AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

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.

There is an inevitable limit to understanding the internal experience of patients with whom therapists work in psychotherapy. The farther their experience is from that of their therapist, the more challenging this endeavor can be. Accepting that therapists cannot exactly know a patient's internal experience invites them to explore novel ways of appreciating another person's way of perceiving relationships, deriving meaning from them, and using their experience to motivate behavior. The concept of umwelt can be used as a metaphor to help therapists imagine the internal world of their patients, as shaped by patients' developmental, interpersonal, and traumatic experiences. Umwelt refers to the unique worldview created by a species' idiosyncratic perceptual organs and survival strategies. This first Psychotherapy Musings describes the concept of umwelt, applies it to the case of a patient with difficult-to-treat mental health problems, and explicates the benefit of this novel perspective.

Epigenetic modifications play a pivotal role in the regulation of gene expression and cell function, offering potential markers of disease states and therapeutic outcomes. Recent advancements in neuroscience have spurred interest in studying the epigenetic underpinnings of psychosomatic medicine. This review presents a new perspective on the role of epigenetic regulation in the realms of psychosomatics and psychotherapy. The authors first highlight epigenetic patterns associated with prevalent psychosomatic disorders, including irritable bowel syndrome, fibromyalgia, psoriasis, and lichen planus. For these conditions, psychotherapy serves as a treatment modality and can be conceptualized as an epigenetic intervention that beneficially affects the epigenome as part of the therapeutic process. Focusing on cognitive-behavioral and mindfulness-based therapies, the authors highlight evidence on psychotherapy-associated epigenetic signatures occurring at genes that are involved in stress response, inflammation, neurotransmission, neuroplasticity, and aging. Educating patients about the potential of psychotherapy to affect the epigenome may enhance patient engagement with and adherence to treatment, and psychotherapy-induced epigenetic changes have the potential to promote transgenerational disease prevention, underscoring the far-reaching implications of this therapeutic approach. Challenges persist in epigenetic studies, and this review aimed to catalyze further research in this burgeoning field, with the goal of enhancing patient care.

The authors discuss the two broad domains of affect-focused and exposure-focused psychotherapies, defining the characteristics and potential advantages and disadvantages of each. The two domains differ in their theoretical approaches, structures, and techniques. Exposure-focused therapies have come to dominate research and practice, leading to the relative neglect of affect-focused therapies. When the two approaches have been examined in well-conducted clinical trials, they generally appear to be equally beneficial for treating common mood, anxiety, and trauma disorders, although further research may better define differential therapeutics. The authors argue for better training in affect awareness and tolerance across psychotherapies and use a brief case vignette to illustrate several aspects of these different approaches.