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

Sunday, October 11, 2020

Psychotherapy With Suicidal Patients Part 2: An Alliance Based Intervention for Suicide

E. M. Plakun
Psychiatric Practice
January 2019 - Volume 25: Issue 1, 41-45

Abstract

This column, which is the second in a 2-part series on the challenge of treating patients struggling with suicide, reviews one psychodynamic approach to working with suicidal patients that is consistent with the elements shared across evidence-based approaches to treating suicidal patients that were the focus of the first column in this series. Alliance Based Intervention for Suicide is an approach to treating suicidal patients developed at the Austen Riggs Center that is not manualized or a stand-alone treatment, but rather it is a way of establishing and maintaining an alliance with suicidal patients that engages the issue of suicide and allows the rest of psychodynamic therapy to unfold.

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From the Conclusion

There is no magic in ABIS (Alliance Based Intervention for Suicide), and it will not work in all cases, but these principles are effective in making suicide an interpersonal issue with meaning in the relationship. This allows direct engagement of the issue of suicide in the therapeutic relationship and direct discussion of the central question of whether the patient can and will commit to the work. ABIS supports the therapist in efforts to assess whether the therapist has the will and the wherewithal to meet the patient’s anger and hate, as manifested by suicide, as fully as the therapist is prepared to meet the patient’s love and attachment. Neither side of the transference alone is adequate in work with suicidal patients.

There are no randomized trials of ABIS, but it is a way of working that has evolved at Austen Riggs over the course of a hundred years. In a study of previously suicidal patients at Riggs, at an average of 7 years after admission, 75% were free of suicidal behavior as an issue in their lives.6 These patients were considered “recovered” rather than “in remission,” using the same slope-intercept mathematical modeling as in cancer research. These findings offer encouraging support for the value of ABIS as an intervention to add to psychodynamic psychotherapy as a way to establish and maintain a viable therapeutic alliance with suicidal patients.

The article is here.

Friday, May 1, 2020

The therapist's dilemma: Tell the whole truth?

Image result for psychotherapyJackson, D.
J. Clin. Psychol. 2020; 76: 286– 291.
https://doi.org/10.1002/jclp.22895

Abstract

Honest communication between therapist and client is foundational to good psychotherapy. However, while past research has focused on client honesty, the topic of therapist honesty remains almost entirely untouched. Our lab's research seeks to explore the role of therapist honesty, how and why therapists make decisions about when to be completely honest with clients (and when to abstain from telling the whole truth), and the perceived consequences of these decisions. This article reviews findings from our preliminary research, presents a case study of the author's honest disclosure dilemma, and discusses the role of therapeutic tact and its function in the therapeutic process.

Here is an excerpt:

Based on our preliminary research, one of the most common topics of overt dishonesty among therapists was their feelings of frustration or disappointment toward their clients. For example, a therapist working with a client with a diagnosis of avoidant personality disorder may find herself increasingly frustrated by the client’s continual resistance to discussing emotional topics or engaging in activities that would broaden his or her world. Such a client —let’s assume male—is also likely to feel preoccupied with concerns about whether the therapist “likes” him or feels as frustrated with him as he does with himself. Should this client apologize for his behavior and ask if the therapist is frustrated with him, the therapist may feel compelled to reduce the discomfort he is already experiencing by dispelling his concern: “No, it’s okay, I’m not frustrated.”

But either at this moment or at a later point in therapy, once rapport (i.e., the therapeutic alliance) has been more firmly established, a more honest answer to this question might be fruitful: “Yes, I am feeling frustrated that we haven’t been able to find ways for you to implement the changes we discuss here, outside of session. How does it feel for you to hear that I am feeling frustrated?” Or, arguably, an even more honest answer: “Yes, I am sometimes frustrated. I sometimes think we could go deeper here—I think it’d be helpful.” Or, an honest answer that is somewhat less critical of the patient and more self‐focused: “I do feel frustrated that I haven’t been able to be more helpful.” Clearly, there are many ways for a therapist to be honest and/or dishonest, and there are also gradations in whichever direction a therapist chooses.

