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Adolescent, caregivers, and therapists' experiences of youth and family suicide intervention: A qualitative study. 青少年、照顾者和治疗师对青少年和家庭自杀干预的体验:定性研究。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-04 DOI: 10.1080/10503307.2024.2415991
Di Simes, Ian Shochet, Kate Murray, Isobel G Sands

Objective: This study explores the experience of an individual and family therapy youth suicide intervention from the perspectives of seven psychotherapy triads (young people aged 12-18, their parents/caregivers and therapists).

Method: Data were collected through semi-structured individual interviews and analyzed using consensual qualitative research methods.

Results: Four domains were identified: Focusing on the youth-parent relationship, individual therapy for young people and their parents, conjoint therapy, and public service structures and systemic practice that facilitated tailored treatment. All participant groups valued intervention that improved the youth-parent relationship; however, they held different views about its influence on suicidality and recovery. Separate youth and parent therapy was crucial for facilitating the tailoring of treatment and enhancing the reparative potential of conjoint therapy. Barriers to productive intervention included inaccessible, fragmented, and siloed treatment that excluded parents, stigmatizing clinician responses, and acute care that was not attuned to need or developmental context. Helpful intervention was systemically and attachment-informed, multi-disciplinary, individually tailored, and integrated freely available specialist therapy with crisis and inpatient care.

Conclusion: A relational, nuanced, and flexible approach is needed to tailor youth suicide treatment in the context of the complexity of youth-parent relationships.

研究目的本研究从七个心理治疗三人组(12-18岁的青少年、他们的父母/照顾者和治疗师)的角度,探讨个人和家庭治疗青少年自杀干预的经验:方法:通过半结构化个人访谈收集数据,并采用共识定性研究方法对数据进行分析:结果:确定了四个领域:重点关注青少年与父母的关系、针对青少年及其父母的个体治疗、联合治疗以及促进量身定制治疗的公共服务结构和系统实践。所有参与小组都重视改善青少年与家长关系的干预措施;但是,他们对干预措施对自杀和康复的影响持有不同的观点。将青少年和家长的治疗分开,对于促进针对性治疗和增强联合治疗的修复潜力至关重要。阻碍有效干预的因素包括:无法获得的、零散的、孤立的治疗(将家长排除在外)、临床医生的鄙视性回应,以及与需求或发展背景不相适应的急性护理。有帮助的干预措施是系统性的、以依恋为基础的、多学科的、针对个人的,并将免费提供的专家治疗与危机和住院治疗相结合:结论:在青少年与家长关系复杂的背景下,需要采取一种关系性的、细致入微的、灵活的方法来定制青少年自杀治疗。
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引用次数: 0
Therapist responsiveness in psychotherapy: Introduction to the special issue. 心理治疗中治疗师的反应能力:特刊简介。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-04 DOI: 10.1080/10503307.2024.2417401
Ueli Kramer, Jan R Boehnke, Giovanna Esposito

Therapist responsiveness denotes that therapists provide therapeutic interventions within an emerging context of client manifestations and moment-by-moment internal and external changes. So far, psychotherapy research on explaining how therapy works falls short of operationalizing the sequence of events constituted by therapist responsiveness. The present special section of Psychotherapy Research addresses this conceptual and methodological gap and proposes six original contributions, using several validated assessment protocols, both from a quantitative and qualitative viewpoint, to study therapist responsiveness in psychotherapy. It aims at providing a rigorous conceptual and methodological basis for studying a core principle of change in psychotherapy for the future.

治疗师的反应能力是指治疗师在当事人的表现和每时每刻的内外部变化的新背景下提供治疗干预。迄今为止,心理治疗研究在解释治疗如何起作用时,还没有将治疗师反应性所构成的事件序列具体化。本期《心理治疗研究》特刊针对这一概念和方法上的空白,提出了六项原创性的研究成果,从定量和定性的角度,使用几种经过验证的评估方案来研究心理治疗中治疗师的反应性。它旨在为研究未来心理治疗中的核心改变原则提供一个严谨的概念和方法论基础。
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引用次数: 0
Therapists' experiences of negative effects in intensive short-term dynamic psychotherapy: A qualitative interview study. 治疗师在短期强化动态心理治疗中对负面影响的体验:定性访谈研究。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-04 DOI: 10.1080/10503307.2024.2420717
Tomas Lindegaard, Lovisa Persson, Maria Thorängen, Alexander Rozental

Objective: Negative effects of psychotherapy are a broad term that encompasses events such as non-response, deterioration, and novel symptoms. The aim of the present study was to explore experiences with negative effects among clinicians working within an intensive short-term dynamic psychotherapy (ISTDP) framework.

