What Differentiates Poor- and Good-Outcome Psychotherapy? A Statistical-Mechanics-Inspired Approach to Psychotherapy Research, Part Two: Network Analyses.

Statistical mechanics is the field of physics focusing on the prediction of the behavior of a given system by means of statistical properties of ensembles of its microscopic elements. The authors examined the possibility of applying such an approach to psychotherapy research with the aim of investigating (a) the possibility of predicting good and poor outcomes of psychotherapy on the sole basis of the correlation pattern among their descriptors and (b) the analogies and differences between the processes of good- and poor-outcome cases. This work extends the results reported in a previous paper and is based on higher-order statistics stemming from a complex network approach. Four good-outcome and four poor-outcome brief psychotherapies were recorded, and transcripts of the sessions were coded according to Mergenthaler's Therapeutic Cycle Model (TCM), i.e., in terms of abstract language, positive emotional language, and negative emotional language. The relative frequencies of the three vocabularies in each word-block of 150 words were investigated and compared in order to understand similarities and peculiarities between poor-outcome and good-outcome cases. Network analyses were performed by means of a cluster analysis over the sequence of TCM categories. The network analyses revealed that the linguistic patterns of the four good-outcome and four poor-outcome cases were grounded on a very similar dynamic process substantially dependent on the relative frequency of the states in which the transition started and ended ("random-walk-like behavior", adjusted R 2 = 0.729, p < 0.001). Furthermore, the psychotherapy processes revealed statistically significant changes in the relative occurrence of visited states between the beginning and the end of therapy, thus pointing to the non-stationarity of the analyzed processes. The present study showed not only how to quantitatively describe psychotherapy as a network, but also found out the main principles on which its evolution is based. The mind, from a linguistic perspective, seems to work-through psychotherapy sessions by passing from the most adjacent states and the most occurring ones. This finding can represent a fertile ground to rethink pivotal clinical concepts such as the timing of an interpretation or a comment, the clinical issue to address within a given session, and the general task of a psychotherapist: from someone who delivers a given technique toward a consultant promoting the flexibility of the clinical field and, thus, of the patient's mind.

Reflective functioning and personal recovery process of users with borderline personality disorder on Instagram: an explorative study using computerized and thematic analysis.

Although recent literature has stated that mentalizing (or reflective functioning; RF) promoted the clinical recovery (symptomatic remission; CR) of individuals with borderline personality disorder (BPD), to our knowledge, there have been no studies that analyzed the relationship between RF and a process more complex than CR, namely personal recovery (PR) - a deep and unique process of change in one's attitudes, values, feelings, goals and/or roles. Furthermore, while there have been a few studies concerning PR of BPD individuals, but to date none analyzed PR of BPD individuals through online narratives shared on social media platforms. This study investigates the relationship between RF and PR of 14 Instagram users with a selfreported diagnosis of BPD. Two groups of users were distinguished on the basis of hashtags, #bpd and #bpdrecovery. Seventy randomized text posts (5 from each user) were extracted from users' profiles: 35 from the #bpd group and 35 from #bpdrecovery. Two methods of analysis were applied: i) a thematic analysis, by using the theoretical framework CHIME, which identifies five dimensions of PR; and ii) a stylistic analysis of RF utilizing computerized reflective functioning (CRF), which identifies RF lexical markers. Results indicate that the #bpdrecovery group presented more dimensions of PR, and that its posts showed a significantly higher RF than the #bpd group. These findings suggest that RF could be involved in the PR of BPD individuals, thus mentalization-based treatment could be effective in supporting PR processes and enhancing the impaired RF in BPD users even in the online context.

Early in-session cognitive-emotional problem-solving predicts 12-month outcomes in depression with personality disorder.

Therapist-patient verbalizations reveal complex cognitive-emotional linguistic data. How these variables contribute to change requires further research. Emotional-cognitive text analysis using the Ulm cycles model software was applied to transcripts of the third session of psychotherapy for 20 patients with depression and personality disorder. Results showed that connecting cycle sequences of problem-solving in the third hour predicted 12-month clinical outcomes. Therapist-patient dyads most improved spent significantly more time early in session in connecting cycles, whilst the least improved moved into connecting cycles late in session. For this particular sample, it was clear that positive emotional problem-solving in therapy was beneficial.

Emotional and cognitive processing of narratives and individual appraisal styles: recruitment of cognitive control networks vs. modulation of deactivations.