Wednesday, December 26, 2018

Therapy Is No Longer a Politics-Free Zone

Peggy Drexler
The Wall Street Journal
Originally posted November November 23, 2018

Here is an excerpt:

A May 2018 survey published in the Journal of Clinical Psychology—which devoted an entire issue to how mental health professionals can understand and deal with the dramatic increase in clients feeling politics-related anxiety—found that of 604 psychotherapy patients from 50 states, only 32 percent said their therapist didn’t disclose their political beliefs, while 30 percent said their therapists divulged their views and the other 38 percent said their therapists very clearly made their beliefs known. “The old rules are pretty straightforward: Don’t talk about it,” says Dr. Steven Schlozman. a psychiatrist at Massachusetts General Hospital in Boston. “But our country right now is so about what side you’re on that almost every interaction people have these days is characterized by that.”

Full disclosure may be surprising, but it isn’t necessarily unwelcome. A 2018 poll conducted by market research firm Branded Research found that 61 percent of more than 8,000 therapy patients surveyed say it is “very” or “somewhat” important that they and their therapist share the same political values. Manhattan clinical psychologist Sarah Gundle, the co-clinical director of Octave, a “behavioral health studio” that opened in October offering individual and group therapy—including support groups for those feeling politics-related stress or anxiety—recalls a recent patient who wanted to know where she stood.

The info is here.

Saturday, October 27, 2018

Obtaining consensus in psychotherapy: What holds us back?

Goldfried, M.R.
American Psychologist
2018

Abstract

Although the field of psychotherapy has been in existence for well over a century, it nonetheless continues to be preparadigmatic, lacking a consensus or scientific core. Instead, it is characterized by a large and increasing number of different schools of thought. In addition to the varying ways in which psychotherapy has been conceptualized, there also exists a long-standing gap between psychotherapy research and how it is conducted in actual clinical practice. Finally, there also exists a tendency to place great emphasis on what is new, often rediscovering or reinventing past contributions. This article describes each of these impediments to obtaining consensus and offers some suggestions for what might be done to address them.

Here is an excerpt:

There are at least three problematic issues that seem to contribute to the difficulty we have in obtaining a consensus within the field of psychotherapy: The first involves our long-standing practice of solely working within theoretical orientations or eclectic combinations of orientations. Moreover, not agreeing with those having other frameworks on how to bring about therapeutic change results in the proliferation of schools of therapy (Goldfried, 1980). The second issue involves the longstanding gap between research and practice, where many therapists may fail to see the relevance to their day-to-day clinical practice and also where many researchers do not make systematic use of clinical observations as a means of guiding their research (Goldfried, 1982).2 The third issue is our tendency to neglect past contributions to the field (Goldfried, 2000). We do not build on our previous body of knowledge but rather rediscover what we already know or—even worse—ignore past work and replace it with something new. What follows is a description of how these three issues prevent psychotherapy from achieving a consensus, after which there will be a consideration of some possible steps that might be taken in working toward a resolution of these issues.

The article is here, behind a paywall.

Friday, June 29, 2018

The Surprising Power of Questions

Alison Wood Brooks and Leslie K. John
Harvard Business Review
May-June 2018 Issue

Here are two excerpts:

Most people don’t grasp that asking a lot of questions unlocks learning and improves interpersonal bonding. In Alison’s studies, for example, though people could accurately recall how many questions had been asked in their conversations, they didn’t intuit the link between questions and liking. Across four studies, in which participants were engaged in conversations themselves or read transcripts of others’ conversations, people tended not to realize that question asking would influence—or had influenced—the level of amity between the conversationalists.

The New Socratic Method

The first step in becoming a better questioner is simply to ask more questions. Of course, the sheer number of questions is not the only factor that influences the quality of a conversation: The type, tone, sequence, and framing also matter.

