The Revised Pathogenic Beliefs Scale: A Transtheoretical Measure of Maladaptive Beliefs That Are Associated with Psychological Distress.

Pathogenic beliefs are maladaptive cognitive schema that may obstruct a person's ability to achieve meaningful goals in their life. This study sought to revise a previously existing measure of pathogenic beliefs (the Pathogenic Beliefs Scale) by improving the quality of items and separating the ratings of the presence of a pathogenic belief from the distress associated with it. In Study 1 (n = 272), we used item-response theory to identify 21 items from an initial pool of 44 items. In Study 2 (n = 422), we tested the items from Study 1 using confirmatory factor analysis. Study 3 used the combined samples from Study 1 and Study 2 (total n = 528) to compare the revised measure to the Experiences in Close Relationships and the Measure of Parental Style. Results indicate that the revised 21-item PBS has good reliability and convergent validity with related measures, consistent with previous studies of the longer version of the PBS. The 21-item revised PBS is included as supplemental material, and freely available to clinicians and researchers.

"It Felt Like I Was Being Tailored to the Treatment Rather Than the Treatment Being Tailored to Me": Patient Experiences of Helpful and Unhelpful Psychotherapy.

OBJECTIVE: This qualitative study explores patients' experiences of psychotherapy, focusing on elements perceived as helpful or unhelpful and suggestions for improvement in the context of public mental health care. METHODS: A total of 148 adults (Mean age = 32.24, SD = 9.92) who had been or are currently receiving psychological treatment from the National Health Service (NHS) responded to an online survey. The survey included open-ended questions regarding their experiences of psychotherapy, asking them to identify helpful or unhelpful aspects, and suggestions for improvement. Using thematic analysis, key themes were identified. RESULTS: The analysis highlighted the patient's preference for personalized treatment, the importance of therapeutic alliance, the demand for depth in therapy, and life skills and agency as therapeutic outcomes. Participants suggested improvements such as more tailored approaches and stronger therapist-patient relationships, supporting an adaptable, patient-centered model. CONCLUSION: The study highlights challenges in public mental health services where patients might feel their specific needs are not being recognized and met and underscores the importance of personalized treatment plans that satisfy and evolve with patient needs, suggesting that therapists must be attentive and responsive to individual desires to enhance the patient experience.

Measures of trauma exposure and trauma response: A scoping review.

BACKGROUND: In contrast to the vast clinical, theoretical, and empirical literature on the impact of trauma, relatively few studies have reviewed the trauma measures that researchers and clinicians can choose to use in their work. This scoping review aimed to catalog all trauma measures (trauma exposure and its subjective responses) that have been published in the peer-reviewed literature, developed for use with adult populations. METHOD: Through a systematic search of the literature and the screening of 19,631 abstracts, a total of 363 unique trauma measures were identified. RESULT: Most of these measures were developed for assessment purposes rather than for clinical screening or diagnostic purposes. Most of these measures are patient-self-report measures that assess trauma exposure in the patients' lifetime, or subsequent symptoms, particularly cognitive impairments. DISCUSSION: Complications in the trauma literature are highlighted, including the use of very similar abbreviations of measures, substantial discrepancies regarding the definition of trauma, and the general assumption that a potentially traumatic event inevitably leads to traumatic distress rather than a path of resilience.

Interpersonal guilt and the working alliance in psychotherapy: The moderating role of childhood experience.

Interpersonal guilt often encompasses pathogenic beliefs that imply omnipotent responsibility for others and concerns about abandoning, humiliating or threatening others. This study sought to examine how interpersonal guilt may influence patients' and therapists' ratings of early working alliance and the potential moderating effect of perceived adverse parenting in childhood. Ninety-five patients and their 19 therapists in an outpatient psychotherapy clinic rated their early working alliance after the first and the fifth session in treatment. We conducted separate moderation analyses for patient and therapist-reported working alliance and controlled for psychological distress at baseline. Results suggest that perceived adverse parenting in childhood significantly moderated the effect of interpersonal guilt on the working alliance in such a way that for patients reporting very low levels of perceived adverse experiences, the interpersonal guilt beliefs had a positive effect on working alliance, whereas for those with very high levels of perceived adverse experiences, interpersonal guilt had a negative effect on working alliance. This same pattern of moderation was found for patient- and therapist-reported working alliance at session 1 and therapist-reported working alliance at session 5. Thus, although the effect of interpersonal guilt on the working alliance depends somewhat on the perspective of the working alliance rating (patient or therapist), it mainly depends on developmental experiences of the patient.