Research in psychotherapy has shown that the frequency of use of specific classes of words (such as terms with emotional valence) in descriptions of scenes of affective relevance is a possible indicator of psychological affective functioning. Using functional magnetic resonance imaging (MRI), we investigated the neural correlates of these linguistic markers in narrative texts depicting core aspects of emotional experience in human interaction, and their modulation by individual differences in the propensity to use these markers. Emotional words activated both lateral and medial aspects of the prefrontal cortex, as in previous studies of instructed emotion regulation and in consistence with recruitment of effortful control processes. However, individual differences in the spontaneous use of emotional terms in characterizing the stimulus material were prevalently associated with modulation of the signal in the perigenual cortex, in the retrosplenial cortex and precuneus, and the anterior insula/ventrolateral prefrontal cortex. Modulation of signal by the presence of these textual markers or individual differences mostly involved areas deactivated by the main task, thus further differentiating neural correlates of these appraisal styles from those associated with effortful control. These findings are discussed in the context of reports in the literature of modulations of deactivations, which suggest their importance in orienting attention and generation of response in the presence of emotional information. These findings suggest that deactivations may play a functional role in emotional appraisal and may contribute to characterizing different appraisal styles.

Development and criterion validity of a computerized text analysis measure of reflective functioning.

The Reflective Functioning scale (RF) is a narrative-based assessment of the capacity to coherently conceptualize one's own and others' subjective motivations, emotions, beliefs, and desires. We report the preliminary results of an effort to develop a computerized text analysis version (CRF) of the RF assessment system. A sample of 113 clinical and non-clinical Adult Attachment Interviews (AAI) were utilized to develop the CRF measure. Using the Marker Approach (Mergenthaler & Bucci, 1999), 54 linguistic markers of high RF language were identified. The associations between CRF and RF were significant in both a clinical sample of patients diagnosed with Borderline Personality Disorder (BPD) (Spearman rho=.57, p<.0001) and a non-clinical sample of adults (Spearman rho=.57, p=.002). These results suggest that a CRF rating scale is feasible, has preliminary criterion validity, and, therefore, has potential to facilitate the efficient assessment of RF.

Unconventional metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy.

This study investigates the relationship between unconventional (i.e., creative) metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy (MIT). The occurrence of unconventional metaphor was identified using the Metaphor Analysis in Psychotherapy (MAP) model, and emotional-cognitive regulation was assessed by the Therapeutic Cycles Model (TCM). The results showed that the dyad's frequency of unconventional metaphors is significantly related to emotional-cognitive integration, reflective processes and moments of therapeutic engagement based on the quality of such regulation. More specifically, client metaphors were associated with emotional-cognitive integration and moments of therapeutic engagement, while therapist metaphors were associated with reflective processes. The results suggest that unconventional metaphors may be considered markers for different cognitive-emotional regulatory processes and moments of heightened therapeutic work and change in MIT.

Psychodynamic change in psychotherapy: cycles of patient-therapist linguistic interactions and interventions.

Psychodynamic change is understood to occur in part through the unique therapeutic relationship developed between therapist and patient, and the subtle cycles of their conversation from relaxed connection to intense experiencing. The Therapeutic Cycles Model (TCM) (Mergenthaler, 1996 ) and Heidelberg Structural Change Scale (HSCS) (OPD Task Force, 2008 ) were used to investigate therapist-patient dynamic processes across 16 sessions of psychotherapy. The TCM identified interventions of the therapist instigating change in emotion-abstraction patterns. Structural personality change was higher in TCM cycles, and differed according to emotion-abstraction patterns. The interventions of the therapist promoted dynamic structural change in the patient. The findings demonstrate for the first time the interconnection between specific types of therapist and patient dialogue that promote deep changes.

Coincidência de conexão do tom emocional com abstração e o resultado psicoterapêutico / Coincidence of connecting emotional tone with abstraction and the psychotherapeutic outcome

O estudo objetivou testar a afirmação de que "pacientes que não têm êxito em conectar suas emoções com cognição durante suas terapias provavelmente não melhorarão". Dois processos de psicoterapias psicodinâmicas breves, um bem-sucedido e outro malsucedido, foram analisados com o Modelo dos Ciclos Terapêuticos. O Modelo dos Ciclos Terapêuticos é um método de análise de texto por computador que permite identificar padrões de emoção-abstração na narrativa de interlocutores. Quatro padrões são identificados: Relaxamento, Experiência, Reflexão e Conexão. Momentos clinicamente significantes são mais associados à Conexão. Levantou-se a hipótese de que o caso bem-sucedido apresentaria maior proporção de Conexão. Quanto à Reflexão, ao Relaxamento e à Experiência, não eram esperadas diferenças. Encontrou-se maior proporção de Conexão e de Relaxamento no caso bem- sucedido, e diferenças não significantes em Reflexão e Experiência. Considerações sobre a magnitude das mudanças, valência das emoções e abstrações e sequência de ocorrência dos padrões sugerem novas análises.