Method: Eight ISTDP clinicians consented to participate and were interviewed using semi-structured video interviews. Data were transcribed and analyzed using a reflexive thematic analysis framework.

Results: The thematic analysis resulted in five themes. Overall, the clinicians found it difficult to define negative effects, but that negative effects, regardless of cause, could be used therapeutically. Inaccurate assessment was seen as the main cause of negative effects. Other themes concerned the connection between dropout and negative effects, patient feedback, and the ISTDP community's relationship to negative effects.

Conclusions: The results are largely in line with qualitative studies of CBT clinicians' views of negative effects although clinicians in the present study emphasized more strongly the therapeutic potential of these events. The research field could be further improved by using mixed-method designs while including both patients and therapists.

目的:心理治疗的负面效应是一个广义的术语,包括无反应、恶化和新症状等事件。本研究旨在探讨在短期强化动态心理疗法(ISTDP)框架内工作的临床医生对负面效应的体验:方法:八名 ISTDP 临床医生同意参与研究,并接受了半结构化视频访谈。采用反思性主题分析框架对数据进行转录和分析:专题分析产生了五个主题。总体而言,临床医生认为很难界定负面影响,但无论原因如何,负面影响都可以用于治疗。评估不准确被认为是造成负面影响的主要原因。其他主题涉及辍学与负效应之间的联系、患者反馈以及 ISTDP 社区与负效应的关系:研究结果与 CBT 临床医生对负面效应的定性研究结果基本一致,但本研究中的临床医生更强调这些事件的治疗潜力。通过采用混合方法设计,同时将患者和治疗师都包括在内,可以进一步改善研究领域。
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引用次数: 0
Sudden gains in PTSD symptoms and social functioning in cognitive processing therapy for posttraumatic stress disorder. 创伤后应激障碍认知处理治疗中PTSD症状和社会功能的突然改善。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-10-17 DOI: 10.1080/10503307.2023.2265046
Iris Antonopoulos, Alison E Carney, Shannon Wiltsey Stirman, Candice M Monson

Objective: Sudden gains (SGs) are rapid symptom improvements between two consecutive therapy sessions that predict treatment outcomes. This study investigated SGs in posttraumatic stress disorder (PTSD) symptoms, interpersonal relationship functioning, and social role functioning in Cognitive Processing Therapy (CPT).

Method: Participants were 121 patients and 81 therapists involved in a parent randomized controlled hybrid implementation-effectiveness trial of CPT. Descriptive analyses examined the frequency and timing of different forms of SGs. Multilevel modeling examined the impact of the three SGs on outcomes.

Results: PTSD SGs occurred more often and at different sessions than SGs in facets of social functioning. Most individuals experienced only one form of SG and there were no significant clinical or demographic differences in those who had PTSD only SGs, social functioning only SGs, or both SGs. PTSD SGs and interpersonal relationship functioning SGs both predicted changes in PTSD symptoms and interpersonal difficulties over time, but not changes in social role functioning. SGs in social role functioning predicted all three forms of outcomes.

Conclusions: The findings suggest that there are multiple forms of SGs in CPT beyond primary symptom changes that are predictive of patient outcomes. Clinicians should highlight various SGs that patients experience to further enhance outcomes.