The plan formulation method: An empirically validated and clinically useful procedure applied to a clinical case of a patient with a severe personality disorder.

The plan formulation method (PFM) is an empirically validated procedure for identifying a patient's goals for therapy, what is hindering the patient from attaining those goals, and how the patient is likely to work in therapy. In this paper, we employ the PFM to analyze the initial psychotherapy sessions of Geena, a 30-year-old outpatient with borderline personality disorder and relational and substance abuse problems. Employing the PFM, we identify a family of pathogenic beliefs (e.g., that she is unlovable and unworthy; that her parents will be hurt if she has satisfying intimate relationships) that Geena sought to disprove in her therapy and explain how she worked with the therapist to do so. We illustrate how the PFM can help the therapist identify what information and what types of interventions will be helpful for a given patient.

Within-patient perceptions of alliance and attunement: Associations with progress in psychotherapy.

The most frequently examined aspect of the therapeutic relationship is the working alliance, which reflects the conscious collaborative bond, and agreement on task and goal. In addition to the established importance of the working alliance, the therapists' attunement and responsiveness might reflect another important aspect of the therapeutic relationship that can be considered in relation to session-by-session progress over treatments. Emerging research suggests that the quality of the working alliance not only differs between patients but also within patients over time. However, little is known about the quality of the therapeutic relationship between and within patients in relation to progress in psychotherapy. We examined fluctuations of the working alliance measure (WAI) and the newly developed measure of the Patients' Experiences of Attunement and Responsiveness (PEAR) during treatment in a naturalistic sample of patients in an outpatient psychotherapy clinic. Multilevel modelling was used to examine the respective contribution of these measures to subsequent improvement in psychological functioning longitudinally. Results suggest that the within-patient effect, instead of between-patient effect, was significant for WAI (and did not reach significance for PEAR), indicating that the fluctuation of WAI was predictive of psychological functioning in the subsequent month. Based on these findings, therapists and their patients might benefit from regular tracking of the patient-reported working alliance. The findings underscore the importance of the alliance, specifically at the within-patient level. It also highlights the challenge for research to tap into other aspects of the therapeutic relationship that can help explain progress in therapy. Given the breadth and accessibility of the working alliance construct, more work is needed for researchers to examine the construct of attunement and responsiveness.

Assessing internalized beliefs: Development of the Pathogenic Belief Scale.

The way that people internalize adverse experiences plays an important role in the development of psychopathology. The Pathogenic Belief Scale (PBS) is intended to operationalize a transtheoretical understanding of repetitive patterns of emotion-laden beliefs that develop in childhood and continue to influence people's current experience. Using a cross-sectional survey design, we recruited a large heterogeneous sample of 246 clinic outpatients and 732 adults in the community. Besides the PBS, measures of adverse parenting experiences and common psychopathology were administered. An exploratory factor analysis of the total sample of 978 participants was conducted followed by a convergent validity analysis for the 246 clinic outpatients. The three-factor solution included "cannot rely on others," "undeserving," and "interpersonal guilt," and it showed good psychometric properties, including convergent validity with the measures of adverse parenting experiences and psychopathology. The 34-item PBS offers a promising self-report measure that could help delineate and understand the pathogenic beliefs that heterogeneous samples of patients may hold. Pathogenic beliefs may be relevant to the psychotherapy process, regardless of model or theoretical context.

Interpersonal and Social Functioning Among Psychotherapy Patients: The Indirect Effect of Childhood Adversity.