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Not all questions are created equal. Alison’s research, using human coding and machine learning, revealed four types of questions: introductory questions (“How are you?”), mirror questions (“I’m fine. How are you?”), full-switch questions (ones that change the topic entirely), and follow-up questions (ones that solicit more information). Although each type is abundant in natural conversation, follow-up questions seem to have special power. They signal to your conversation partner that you are listening, care, and want to know more. People interacting with a partner who asks lots of follow-up questions tend to feel respected and heard.

An unexpected benefit of follow-up questions is that they don’t require much thought or preparation—indeed, they seem to come naturally to interlocutors. In Alison’s studies, the people who were told to ask more questions used more follow-up questions than any other type without being instructed to do so.

The article is here.

This article clearly relates to psychotherapy communication.

Tuesday, June 26, 2018

The alliance in adult psychotherapy: A meta-analytic synthesis.

Flückiger C, Del Re AC, Wampold BE, & Horvath AO
Psychotherapy (Chicago, Ill.) [24 May 2018]

Abstract

The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.

The research is here.

Saturday, May 21, 2016

Ghosting on Freud: why breaking up with a therapist is so tricky

Alana Massey
The Guardian
Originally posted May 2, 2016

Here is an excerpt:

Carole Lieberman, a psychiatrist in California, said that patients need to take on some responsibility in letting therapists know when things aren’t working out. “Patients need to come for at least one more session when they are thinking of breaking up with their therapist. Oftentimes, the therapist can resolve a misunderstanding that occurred, or help them to understand why it’s important for them to delve into their past. Even if the patient still decides to leave, they will do so with more insight into themselves and with an open door to return.”

But this expectation demands a great deal, too. Is it really the job of the patient to offer tips and tricks on how the therapist can improve their approach, particularly if the patient is already in a vulnerable or wounded state? Therapists who expect everyone to be experts at the therapeutic process are going to miss or dismiss the patients who need therapy the most.

The article is here.

Friday, January 23, 2015

Empathy represses analytic thought, and vice versa: Brain physiology limits simultaneous use of both networks

Case Western Reserve
Press Release via Science Daily
Originally posted October 30, 2012

Summary

When the brain's analytic network is engaged, our ability to appreciate the human cost of our action is repressed, researchers have found. The study shows for the first time that we have a built-in neural constraint on our ability to be both empathetic and analytic at the same time.

Here is an excerpt:

The work suggests that established theories about two competing networks within the brain must be revised. More, it provides insights into the operation of a healthy mind versus those of the mentally ill or developmentally disabled.

"This is the cognitive structure we've evolved," said Anthony Jack, an assistant professor of cognitive science at Case Western Reserve and lead author of the new study. "Empathetic and analytic thinking are, at least to some extent, mutually exclusive in the brain."

The Science Direct repost of the press release is here.

Editor's note: This research highlights how psychologists need to balance empathy with analytic reason during psychotherapy.  Self-reflection may aid with assessing your skills in both empathy and analysis, and your ability to switch cognitive sets when needed.

For those interested in the problems with empathy, search "Paul Bloom" on this site for articles highlighting the issue.

Saturday, September 20, 2014

When Mental Health Professionals are on Facebook

By Steven Petrow
The Washington Post
Originally posted on August 25, 2014

For the past two weeks, whenever I’ve scrolled through my Facebook newsfeed I’ve come to the section “People You May Know.” The suggestions offered have included relatives, co-workers, some people I don’t even like in “real” life — and my current psychologist. “OMG!” I’ve winced repeatedly at the profile photo of my shrink, who for the sake of his privacy I’ll just call Dr. E.

Still, being the curious sort, I clicked to view his page, which isn’t very well protected from eyes like mine. For starters, there are 12 photos of him available for all the world to enjoy, several of them shirtless and one that had a “friend” of his posting “Woof!” underneath it. I also discovered pictures of Dr. E from high school with two nice-looking young ladies. Although I’ve known he was gay, I started to wonder: Was he bisexual then? When did he come out? I found myself thinking much more about his personal life than any patient should.

