Intensive short-term dynamic psychotherapy provided by novice psychotherapists: effects on symptomatology and psychological structure in patients with anxiety disorders.

This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality diagnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.

The relationship between self-observed and other-observed countertransference and session outcome.

For the psychodynamic approach, being aware of and managing countertransference is a core therapeutic competency. Research has demonstrated the negative effect of unmanaged countertransference on the outcomes of all kinds of psychotherapy. In this study, we focused on the relationship between countertransference when measured by therapists and external observers and its impact on session quality. We analyzed 69 counseling sessions, held by 23 in-training psychotherapists with 23 patients. We used the Therapist Response Questionnaire and three external observers (who used the Countertransference Behavior Measure) to measure psychotherapists' countertransference. We rated the session impact perceived by patients and psychotherapists using the Session Evaluation Questionnaire and by patients through the Session Impact Scale. Psychotherapists' and observers' ratings of countertransference correlated though on different dimensions. These results indicate that comparing external and internal evaluations can help to understand various aspects of countertransference since they have different associations with the session outcome. From a methodological point of view, it is necessary to adopt various perspectives to investigate countertransference. Future research should confirm these results on a sample of experienced psychotherapists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Functional Psychotherapy Approach: A Process-Outcome Multiple Case Study.

Objective: The present work aims to conduct the first naturalistic empirical investigation of the process and outcome assessment of functional psychotherapy (FP) treatment. The FP model of psychotherapy is rooted in psychoanalysis and integrates the verbal communication approach founded on transference and countertransference dynamics with the analysis of bodily processes. Method: The study sample included ten patients recruited on a voluntary basis and treated by clinicians in their private practices. Each patient received FP with an average duration of 40 h (min 35 and max 42). Therapies had weekly sessions, were audio-recorded with the patient's written consent, and lasted for an average of 10 months (min 9 and max 12). Outcome and process tools included the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Luborsky's the Core Conflictual Relationship Theme (CCRT), used to assess therapeutic benefit, and the Metacognition Assessment Scale (MAS) and the Italian Discourse Attributes Analysis Program (IDAAP) system, used to evaluate therapeutic benefit and process. The MMPI-2 was used also in the follow-up assessment. Results: Results show that FP had a positive therapeutic outcome on the patients assessed in this study, and that the therapeutic benefits were maintained over time. Some specific features of the FP approach were found to contribute more than others to the observed therapeutic benefits. Conclusion: The current investigation constitutes a first step toward assessment of the therapeutic effectiveness of FP. Future developments should apply the methodology to a larger sample, possibly introducing different methodologies to enable detection of specific bodily oriented processes and techniques.

First Validation of the Referential Process Post-Session Scale - Therapist Version (RPPS-T).

OBJECTIVE: Bucci's multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases. METHOD: We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale - Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts. RESULTS: In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the four-factor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts. CONCLUSIONS: The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervision.

Key factors in psychotherapy training: an analysis of trainers', trainees' and psychotherapists' points of view.

The literature on clinical training lacks identifications of the factors that are most relevant in training programs; accordingly, the main aim of this work is to fill this research gap by assessing which factors that trainers, trainees and psychotherapists consider most relevant in psychotherapy training programs. A secondary aim is to identify whether these factors differ among trainers, trainees and psychotherapists. An ad hoc questionnaire was created and administered at 24 psychotherapy schools from 14 institutions; the sample included 641 trainees, 172 trainers and 218 psychotherapists of various theoretical orientations. The questionnaire included 63 items and used a 5-point Likert scale. An exploratory factor analysis was completed to identify the latent structure. The reliability of the dimensions was then checked. Finally, an analysis of variance and a multivariate analysis of variance were completed to achieve the study's aims. Four factors emerged from the study's results: trainers' relational characteristics, supervision, transmission of clinical know-how, and theoretical background and technical support. All these factors displayed acceptable reliability and internal consistency. Moreover, their relative rankings varied based on the participants' roles and theoretical backgrounds. This study's results indicate that the new instrument's psychometric qualities are acceptable. It thus could be used to develop a new approach to psychotherapy training, as this study's results regarding trainees' needs underline the differences between trainees' perceptions of those needs, as compared to trainers' and psychotherapists' perceptions.