ABSTRACT: This study examined the mediating role of pathogenic beliefs on the relationship between patients' recollections of experienced adverse parenting in childhood and adult interpersonal and social problems. A total of 210 psychotherapy outpatients rated their experiences of perceived adverse parenting in childhood and completed measures of psychological distress, interpersonal problems and social impairment, and internalized beliefs about self and others. Significant mediation effects were observed for two of the three belief domains: "cannot rely on others" and "undeserving." Although both were significant mediators between adverse parenting and symptom distress, only "cannot rely on others" was a significant mediator predicting interpersonal problems, and only "undeserving" was a significant mediator predicting impaired social functioning. Thus, patients' underlying convictions regarding their self-worth seem to play a role in the ability to develop social roles, whereas the beliefs about the steadfastness of others play an important role in the capacity for interpersonal relating.

Perceived Adverse Parenting in Childhood and Psychological Distress Among Psychotherapy Patients: The Mediating Role of Pathogenic Beliefs.

ABSTRACT: The way people derive inferences from actual adverse experiences plays an important role in the development of psychopathology. This study aims to examine the mediating role of pathogenic beliefs (i.e., emotion-laden, powerful, painful convictions about self and others) on the relation between perceived adverse parenting behaviors in childhood and subsequent adult psychopathology. Participants (mostly Caucasian and heterosexual) were 204 consecutively admitted patients with a range of psychological difficulties, including depression, anxiety, and interpersonal problems, at a low-fee outpatient clinic. Participants completed standard self-report assessments of perceived parental style, depressive and anxiety symptoms, and a clinically derived measure of pathogenic beliefs. We examined the indirect effects of adverse parenting on anxiety and depressive symptom severity through pathogenic beliefs. Pathogenic beliefs reflecting the unreliability of others significantly mediated the relationship between adverse parenting and anxiety symptoms. The other mediation model is consistent with the theory that perceived adverse parenting contributes to the severity of depressive symptoms through beliefs about not being deserving and other people being unreliable. Within the limitations of the cross-sectional, retrospective, and self-report nature of the data, our results seem to suggest that attending to intermediary subjective beliefs might be important in understanding psychopathology development in the context of childhood adversity. Aiming to modify the beliefs in therapy might modify the symptoms. However, this would remain to be demonstrated through formal intervention research.

Cognitive mediators of the relationship between adverse childhood experiences and adult psychopathology: A systematic review.

This is the first review to rigorously examine the mediating role of cognitive factors in the relationship between childhood trauma and subsequent adult psychopathology, and highlight areas for future research. A database search (Child Development & Adolescent Studies, ERIC, Global Health, PsycARTICLES, and PsycINFO) was conducted to identify empirical studies on cognitive factors, explaining the relationship between different types of adverse childhood experiences and adult psychopathology across clinical and nonclinical populations. A narrative synthesis and appraisal of the methodological quality of the studies was conducted. Ninety-eight mediation studies were identified, comprising 4,137 clinical and 28,228 nonclinical participants. Despite great variation in methodological quality of the studies, our narrative synthesis suggests that cognitive factors mediate the relationship between early trauma and later psychopathology. This finding is consistent across different measures of traumatic experiences, psychopathology, and cognitive mediators. Cognitive mediators represent potentially valuable intervention targets for (non)clinical patients who have experienced childhood adversity. Future studies are needed to (a) establish longitudinal causal connections, and (b) assess the effect of interventions that specifically target cognitive change in patients with different levels and types of pathology.

Improving the yield of psychotherapy research.

OBJECTIVE: Although the effectiveness of psychotherapy is well documented, little progress has been made in elucidating mechanisms of change. Major impediments to progress are the homogeneity assumptions evident in many psychotherapy studies. Case-specific research strategies avoid treating patients, therapists, and treatments as homogeneous variables and such studies are more successful at elucidating the link between psychotherapy processes and treatment outcome. METHOD: A case-specific, process-outcome study comprised of 39 patients treated by experienced therapists is presented. We did not focus on a supposedly homogeneous diagnostic group of patients (e.g., depressed patients) or particular manualized brands of therapy. Instead, we identified each patient's particular problems and conflicts (plan formulation) and then determined the degree to which therapists effectively addressed the patient's problems-that is, the degree to which therapists' interventions were compatible with (i.e., responsive to) the patient's plan. RESULTS: Correlations between ratings of therapist responsiveness (plan compatibility of interventions) and a variety of outcome assessments were significant and substantial (accounting on average for 25% of outcome variance). CONCLUSION: The findings presented here suggest that the extent to which therapists are responsive to their patients' plans is a strong predictor of treatment outcome and of patients feeling positively about their therapy experience.