Among Dr. E’s Facebook friends was another psychologist, one who seemed to deploy no privacy safeguards whatsoever. Any patient clicking on his Facebook page could see tons of photos, including those of his wedding and honeymoon, and even his attendance at a celebration of “Bush 43’s” last night in office. (That makes it a good bet he’s a Dem, which might be TMI for a GOP patient.)

The entire article is here.

Thursday, May 29, 2014

Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

By Glyn Elwyn, Christine Dehlendorf, Ronald Epstein, Katy Marrin, James White, and Dominick Frosch
doi: 10.1370/afm.1615
Ann Fam Med May/June 2014 vol. 12 no. 3 270-275

Abstract

Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems.

The entire article is here.

Thursday, May 15, 2014

Erotic Feelings Toward the Therapist: A Relational Perspective

By Jenny H. Lotterman
Journal of Clinical Psychology
Volume 70, Issue 2, pages 135–146, February 2014

Abstract

This article focuses on the relational treatment of a male patient presenting with sexual and erotic feelings toward the therapist. The use of relational psychotherapy allowed us to collaborate in viewing our therapeutic relationship as a microcosm of other relationships throughout the patient's life. In this way, the patient came to understand his fears of being close to women, his discomfort with his sexuality, and how these feelings impacted his ongoing romantic and sexual experiences. Use of the therapist's reactions to the patient, including conscious and unconscious feelings and behaviors, aided in the conceptualization of this case. Working under a relational model was especially helpful when ruptures occurred, allowing the patient and therapist to address these moments and move toward repair. The patient was successful in making use of his sexual feelings to understand his feelings and behaviors across contexts.

The entire article is here.

Editor's Note: Psychologists do not talk enough about erotic transference and countertransference in psychotherapy.  These emotions happen more frequently than psychologists are willing to admit.

Sunday, December 1, 2013

Morality, Disgust, and Countertransference in Psychotherapy

John D. Gavazzi, Psy.D., ABPP
Samuel Knapp, Ed.D., ABPP
            
At the most basic level, successful outcomes in psychotherapy require a strong therapeutic alliance between psychologist and patient. A strong therapeutic bond can be cultivated in many different ways including, but not limited to, similarities between psychologist and patient (such as age, socioeconomic status, gender, etc.), psychologist empathy and acceptance, and patient confidence in the psychologist’s skills. A similarity in moral beliefs likely enhances the working relationship and correlates with positive outcomes in psychotherapy.

            
Just as shared values and moral similarities can strengthen the therapeutic relationship, negative moral judgments about a patient’s behaviors and beliefs (both past and current) can erode or rupture the helping relationship. In clinical terms, moral judgments can lead to negative countertransference. When a psychologist experiences a negative, morally-driven emotion related to the patient, this dynamic may adversely affect the quality of the therapeutic relationship. Within the therapeutic discourse, there are many topics related to the patient’s values, personal responsibility, and moral behaviors. Moral judgments and beliefs, like countertransference, are complex, intuitive, automatic, and emotional. In this article, we will focus on one theory of moral origins to understand how these complicated, instinctive, and gut-level reactions may promote negative countertransference.

Monday, September 16, 2013

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity.

By Kevin B. O'Reilly
amdnews.com
Originally posted September 2, 2013

Here is an excerpt:

Because few physicians, medical students or others will admit openly to bias, researchers have developed a tool to plumb their unconscious attitudes. The Weight Implicit Association Test asks participants to pair images of “thin” or “fat” people with negative or positive words. The faster the test-taker links the type of person to a negative attribute, the stronger the unconscious negative attitude. The validated survey tool has been used to measure implicit biases related to race, age, gender, sexuality and other areas.

The vast majority of the people who take the Web-based test exhibit a strong preference for thin people and associate the fat people with negative words, and nearly 2,300 physicians scored about the same as the general populace, said a study published Nov. 7, 2012, in PLoS One. A survey of 620 U.S. doctors found that more than half viewed obese patients as “awkward, unattractive, ugly and noncompliant with therapy,” said a study published October 2003 in Obesity Research.