目的:突增是指连续两次治疗之间症状的快速改善,可以预测治疗结果。本研究调查了创伤后应激障碍(PTSD)症状、人际关系功能和认知加工治疗(CPT)中社会角色功能的SGs。方法:参与者包括121名患者和81名治疗师,参与了CPT的父母随机对照混合实施有效性试验。描述性分析检查了不同形式的SG的频率和时间。多层次建模检验了三个SG对结果的影响。结果:在社会功能方面,PTSD SGs比SGs发生得更频繁,发生在不同的阶段。大多数人只经历过一种形式的SG,而那些只患有创伤后应激障碍的SG、只患有社交功能的SG或同时患有这两种SG的人没有显著的临床或人口统计学差异。PTSD SGs和人际关系功能SGs都预测了PTSD症状和人际困难随时间的变化,但没有预测社会角色功能的变化。社会角色功能的SG预测了所有三种形式的结果。结论:研究结果表明,CPT中除了可预测患者预后的主要症状变化外,还有多种形式的SG。临床医生应强调患者经历的各种SG,以进一步提高疗效。
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引用次数: 0
A longitudinal view of an approach to responsiveness: Principles followed and lessons learned. 响应性方法的纵向观点:遵循的原则和吸取的教训。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-11-14 DOI: 10.1080/10503307.2023.2275627
Franz Caspar

AbstractResponsiveness is currently a hot topic in the psychotherapy literature with a large variation in what the term means to colleagues of various orientations. This adds to its popularity but limits the scope of whatever is written or said about responsiveness. The fact that the meaning of responsiveness has developed over time within the approaches adds also to the variation, while an understanding of development has the potential of deepening the understanding of each approach. As a fair description and comparison of even just the most important approaches is by far out of reach for a page-limited article, the development of one approach, which may be termed the "Bernese" approach is described here, along with lessons learnt and general comments. The approach includes Plan Analysis case formulations, the concept of complementary or Motive-Oriented Relationship, a description of a combined qualitative and quantitative assessment, and many methodological and conceptual considerations. Personal development is woven in. Overall, it seems fair to say that this approach, at its core developed long before responsiveness became popular, has turned out to still be useful, with a gain in depth as far as concepts and assessment are concerned.

摘要响应性是当前心理治疗文献中的一个热门话题,但对于不同取向的同事来说,这个术语的含义存在很大差异。这增加了它的受欢迎程度,但限制了任何关于响应性的书面或口头表述的范围。随着时间的推移,反应的含义在各种方法中不断发展,这一事实也增加了变化,而对发展的理解有可能加深对每种方法的理解。由于一篇篇幅有限的文章无法对最重要的方法进行公平的描述和比较,因此本文描述了一种可称为“伯尔尼”方法的发展,以及所吸取的经验教训和一般性评论。该方法包括计划分析的案例表述、互补或动机导向关系的概念、对定性和定量综合评估的描述,以及许多方法和概念上的考虑。个人发展是交织在一起的。总的来说,公平地说,这种方法的核心是早在响应性流行之前就发展起来的,结果证明仍然是有用的,就概念和评估而言,它的深度有所增加。
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引用次数: 0
Do treatments for mental disorders affect relationship satisfaction? A systematic review and meta-analysis. 精神障碍治疗会影响人际关系满意度吗?系统回顾和荟萃分析。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-08-23 DOI: 10.1080/10503307.2023.2249215
Tapan A Patel, Sophie R Abber, Jesse R Cougle

Objective: Psychiatric disorders have been linked to poor social functioning, including deficits in relationship satisfaction. Treatments have shown strong effectiveness in reducing clinical symptoms for a range of disorders, though less is known of the effects disorder-focused treatments have on relationship satisfaction.

Methods: The present study describes a systematic review that was conducted to determine the efficacy of treatments for specific psychiatric disorders in improving relationship satisfaction. Surprisingly, only seventeen studies were identified and included in the review.

Results: We found that a majority of these studies reported modest improvement in relationship satisfaction among people who completed treatment. However, studies were severely hampered by methodological limitations, and all therapy-related improvements could be attributable to placebo effects or the passage of time.

Conclusion: Important gaps in the literature were found that future research should seek to address to maximize treatment outcomes and psychosocial functioning.

