crucial role in the relationship between therapists' interventions and patients' ODF
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