The entire article is here.

Wednesday, September 4, 2013

The Contribution of the Quality of Therapists' Personal Lives to the Development of the Working Alliance

By Helene A. Nissen-Lie, Odd E. Havik, Per A. Hoglend, Jon T. Monsen, and Michael Helge Ronnestad
Journal of Counseling Psychology. 2013 Aug 19

Abstract

Research suggests that the person of the psychotherapist is important for the process and outcome of psychotherapy, but little is known about the relationship between therapists' personal experiences and the quality of their therapeutic work. This study investigates 2 factors (Personal Satisfactions and Personal Burdens) reflecting therapists' quality of life that emerged from the self-reports of a large international sample of psychotherapists (N = 4,828) (Orlinsky & Rønnestad, 2004, 2005) using the Quality of Personal Life scales of the Development of Psychotherapists Common Core Questionnaire (Orlinsky et al., 1999). These factors were investigated as predictors of alliance levels and growth (using the Working Alliance Inventory) rated by both patients and therapists in a large (227 patients and 70 therapists) naturalistic outpatient psychotherapy study (Havik et al., 1995). The Personal Burdens scale was strongly and inversely related to the growth of the alliance as rated by the patients, but was unrelated to therapist-rated alliance. Conversely, the factor scale of therapists' Personal Satisfactions was clearly and positively associated with therapist-rated alliance growth, but was unrelated to the patients' ratings of the alliance. The findings suggest that the working alliance is influenced by therapists' quality of life, but in divergent ways when rated by patients or by therapists. It seems that patients are particularly sensitive to their therapists' private life experience of distress, which presumably is communicated through the therapists' in-session behaviors, whereas the therapists' judgments of alliance quality were positively biased by their own sense of personal well-being.

Introduction

The notion that the psychotherapist as an individual is important for psychotherapeutic outcomes stems in part from the well-known and frequently cited finding of meta-analyses that therapy outcome appears to be less related to the use of different therapy methods associated with established schools of therapy, and significantly related to differences between the individual psychotherapists providing the therapy (Benish, Imel, & Wampold, 2008; Blatt, Zuroff, Quinlan, & Pilkonis, 1996; Huppert et al., 2001; Kim, Wampold, & Bolt, 2006). Moreover, in efforts to identify the characteristics in therapists that promote treatment success or failure, the studies to date suggest that experience level, type of training, theoretical orientation, and so forth have limited value in distinguishing between more or less successful therapists (Beutler et al., 2004; Dunkle & Friedlander, 1996; Sandell et al., 2007; Skovholt & Jennings, 2004; Strupp & Hadley, 1977). Instead, therapists' interpersonal qualities appear to be more relevant, such as their facilitative interpersonal skills (Anderson, Ogles, Pattersen, Lambert, & Vermeersch, 2009); their ability to be affirmative, responsive, and empathic (Bohart, Elliott, Greenberg, & Watson, 2002; Najavits & Strupp, 1994); their ability to resist counteraggression when confronted with devaluation and rejections by patients (von der Lippe, Monsen, Ronnestad, & Eilertsen, 2008); and their interpersonal functioning in their personal lives (Dunkle & Friedlander, 1996; Hersoug, Hoglend, Havik, von der Lippe, & Monsen, 2009b). Hence, although therapists are professional helpers, it may be that their personal characteristics are more important than their professional qualifications in determining their therapeutic capabilities. This suggestion echoes the statements of Rosenzweig (1936), Strupp (1958), and Rogers (1957, 1961), who emphasized that studying the personal characteristics of psychotherapists is necessary in order to understand patient development in psychotherapy.

Thanks to Ken Pope for this information.

Saturday, May 11, 2013

Physicians build less rapport with obese patients

By K.A. Gudzune, M.C. Beach, D.L. Roter, & L.A. Cooper
Obesity (Silver Spring). 2013 Mar 20. doi: 10.1002/oby.20384.

