Measuring psychotherapist functioning with the Therapist Work Involvement Scales (TWIS): reliability, factor structure, and measurement invariance.

OBJECTIVES: The Therapist Work Involvement Scales (TWIS) is a self-report research instrument that enables a multilayered description of psychotherapists' experiences when treating clients. The TWIS was created in a comprehensive study of close to 5,000 psychotherapists, and has been used in multiple studies. The aim of the current paper is to clarify the organization and statistical characteristics of the TWIS, and to present an updated version for longitudinal and cross-sectional research. METHODS: Collection of a large sample of psychotherapy trainees made possible the use of confirmatory factor analysis (CFA) to evaluate the dimensions and structure of therapists' process experiences, assessing reliabilities, measurement invariance over gender, item statistics, and correlations with other measures to show concurrent and predictive validity. RESULTS: The CFAs largely confirmed the factor structure of four of the five facets, and of the global super-factors. The global factors of Healing Involvement and Stressful Involvement each showed substantial correlations with therapists' attachment style and professional growth, and were used to describe four practice patterns that typify the experiences of therapists. CONCLUSION: The results have shown the TWIS to be a statistically sound, multidimensional research instrument enabling therapists to describe their experience in current therapeutic work.

Mentalizing in psychotherapeutic processes of patients with eating disorders.

Background: Improvement in the capacity to mentalize (i.e., reflective functioning/RF) is considered both, an outcome variable as well as a possible change mechanism in psychotherapy. We explored variables related to (in-session) RF in patients with an eating disorder (ED) treated in a pilot study on a Mentalization-Based Treatment (MBT) - oriented day hospital program. The research questions were secondary and focused on the psychotherapeutic process: What average RF does the group of patients show in sessions and does it change over the course of a single session? Are differences found between sections in which ED symptomatology is discussed and those in which it is not? Does RF increase after MBT-type interventions? Methods: 1232 interaction segments from 77 therapy sessions of 19 patients with EDs were rated for RF by reliable raters using the In-Session RF Scale. Additionally, content (ED symptomatology yes/no) and certain MBT interventions were coded. Statistical analysis was performed by mixed models. Results: Patients showed a rather low RF, which increased on average over the course of a session. If ED symptomatology was discussed, this was associated with significantly lower RF, while MBT-type interventions led to a significant increase in RF. Conclusions: Results suggest that in-session mentalizing can be stimulated by MBT-typical interventions. RF seems to be more impaired when disorder-specific issues are addressed. Further studies have to show if improving a patient´s ability to mentalize their own symptoms is related to better outcomes.

Illness perception in functional neurological disorder: low illness coherence and personal control.

Introduction: Illness perception refers to patients' subjective representations and appraisals of somatic and mental symptoms. These are relevant for self-management and outcome. In clinical practice, patients with functional neurological disorder (FND) often encounter a fragmented biomedical attitude, which leaves them without clear concepts. In this context, illness perception is relevant. Methods: Illness perception was assessed in FND patients and compared with samples of psychosomatic patients (PSM) as well as poststroke patients (STR). The three samples (FND, n=87; PSM, n=97 and STR, n=92) were almost all in inpatient treatment or rehabilitation. Illness perception was assessed with the revised German version of the Illness Perception Questionnaire (IPQ-R). For assessments of correlations, depressive symptoms were tested with the Patient Health Questionnaire-9, dissociative and functional neurological symptoms by the German adaption of the Dissociative Experiences Scale and biopsychosocial complexity by the INTERMED Self-Assessment questionnaire. Results: Apart from the chronicity subscale, all dimensions of the IPQ-R differed between groups. FND patients perceived lower illness coherence and personal control than both other groups and attributed their illness more to chance than to behavioural risk factors. PSM patients had the strongest emotional representations. There were only few correlations with dissociative scores and biopsychosocial complexity. Conclusion: Illness perception is an important issue in patients with FND with particular emphasis on low illness coherence and personal control. Missing associations with biopsychosocial complexity suggest that subjective illness perception is an important complementary but separate issue, which likely influences therapeutic alliance and self-management in FND. Future studies should assess its influences on outcome. Trial registration number: DRKS00024685; German Clinical Trials Register; www.drks.de.