Banter in psychotherapy: Relationship to treatment type, therapeutic alliance, and therapy outcome.

INTRODUCTION: The use of humor in psychotherapy is widely considered to improve therapy outcomes and typically depends on context, patient sensitivity, and the therapist's humor style. Different types of humor may impact treatment type, therapeutic alliance, and therapy outcome; however, evidence from psychotherapy sessions on the role of banter has been sparse to date. Therefore, the study aims to examine banter in a secondary analysis of psychotherapy sessions. METHOD: The sample consisted of 68 depressed outpatients treated with one of three treatment types: psychoanalytic therapy (PA), psychodynamic therapy (PD), and cognitive-behavioral therapy (CBT). Banter and therapeutic alliance were rated for therapy sessions taken from the middle phase of treatment, outcome was assessed at the end of treatment. RESULTS: The main findings were (1) clinical examples of banter in psychotherapy were found in 62 from 68 sessions, (2) significantly more bantering in the main bantering category of facilitation for CBT sessions as compared to other treatment types, (3) facilitative banter as a significant predictor for the positive introject, (4) a significant correlation between bantering and bond between therapist and client. Furthermore, based on these results, psychometric properties of the Klagenfurt Bantering Instrument (KBI) are reported. CONCLUSION: From a bantering perspective, this study emphasizes the need to consider session context, client response, and sarcastic markers when categorizing negative banter using the KBI.

Insight and Outcome in Long-Term Psychotherapies of Depression.

Objectives: In different therapeutic approaches, insight is acknowledged as an important part of patient's therapeutic change process. We examined whether the level of insight (1) differs between psychoanalytic (PA), psychodynamic (PD) and cognitive-behavioral therapy (CBT), and (2) predicts long-term symptomatic outcome. Methods: A completer sample of 67 depressed patients from the Munich Psychotherapy Study was analyzed. Symptoms were assessed with Beck Depression Inventory (BDI) and Symptom Checklist-Revised (SCL-90-R) at pre-treatment and three-year follow-up. Insight was assessed from 242 sessions of mid-therapy phase with the Experiencing Scale. Results: The general level of insight was higher in PA as compared to CBT, and associated with lower depressive symptoms (BDI) across all three therapeutic modalities at three-year follow-up. Insight was unrelated to general distress (SCL-90-R). Exploratory analyses suggested that patients treated with PA showed higher levels of insight especially in high quality sessions (assessed by therapist). Patients for whom the extent of insight was positively linked to session quality, suffered from more depressive symptoms at three-year follow-up than patients gaining insight when session quality was low. Conclusion: Insight differs between PA and CBT and may be a common change mechanism in long-term psychotherapies.

[Personality organization and mentalization of depressive inpatients in a long-term-study]. / Psychische Struktur und Mentalisierungsfähigkeit bei stationären depressiven Patienten im Langzeitverlauf.

Personality organization and mentalization of depressive inpatients in a long-term-study Objectives: In a naturalistic long-term follow-up design this study investigated the improvement of depressive symptom severity, mentalization deficiency and personality organization. Methods: 300 patients with depressive symptoms were assessed at three evaluation times (before therapy, after therapy and one to three years after discharge) with the Patient Health Questionnaire Depression Scale (PHQ-9), the Mentalization Questionnaire (MZQ) and the Inventory of Personality Organization (IPO-16). Results: Patients improved significantly in depressive symptom severity with strong impact. Especially patients with severe depression symptoms improved in mentalization deficits and personality organization during and after inpatient treatment. Chronic depressive patients improved in mentalization rather than in personality organization. Depressive symptom severity correlates with mentalization deficits and structural impairment. Discussion: Mentalization deficits differed depending on the severity of depression, as other studies already showed. The more severe depressive symptoms, the more likely mentalization deficits and structural impairment improved. However, the lack of control groups limits the causal proof of efficacy. Mentalization deficits and personality organization should be recorded timely in order to choose adequate technique.

Is It All about the Higher Dose? Why Psychoanalytic Therapy Is an Effective Treatment for Major Depression.

UNLABELLED: Empirical evidence for the effectiveness of long-term psychodynamic psychotherapy (LTPP) in patients with mood disorders is growing. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/psychoanalytic techniques or to a higher number of sessions. We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) and cognitive-behavioural therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy and 24 receiving CBT. Depressive symptoms, interpersonal problems and introject affiliation were assessed prior to treatment, after treatment and at the 1-, 2- and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT. Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques on changes in introject affiliation during follow-up. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression. KEY PRACTITIONER MESSAGE: Psychoanalytic therapy is an effective treatment for major depression, especially in the long run. The differential effectiveness of psychoanalytic therapy cannot be fully explained by its higher dose. Distinctive features of psychoanalytic technique (e.g., focusing on patients' dreams, fantasies, sexual experiences or childhood memories) may play an important role in establishing sustained therapeutic change.

[Psychiatric crisis-consultation with a focus on the working relationship]. / Krisenberatungsgespräche unter besonderer Berücksichtigung der Arbeitsbeziehung - Feldstudie zur Evaluation des psychiatrischen Bereitschaftsdiensts im Elisenhof, München -

OBJECTIVE: Evaluation of a psychiatric emergency service in Munich that was implemented in spring 2000. METHOD: Socio-demographic and clinical data as well as the working relationship between patients and psychiatrists were documented. 92 psychiatrists rated 137 crisis consultations. 58 patients were able to answer a questionnaire in the acute crisis situation. RESULTS: The largest diagnostic group consists of patients with affective disorders, followed by patients with neurotic, stress, and somatoform disorders. The results indicate an overall high satisfaction of patients and psychiatrists concerning the efficacy of the crisis consultations. As to be expected from psychotherapy research, socio-demographical factors are hardly of any consequence, whereas relationship-based factors have a considerable influence. CONCLUSIONS: Directivity and giving structure on the psychiatrist's part can clearly enhance the patient's confidence.