Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Outcome. Show all posts
Showing posts with label Outcome. Show all posts

Saturday, February 11, 2023

Countertransference awareness and treatment outcome

Abargil, M., & Tishby, O. (2022). 
Journal of counseling psychology,
69(5), 667–677.
https://doi.org/10.1037/cou0000620

Abstract

Countertransference (CT) is considered a central component in the therapy process. Research has shown that CT management does not reduce the number of CT manifestations in therapy, but it leads to better therapy outcomes. In this study, we examined therapists' awareness of their CT using a structured interview. Our hypotheses were (a) treatments in which therapists were more aware of their CT would have a better outcome and (b) different definitions of CT would be related to different therapy outcomes. Twenty-nine patients were treated by 19 therapists in 16 sessions of short-term psychodynamic therapy. We used the core conflictual relationship theme to measure CT, a special interview was developed to study CT awareness. Results show that awareness of CT defined as the relationship with the patient moderated 10 outcome measures and awareness of CT defined as the relationship with the patient that repeats therapist conflicts with significant others moderated three outcome measures We present examples from dyads in this study and discuss how awareness can help the therapist talk to and handle patient challenges.

From the Discussion section

Increased therapist awareness of CT facilitate improvement in patient symptoms, emotion regulation and affiliation in relationships. Since awareness is an integral part of CT management, these findings are consistent with Hayes’ results from 2018 regarding the importance of CT management and its contribution to treatment outcome. Moreover, therapist’s self-awareness was found to be important in treating minorities (Baker, 1999). This study expands the ecological validity of therapist awareness and shows that the therapists’ awareness of their own wishes in therapy, as well as his perception of himself and the patient, is relevant to the general population as well. Thus, therapists of all theoretical orientations are encouraged to attend to their personal conflicts and to monitor their reactions to patients as a routine part of effective clinical practice. Moreover, therapist awareness has been found in the past to lead to less therapist self-confidence, but to better treatment outcomes (Williams, 2008). Our clinical examples illustrate these findings (the therapist who had high awareness showed much more self- doubt) and the results of multilevel regression analysis demonstrate better improvement for patients whose therapists were highly aware. Interestingly, the IIP control dimension was not found to be related to the therapist’s awareness of CT. It may be that since this dimension relates to the patient’s control need, the awareness of transference is more important. Another possibility is that the patient’s experience of the therapist as “knowing” may actually increase his control needs. Moreover, regarding patient main TC, we only found a trend and not a significant interaction. One reason may be the sample size. Another explanation is that patients do not necessarily link the changes in their lives to the relationship with the therapist and the insights associated with it. Thus, although awareness of CT helps to improve other outcome measures, it is not related to the way patients feel about the reason they sought out treatment.

A recent study of CT found that negative types of CT were correlated with more ruptures and less repair in the alliance. For positive CT the picture is more complex; Positive patterns predicted resolution when the therapists repeated positive patterns with par- ents but predicted ruptures when they tried to “repair” negative patterns with the parents (Tishby & Wiseman, 2020). The authors suggest that awareness of CT will help the therapist pay more attention to ruptures during treatment so they can address it and initiate resolutions processes. Our findings support the authors’ suggestion. The clinical example demonstrates that when the therapist was aware of negative CT and was able to talk about it in the awareness interview, he was also able to address the difficult feelings that arose during a session with the patient. Moreover, the treatment outcomes in these treatments were better which characterizes treatments with proper repair processes.

