ABSTRACT
Trainees rotate onto the medical psychiatric inpatient unit at Massachusetts General Hospital every 6 weeks to learn how to conduct brief inpatient psychotherapy from two staff psychologists and one staff psychiatrist. This article focuses on four key therapeutic principles/techniques used when teaching these trainees about brief inpatient psychotherapy. These include support, affective experience and expression, chain analysis, and identification of relational styles/maladaptive relational patterns. We also briefly discuss our approach to training. Theoretical rationale, numerous clinical examples, and empirical support (of inpatient psychotherapy) are provided.
Subject(s)
Hospitalization , Internship and Residency , Psychiatry/education , Psychotherapeutic Processes , Psychotherapy, Brief/methods , Adult , Affect , Cognitive Behavioral Therapy/education , Cognitive Behavioral Therapy/methods , Conflict, Psychological , Curriculum , Humans , Interpersonal Relations , Mentors/education , Psychiatric Department, Hospital , Psychotherapy, Brief/educationABSTRACT
BACKGROUND: Therapeutic alliance is one of the most widely investigated variables in psychotherapy research but few studies have explored its role in inpatient psychotherapy. Many factors likely contribute to the lack of inpatient alliance research including the short length of hospital stays, complexity of patient psychopathology and the burdensome quality of most alliance scales. This paper reports on the development and initial application of two comparable brief scales designed to capture patient and therapist alliance ratings. METHOD: Participants were 20 patients receiving supportive-expressive inpatient psychotherapy. The patients were predominantly depressed women. Baseline measures of distress, symptom severity and functioning were obtained at the first and third sessions. Measures of alliance were obtained at the second session. RESULTS: The brief alliance scales demonstrated adequate internal consistency and the individual items had good adjusted item-to-scale correlations. Consistent with the broad alliance literature, we found that patients rated alliance higher than therapists, patient and therapist alliance ratings were not significantly correlated, and level of functioning was significantly associated with both patients and therapists' alliance ratings. The perceived depth of psychotherapy was also significantly associated with alliance. Unexpectedly, alliance ratings were also negatively associated with improvement during hospitalization. CONCLUSIONS: Overall, the study demonstrates both the feasibility and potential benefit of conducting inpatient psychotherapy research.
Subject(s)
Attitude to Health , Hospitalization , Mental Disorders/psychology , Mental Disorders/therapy , Professional-Patient Relations , Psychotherapy, Brief/methods , Adult , Attitude of Health Personnel , Cooperative Behavior , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Depressive Disorder/therapy , Feasibility Studies , Female , Humans , Male , Mental Disorders/diagnosis , Outcome Assessment, Health Care , Psychiatric Status Rating Scales/statistics & numerical data , Psychometrics , Research Design , Surveys and Questionnaires , Treatment OutcomeABSTRACT
The purpose of this study was to explore the usefulness of the Personality Assessment Inventory (PAI; Morey, 1991) Borderline full scale (BOR) and subscales in the assessment of patients being evaluated for dialectical behavior therapy (DBT; Linehan, 1993). We administered 67 patients both the PAI and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Structured Clinical Interview for Axis II disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1997). Point biserial correlations showed a significant relationship between the presence of borderline personality disorder (BPD) and scores on the BOR and Schizophrenia (SCZ) scales. A regression analysis showed that among the BOR subscales, those measuring identity disturbance, self-harming behavior, and negative relationships were significantly related to the total number of SCID-II BPD criteria. Diagnostic efficiency statistics between the BOR scale and the number of SCID-II BPD criteria indicated that a T score cutoff of 65 optimally differentiates patients who do and do not meet criteria for BPD. The relationship between BOR and SCID-II BPD demonstrates the concurrent validity of the PAI and shows its usefulness in this setting.