The current study aimed to test the statement that "patients who do not succeed in connecting their emotions with cognition during therapy are unlikely to improve". Two processes of brief psychodynamic psychotherapies, one successful the other not, were analyzed in accordance with the Therapeutic Cycles Model. The Therapeutic Cycles Model is a computer-assisted text analysis method that permits the identification of emotion-abstraction patterns in narratives by interlocutors. Four patterns are identified: Relaxing, Experiencing, Reflecting and Connecting. Clinically significant moments are mostly associated with Connecting. It was hypothesized that a successful process would differ from an unsuccessful one, having a higher proportion of Connecting. As far as Reflecting, Experiencing and Relaxing are concerned, no differences were expected. Results pointed to a higher proportion of Connecting and Relaxing in the successful process and no difference in respect of Experiencing and Reflecting. Considerations about the magnitude of change, emotion and abstraction valence and the sequence of patterns, suggest further analysis.

The synchronization of plan activations and emotion-abstraction patterns in the psychotherapeutic process: a single-case study.

The question of whether the dynamic of interpersonal plans in the psychotherapeutic process is reflected in the emotion-abstraction (EA) patterns (relaxing, reflecting, experiencing, connecting) described by Mergenthaler (e.g., 2008) was examined in a single-case study. The activation of interpersonal plans was encoded in 10-s intervals by means of sequential plan analysis on the basis of video recordings. The EA patterns were identified in 2-min intervals on the basis of a transcript of the nine-session short-term therapy. The hypothesis that the dynamic complexity of plan activation time series of the patient increases during intensified phases of the EA pattern connecting was examined and confirmed. This can be considered an indicator for the occurrence of critical instabilities in the environment of order transitions in the direction of more strongly integrated states of processing.

Observing therapeutic interaction in the "Lisa" case.

This is the third of a series of pilot studies that seeks to validate a method for the identification and analysis of clinically significant interactions in the psychotherapy process. Using a combined method, the authors demonstrate that the therapeutic cycles model (Mergenthaler, 1996) can be used reliably to identify clinically significant events across sessions, which can then be analyzed at the level of the therapist-client interaction using conversation analysis, a discipline that has generated a substantial body of knowledge of how meaningful interaction is achieved by speakers on a turn-by-turn basis. The authors demonstrate that significant events can be compared within and across cases in order to understand how therapist interventions contribute to within-session micro-outcomes and, ultimately, to outcomes across populations of cases.

Resonating minds: a school-independent theoretical conception and its empirical application to psychotherapeutic processes.

The resonating minds theory will be introduced as a means to describe psychotherapeutic processes and change. It builds on the mind-brain interface with psychotherapeutic interventions causing change in the brain, an altered brain causes changes in the emotional, cognitive, and behavioral regulation, and this again will change the types of subsequent therapeutic interventions. For the empirical assessment of this theory the therapeutic cycles model will be used. It is based on computer assisted analysis of verbatim transcripts using emotional tone, abstraction and narrative style as language measures. Sample applications and studies are shortly presented in order to provide evidence for the applicability and face validity of this approach.

Therapeutic factors and language patterns in group therapy application of computer-assisted text analysis to the examination of microprocesses in group therapy: preliminary findings.

The aim of this single-case-design study was to examine the relationships between therapeutic factors in group therapy and the language features of the group dialogue. Forty-two transcripts from a group treatment were investigated. Emotion-abstraction patterns (EAPs) were identified for the group as a whole using computer-assisted text analysis, and therapeutic factors were rated by external judges using the Kiel Group Psychotherapy Process Scale. Significant positive relationships were found between insight and the EAP connecting and between catharsis and the EAP experiencing. Interpersonal learning-output, catharsis, and self-disclosure showed higher scores in connection with the therapeutic cycle, which, according to the therapeutic cycle model, represents a sequence of EAP related to a successful therapeutic process. The current findings show that the use of EAPs allows the identification of key moments in a group therapy process.

The German specimen case, Amalia X: empirical studies.

