How do patients with anorexia nervosa "process" psychotherapy between sessions? A comparison of cognitive-behavioral and psychodynamic interventions.

OBJECTIVE: Patients' processing of psychotherapy between sessions ("inter-session process" (ISP)) has been repeatedly shown to be related to outcome. The aim of this study was to compare ISP characteristics of cognitive-behavioral vs. psychodynamic psychotherapy in the treatment of anorexia nervosa (AN) and their relation to outcome. METHODS: Data of 106 patients participating in a randomized-controlled trial who received either 40 sessions of enhanced cognitive-behavioral therapy (CBT-E) or focal psychodynamic therapy (FPT) were analyzed. The ISP was measured with the Inter-session Experience Questionnaire (IEQ). Three outcome classes were distinguished: full recovery, partial recovery, and still fulfilling all AN criteria. RESULTS: Patients receiving CBT-E reported more on "applying therapy" in the initial and the final treatment phase compared to FPT patients. In terms of process-outcome relations, higher levels of "recreating the therapeutic dialogue between sessions," "recreating the therapeutic dialogue with negative emotions" as well as "applying therapy with negative emotions" in the final phase of treatment predicted negative outcome in FPT, whereas overall higher levels of negative emotions predicted negative outcome in CBT-E. CONCLUSIONS: In outpatient treatment in AN, the processing of therapy as measured by the IEQ showed surprisingly few differences between CBT-E and FPT. However, different ISP patterns were predictive of outcome, pointing to different mechanisms of change.

Ironies in the history of psychotherapy research: Rogers, Bordin, and the shape of things that came.

This paper discusses Bordin's (1948) contribution to this journal in the context of the historical period in which it was written, in relation to Bordin's later contributions to the field of psychotherapy research, and in anticipation of issues that seem likely to emerge as critical in that field during the coming decades.

The influence of a capacitor plant in Serpukhov on vegetable contamination by polychlorinated biphenyls.

PCB content in soil and vegetables grown on the polluted soils in some districts of the town of Serpukhov have been studied for 10 years after the use of PCBs had been banned at the local capacitor plant. Soil contamination with PCBs in the vicinity of the plant is still extremely high (up to 30 mg/kg). Vegetables grown on the polluted soils, especially carrots and green parts of fennel, parsley, celery are also highly contaminated. The primary pollutants are found to be tri- and tetrachlorobiphenyls (up to 70-80% of total PCBs).

Mycophenolate mofetil in autoimmune and inflammatory skin disorders.

Mycophenolate mofetil (MMF) has been widely used as an immunosuppressant in organ transplantation. MMF has recently been added to therapeutic regimens for skin disorders. Expanding the use of MMF in dermatology, we describe additional patients with autoimmune and inflammatory skin diseases, including 4 cases of pemphigus vulgaris, 1 case of pemphigus foliaceus, 1 case of perineal and metastatic cutaneous Crohn's disease, 1 case of bullous pemphigoid and psoriasis, and 1 case of psoriasis. Most of these patients had refractory disease or had developed significant side effects to conventional therapy, including azathioprine, methotrexate, prednisone, cyclosporine, acitretin, PUVA, UVB, and tacrolimus. MMF was effective and well tolerated in all these patients. The dosages of MMF ranged from 500 mg twice daily (for psoriasis and Crohn's disease) to 1250mg twice daily (for 3 of 4 patients with pemphigus vulgaris). MMF is an effective and relatively safe immunosuppressant in autoimmune and inflammatory skin diseases.

Psychotherapy research in historical perspective. Implications for mental health care policy.

This article is a sketch of the historical development of the field of behavioral and non-behavioral therapy research. Four phases are characterized: (1) establishing scientific research (1927-1954), (2) searching for scientific rigor (1955-1969), (3) expansion and organization (1970-1983), and (4) consolidation and reformulation (1984-present). Continuities between and key developments within successive phases are outlined, with emphasis given to methodological innovations. The corroboration of select findings about process and outcome and the development of several critical discourses within the third and fourth phases have implications for the provision of mental health care and for policy discussions.

[Quality of the therapeutic relationship: do common factors in psychotherapy correspond with common characteristics of psychotherapists? SPR Collaborative Research Network]. / Die Qualität der therapeutischen Beziehung: Entsprechen gemeinsame Faktoren in der Psychotherapie gemeinsamen Charakteristika von PsychotherapeutInnen? SPR-Collaborative Research Network.

