The Moderating Role of Working Alliance in the Association Between Depression and Suicide Ideation in Messaging Therapy.

Introduction: Suicide is one of the leading causes of death worldwide, and it can be prevented by psychotherapy. The objective of this study was to examine the risk factors predicting suicide ideation during messaging psychotherapy, and the moderating role of working alliance (WA) in the association between baseline depression and later suicide ideation. Materials and Methods: A large outpatient sample (n = 4,388) engaged in daily messaging with licensed clinicians from a telemedicine provider. Using a longitudinal design, depression and anxiety symptoms were assessed at baseline, using the Patient Health Questionnaire (PHQ-8) for depression and the Generalized Anxiety Disorder (GAD-7) for anxiety. The WA was measured with the short version of the Working Alliance Inventory after 3 weeks of therapy, and suicide ideation was assessed at baseline and after 6 weeks of therapy, by item 9 of the Patient Health Questionnaire (PHQ-9). Demographic measures were also assessed. Results: Results indicate that depression (ß = 0.09, p < 0.001), baseline suicide ideation (ß = 0.50, p < 0.001), and WA (ß = -0.08, p < 0.001), especially the task subscale (ß = -0.14, p < 0.001), significantly predicted suicide ideation after 6 weeks. WA (ß = -0.07, p < 0.001), especially the task (ß = -0.14, p < 0.001) and bond subscales (ß = 0.06, p = 0.002), moderated the association between depression at baseline and suicide ideation after 6 weeks, so that experiencing higher quality of WA decreased the association between depression and suicide ideation. Discussion and Conclusions: Suicide ideation may be reduced by experiencing the therapeutic relationship as beneficial, even among at-risk populations, which suffer from depressive symptoms. It is the first study to show this moderation effect in any platform of therapy.

NARCISSISM AND CONCERN: THE RELATIONSHIP OF SELF-OBJECT NEEDS AND NARCISSISTIC SYMPTOMS WITH HEALTHY AND PATHOLOGICAL CONCERN.

While concern and narcissism seem to be contradictory in nature, clinical evidence and theoretical writings on pathological forms of concern--tracing their origin to deficiencies in early relationships with primary caretakers--suggest that the actual relationship between these two characteristics might be much more complicated. We respond to a study aimed to add empirical data to the clinical and theoretical knowledge examined the relationships between self-object functions, types of narcissism and pathological concern. The findings of the study showed that pathological concern was positively associated with self-object needs and that this association was mediated by covert narcissism. Our discussion focuses on the developmental and psychodynamic sources of pathological concern, as well as its significance in the intrapersonal and interpersonal domains.

Revisiting the intake policy at the mental child and adolescent clinics.

BACKGROUND: The psychiatric intake interview is crucial for the delivery of quality care. Currently, the interview in most public clinics varies in nature. It often consists of a clinical face-to-face interview (structured/unstructured) with or without self-report questionnaires (systematic/non-systematic). By integrating structured computerized self-report questionnaires into the intake, the assessment process could be shortened, and diagnostic accuracy increased. OBJECTIVES: The study aims to assess whether adding structured computerized questionnaires will increase the efficacy of the intake process, as indicates by shortened intakes and a higher level of diagnostic accuracy, for children and adolescents in mental health clinics in Israel. METHODOLOGY: Patients (Mage = 8.62, SDage = 1.86; 33.8% females) referred to the youth mental health clinic of Maccabi HaSharon district, were included in either the CIA group (Comprehensive Intake Assessment - with questionnaires) or IAU group (Intake as Usual - without questionnaires). RESULTS: In terms of accuracy and time measurements, the CIA group had higher diagnostic accuracy and a shorter intake duration of 6.63 min, almost 15% of an intake meeting, compared to the IAU group. No differences were found in satisfaction and therapeutic alliance between the groups. CONCLUSIONS AND IMPLICATIONS: More accurate diagnosis is essential to tailor the appropriate treatment for the child's needs. Moreover, reducing intake time by a few minutes contributes significantly to the ongoing activities of mental health clinics. With this reduction, more intakes can be scheduled at a given time, optimizing the intake process, and reducing long wait times, which are increasing due to the growing demand for psychotherapeutic and psychiatric care.

Categorization and affect: evidence for intra-hemispheric interactions.

Both emotional reactivity and categorization have long been studied within the framework of hemispheric asymmetry. However, little attempt has been made to integrate both research areas using any form of neuropsychological research, despite behavioral data suggesting a consistent relationship between affective and categorization processes. The primary goal of the current study was to examine the possibility of a laterally mediated interaction between emotional reactivity and the cognitive process of categorization. Using a split visual fields categorization task combined with affect inducing procedures, we hypothesized that the relationship between state affect and categorization would be dependent on the nature of state affect and on the hemisphere targeted. Results offered support for this hypothesis, showing that state affect related changes in categorization appeared only in the hemisphere commonly associated with both a specific affective state and categorization strategy employed. Findings are discussed in terms of possible evidence for a hemispheric arousal effect underlying the relationship between affect and categorization.