Trajectories of change among highly challenging patients in intensive long-term psychoanalytic psychotherapy.

OBJECTIVES: This study aimed to identify and describe trajectories of change in distress among highly challenging patients who had received long and intensive psychoanalytic psychotherapy. METHODS: The longitudinal version of the K-means algorithm was applied to the outcome measures data of 74 patients treated in four public mental health centers. The patients were measured five times at 6-month intervals for three outcome measures. RESULTS: For the OQ45 and Symptom Checklist-90, one trajectory was marked by a lower initial distress level. In this trajectory, the improvement occurred in the first half of the measurements, with a plateau thereafter. A second trajectory was characterized by higher initial severity and an improvement, mainly in the second part of the measurements. For the Beck Depression Inventory, one trajectory was marked by lower initial distress. In this group, the improvement occurred throughout the entire period. The remaining patients were characterized by higher initial distress and a decreased level of distress in the last part of treatment. They began to improve only during the third year of therapy. CONCLUSION: The response to treatment is not uniform in long-term treatment for highly challenging patients. A significant number of patients require a longer period of therapy to ignite improvement.

Psychotherapy with older adults: Ageism and the therapeutic process.

Objective This study explores how ageism in therapists is manifested in psychotherapy with older adults and how therapists deal with its impact on their therapeutic work. Method: Semi-structured interviews were conducted with 14 therapists and analyzed using grounded theory methodology. Results: Findings clustered around two themes: (i) maintaining openness to change while acknowledging limitations; (ii) dealing with manifestations of ageism inside therapy by going beyond relating to older patients only in terms of their chronological age. Conclusions: Our findings indicate that while therapists maintain an optimistic view regarding the possibility of therapeutic change, the therapeutic encounter with older patients triggers certain ageist therapeutic biases and behaviors in therapists, even in experienced therapists who have competency in working with older adults. Our findings also indicate that dealing with therapists' ageism in psychotherapy with older patients requires therapists not only to be aware in advance of their ageist attitudes but also to continuously engage in the management of the manifestations of ageism inside treatment. We use the conceptual framework of countertransference to suggest an understanding of the relationship between therapists' ageism and the therapeutic process. Implications for training and practice are discussed.

Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients.

OBJECTIVES: This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. METHOD: 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. RESULTS: Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). CONCLUSION: These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients.

Changes in playfulness, creativity and honesty as possible outcomes of psychotherapy.

Objectives: This study comprised an examination of whether clients' playfulness, creativity, honesty, humor, and happiness changed during psychotherapy. Methods: Sixty-two clients who underwent psychotherapy in a naturalistic setting completed questionnaires at five time points throughout treatment. An HLM analytic approach was applied to account for the hierarchical nature of the data. Results: Mental distress declined during treatment, while playfulness and creativity increased significantly. Honesty decreased significantly in the course of the treatment, while no significant change was found in the level of affiliative humor or the level of happiness. Conclusions: Changes in personality variables that can serve as positive constructs defining mental health, namely playfulness, creativity, and honesty, might be a possible outcome of psychotherapy.

Therapists' honesty, humor styles, playfulness, and creativity as outcome predictors: A retrospective study of the therapist effect.

OBJECTIVE: This study examined whether therapists' honesty, humor style, playfulness, and creativity would retrospectively predict the outcomes of therapies ended five years earlier. METHOD: In the Jerusalem-Haifa study, 29 therapists treated 70 clients in dynamic psychotherapy for 1 year. The Outcome Questionnaire 45 scores were collected at five time points. Five years later, the therapists were contacted via email and asked to fill out honesty, humor styles, playfulness, and creativity self-report questionnaires. Five were excluded since they had only one client in the study each. The remaining 24 therapists treated 65 clients out of whom 20 therapists with 54 clients completed the questionnaires. RESULTS: Therapists' Aggressive Humor Style (AHS) was a significant negative predictor of clients' symptom change over time. The therapists' honesty scores were positively correlated with symptom change. That is, higher AHS therapists were more effective, while higher honesty therapists were less effective. CONCLUSIONS: Therapists' inferred traits of Honesty-Humility and AHS may influence the effectiveness of their treatments.

Internal Representations of the Therapeutic Relationship Among Adolescents in Psychodynamic Psychotherapy.