In view of the great diversity to be found among psychotherapists in many countries in terms of professional background, theoretical orientation, and other personal and demographic characteristics, it is surprising to find certain areas of great commonality. Among the most striking of these are therapists' reports of their ideals and perceptions concerning their manner of relating to their patients. A very large majority of nearly 2,400 therapists surveyed in an on-going study of psychotherapeutic development wanted to and did see their behavior vis-a-vis patients as accepting, friendly, warm, tolerant, committed, and involved. These traits, which indicate a strong proclivity toward forming a positive therapeutic bond or alliance, also closely match qualities that therapists perceive in their own personal relationships. Discussion of these findings focuses on the possible sources and therapeutic consequences of this common pattern of interpersonal behavior.

[Development of the theoretical orientation of psychotherapists. SPR Collaborative Research Network]. / Zur Entwicklung der theoretischen Orientierung von PsychotherapeutInnen. SPR Collaborative Research Network.

This article explores the extent to which, and ways in which, German speaking psychotherapists modify their theoretical orientations as a function of increasing clinical experience. The data for this come from the Development of Psychotherapists Common Core Questionnaire (CCQ), an instrument designed by the SPR Collaborative Research Network to collect a broad range of information about the therapist's background, training, practice etc. Two sections ask directly about the theoretical framework used by therapists to guide their therapeutic work, using a set of scales to assess the degree to which practitioners rely on various general models (analytic/psychodynamic, behavioral, humanistic, cognitive, systems theory, other). This permits the construction of profiles of formal and content based theoretical orientation patterns. By asking the question separately about the therapist's current practice, and about their practices as beginners, it also permits an evaluation of self-assessed change. In order to amplify the meaning of the theoretical background we ask therapists to indicate the relative importance of their patients realizing each of a series of therapeutic goals. The findings show very clearly that psychotherapists are very diverse both in the formal patterns and specific contents of their therapeutic orientations, and that they tend, as a role, to integrate two or more distinct theoretical approaches in guiding their clinical work with patients. The adherence to theoretical orientations has a strong impact on the goals that therapists typically work toward with their patients. Our findings show that therapists do pursue different goals depending on which conceptual framework they rely on.

Patients' representations of psychotherapy: a new focus for psychodynamic research.

This article presents a psychodynamic framework and research methods for investigating the significance of patients' internal representations of therapy-with-their-therapists. In this article, 2 instruments developed for this purpose--the Therapist Representation Inventory and the Intersession Experience Questionnaire--are introduced, and their psychometric characteristics are described. Also, findings from a series of studies conducted with these instruments are summarized. Finally, the types of questions these instruments appear to be well suited to are proposed for addressing in future research.

Patterns of psychotherapy utilization.

Epidemiologic research indicates that a small minority of patients make the great majority of outpatient mental health visits. This small group of long-term patients constitutes the bulk of psychotherapeutic practice and creates a disproportionate impression on mental health professionals. The authors confirmed this finding by studying 405 patients in a clinical setting with an orientation toward long-term psychotherapy: 68% of the patients attended 26 or fewer psychotherapy sessions, representing 23.3% of the total number of sessions used by all patients; 32% attended more than 26 sessions, representing 77% of the total number of sessions used by all patients.

Conjoint Psychotherapeutic Experience: Some Dimensions and Determinants.

In our previous reports we have specified the empirical structure of patients' and therapists' experiences in psychotherapeutic sessions. The present report explores the structure of experience within the therapeutic dyad -- conjoint experience. Seven factors were derived from the reports of 28 patient-therapist pairs. One factor reflected the therapist's approach to his role as a help-giver, and another reflected the patient's approach to her role. Other patterns showed convergent perceptions, while still others showed conjoint experiential processes -- inter-experience. Determinants of these experiences were sought among the personal and social characteristics of the participants. Several clinically suggestive patterns of determinants emerged.

THE THERAPIST'S EXPERIENCE OF PSYCHOTHERAPY: SOME DIMENSIONS AND DETERMINANTS.

Eleven dimensions of therapists' experiences during psychotherapy ses- sions were derived, factor analytically, for a sample of 17 therapists. These therapists completed a standard questionnaire after each of 8 or more sessions with 31 female patients. In general, the 11 dimensions reflected various experiences of (a) being helpful towards patients, (b) attempting to deal with difSicult patients, (c) making non-therapeutic responses to patients, and (d) entrapment in personally distressing situations with patients. Personal-social characteristics of patients and therapists were examined as possible determinants of therapist experience. Among other characteristics, patients' employment and marital status, diagnosis and previous treatment, influenced certain therapist experience dimensions-as did therapists' profession, marital status, and personal psychotherapy.