Assessment of suitability for psychotherapy. II. Assessment based on basic process goals.

Part II of this paper presents an outline for the assessment of suitability for psychotherapy based on the patient's ability to participate in the basic tasks of the therapeutic process and provides a coherent approach to this complex and difficult task. Several factors, such as therapeutic interaction and relational history, influencing the patient's ability to form a productive working relationship can be assessed clinically and are well supported by research. Others, such as motivation and supportive life circumstances, although less supported by research, still appear to be clinically important. Influences on the ability to create a model of the patient's psychopathology, such as introspection, circumscribed focus, and some aspects of the model itself, are supported by limited research but important for some therapies. There is little research on trial interventions, though these remain a crucial assessment dimension for short-term therapies, particularly. Countertransference, although traditionally not viewed as part of assessment, is actually an important tool that has been validated by research.

Assessment of suitability for psychotherapy. I. Introduction and the assessment process.

Part I of this paper reviews the value of detailed psychotherapy-suitability assessments using criteria independent of illness severity. False-positive and false-negative determinations of suitability are minimized along with the associated problems. These assessments must be done by psychotherapists, and they typically take several sessions. An assessment process based on three components--diagnosis and the traditional history, creation of a model of the patient's psychopathology, and the use suitability criteria (reviewed in detail in part II)--is described. The value of diagnosis is discussed using the two most common ones of depression and personality disorder, along with the implications for the prescription of psychotherapy.

Therapeutic models of psychopathology. Part II: The influence of activators, biological factors, and the childhood environment on the psychological organization.

Part II of this paper continues the discussion of key components of an integrated model of psychopathology. The interaction of the environment with aspects of the psychological organization and the development of this organization through the interaction of biological factors and the childhood interpersonal environment is discussed in some detail. The role of aspects of personality organization in creating personal meaning for environmental events and the role of feedback processes, interactions and sequences are explored. The role of childhood relationships, the qualities sought in relationships, and the psychopathological consequences of disturbances in these relationships are also reviewed.

Therapeutic models of psychopathology. Part I: Introduction, overview of the model, and personality organization.

Part I of this paper introduces an integrated model of psychopathology that may be used as a guide for formulating a more specific model for patients in psychotherapy. This model considers the influence of biological and environmental factors in development, as well as the influence of the current environment on the psychological structure of the adult. It is compatible with a broader biological context and with current scientific thinking about the functioning of the human mind. Key principles in the development and functioning of the psychological organization of the individual are introduced. The central concept of Psychological Organization and the major dimensions of motivation, models of self and other, and information processing are discussed in detail.

Personality diagnosis and childhood care associated with adult marital quality.

This paper reports on a continuation of previous research into the connection between childhood experience of relationships and adult relationships such as marriage. A group of 41 married, mixed psychiatric patients showed the strongest correlations between adult marital quality as measured by the Marital Adjustment Test and mother care, same sex parent care or lowest caring parent care, as measured by the Parental Bonding Instrument. There was little correlation between childhood care and adult marital quality in both subgroups; one group was composed of 24 patients with Axis I diagnosis alone and the other group was composed of 17 patients with personality disorder. Married patients with personality disorder, almost all of whom had an Axis I diagnosis as well, did report lower levels of both childhood care and adult marital quality compared with patients with Axis I diagnoses and no personality disorder. The possible significance of these findings is discussed.

Basic principles of psychotherapy. II. The patient model, interventions, and countertransference.

This paper (Part II) discusses the details of techniques used in achieving the goals of creating an individualized patient model, making effective interventions and monitoring countertransference. Models of patients' functioning can be created by using selection strategies regarding patients' characteristics and drawing on general models to explain these phenomena. Interventions are based on this model and should increase patients' understanding but are selected on the basis of goals and the individual's current state. Countertransference is a universal phenomena that can be managed in a variety of professional ways.

Basic principles of psychotherapy. I. Introduction, basic goals, and the therapeutic relationship.

This paper (Part I) outlines some fundamental principles of psychotherapy. The concept of "supportive" psychotherapy and the problems associated with those techniques are discussed, along with the advantage of learning basic principles of psychotherapy. The basic principles of psychotherapy are introduced in terms of basic goals. The techniques used in achieving the goal of an effective therapeutic relationship are discussed in detail. Other goals of creating an individualized patient model, making interventions, and monitoring countertransference are introduced but detailed discussion is left for Part II.

How psychiatrists weigh risk factors when assessing suicide risk.

The clinical assessment of suicide risk is a difficult task that the traditional literature contributes to in a limited way. This study aims to complement the traditional literature by determining the ranking of suicide risk factors by a group of 81 psychiatrists. Hopelessness was ranked the most important risk factor, followed by Suicidal Ideation, Previous Attempts, the Level of Mood and Affect, Quality of Relationships, Signs and Symptoms of Depression, and Social Integration. Less highly ranked risk factors are also noted. The significance of these findings is discussed with respect to the literature and commonly used textbooks of psychiatry.

Psychiatrists' experience of suicide in their patients.

Ninety-nine psychiatrists from a defined geographical area were sent a questionnaire asking them to report on clinical, social and demographic characteristics of patients who suicided while under their care. Seventy-three psychiatrists returned the questionnaire and reported having seen a total of 122 suicides. This resulted in a mean of 0.12 suicides per psychiatrist per year of practice. Twenty-four percent of the patients were reported to have had a diagnosis of schizophrenia which is significantly higher than in studies based on coroner's cases. Evidence of withdrawal, considering oneself a burden to others and help negation are factors that had frequently been present in the month prior to the suicide. The authors recommend that these three factors should be examined further by using a prospective strategy.

Separation experiences in childhood and adult marital quality.

A relational model of the influence of childhood relationships on adult marital quality is proposed and tested in a family medical centre and a psychiatric outpatient population by a questionnaire of separation experiences, the Parental Bonding Instrument and the Locke-Wallace Short Marital Adjustment Test. This paper presents results from a psychiatric outpatient population that correspond with previously reported results on the family medical centre patients. The paper also presents data from both populations on the association of childhood separation experiences with adult marital quality. The presence or absence of self-reported childhood separation experiences was not associated with variations of marital quality in either population. The variation in other aspects of separation experiences similarly was not associated with marital quality. The association between representations of childhood experience and adult marital quality, found in a previous study of the family medical centre patients, was not found in the psychiatric outpatient population. The possible reasons for these findings are discussed.

The relationship of childhood experience to the quality of marriage.

A model for the effect of child-parent relationships on later adult marital quality was tested by questionnaire in 124 general practice patients. Recollections of parental care and overprotection measured by the PBI correlated significantly with Locke-Wallace measures of marital quality primarily in females. Correlations were larger in a homogeneous group where previous marriages and emotional illness were eliminated, and in those who had experienced childhood separations from parents. The results are consistent with an interactive model where the quality of childhood experience determines the quality of adult marriages primarily when separation experiences have been present.