目的:精神障碍与社会功能低下有关,包括人际关系满意度方面的缺陷。针对一系列精神障碍的治疗在减轻临床症状方面显示出很强的有效性,但人们对以精神障碍为重点的治疗对人际关系满意度的影响却知之甚少:本研究介绍了一项系统性综述,该综述旨在确定针对特定精神障碍的治疗方法在提高人际关系满意度方面的疗效。出乎意料的是,只有 17 项研究被确定并纳入综述:结果:我们发现,这些研究中的大多数报告称,完成治疗的患者在人际关系满意度方面略有改善。然而,这些研究在方法上存在严重的局限性,所有与治疗相关的改善都可能归因于安慰剂效应或时间的流逝:结论:我们发现文献中存在一些重要的空白,未来的研究应设法弥补这些空白,以最大限度地提高治疗效果和社会心理功能。
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引用次数: 0
Statement of Retraction: Therapist Immediacy: The association with Working Alliance, Real Relationship, Session Quality and Time in Psychotherapy. 撤回声明:治疗师的即时性:与心理治疗中的工作联盟、真实关系、疗程质量和时间的关系。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2024-03-25 DOI: 10.1080/10503307.2024.2333703
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引用次数: 0
Applying precision methods to treatment selection for moderate/severe depression in person-centered experiential therapy or cognitive behavioral therapy. 应用精确方法选择以人为中心的体验疗法或认知行为疗法治疗中重度抑郁症。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-11-02 DOI: 10.1080/10503307.2023.2269297
Danilo Moggia, David Saxon, Wolfgang Lutz, Gillian E Hardy, Michael Barkham

Objective: To develop two prediction algorithms recommending person-centered experiential therapy (PCET) or cognitive-behavioral therapy (CBT) for patients with depression: (1) a full data model using multiple trial-based and routine variables, and (2) a routine data model using only variables available in the English NHS Talking Therapies program.

Method: Data was used from the PRaCTICED trial comparing PCET vs. CBT for 255 patients meeting a diagnosis of moderate or severe depression. Separate full and routine data models were derived and the latter tested in an external data sample.

Results: The full data model provided the better prediction, yielding a significant difference in outcome between patients receiving their optimal vs. non-optimal treatment at 6- (Cohen's d = .65 [.40, .91]) and 12 months (d = .85 [.59, 1.10]) post-randomization. The routine data model performed similarly in the training and test samples with non-significant effect sizes, d = .19 [-.05, .44] and d = .21 [-.00, .43], respectively. For patients with the strongest treatment matching (d ≥ 0.3), the resulting effect size was significant, d = .38 [.11, 64].

Conclusion: A treatment selection algorithm might be used to recommend PCET or CBT. Although the overall effects were small, targeted matching yielded somewhat larger effects.

目的:开发两种预测算法,为抑郁症患者推荐以人为中心的体验疗法(PCET)或认知行为疗法(CBT):(1)使用多个基于试验和常规变量的完整数据模型,以及(2)仅使用英国NHS Talking Therapies计划中可用变量的常规数据模型。方法:使用来自PRaCTICED试验的数据,比较255名诊断为中度或重度抑郁症的患者的PCET与CBT。导出了单独的完整数据模型和常规数据模型,并在外部数据样本中对后者进行了测试。结果:全数据模型提供了更好的预测,在6岁时接受最佳治疗与非最佳治疗的患者之间产生了显著的结果差异(Cohen’s d = .65[40,.91])和12个月(d = .85[.59,1.10])。在具有非显著效应大小的训练和测试样本中类似地执行的常规数据模型,d = .19[-.05,.44]和d = .21[-.00,.43]。对于具有最强治疗匹配(d ≥ 0.3),得到的效应大小是显著的,d = .38[11,64]。结论:治疗选择算法可用于推荐PCET或CBT。尽管总体效果很小,但有针对性的匹配产生了更大的效果。
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引用次数: 0
Between- and within-person effects of affective experiences on coping in CBT: Direct effects and interplay with therapeutic alliance and resource activation. CBT中情感体验对应对的人际影响:与治疗联盟和资源激活的直接影响和相互作用。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-11-03 DOI: 10.1080/10503307.2023.2277290
Nicolas Wrede, Nils F Töpfer, Gabriele Wilz

Objective: The role of affective experiences (AE) in cognitive-behavioral therapy (CBT) has rarely been investigated. We examined between- and within-person effects of AE on coping in CBT for family caregivers and interactions with therapeutic alliance and resource activation.

Methods: 67 family caregivers rated AE, therapeutic alliance, resource activation, and coping after each of 12 sessions of telephone-based CBT. We examined direct session-to-session effects of AE on coping in structural equation modeling and interactions of AE with therapeutic alliance and resource activation in multilevel models.

