Therapist responsiveness in the blank landscape of depression: A qualitative study among psychotherapists.

OBJECTIVE: Evidence about the high burden of depression on society and the immediate environment of patients has accumulated over the past decades. Yet, empirical data about the impact of depression on the environment of psychotherapy are limited. The present study investigates the phenomenon of therapist responsiveness in the treatment of depression. Specifically, this qualitative study examines the influence of a client's severe depressive symptomatology on psychotherapists' immediate experience and reflections about interventions. METHOD: The responses of 26 Flemish psychotherapists and counselors to a questionnaire with open questions and as part of a focus group were investigated by using Consensual Qualitative Research methodology. RESULTS: First, experiences with a negative valence were most common in the responses of the psychotherapists and counselors. A particular negative experience, a sense of "constriction", affecting the therapist's relational, cognitive, emotional, and bodily level of experiencing, was a predominant response. Second, most psychotherapists and counselors considered a therapeutic attitude of being present for the client and the different aspects in the client's experience to be crucial, although most of them experienced difficulty in maintaining an attitude of presence. CONCLUSIONS: The results of this study suggest that exploration of the different aspects of the clients' experience and working with the self-split of the client might be essential in the psychotherapeutic treatment of depressive disorder.

Meaning profiles and the perception of the working alliance at the start of outpatient person-centered, experiential, and existential psychotherapies.

OBJECTIVE(S): Quantitative research on meaning in life in the context of psychotherapy is relatively limited. The current study aims to investigate the profiles of the meaning of clients and their perception of the working alliance and initial symptomatology at the start of therapy. DESIGN: In a sample of 145 clients (62.1% female; mean age, 34.77) who started person-centered psychotherapy, the relationship between meaning, search for meaning, symptomatology, and the working alliance was analyzed. The assessment took place after the second session. RESULTS: Cluster analysis revealed four profiles: Low Presence High Search, High Presence Low Search, High Presence High Search, and Low Presence Low Search. These meaning profiles are distinguished in terms of symptomatology but not in terms of the working alliance perception. However, the experience of meaning is significantly associated with the working alliance. CONCLUSIONS: Results show the relevance of meaning-related questions for certain groups of clients at the start of therapy.

A quest for self-soothing: A systematic case study into emotion-focused therapy with an emotionally avoidant client who committed sexual offenses.

OBJECTIVE: The current study is part of a multiple case study that investigated the emotional change in individuals who have committed sexual offenses (ISOs). This case study highlights how one client used sex as a maladaptive coping strategy to suppress negative emotions. METHOD: A mixed-methods design was used to track changes in the client's affect regulation (AR) during four phases, including a baseline (Phase A), treatment as usual (Phase B), treatment with an emotion-focused therapy (EFT) component added (Phase C), and follow up (Phase A). RESULTS: The qualitative description with verbatim clinical vignettes, revealed deeper insight into some important steps and hindrances and the impact of specific EFT-interventions. Quantitative analysis of self-report and observational measures showed a significant improvement in the client's AR across different phases of treatment. CONCLUSIONS: The study improves our knowledge of the emotional change in ISOs during treatment and illustrates some key interventions, steps, and hindrances.

Spirituality and Well-Being in Old Age: Exploring the Dimensions of Spirituality in Relation to Late-Life Functioning.

A growing body of research connects spirituality with positive late-life functioning. In this research, spirituality is often approached as a single measure in relation to well-being, neglecting its complex nature. Therefore, this study explores whether different dimensions of spirituality contribute uniquely to psychological well-being in advanced age. Results indicated that well-being was positively predicted by spirituality experienced through connectedness with the transcendent and through connectedness with others. Spirituality experienced through connectedness with nature did not predict well-being. These findings highlight the unique influence of each spirituality dimension on well-being as well as the need for a multidimensional approach.

Posttraumatic Growth in Sex Offenders.