The Patient's Experience of Attunement and Responsiveness Scale.

OBJECTIVE: This study sought to test the correlation between the patient's experience of attunement and responsiveness, and treatment outcome. METHOD: Utilizing a new measure-the Patient's Experience of Attunement and Responsiveness (PEAR) Scale-we asked both patients and therapists to rate their experience of a therapy session immediately after that session. Scores on the PEAR Scale were then correlated with two measures of treatment outcome. We obtained 405 total PEAR Scale administrations from 38 patient-therapist dyads across multiple sessions. RESULTS: Exploratory factor analyses revealed a three-factor structure for the patient version of the scale and a two-factor structure for the therapist version. Patient ratings on the PEAR Scale were significantly correlated with OQ-45 and a 1-item measure of global outcome measured for the concurrent session. CONCLUSION: These findings suggest attunement during a therapy session may be an important predictor of concurrent session outcome.

The effect of congruence in patient and therapist alliance on patient's symptomatic levels.

OBJECTIVE: The ability of alliance to predict outcome has been widely demonstrated, but less is known about the effect of the level of congruence between patient and therapist alliance ratings on outcome. In the current study we examined whether the degree of congruence between patient and therapist alliance ratings can predict symptomatic levels 1 month later in treatment. METHOD: The sample consisted of 127 patient-therapist dyads. Patients and therapists reported on their alliance levels, and patients reported their symptomatic levels 1 month later. Polynomial regression and response surface analysis were used to examine congruence. RESULTS: Findings suggest that when the congruence level of patient and therapist alliance ratings was not taken into account, only the therapist's alliance served as a significant predictor of symptomatic levels. But when the degree of congruence between patient and therapist alliance ratings was considered, the degree of congruence was a significant predictor of symptomatic levels 1 month later in treatment. CONCLUSIONS: Findings support the importance of the level of congruence between patient and therapist alliance ratings in predicting patient's symptomatic levels.

Plan-compatible termination in psychotherapy: Perspectives from control-mastery theory.

Termination processes in psychotherapy vary widely across patients, therapists, and therapies. While general guidelines on termination can inform ethical and responsible termination practices, termination decisions and processes are likely optimized using a case-specific approach. Control-mastery theory (CMT) provides a framework for considering the unique ways individual patients work in psychotherapy and can be applied to help therapists understand and facilitate optimal terminations. The present article provides a brief overview of CMT and outlines perspectives regarding the decision-making and discussion of psychotherapy termination, the processing of termination, and the final session of therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Traumas and Their Consequences According to Control-Mastery Theory.

The aim of this article is to introduce the reader to how control-mastery theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993), an integrative relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapeutic process, understands traumas, their consequences, and their mastery. In the first part of this article, we will present an overview of the debate about the definition of trauma within the different editions of the Diagnostic and Statistical Manual of Mental Disorders. Then, we will focus on the concept of complex traumas and on their consequences on mental health. Finally, we will discuss how CMT conceptualizes traumas and their pathological consequences. We will stress in particular how, according to CMT, in order for a painful experience to become a trauma, its victim has to come to believe that s/he caused it in the attempt to pursue a healthy and adaptive goal. In order to master traumas and disprove the pathogenic beliefs developed from them, people attempt to reexperience situations similar to the traumatic ones in safer conditions while giving them happier endings.

The Adjective Check List as an outcome measure: assessment of personality change in psychotherapy.