Tuesday, May 11, 2021

How personality shapes third-party moral judgment

Schwartz, F., Djeriouat, H., & Trémolière, B. 
(2021, March 17).
https://doi.org/10.31234/osf.io/4wnhz

Abstract

Although recent research in the moral judgment field has explored third-party judgment, much less is known as to how personality influences these judgments. The present preregistered study addresses this issue by exploring the influence of various personality traits, namely honesty-humility, emotionality, and conscientiousness. Adult participants recruited online (N = 405) read short narratives describing the interaction between two protagonists (“agent” and “victim”). We manipulated the intent of the agent (intent to harm or not) and the outcome for the victim (harmful consequences or no harm). Participants indicated the extent to which they perceived the agent’s behavior as acceptable and blameworthy, and how much punishment they felt the agent deserved, before filling the HEXACO questionnaire. Our results point to a moderate role of honesty-humility, emotionality, and conscientiousness on acceptability of the agent’s behavior, with their relative weight depending upon the type of moral transgression. While higher honesty-humility scores were associated with lower acceptability of moral transgressions overall, higher emotionality was associated with reduced acceptability when the agent attempted to harm, and higher conscientiousness was associated with lower acceptability ratings only when the agent harmed intentionally. We also found a moderate effect of extraversion and emotionality on decisions of punishment and blame of an agent who harmed or attempted to harm. The results suggest that third-party moral judgment is modestly, yet selectively modulated by personality traits and the type of moral transgression.

From the Discussion

However, contrary to our hypothesis, we found that emotionality predicts acceptability of attempted harm, but not accidental harm. Moreover, after adding extraversion to the model in exploratory analyses, emotionality also tended to predict punishment decisions and blame of intentional harm. These results suggest that emotionality may sometimes modulate the intent-based process as much as (or even more so than) the outcome-based process when deciding about moral wrongness. This is consistent with some recent revisions of the dual-process model of moral judgment (Cushman, 2013), which posit that affect may influence both processes. The present findings further converge with the recent observation that distinct emotions may be triggered by the intent to harm on the one hand, and the victim’s harm on the other hand (Hechler & Kessler, 2018). More specifically, anger at an agent who intends to harm is distinct from empathic concern for the victim (Hechler & Kessler, 2018). 

Why did emotionality fail to predict judgment of accidental transgressions in the current study? We see two potential explanations: the contact principle and the action/ omission distinction, which are critical to the judgment of moral transgressions (Cushman, 2013). First, the contact principle of moral judgment suggests that someone who inflicted harm directly (by physical force) is judged more severely than someone who harmed indirectly (Cushman, 2013; Greene et al., 2009). In short, not only the presence of harm induces an emotional response, but also how it has been done (i.e., giving someone poisonous food versus beating someone).The fact that harm is not inflicted directly in all our scenarios may explain why individual differences in emotionality don’t explain the judgment severity of accidental harm. Second, when (accidental) harm results from an action, the transgression is judged more severely than when (accidental) harm results from an omission, an effect known as the “omission bias” (Baron & Ritov, 2004; Spranca et al., 1991). In our study, the victim’s harm resulted mostly from omissions. As a consequence, emotionality may have contributed less to the moral condemnation of harmful omissions than it would have for harmful actions.

Thursday, October 13, 2016

The influence of intention, outcome and question-wording on children’s and adults’ moral judgments

Gavin Nobes, Georgia Panagiotaki, Kimberley J. Bartholomew
Cognition
Volume 157, December 2016, Pages 190–204

Abstract

The influence of intention and outcome information on moral judgments was investigated by telling children aged 4–8 years and adults (N = 169) stories involving accidental harms (positive intention, negative outcome) or attempted harms (negative intention, positive outcome) from two studies (Helwig, Zelazo, & Wilson, 2001; Zelazo, Helwig, & Lau, 1996). When the original acceptability (wrongness) question was asked, the original findings were closely replicated: children’s and adults’ acceptability judgments were based almost exclusively on outcome, and children’s punishment judgments were also primarily outcome-based. However, when this question was rephrased, 4–5-year-olds’ judgments were approximately equally influenced by intention and outcome, and from 5–6 years they were based considerably more on intention than outcome primarily intention-based. These findings indicate that, for methodological reasons, children’s (and adults’) ability to make intention-based judgment has often been substantially underestimated.

The article is here.