Beyond Verbal Behavior: An Empirical Analysis of Speech Rates in Psychotherapy Sessions.

Objective: The present work aims to detect the role of the rate of speech as a mechanism able to give information on patient's intrapsychic activity and the intersubjective quality of the patient-therapist relationship. Method: Thirty clinical sessions among five patients were sampled and divided into idea units (N = 1276) according to the referential activity method. Each idea unit was rated according to referential activity method and in terms of speech rate (syllables per second) for both patient and therapist. A mixed-effects model was applied in order to detect the relationship between the speech rate of both the patient and the therapist and the features of the patient's verbal production in terms of referential activity scales. A Pearson correlation was applied to evaluate the synchrony between the speech rate of the patient and the therapist. Results: Results highlight that speech rate varies according patient's ability to get in touch with specific aspects detected through referential activity method: patient and the therapist speech rate get synchronized during the course of the sessions; and the therapist's speech rate partially attunes to the patient's ability to get in touch with inner aspects detected through RA method. Conclusion: The work identified speech rate as a feature that may help in the development of the clinical process in light of its ability to convey information about a patient's internal states and a therapist's attunement ability. These results support the intersubjective perspective on the clinical process.

A pilot study of the Italian adaptation of the Session Evaluation Questionnaire fourth version.

The Session Evaluation Questionnaire (SEQ) measures the impact of counselling and psychotherapy sessions; it may be conceived as a bridge between psychotherapy process and outcome. Even if the original American SEQ has been translated into many languages, only a few translations have been validated. This is a pilot study that attempted to replicate the five-dimensional structure of the fourth version of the Anglo-American SEQ, for the Italian population. The SEQ is a self-report tool asking patients about their experience with the clinical session just ended; it consists of 27 adjectives in semantic differential scale, divided into three thematic parts: evaluation of the session itself, feelings after the session, and evaluation of the therapist. Data were collected on 111 outpatients attending the Dynamic Psychological Service for University Students, after their first two clinical interviews. Exploratory factor analyses were performed on each of the three parts of the SEQ. Results confirmed the original factorial structure, for Depth, Smoothness, Positivity and Arousal dimensions; Good Therapist dimension overlapped perfectly with the original one. The Italian SEQ showed adequate internal consistency. Convergent validity measured with an index of perceived satisfaction in the counselling process showed significant positive correlations. This pilot study showed that the Italian SEQ is a reliable instrument to measure the impact of clinical sessions. Validation studies are needed, especially to replicate the factor structure of the instrument and to better assess its validity.

Dynamic mapping of the structures of content in clinical settings (DMSC). A new coding system for analysing the patient's narratives.

OBJECTIVES: The paper presents a method of content analysis framed within a semiotic and contextual model of the psychotherapy process as a situated dynamics of sensemaking: the Dynamic Mapping of the Structures of Content in Clinical Settings (DMSC). DESIGN: DMSC is a system of content analysis focused on a generalized level of meaning, concerning basic aspects of the patient's narrative (e.g., if the narrative concerns herself or other than herself). METHOD: The paper presents the result of the application of DMSC to an intensive single-case analysis (Katja). The method has been applied by judges to the transcripts of sessions and is aimed at identifying patterns of combinations (defined: Patterns of content) of the categories characterizing the patient's narratives (pattern analysis approach) as well as at mapping the transition among these patterns (sequential analysis approach). RESULTS: These results provide evidence of its construct validity. In accordance with the theoretical model grounding the method, we have found that: (a) DMSC provides a meaningful representation of the patient's narratives in terms of Patterns of content; (b) the probability of transition among the Patterns of content have proved to be significantly associated with the clinical quality of the sessions. CONCLUSION: The DMSC has to be considered an attempt paving the way for further investigations aimed at developing a deeper understanding of the role played by the dynamics of sensemaking in the psychotherapy process.