To investigate the value of the Adjective Check List (ACL) as a psychotherapy outcome measure, the ACL and Symptom Checklist-90-Revised (SCL-90-R) were administered at four times (before therapy, immediately after therapy, and at 6-month and 1-year follow-ups) to 38 patients in brief dynamic psychotherapy. High correlations between selected ACL scales and SCL-90-R Global Severity Index scores (GSI) were found. GSI change from before to after therapy correlated with change on the ACL scales. Changes from before to after therapy were detected for ACL scales at both the mean group and the individual levels. Because the ACL provides valuable information on personality dimensions as well as concurrent levels of distress, it is a particularly promising psychotherapy outcome measure.

What have we learned about how the alliance develops over the course of therapy?

This is a commentary on Dinger, Strack, Sachsse, and Schauenburg's (2009) study of how therapist attachment styles and patient factors contribute to the development of the therapeutic alliance. I first address whether the research is useful for clinicians, arguing that it is not, and then discuss how the work could be presented to maximize both its scientific and its clinical impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Preliminary Data about the Validation of a Self-Report for the Assessment of Interpersonal Guilt: The Interpersonal Guilt Rating Scales-15s (IGRS-15s).

The aim of this article is to present validation data about a self-report rating scale for the assessment of interpersonal guilt according to Control-Mastery Theory (CMT; Silbershatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986), the Interpersonal Guilt Rating Scale-15s (IGRS-15s). In order to perform the validation of this tool in an Italian sample we have collected a sample of 645 nonclinical subjects. They had to complete the IGRS-15s, the Scale for the Measurement of the Impending Punishment (SMIP; Caprara et al., 1990), the Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor et al., 1997), the Psychological General Well-Being Index (PGWBI; Dupuy, 1984), and the Affective Neuroscience Personality Scales (ANPS; Davis, Panksepp, & Normansell, 2003), together with an ad-hoc questionnaire for collecting demographic data, the Socio-Demographical Schedule. We have performed a confirmatory factor analysis to verify if the four-factor solution based on CMT and replicated in previous research (Gazzillo et al., 2017) was confirmed. Then, we checked the retest reliability of IGRS-15s after four weeks in a random subsample of 54 subjects. In order to assess its concurrent and discriminant validity, we calculated the correlations between IGRS-15s assessment and SMIP and IGQ-67. Finally, to test its construct validity, we assessed the relationships between the IGRS-15s and the affective systems using the ANPS and the wellbeing assessed with the PGWBI. The data collected support the retest reliability and the concurrent and discriminant validity of the measure, and we have collected preliminary data about its construct validity. Examples of the possible clinical and research applications of this tool are discussed.

Comments on "The necessary and sufficient conditions of therapeutic personality change.".

This commentary describes the impact of Carl Rogers' classic article (see record 2007-14630-002) on the field of psychotherapy in general and on control-mastery theory and research in particular. The relevance of Rogers' model in the current psychotherapy literature and debates is addressed as are some of the limitations of the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Reliability and Validity of the Interpersonal Guilt Rating Scale-15: A New Clinician-Reporting Tool for Assessing Interpersonal Guilt According to Control-Mastery Theory.

This article introduces the Interpersonal Guilt Rating Scale-15 (IGRS-15), a brief clinician-rated tool for the clinical assessment of interpersonal guilt as conceived in Control-Mastery Theory (CMT; Silberschatz, 2015; Weiss, 1993), and its psychometric proprieties. The items of the IGRS-15 were derived from the CMT clinical and empirical literature about guilt, and from the authors' clinical experiences. Twenty-eight clinicians assessed 154 patients with the IGRS-15, the patient self-reported Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor, Berry, Weiss, Bush, & Sampson, 1997), and the Clinical Data Form (CDF; Westen & Shedler, 1999). A semi-exploratory factor analysis pointed to a four-factor solution in line with the kinds of guilt described in CMT: Survivor guilt, Separation/disloyalty guilt, Omnipotent responsibility guilt, and Self-hate. The test-retest reliability of the IGRS-15 was good. Moreover, the IGRS-15 showed good concurrent and discriminant validity with the IGQ-67. IGRS-15 represents a first step in the direction of supporting the clinical judgment about interpersonal guilt with an empirically sound and easy-to-use tool.