Results: AE did not directly predict coping. Instead, within-person effects of AE interacted with simultaneous within-person emotional bond. Given strong emotional bond, AE positively predicted coping, whereas given weak emotional bond, AE negatively predicted coping. Further, cross-level interactions of between-person AE and within-person agreement on collaboration and resource activation indicated that these positively predicted coping only in dyads with high between-person AE.

Conclusion: AE may enhance coping when complemented with strong emotional bond. Further, within-person effects of agreement on collaboration and resource activation seem to rely on a certain degree of between-person AE. Results are discussed in relation to current findings on emotional processing in CBT.

目的:情感体验(AE)在认知行为治疗(CBT)中的作用很少被研究。我们研究了AE对家庭照顾者应对CBT的人际和内部影响,以及与治疗联盟和资源激活的互动。方法:67名家庭护理人员在12次基于电话的CBT后分别对AE、治疗联盟、资源激活和应对进行评分。我们在结构方程模型中研究了AE对应对的直接会话间影响,以及在多层次模型中AE与治疗联盟和资源激活的相互作用。结果:不良事件不能直接预测应对能力。相反,AE的人内效应与同时发生的人内情感纽带相互作用。在情感纽带较强的情况下,AE积极预测应对,而在情感纽带较弱的情况下则消极预测应对。此外,人与人之间的AE和人与人在协作和资源激活方面的一致性的跨层面互动表明,只有在人与人间AE较高的二人组中,这些交互作用才能积极预测应对。此外,协议对协作和资源激活的人内效应似乎在一定程度上依赖于人与人之间的AE。结果与CBT中情绪处理的当前发现有关。
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引用次数: 0
Countertransference in the treatment of patients with personality disorders: A longitudinal study. 反移情在人格障碍患者治疗中的作用:一项纵向研究。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-11-14 DOI: 10.1080/10503307.2023.2279645
R B Øvstebø, G Pedersen, T Wilberg, J I Røssberg, H S J Dahl, E H Kvarstein

Objective: This study examines how therapist emotional response/countertransference (CT) develops during treatment for patients with personality disorders (PDs) and how pre-treatment patient factors (severity of personality pathology, PD category, level of symptom distress) predict CT responses. Secondly, we explored associations between patient clinical outcome and CT.

Method: A longitudinal, observational study including 1956 patients with personality pathology treated at psychotherapy units within specialist mental health services. Therapists' emotional response was repeatedly assessed by the Feeling Word Checklist-Brief Version (FWC-BV) with three subscales-Inadequate, Confident, and Idealized.

Results: Levels of Inadequate CT were lowest and stable over time while Confident and Idealized increased over time. Greater severity of personality pathology and borderline PD predicted higher initial Inadequate, lower initial Confident and decreasing Inadequate over time. Antisocial PD predicted decreasing Confident. Number of PD criteria had higher impact on therapist CT than level of symptom distress. Clinical improvement was associated with decreasing Inadequate.

Conclusion: Therapists reported predominantly Confident CT when working with PD patients. More severe personality pathology, and borderline PD, specifically, predicted more negative CT initially, but the negative CT decreased over time. Patients who did not improve were associated with increasing Inadequate.

目的:本研究探讨人格障碍(PD)患者治疗过程中治疗师情绪反应/反移情(CT)的发展,以及治疗前患者因素(人格病理严重程度、PD类别、症状困扰水平)如何预测CT反应。其次,我们探讨了患者临床结果与CT之间的关系。方法:一项纵向观察研究,包括1956名在专业精神卫生服务的心理治疗单位治疗的人格病理学患者。治疗师的情绪反应被反复评估的感觉词检查表-简要版本(FWC-BV)有三个子量表:不充分,自信,和理想化。结果:随着时间的推移,不充分的CT水平最低且稳定,而自信和理想化的水平随着时间的推移而增加。越严重的人格病理和边缘性PD预示着越高的初始不足,越低的初始自信和随着时间的推移而减少的不足。反社会PD预测自信心下降。PD标准的数量对治疗师CT的影响大于症状困扰程度。临床改善与不足减少有关。结论:当治疗PD患者时,治疗师报告的主要是自信CT。更严重的人格病理,特别是边缘性PD,最初预测更多的阴性CT,但随着时间的推移,阴性CT减少。没有改善的患者与不充分的增加有关。
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引用次数: 0
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Psychotherapy Research
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