AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

This article introduces an innovative adaptation of interpersonal psychotherapy tailored to the needs of individuals identifying as gender diverse and navigating the complexities of gender transition. The few available therapeutic models designed for this population are reviewed, and the novel intervention, grounded in clinical insights and empirical research, is presented. Key components of this adaptation include expanding the interpersonal inventory with targeted processing questions and developing a disclosure timeline-a structured tool designed to guide patients through gender transition-while bolstering social support, reducing distress, and improving interpersonal effectiveness. An illustrative case vignette is included to elucidate the practical applications of this approach and to underscore essential therapeutic considerations.

Patients' access to their psychotherapy records may be assumed to be well protected; however, the matter is intricately regulated. In fact, the statutes and rights pertaining to patient access to psychotherapy notes vary across states. Taken together, federal and state laws indirectly and inconsistently delineate lawful access-as well as clinical exceptions to providing access-to psychotherapy notes. Federal law defers to state laws when the latter afford individuals greater access to their notes. Both federal and individual state levels vary in providing for possible conditions under which access may be restricted. Right of access to psychotherapy notes is a matter of importance for all mental health clinicians in the United States. Awareness and integration of pertinent laws and regulations allow clinicians to manage such matters without a negative impact on their clinical care. Further consideration of how clinical practice interacts with other dimensions of health care administration (clinical, ethical, and legal) may serve to enhance the integrity of a clinician's work and the ability to adapt to difficult clinical circumstances with confidence.

Although integrative therapies are increasingly popular in clinical psychology, their dissemination in the psychiatric literature has been limited. To care for patients living with complex psychiatric problems, the authors formulated a flexible, pragmatic, problem-oriented integrative therapy (PIT). The aims of this article are to increase psychiatric attention to the value of integrative therapies, authorize their use, and present the authors' PIT approach. PIT combines common factors, theoretical synthesis, and technical eclecticism. After delineating patients' problems and goals, clinicians apply discrete therapeutic elements derived by unbundling numerous theories and practices. Clinicians improvise and pivot their practice in response to patients' shifting problems and goals, as well as to advances in the field. Practicing PIT requires familiarity with numerous therapeutic theories and models and a willingness to continually expand skill sets. PIT's effectiveness may be assessed by comparing results obtained with PIT with those obtained via conventional psychotherapeutic modalities.

Objective: The purpose of this study was to investigate the extent to which patients feel racially and culturally similar to their therapist, patients' perceptions of their therapist's cultural competence, and how these factors relate to the working alliance in a naturalistic treatment setting.

Methods: Participants were 119 adult patients treated at a large outpatient clinic by clinicians with a range of professional backgrounds (e.g., psychiatric residents, psychologists in training, and staff therapists). Patients were asked to rate the level of racial and cultural similarity between themselves and their therapist and to provide their assessment of their therapist's cultural competency and of the working alliance.

Results: Findings suggest that patients' ratings of perceived cultural and racial similarity were not significantly related to the working alliance. However, perceptions of racial and cultural similarity were significantly associated with perceived therapist cultural competence. Perceived cultural competence was also strongly related to the working alliance. Finally, patients' ratings of their therapist's cultural competencies in the areas of awareness and skill, but not knowledge, predicted a strong working alliance after analyses controlled for ratings of racial and cultural similarity.

Conclusions: This study suggests the importance of heightening mental health clinicians' awareness of the influence of culture on the therapeutic relationship and the important role of a therapist's cultural competencies (specifically, awareness and skill) in the working alliance, which may matter more to patients than perceptions of racial or cultural similarity.

Objective: This study aimed to quantify the instability of psychotherapy process variables by using a novel data-analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem.

Methods: Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between-person associations of alliance instability with self-esteem.

Results: Although some preliminary analyses showed an association between a more stable alliance and higher self-esteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level.

Conclusions: This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.

The authors make the case for using a written instead of a spoken supervision agreement at supervision's outset in order to provide clarity and education about supervision, supply an accessible document that supervisees can readily reference, sidestep memory issues that negatively affect the supervision process, and enable dyadic collaboration that sets an immediate positive tone for supervision. The invitational, clarifying, educational, empowering, and transparent (ICEE-T) supervision agreement approach is described, with emphasis on the essential elements to put in place at the outset of supervision. A written agreement, which is valuable at any supervisee developmental stage, can be invaluable when working with novice supervisees (e.g., because of the anxieties and self-doubt of first-time supervisees) and is explored with that group foremost in mind.

Countertransference is a basic tenet of psychodynamic theory. Although it was initially considered an unwelcome phenomenon in psychiatry, attitudes have shifted, and many mental health professionals now consider it to be a useful therapeutic tool. In this article, the author discusses countertransference as defined by the International Psychoanalytical Association's Inter-Regional Encyclopedic Dictionary of Psychoanalysis (IRED) and examines its clinical impact by using constructed vignettes of psychodynamic psychotherapies to illustrate theoretical points. As IRED delineates, countertransferences may exist at the conscious or unconscious level. In addition, the author suggests that countertransference may also exist at the preconscious level. Clinicians' examination of all levels of countertransference has the potential to be revelatory and facilitate therapeutic action, whereas unexamined countertransference can interfere with effective treatment. For this reason, self-reflection on the part of psychiatrists is essential.

First responders face greater exposure to potentially traumatic events compared with the general public, which can lead to an increased likelihood of developing mental health concerns. The challenges of disaster relief take a physical and mental toll on first responders. Critical incident stress debriefing (CISD), the widely accepted gold-standard treatment for psychological debriefing, is often applied to offset this toll among first responders. CISD is a manualized seven-stage group intervention that was developed to provide support and aid in coping and to allow individuals who respond to emergencies and disasters to continue working. Substantial evidence has been found for its effectiveness. However, there is a general dearth of evidence about the field of prolonged disaster response, and research is hampered by the difficulties of executing a controlled study in the context of an emergency scenario.