In recent qualitative studies, posttraumatic growth has been highlighted as a possible sign of change in how offenders relate to their basic existential needs. In this article, we present results of a pilot study with a mixed-method design on posttraumatic growth and psychological stress in a sample of sexual offenders ( n = 30) in ongoing therapy. We performed univariate analyses and subsequent hierarchical analyses, and the results affirmed our hypothesis that posttraumatic growth is negatively associated with psychological stress. We used phenomenological analysis to identify themes in the participants' reflections on posttraumatic growth. We found that prison experiences forced the participants to change. Prisoners experience emotional support from others during incarceration as crucial to positive change. Taking responsibility for the crime helped them engage in the therapy more fully and resulted in more posttraumatic growth.

Meaningful coping with chronic pain: Exploring the interplay between goal violation, meaningful coping strategies and life satisfaction in chronic pain patients.

Trying to cope with chronic pain is a highly demanding and challenging task and pain patients often need to reformulate goals or aspirations due to their pain condition. This goal violation is often related with experienced distress and requires coping processes in order to decrease the distress and stimulate a healthy adaptation. Some scholars, however, argued that in so-called unsolvable or irreparable stressors such as chronic pain, conventional coping strategies like problem-focused coping might not be the most adaptive option. In these situations, meaningful coping strategies attempting to transform the meaning of the stressful experience would be more accurate. In this study, we aim to test if goal violation triggers meaningful coping strategies over time and whether engagement in these meaningful coping strategies result in improved life satisfaction, as an indicator of adaptation. A longitudinal three wave study in a sample of paint patients (n = 125) tests whether goal violation triggers positive reappraisal and downward comparison, two possible meaningful coping strategies. The study furthermore tests if engagement in these strategies results in a better adaptation to the pain condition, reflected in higher life satisfaction. Results partially supported our hypotheses by pointing to the benevolent role of downward comparison on life satisfaction via decreased goal violation of pain patients. Our findings however did also show that positive reappraisal predicted lower life satisfaction via increased levels of appraised goal violation which questions the role of positive reappraisal as a genuine meaningful coping strategy. Implications and limitations are discussed.

Loss of Meaning as a Predictor of Distress in Prison.

Incarceration has been described as a distressing experience, marked by important losses and accompanied by deep existential crises. Some prisoners "hit rock bottom" and are confronted with the fact that their life does not make sense anymore. Surprisingly, loss of meaning among prisoners has not been studied in a quantitative way before. In this study, we explored the relationship between loss of meaning inflicted by incarceration and distress. In a sample of 365 prisoners, univariate analyses and hierarchical multiple regression analyses confirmed that a loss of meaning positively predicted distress in prison. Differences between prison regimes predicted distress, but had no influence on the loss of meaning. Unsentenced incarceration, in contrast, did not have a direct relationship to distress, but amplified the effect of loss of meaning on distress. Psychotherapy and chaplain support did not affect the relationship between loss of meaning and distress during incarceration.

Chronic pain care.

Objective Experiencing pain not only affects patients' biopsychosocial functioning but also the existential domain. Attention to the existential, in addition to the biopsychosocial domains, might thus be important in chronic pain care. Therefore, we investigated: (a) how satisfied patients were with the attention of their practitioners to the impact of pain on biological, psychological, social, and existential life domains, and (b) how satisfaction with each domain was related to patient functioning. Method Pain patients ( N = 163) were questioned on their satisfaction with the attention of their practitioners to biological, psychological, social, and existential life domains, and on pain intensity, pain disability, life satisfaction, and depressive symptoms. Results Patients reported low satisfaction with the attention of their practitioners to the social and existential domains. Satisfaction with each domain was negatively related with pain intensity, pain disability, and depressive symptoms and positively related with life satisfaction. Only satisfaction with the existential domain was able to predict all functional outcomes above and beyond all other satisfaction variables modeled simultaneously. Conclusions Patients reported not feeling satisfied with the attention to the social and existential life domains. Furthermore, practitioners' attention to the existential domain seems highly important for patient functioning. Openness to existential concerns of pain patients might thus be an important aspect of chronic pain care.