AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

Rates of depression among individuals with autism are notably high. Mental health services are often inaccessible, and very few interventions are adapted to their needs. Interpersonal psychotherapy (IPT) can be relevant to treating autistic individuals' depression but needs to be adapted. This article presents an adapted IPT framework for treating autistic individuals who have depressive symptoms (IPT-Au). The framework integrates a neurodiversity-informed approach with the classic IPT model along with several key adaptations. IPT-Au accounts for the tridirectional dynamics of interpersonal interactions, depressive symptoms, and autistic lived experience. This model provides a framework for implementing IPT with autistic individuals who have verbal skills suitable for brief psychotherapy.

Objective: Brief, technology-enhanced interventions can increase treatment access while effectively addressing widespread clinical problems, such as major depression and suicidal thoughts and behavior, among young adults. Understanding the extent to which the digital components of these innovative interventions contribute to outcomes is key to realizing their potential. This study investigated whether text engagement enhances the effectiveness of a brief, adjunctive intervention, Skills to Enhance Positivity (STEP).

Methods: Thirty-five young adults in outpatient treatment received the STEP intervention, which was hypothesized to reduce depression and suicidal ideation by engaging the transdiagnostic mechanism of positive affect. Text engagement was examined as a predictor of positive affect, depressive symptoms, and suicidal ideation at posttest and follow-up, with baseline scores controlled. The authors also examined associations of text engagement with baseline clinical and demographic variables.

Results: A significant effect was found for text engagement on positive affect, and a trend toward a significant effect was found for text engagement on depressive symptoms. No significant effect was found for suicidal ideation.

Conclusions: Findings add to a growing body of literature suggesting that light-touch, low-cost technology enhancements, such as text messaging, may enhance the impact of therapeutic interventions. Future research with larger sample sizes is essential to better understand when, how, and for whom such light-touch enhancements may increase intervention effectiveness.

Objective: Patient coaching refers to patient-initiated communication that helps therapists understand therapy goals, maladaptive beliefs, personal challenges, and preferred therapeutic approaches. Despite its theoretical significance, empirical research remains limited, with a few recent studies relying on labor-intensive methods involving extensive training of raters and detailed case analysis. To support broader empirical research, this study introduces the Patient Coaching Rating System (PCRS) to assess two dimensions of patient coaching: information coaching (what and why) and direction coaching (how).

Methods: Seven raters used the PCRS to rate 22 segments from an early psychotherapy session. Each segment was rated on two dimensions-information coaching and direction coaching-with a 0-4 scale.

Results: The raters achieved interrater reliability scores of 0.86 for information coaching and 0.68 for direction coaching. Whereas information coaching demonstrated excellent reliability, direction coaching showed moderate to good reliability, highlighting the need for further refinement of the coding manual.

Conclusions: This pilot study provides a structured method for assessing patient coaching and represents an initial step toward facilitating empirical investigation within therapy sessions.

Objective: Intensive short-term dynamic psychotherapy (ISTDP) has been shown to be effective with patients with common mental disorders, including personality disorders. In the Netherlands, a 6-month residential version (R-ISTDP) of this traditionally outpatient therapy for patients with treatment-resistant personality disorders was developed and tested. This study focused on changes that occurred directly after treatment and 1-10 years after discharge.

Methods: All patients admitted to the R-ISTDP program between 1995 and 2005 were assessed at admission, discharge, and a variable follow-up of 1-10 years. In this single-arm trial, treatment outcome was measured in terms of symptom severity (with the Symptom Checklist-90-R [SCL-90-R]), general functioning (with the Global Assessment of Functioning [GAF] Scale), employment status, social welfare benefits, and living situation. Demographic variables and psychopathology indicators were included as predictors. Because of the variable distribution of length of follow-up, outcome data from 155 patients were evaluated by using mixed-models analysis.

Results: From admission to discharge, significant and large improvements were seen in SCL-90-R total scores (d=1.2) and GAF scores (d=0.9). From discharge over the course of 10-year follow-up, SCL-90-R total scores remained stable, and GAF scores further improved (d=1.5). At follow-up 1-10 years after discharge, more patients had returned to work compared with pretreatment. No statistically significant association between any of the predictors and outcome was found.

Conclusions: Patients with treatment-resistant personality disorders showed substantial improvements at discharge from R-ISTDP. Although several limitations of this naturalistic study design must be considered, these findings are important in demonstrating stable long-term improvement after R-ISTDP.

Over the past 50 years, intensive short-term dynamic psychotherapy (ISTDP) has been developed, implemented, and evaluated with respect to the treatment of a broad spectrum of complex, chronic, and treatment-resistant conditions. This therapy was developed specifically to treat a range of patients, including those who are highly defensive, those who experience the repression of emotions, and those who have cognitive-perceptual disruptions along with primitive defenses. These three groups of patients are characterized by patterns of attachment trauma and deficits related to neglect. Among the many categories of mental illness with these features that ISTDP can treat, personality disorders, treatment-resistant depression, and somatic symptoms have been the most frequently studied. In this article, the authors provide an overview of the ISTDP treatment method with regard to complex, chronic, and treatment-resistant conditions and summarize evidence for its effectiveness for diverse patient populations. On the basis of the available evidence, ISTDP warrants consideration as a tool for the management of diverse populations who have chronic and complex conditions and have not responded to other treatments.

The year 2024 celebrates the 15th anniversary of nationally organized training in and delivery of intensive short-term dynamic psychotherapy (ISTDP) in Norway. Accordingly, the authors provide an overview of the implementation of ISTDP in Norway, examine ISTDP's impact on mental health delivery, review research, reflect on practice, and discuss future directions for ISTDP in the country. Since its introduction in Norway, ISTDP has gained significant popularity and recognition in the mental health field. The training of Norwegian trainers and the founding of the Norwegian Institute for ISTDP allowed for the expansion and scalability of the ISTDP training program. Alignment of the training program with the existing framework for postgraduate specialization for psychologists and its accreditation by the Norwegian Psychological Association has ensured recognition and relevance in the mental health field. Private- and public-sector applications have further contributed to the growth and dissemination of the method in Norway. ISTDP has thus become an integral and important part of the therapeutic landscape, providing hope and healing to individuals facing various emotional challenges. ISTDP's influence is likely to keep growing, both within Norway and internationally, thus contributing to the advancement of effective psychotherapy practices worldwide.

Intensive short-term dynamic psychotherapy (ISTDP) delivered in an individual therapy (vs. group) format has proved to be an effective treatment option for a broad range of patients with treatment-resistant mental health conditions. A novel residential program based on ISTDP was designed for patients whose personality disorders were treatment resistant (N=155), meaning that patients did not benefit from outpatient psychotherapy. The authors proposed that a specific treatment approach-residential ISTDP-can be a treatment option for patients with personality disorders. This article describes the ideas and characteristic features of how ISTDP was integrated within an innovative residential treatment program to accelerate change processes and reduce health care consumption.

Despite the efforts of Paul Gray and others, a "developmental lag" persists in the translation of Freud's structural theory into psychodynamic clinical technique, especially regarding the clinical manifestations and significance of signal anxiety. In this article, the author introduces Habib Davanloo's pathways of anxiety discharge as a conceptual tool that can be used for detecting Freud's signal anxiety and offers clinical hypotheses that can be extrapolated from a marriage of Freud's and Davanloo's ideas. The author demonstrates the clinical application of these ideas with a case example and discusses the virtues and limitations of incorporating Davanloo's ideas into psychodynamic clinical work in general, with the hope that therapists will further test these hypotheses as they listen to and intervene with their patients.