Delineating prototypes of training psychotherapy.

Abstract There is no reported research comparing psychotherapy for trainees to psychotherapy for clinical patients. This preliminary study examines similarities and differences between the Training Psychotherapy Experience (TPE), an elective offered to residents in a large psychiatry training program, and psychotherapy conducted by the same clinicians in their private practices (TAU). We used the Psychotherapy Process Q-set (PQS; Ablon & Jones, 1988; Ablon, Levy, & Katzenstein, 2006). All program consultants who perform TPE were offered their standard fee to complete one PQS while envisioning a typical TPE session and another while envisioning a typical TAU session, using their own assessment of what happens in such sessions. These data were subjected to factor analysis to develop prototypes (TAU and TPE) that could be compared with each other and with validated prototypes developed by Ablon and Jones (1998, 2002). Twenty-two of the 25 clinicians who perform TPE (88%) responded to the study. We found two distinct prototypes in both TPE and TAU. One correlated significantly with Ablon and Jones' Cognitive-Behavioral and Interpersonal prototypes, and the other with their Psychodynamic prototype. There was no significant difference between corresponding TPE and TAU prototypes. We conclude, first, TPE offers trainees an experience of psychotherapy that is very similar to psychotherapy of actual patients. Second, experienced clinicians integrate a broad array of useful interventions into both TPE and TAU.

Psychotherapy integration as practiced by experts.

Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive-behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive-behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive-behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations.

Post-traumatic stress disorder (PTSD) represents a frequent consequence of a variety of extreme psychological stressors. Lists of empirically supported treatments for PTSD usually include cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), but nonresponse and dropout rates in these treatments often are high. We review the treatment dropout and nonresponse rates in 55 studies of empirically supported treatments for PTSD, review the literature for predictors of dropout and nonresponse, discuss methodological inconsistencies in the literature that make comparisons across studies difficult, and outline future directions for research. Dropout rates ranged widely and may have depended, at least in part, on the nature of the study population. It was not uncommon to find nonresponse rates as high as 50%. Standard methods of reporting dropout and nonresponse rates are needed for reporting outcomes. We suggest guidelines for collecting data to help identify characteristics and predictors of dropouts and nonresponders.

Contributions of psychodynamic approaches to treatment of PTSD and trauma: a review of the empirical treatment and psychopathology literature.

Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may result in improved self-esteem, increased ability to resolve reactions to trauma through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

Memory deficits among alcoholics: performance on a selective reminding task.

This article compared alcoholics and healthy controls on the Buschke Selective Reminding Task. Alcoholics demonstrated deficits in memory and learning when compared to healthy controls, even when controlling for age. Examination of the alcoholic sample initially showed that age predicted memory deficits; however, age was no longer a significant predictor once the number of years of heavy drinking was entered into the regression equation. Findings suggest a direct link or mechanism of action between alcohol use and memory impairments, above and beyond effects of age or education.

Relationships among aging, IQ, and intracranial volume in alcoholics and control subjects.

The current article examined the relationships among aging, intelligence, intracranial volume, and brain shrinkage in alcoholics and nonalcoholic controls. Magnetic resonance imaging was used to measure intracranial and cerebral volumes in 146 subjects with alcohol use disorders and 42 comparison subjects who were not alcoholic. The authors' findings show that performance on Block Design decreases as alcoholics age, and this decrease is predicted by brain shrinkage. This is consistent with a process of cumulative brain damage related to alcohol use. However, the authors' data also show that vocabulary does not decrease with age and is correlated with premorbid brain size as measured by intracranial volume, suggesting that lower verbal ability precedes heavy alcohol use and may be a risk factor for alcoholism.

The structure of worry: relations between positive/negative personality characteristics and the Penn State Worry Questionnaire.

The present studies investigated the structure, correlates, and predictors of worry, as assessed by the Penn State Worry Questionnaire (PSWQ), in a large nonclinical sample (N=1439). Exploratory factor analysis of the PSWQ in Study 1 revealed a two-factor solution (Worry Engagement and Absence of Worry). Confirmatory factor analysis in Study 2 indicated that the two-factor solution provided a better fit to the data than a one-factor model. The PSWQ and its factors evidenced good internal consistency, and correlations with measures of positive and negative state-trait variables provided evidence for good convergent and discriminant validity in both studies. Evidence for the specificity of the two-factor solution was also found such that the Worry Engagement factor demonstrated higher correlations with negative state-trait variables than the Absence of Worry factor. However, path analyses in Study 3 examining predictors of worry provided support for a one-factor solution to the PSWQ. Furthermore, path analyses showed that trait anxiety significantly mediated the relationship between negative characteristics and worry, whereas trait anxiety inversely mediated the relationship between positive characteristics and worry. These findings support the use of the PSWQ in research examining the nature of worry and highlight how positive and negative characteristics may have unique relations with worry in the context of trait anxiety.

Religious coping research and contemporary personality theory: an exploration of Endler's (1997) integrative personality theory.

Notable weaknesses in the literature on religion and mental health include theoretical inconsistencies and lack of integration with contemporary personality theory. The current study explored a potential solution to these theoretical limitations. A modified form of Endler's (1997) interactive model of personality was applied to the prediction of religious coping and tested using structural equation modelling. As predicted by the model, personality dispositions predicted coping directly, as well as indirectly through perception of the situation and situational anxiety. These patterns were, as expected, found to interact with the type of situation. Results indicated that having a positive disposition appears to buffer one's negative perceptions of situations over which one has little control. Participants tended to use more religious coping in low-control situations; in high-control situations, participants tended not to use negative religious coping techniques such as pleading for miracles.