UNLABELLED: This study examined changes in adolescents' internal representations of their relationship with their therapist and the extent to which these changes were related to changes in their representations of their relationship with their parents and to treatment outcomes. METHOD: Thirty adolescents (aged 15-18 years, 70% women) undergoing psychodynamic psychotherapy participated in relationship anecdote paradigms interviews based on the core conflictual relationship theme method and completed outcome measures at the beginning of treatment and a year later. RESULTS: Adolescents' positive representations of their therapists increased throughout the year of treatment, whereas their negative representations did not change. There was an association between the development of the therapeutic relationship and improvement in the perception of the relationship with parents over the course of therapy. Increases in the level of positive representations and decreases in the level of negative representations of the therapist were associated with greater satisfaction with treatment but not with the other outcome measures. These results support the centrality of the therapeutic relationship in the process of change during adolescents' psychodynamic psychotherapy. KEY PRACTITIONER MESSAGE: The finding that positive representations of the therapist increased throughout treatment but that negative representations remained steady suggests that therapists who treat adolescents should expect and be able to hear adolescent clients' positive and negative internal representations of themselves. Therapists need to realize that although adolescents often experience negative emotions and perceptions in therapy as in other significant relationships, this does not necessarily block the development of positive emotions. The finding that changes in the representations of the therapist are associated with changes in the representations of parents is in line with psychodynamic theory, which posits that psychotherapy facilitates new interpersonal experiences and new insights through the exploration of the therapeutic relationship. Working in the 'here and now' may eventually impact the nature of other significant relationships, particularly with parents in the case of adolescents.

Adolescents in psychodynamic psychotherapy: changes in internal representations of relationships with parents.

This study explored whether and how internal representations of adolescents' relationship with their parents--a fundamental concept in psychodynamic theory--changed in the course of a year of treatment and whether the observed changes were related to changes in symptoms. Seventy two adolescents (ages 15-18; 30 in treatment and 42 in a non-treatment "community group") underwent Relationship Anecdote Paradigm (RAP) interviews according to the Core Conflictual Relationship Theme method (CCRT; Luborsky & Crits-Christoph, 1998) and completed outcome measures at two time points. A novel data-driven approach to clustering CCRT categories was used to characterize internal representations. The potential contribution of this approach to the CCRT method is discussed. The results indicate that adolescents' internal representations of their relationships with their parents changed significantly throughout treatment, and were related to changes in symptoms.

Changes in rigidity and symptoms among adolescents in psychodynamic psychotherapy.

UNLABELLED: The present study examined changes in the rigidity of interpersonal patterns and symptoms in adolescents (ages 15-18) in a year-long psychodynamic psychotherapy. Seventy-two adolescents (30 in treatment and 42 in a non-treatment "community group") underwent Relationship Anecdote Paradigm (RAP) interviews according to the Core Conflictual Relationship Theme method (CCRT; Luborsky & Crits-Christoph, 1998), and completed outcome measures at two time points. RESULTS: Adolescents in the treatment group became less rigid in their interpersonal patterns and improved significantly in their symptoms, whereas no such changes were observed in the community group. Levels of rigidity were not related to initial symptom distress; however, changes in rigidity were related to improvement in symptoms within the treatment group.

Do positive features of mental health change together with symptoms and do they predict each other?

In a previous study, it was found that several constructs derived from a positive definition of mental health had changed during psychotherapy. It remains unclear whether they change as part of a single process together with symptomatic change, as part of separate processes, or whether a change in one of the variables predicts change in another variable. Our objective in this study was to examine the relationship between the observed changes and to establish temporal precedence that constitutes a necessary condition for causation. Sixty-two clients who underwent psychotherapy in a naturalistic setting completed questionnaires at 5 time points throughout treatment. The change scores for each client in each of the variables were calculated. The correlations between the changes' scores were tested. To examine the time order, we used autoregressive cross-lagged modeling. A negative correlation was found between the symptoms change score and the happiness change score, r(60) = -0.53, p < .000. A positive correlation was detected between playfulness and happiness change scores, r(60) = 0.31, p = .014. Playfulness predicted subsequent levels of creativity, b = 0.66, t(121) = 2.1, p < .05. Honesty-humility levels predicted subsequent levels of creativity, b = 0.65, t(121) = 9.71, p < .001. The findings support the claim that the change in positive features of mental health is an independent process from symptomatic improvement. In addition, playfulness and honesty-humility temporally precede creativity, and thus might be part of a single change in a mental health construct that is positively defined. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The ethical significance of diagnostic test results in psychology practice.

"Psychologists base the opinions contained in their recommendations, reports and diagnostic or evaluative statements including forensic testimony on information and techniques sufficient to substantiate their findings". Do expert psychodiagnosticians rely in their professional final reports on the materials and raw data obtained from test materials? How ethical are they in their professional performances? In order to answer this question, expert clinical psychologists were given batteries of psychodiagnostic tests, accompanied by one of two different types of background information, suggesting either a Borderline Personality Disorder, or a Paranoid Personality Disorder. This background information was a full and strongly suggestive story in one experiment, and a mere hypothesis in another. All conditions manifested a confirmation bias: the psychodiagnostic reports were profoundly biased by the background suggestions. The present paper focuses on a content analysis of the reports, and shows that the experts referred very little if at all to the psychodiagnostic materials they received. They were found less professional and as a result- less ethical. The ethical relevance of these findings to the teaching and training of professional psychodiagnosticians is discussed, with an emphasis on the importance of teaching students and interns in clinical psychology to base their diagnostic reports on the test data.

Ultra-orthodox rabbinic responses to religious obsessive- compulsive disorder.