The authors provide a perspective on how psychoanalytic process research can be implemented. This is based on a process research model described elsewhere and summarizes the kinds of studies that can be situated on the four levels of the model. The authors summarize multiple empirical studies that were performed in a completely tape-recorded psychoanalytic therapy and have been published. These studies demonstrate the many modalities empirical process research has available to objectively study psychoanalytic process phenomena and their implication for outcome.

What happens in therapy with sexual offenders? A model of process research.

This paper presents two studies (one single case and one comparative study) examining change processes within individual therapy sessions as well as during the course of treatment. The Therapeutic Cycle Model (TCM), developed for general psychotherapy to objectify change events in the course of psychotherapies, is applied to transcribed tape recordings of therapy sessions with sexual offenders. The TCM focuses on emotional experience and cognitive mastery and uses computer assisted text analysis. In addition to the TCM approach clinical ratings are used as independent criteria. The predicted relationship between the phases of the TCM and scores on the respective scales of the clinical ratings were supported.

[Change events during the psychotherapy process of a patient detained by court order due to sexual offences in a high security forensic clinic]. / Veränderungsprozesse im Verlauf der Psychotherapie eines wegen Sexualdelikten im Massregelvollzug untergebrachten Patienten.

BACKGROUND: Psychotherapy of sex offenders is effective and reduces relapse rates when compared with untreated controls. As compared to the effectiveness of psychotherapy at large, however, effect sizes are much lower. OBJECTIVE: To provide evidence for change processes in a therapy with a sex offender. METHOD: This is an exploratory single case study in which the Therapeutic Cycles Model (TCM)--developed for general psychotherapy and based on emotional experience and cognitive mastery--is being applied. In addition to the computer assisted approach of the TCM clinical ratings are used as independent criteria. RESULTS: The predicted relationship between the phases of the TCM, the rating for Quality of Sessions and the Therapeutic Alliance was observed.

Assessing problematic States in patients' narratives: the grid of problematic States.

The authors present the theoretical background, development, and validation of a new psychotherapy process rating tool: Grid of Problematic States (GPS). The GPS is based on Horowitz's states of mind theory, which describes recurrent patterns of experience and behavior. Meaningful changes in the observed states indicate therapeutic change. The GPS is designed for use with transcripts from psychotherapy sessions and focuses on narrative episodes within the patient dialogue. The GPS was applied to a completely transcribed cognitive psychotherapy with a patient diagnosed as mild major depressive. The authors demonstrated that the GPS could reliably assess disorganization and the development of stable construct clusters of thought themes, emotions, and somatic sensations. The interpretation of results is consistent with the patient's clinical assessment.

Descripción de las reglas para la transcripción de sesiones de psicoterapia / Description of rules to transcribe psychotherapy sessions

A pesar de la importancia creciente del uso de transcripciones de sesiones en el campo de la investigación en psicoterapia, una amplia gama de estudios colaborativos se ven obstaculizados por falta de un adecuado uso de normas para llevarlas a cabo. Se presentan en este trabajo guías para realizar la transcripción del discurso en idioma español, particularmente para sesiones de psicoterapia. Estas pueden ser utilizadas, tanto para investigación, como con propósitos de formación. Las transcripciones que resultan siguiendo estas reglas podrán ser legibles para jueces humanos, así como fácilmente admitidas para análisis de textos a través de la computadora, permitiendo así tanto el recuento de la frecuencia de ocurrencia de determinadas palabras como el análisis de contenido.

Analisis computarizado de la conducta verbal de pacientes y terapeutas en la primer entrevista diagnostica / Computarized analysis of patients', and therapists' talking behavior in first-interview

De las 282 primera entrevistas diagnósticas (psicoterapéuticas) de que dispone el Banco Computadorizado de Textos de la Universidad de Ulm se seleccionaron 68 con el fin de: a) Evaluar la influencia de los factores diagnósticos, sexo y edad en la conducta verbal de pacientes y terapeutas; b) Construir una muestra que cumpla la función de estructura básica para el desarrollo ulterior de un Banco de Textos de Primeras Entrevistas; y, c) Probar algunas hipótesis, sobre la base de la literatura, preexistente, respecto a diferençias entre los grupos definidos. Utilizando el Sistema Electrónico de Análisis Verbal se realizaron análisis formales, gramaticales y de contenido pudiéndose demostrar la influencia decisiva de la ordenación diagnostica y la importante influencia del sexo y de la edad en la conducta verbal de pacientes y terapeutas. El análisis gramatical muestra la mayor capacidad de discrinación