Patient crying during psychotherapy intake sessions: Relationship to patient characteristics and early treatment process.

The aim of the present study is to further the understanding of who cries at the beginning of psychotherapy and patients' experience of crying in that process. Intake sessions for 53 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics were also collected at intake. Results indicate that crying during intake sessions was related to lower global functioning and higher severity of childhood sexual abuse. Furthermore, patients who cried at intake were over four times more likely to also cry at feedback, and those who cried at feedback were almost 12 times more likely to have cried at intake. Finally, crying in the intake session did not appear to be related to patient- or therapist-rated working alliance. Overall, the present study provides valuable information about characteristics of patients who cry at the outset of the therapy process and patients' experience of crying over time in therapy. Findings suggest the need for further research on patient characteristics and aspects of the therapy process that may predict patient crying over the course of treatment, as well as how these early crying experiences may be related to eventual patient outcomes.

Facets of Object Representation: Process and Outcome Over the Course of Psychodynamic Psychotherapy.

This study explores the effectiveness of psychodynamic psychotherapy in improving facets of object relations (OR) functioning over the course of treatment. The sample consisted of 75 outpatients engaged in short-term dynamic psychotherapy at a university-based psychological services clinic. Facets of OR functioning were assessed at pre- and posttreatment by independent raters using the Social Cognition and Object Relations Scale-Global rating method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011 ; Westen, 1995 ) from in-session patient relational narratives. The Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman, Bonge, & Blais, 2005 ) was used to assess therapist activity and psychotherapy techniques early in treatment. Independent clinical ratings of OR functioning and psychotherapy technique were conducted and all were found to be in the good to excellent range of reliability. Specific facets of OR functioning improved with medium to large effect changes posttreatment. These adaptive changes were significantly related to the incidence of psychodynamic-interpersonal (PI) techniques. Also, this study identified the role specific psychodynamic techniques had in facilitating change in a number of underlying dimensions of OR. Patient self-reported reliable change in symptomatology and reliable change in facets of OR were significantly related as well. This study highlights the utility of incorporating psychological assessment into psychotherapy practice to assess change at the explicit (symptoms) and implicit (OR) level. Limitations of this study, future research directions, and implications for clinical practice are discussed.

Patient Crying in Psychotherapy: Who Cries and Why?

AIM: The aim of the present study is to further the understanding of who cries in therapy and the relation of technique with crying behaviour in therapy. METHOD: Psychological assessment feedback sessions, prior to the initiation of formal therapy for 52 patients beginning psychotherapy at a university-based clinic were coded for discrete crying segments. Data about patient characteristics and the process of the session were collected at the time of the session. Therapist's interventions were recorded verbatim and independently rated. RESULTS: The number of times a patient cried during their session correlated negatively with global assessment of functioning scores and positively with measures of borderline personality disorder pathology as well as a measure of severity of childhood sexual abuse. Patients' crying behaviour demonstrated significant negative correlations with the overall experience of the session (bad/good), smoothness and positivity. Group differences between criers and non-criers reflected these trends as well. No significant correlations or group differences were found with regard to patient-rated or therapist-rated alliance as it relates to crying behaviour. Analysis indicates that therapist intervention prior to patient crying most often encouraged the exploration and expression of difficult affect, new perspectives on key issues or the patient's fantasies and wishes. DISCUSSION: Our study addresses a significant gap in the clinical literature on crying. Crying behaviour seems to be related to certain clinical variables and has a negative impact on patient experience of the session in which they cry, although the alliance remained unaffected. LIMITATIONS: Small sample, outpatients with mild/moderate psychopathology and graduate trainees provided therapy. KEY PRACTITIONER MESSAGE: Patients with greater problems in emotional dysregulation, borderline personality disorder symptoms and greater severity of childhood sexual abuse are more likely to display greater affective intensity during the beginning of treatment. Results suggest that the alliance may remain strong despite patients experiencing a session in which they cried as difficult. Therapeutic interventions that focus on affect, new understanding of old patterns and patient fantasies with outpatient clinical populations appeared to be associated with crying in session.

Relationship between patient pre-treatment object relations functioning and psychodynamic techniques early in treatment.

UNLABELLED: This study explored the relationship between patient pre-treatment object relations (OR) functioning and psychodynamic techniques employed during two early sessions (third and ninth). The sample consisted of 76 outpatients engaged in short-term psychodynamic psychotherapy. Results showed that lower levels of patient pre-treatment OR functioning, particularly in the identity and affective domains, were related to a greater use of psychodynamic-interpersonal techniques in sessions. Patients who had more adaptive management of aggressive impulses were related to a greater use of cognitive-behavioural techniques by therapists. In addition, exploratory analyses between OR functioning and specific psychodynamic-interpersonal and cognitive-behavioural techniques showed that lower OR functioning in terms of affect, self-esteem, identity coherence, social causality, emotional investment in relationships as well as Global OR were significantly related to therapist focus on avoidance of important topics and affective changes during the session. Implications for clinical practice and Q1 future research are discussed. KEY PRACTITIONER MESSAGE: Consider more frequent use of psychodynamic techniques early in treatment with patients expressing more pathological object representations, particularly when these deficits are in the affective and identity domains. Lower patient object relations functioning may necessitate an in session focus on issues that are avoided or uncomfortable early in treatment. Lower patient object relations functioning may necessitate the need to address and explore labile affective expressions in session as they occur early in treatment. When patients are able to more adaptively express or manage aggressive impulses early within psychodynamic psychotherapy consider the integration of problem solving, goal oriented, future focused (i.e., CB) techniques.

English perceptions of elder abuse.

The purpose of this exploratory study was to investigate an English sample's perceptions on elder abuse, inflicted by adult children against their aging parents. Fifty participants (14 males, 46 females) provided examples of extreme, moderate, and mild elder abuse. As examples of extreme abuse, most participants mentioned neglect and physical aggression. Various forms of neglect and psychological abuse were their most common examples of moderate and mild abuse. References to physical aggression appeared most often as examples of extreme abuse rather than of moderate or mild abuse. Within these main categories, the specific subtypes most frequently mentioned by the sample included physical neglect, psychological neglect, verbal abuse, and deprivation. More females than males provided examples of financial abuse and physical neglect. Females were also more likely than males to list psychological neglect as an extreme form of abuse and disrespect as a form of mild abuse. At the moderate level, males referred to abuse relating to power more often than females. A positive relationship was found between age and the number of examples of physical neglect given at the moderate level and the number of examples of emotional abuse given at the mild level.