This presentation deals with the response of rabbis to ultra-orthodox people suffering from religious symptoms of obsessive-compulsive disorder. The symptoms are consistent with religious practice and patients justify their compulsive behaviors by the dictates of the codes of law.Will rabbis see their primary role as protection of the codes of law rather than alleviation of the suffering of the faithful? Will they see the person as someone who is meritoriously meticulous or in need of help? The writings of two eminent rabbis, and advice related by contemporary patients in Jerusalem, Israel are presented. The most arresting example of guidance is provided by Rabbi Nahman of Bratslav (1772-1810) who declared that he himself suffered from excessive religious practices typical of religious OCD until he overcame them. The accounts of rabbis and patients have features similar to the cognitive-behavioral treatment of choice for this disorder. The guidance of a rabbi is based on authority, and detailed knowledge of religious law, while a mental health therapist is an expert on OCD. The latter cannot give religious guidance, and has no authority within the ultra-orthodox community, and is only afforded a role with the rabbi's acquiescence. The role of the patient's rabbi is likely to be crucial in management. Religious guidance without professional help may often only have short-term benefit in this generally chronic condition, although studies have not been carried out.

Characteristics of schizophrenia residents and staff rejection in community mental health hostels.

BACKGROUND: In the era of deinstitutionalization, increasing numbers of schizophrenia patients reside and receive rehabilitational treatment within the framework of community hostels. The quality of staff-patient relationships is a crucial determinant of the rehabilitational process outcome. METHOD: This study examined the characteristics of 56 schizophrenia hostel residents, measured the degree of staff criticism and rejection expressed towards these patients and assessed the contribution of residents and staff characteristics to the induction of staff rejection. Measures included assessments of patients' symptoms using the Positive and Negative Syndrome Scale (PANSS), staff attitudes using the Patient Rejection Scale (PRS), and patients' living skills using the Independent Living Skills Survey (ILSS). RESULTS: Young, relatively inexperienced instructors represented 60% of the hostels staff. Residents' symptoms and staff rejection levels were overall low. However, significantly increased rejection was expressed towards patients who were more symptomatic, as measured by PANSS total and positive symptoms scores and had diminished job-related and health care living skills. Staff older age and longer professional experience were correlated with higher rejection scores. LIMITATIONS: Relatively small sample size and catchment area. CONCLUSIONS: These findings highlight the need for a better definition and understanding of schizophrenia residents selection criteria and treatment goals in community hostels. Moreover, they suggest that improvements in this area should be coupled with the provision of specialized staff training aiming at the achievement of more flexible staff attitudes. Within this framework, the PRS may serve as a practical, cost-effective tool for monitoring crucial aspects of staff-patients relationships.

Do biometric parameters of the hand differentiate schizophrenia from other psychiatric disorders? A comparative evaluation using three mental health modules.

The link between schizophrenia and anomalies in the distal upper limb is well documented. Preliminary studies have identified a number of biometric parameters of the hand by which schizophrenics can be distinguished from matched controls. The current study seeks to determine whether patients with schizophrenia can be singled out from a disparate group of other mental disorders by using the same parameters. We studied three groups, totaling 134 men: 51 diagnosed with schizophrenia, 29 with anxiety and mood disorders, and 54 comprising a control group. Seven parameters were studied: the proximal interphalangeal joint, the eponychia of the middle and ring digits, two dermatoglyphic features, and two constitutional factors. Examiners evaluated the parameters based on photographs and prints. An initial Mann Whitney comparison showed no significant difference between the control group and those identified with anxiety and mood disorders. We therefore accounted for them as a single group. In a discriminant analysis, an overall accuracy of 78.4% was established with a sensitivity of 80.4% (schizophrenics identified correctly) and a specificity of 77.1% (controls identified correctly). These results suggest that the biometric parameters employed may be useful in identifying patients with schizophrenia from a disparate group of other mental disorders.

Obsessive compulsive disorder in ultra-orthodox Jewish patients: a comparison of religious and non-religious symptoms.

Of 28 ultra-orthodox Jewish psychiatric referrals with obsessive compulsive disorder, 26 had religious symptoms, while 18 had non-religious symptoms. On average, each patient had three times more religious symptoms than non-religious symptoms. In only nine cases did the patients view their non-religious symptoms as the main difficulty, and all of these nine cases were ultra-orthodox from birth. There was no significant difference between the distress, resistance, sense of irrationality and hours spent daily of religious and non-religious symptoms. Further, there was no significant difference between the age of onset, age when felt to be a disturbance, and duration until help was sought. They were more likely to turn for help initially to a religious authority for a religious symptom and a mental health worker for a non-religious symptom. It may be concluded that the religious and non-religious symptoms of obsessive compulsive disorder in ultra-orthodox Jews are not experienced in markedly different ways by the sufferers. Two limitations to the study are the sample size, and the selection bias in that all had sought professional help, of itself likely to reflect their attitude to obsessive compulsive disorder.