The development of the Epistemic Trust Rating System (ETRS).

OBJECTIVE: The present study introduces and validates the Epistemic Trust Rating System (ETRS), an observer-based measure designed to assess epistemic trust (ET) within psychotherapy. ET in psychotherapy has gained much theoretical attention as a critical component in the therapeutic context, given its inherent link to social communication. However, its empirical validation remains pending, largely due to the absence of a refined instrument to gauge ET levels within the therapy environment. Therefore, this study aimed to translate ET's theoretical construct into tangible markers within the therapeutic context. METHOD: One hundred eighteen patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression. Incorporating top-down theoretical considerations with bottom-up empirical observations yielded an overall ETRS score accompanied by three distinct sub-scales, each assessing a singular ET element: one gauges the patient's propensity to share; another measures the degree to which "we-mode" moments are achieved within the session; and the third evaluates the patient's receptiveness to learning. RESULTS: The findings demonstrate the psychometric robustness of the ETRS, with good internal consistency, interrater reliability (ICC(1,8) = .86-.90), and convergent (r = .23-.29) and discriminant validity (r = -.10). CONCLUSION: The current study highlights the ETRS as a promising tool bridging theory and empirical exploration, enhancing our understanding of epistemic trust in psychotherapy.

I see you as recognizing me; therefore, I trust you: Operationalizing epistemic trust in psychotherapy.

Epistemic trust (ET) is one's ability to trust others and relies on the information they convey as being relevant and generalizable. This concept has received considerable theoretical and clinical attention, suggesting it is a promising factor in effective psychotherapy, possibly consisting of three elements: sharing, we-mode, and learning. However, for it to be used in clinical practice and research, it is imperative to (a) enhance our clinical understanding of how ET may manifest in the context of treatment and (b) understand how the process of change may occur in the course of treatment. The present study aims to identify patients' trait-like ET characteristics upon initiating treatment and explore the possible state-like changes in ET characteristics throughout treatment. Taking a discovery-oriented approach, we examined how therapists can identify a patient's level of ET at the beginning of treatment. We also examined how, within a treatment for individuals with poor pretreatment ET, the therapist and patient work interactively to bring about a positive change in ET. Identifying the process in which the therapist implements techniques in response to the patient's reactions may enable the active mechanism to be isolated and promote the first formulation of the way changes in ET occur in sequence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How Plan Analysis can inform the construction of a therapeutic relationship.

The construction of a positive therapeutic relationship was shown to be related with outcome in psychotherapy, but there are only a few prescriptive concepts helping the therapist to contribute to such a process. The present case illustrates the use of Plan Analysis (PA) and the motive-oriented therapeutic relationship (MOTR) in the explanation of the construction of a positive therapeutic relationship. We analyze the case of Sharon, a 22-year-old student presenting with major depressive disorder. We present the case formulation according to PA and select Session 7 from the therapeutic process to illustrate three moments of the therapist focus on the underlying motives: (a) a first moment when the therapist presents with nonoptimal features of responding to the patient's profile, (b) a second moment when the therapist intervenes optimally, and (c) a third moment when the therapist intervenes excellently. We discuss this case from the perspective of personalizing psychotherapy.

Object relations, unconscious defences and fear of childbirth, as reflected in maternal-request caesarean section.

OBJECTIVE: To examine a possible association between maternal-request caesarean section (CS) and two intrapsychic psychoanalytic personality variables: object relations (OR) and unconscious defences. BACKGROUND: While maternal-request CS is a growing phenomenon, studies are lacking regarding personality variables that may be associated with it. METHODS: A cross-sectional questionnaire was conducted in one delivery ward. During 2009, 59 primigravida, healthy women were recruited; 28 who had requested and delivered by CS without an obstetrical indication and 31 who opted for a spontaneous vaginal delivery. Due to missing data for some measures, only 27 participants were analysed in each group. All women completed the fear of childbirth (FOC) questionnaire, and the object relations (SCORS) and unconscious defences (DMM) measures of the Thematic Apperception Test (TAT), as well as questionnaires assessing background variables. Multivariate analysis of variance (MANOVA) and a logistic hierarchical multiple regression were performed. RESULTS: Preliminary MANOVA showed significant differences between groups in age, FOC and use of the defence mechanism projection. Hence, these variables entered as predictors of maternal-request CS to a logistic hierarchical multiple regression model. The model was found to have a good fit [χ2(4) = 38.19, p < 0.001]. Age, FOC and projection defence were found to be significant factors associated with maternal-request CS. CONCLUSION: Maternal-request CS was found to be strongly associated with age and FOC. Except for unconscious defence of projection, intrapsychic variables were not found to be associated with maternal-request CS. Possible implications are discussed.

Object relations and real life relationships: a cross method assessment.

This study examines the relationship between the psychoanalytic concept of object relations and real life behavior of being in an intimate relationship among heterosexual women. In a multi-method approach we used two different measures; the self-report Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, Billington & Becker, 1986) and the performance based Thematic Apperception Test (TAT) Social Cognition & Object Relations Scale- Global Rating Method SCORS-G (Westen, 1995) to measure the object relations of 60 women. The Alienation subscale of the BORRTI and understanding of social causality subscale of the SCORS-G explained 34.8% of variance of the intimate relationship variable. Thus, women involved in a romantic relationship reported lower rates of alienation on the BORRTI and produced TAT narratives that were more adaptive with regard to understanding of social causality as measured by the SCORS-G than those not currently in a relationship. Results are discussed with reference to the relationship between object relations and real life measures of healthy individuals and in light of the need for a multi-method approach of assessment.

Personality, fear of childbirth and cesarean delivery on demand.

OBJECTIVES: To investigate both the psychological traits and the demographic factors associated with cesarean section on maternal demand. DESIGN: Cross-sectional questionnaire study. SETTING: Delivery ward, Edith Wolfson Medical Center, Holon, Israel. SAMPLE: Fifty-nine healthy primigravida with a singleton pregnancy were recruited during 2009, of whom 28 requested and were delivered by cesarean section without obstetrical indication, whereas 31 opted for spontaneous vaginal delivery. METHODS: All questionnaires were administered to the two groups at term. Various psychological (fear of childbirth questionnaire, Millon Clinical Multiaxial Inventory III, Anxiety Sensitivity Index, State-Trait Anxiety Index and social support scale) as well as demographic variables were measured before labor and compared. A priori power calculation yielded a power of 95%. MAIN OUTCOME MEASURES: Fear of childbirth, various personality disorders and psychiatric clinical syndromes (29 Millon Clinical Multiaxial Inventory III scales), Anxiety Sensitivity, State Anxiety Index, social support and demographic variables. RESULTS: Differences in age and method of conceiving (p<0.001) were found between the groups. The study group reported a higher level of fear of childbirth (p<0.001), but no differences were found in all other personality characteristics measured (29 Millon Clinical Multiaxial Inventory III scales, State-Trait Anxiety, Anxiety Sensitivity and social support scale). The origin of the difference regarding the fear of childbirth was located to two specific questions: 'Have you always been afraid of giving birth?' and 'Have you sometimes thought of the delivery as something unnatural?' CONCLUSIONS: The only psychological variable associated with the choice for cesarean section on maternal request was the fear of childbirth.