Abstract

Objective: 
Physicians' negative attitudes towards patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. We aimed to describe the relationship between patient BMI and physician communication behaviors (biomedical, psychosocial/lifestyle, and rapport building) during typical outpatient primary care visits.

Design and Methods: 
Using audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients, we examined the frequency of communication behaviors using the Roter Interaction Analysis System. The independent variable was measured patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. We performed a cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication.

Results: 
PCPs demonstrated less emotional rapport with overweight and obese patients (IRR 0.65, 95%CI 0.48-0.88, p=0.01; IRR 0.69, 95%CI 0.58-0.82, p<0.01, respectively) than for normal weight patients. We found no differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI.

Conclusions:
Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.

And, click here for a blog post on this article, with the excerpt below:

Are Doctors Nicer to Thinner Patients?

By TARA PARKER-POPE
The New York Times - Well Column
Originally published April 29, 2013

Here is an excerpt:

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.


Friday, February 1, 2013

Should Therapists Play Cupid?

By Richard A. Friedman
The New York Times Sunday Review
Originally published January 19, 2013

IF you are in psychotherapy, there’s a good chance your therapist knows more about your inner thoughts and secret desires than anyone else.

So, if you’re looking for a mate, wouldn’t your therapist be a more reliable matchmaker than eHarmony and Match.com and other sites that rely on impersonal algorithms?

The idea that therapists might play Cupid with patients tantalizes patients and therapists. An anecdotal survey of my psychiatrist colleagues suggests that the matchmaking impulse is very common.

A senior colleague, for example, tells me he was treating a young man who was struggling to find a partner. My colleague said he knew someone who was perfect for his patient and wanted to set them up on a date, but didn’t because he was afraid — there were too many ways even the most well-intentioned therapist fix-up could go wrong.

Why? Psychotherapy, especially insight-oriented therapy, is designed to conjure intense feelings — on the part of the patient and therapist. Much of what patients feel toward their therapists, the so-called transference, are unconscious feelings that are redirected from important early figures in their lives — parents, family members and teachers. Your therapist mirrors this phenomenon with his own countertransference.

One of psychotherapy’s aims is to use the patient-therapist relationship to better understand the patient’s relationships with others and to remedy problems in the little lab that is the therapeutic connection.

The entire story is here.

Monday, August 13, 2012

6 Practice Recommendations for Reducing Premature Termination in Therapy

Practice recommendations for reducing premature termination in therapy.
Swift, Joshua K.; Greenberg, Roger P.; Whipple, Jason L.; Kominiak, Nina
Professional Psychology: Research and Practice, Vol 43(4), Aug 2012, 379-387.
 
Abstract
 
Premature termination from therapy is a significant problem frequently encountered by practicing clinicians of all types. In fact, a recent meta-analytic review (J. K. Swift & R. P. Greenberg, 2012, Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology. doi:10.1037/a0028226) of 669 studies found that approximately 20% of all clients drop out of treatment prematurely, with higher rates among some types of clients and in some settings. Although this dropout rate is lower than previously estimated, a significant number of clients are still prematurely terminating, and thus further research toward a solution is warranted. Here we present a conceptualization of premature termination based on perceived and anticipated costs and benefits and review 6 practice strategies for reducing premature termination in therapy. These strategies include providing education about duration and patterns of change, providing role induction, incorporating client preferences, strengthening early hope, fostering the therapeutic alliance, and assessing and discussing treatment progress.
 
1. Help clients develop realistic expectations of treatment duration and recovery expectations at the beginning of treatment.
 
2. Utilize role induction prior to starting an intervention.
 
3. Pay attention to patient preferences, such as active versus passive therapist or whether homework will be assigned.
 
4. Instill a sense of hope that treatment will work
 
5. Foster the therapeutic alliance
 
6. Routinely monitor treatment outcomes.
 
Thanks to Ken Pope for this information.