Emergence and assessment of interpersonal experience and behavior in a nonverbal, generative, game-like paradigm.

Dominance, hostility and autonomy are interpersonal phenomena that emerge from the complex dyadic interplay of two individuals reciprocally influencing each other. Assessing the complexity of interpersonal interactions usually involves its reduction, for example with self-report and observer-rated measures informed by the structural analysis of social behavior (SASB). In contrast, letting individuals generate a complex stream of interpersonal experience and behavior from moment to moment is an empirical approach not yet usual in interpersonal theory. In the present study, we developed and evaluated an interpersonal, generative paradigm that allows participants to interact nonverbally and spontaneously with a computer-controlled other player in real-time without the need for introspection or the capacity to verbalize potentially implicit interpersonal processes. In the game-like paradigm, participants use the keyboard to take over objects such as a handcar to move autonomously around and encounter interfering or freedom granting artificial other players. We expected that participants (1) experience the nonverbal so-called game mechanics of the paradigm as interpersonal in nature, (2) behave towards the other players in an interpersonally complementary way, and (3) are influenced by their own trait interpersonal expectations. During the paradigm, 40 participants appraised the majority of the game mechanics and computer-controlled other players as intended. Also, interpersonal traits affected the spontaneous behavior towards artificial characters. These findings corroborate the feasibility and validity of a generative assessment of interpersonal dynamics beyond self-reports and observer ratings. The paradigm paves the way for the empirical testing of formal, computational models of dyadic interaction.

Art therapy and self-image: A 5-year follow-up art therapy RCT study of women diagnosed with breast cancer.

OBJECTIVE: This follow-up study on perceived self-image and psychophysical distress/psychic symptoms was based on a ranomized contolled study of art therapy on women with breast cancer. METHOD: The aim was to examine the long-term effects of time-limited art therapy using the instruments of Structural Analysis of Social Behavior (SASB) and Symptom Check List-90 (SCL-90). RESULTS: Three attachment clusters of the SASB showed significant changes post therapy: Autonomous self (cluster 1), Accepting self (cluster 2), and Loving self (cluster 3). Clusters 2 and 3 continued to change in favor of the intervention group at the 5-year follow-up. There were no significant differences in the SCL-90 results between the intervention group and the control group in the follow-up study. SIGNIFICANCE OF RESULTS: The art therapy intervention was both therapeutic and psycho-educative. The conclusion of this study is that approaching emotions through time-limited art therapy seems to have a long-lasting effect on the attachment behavioral system shown in the SASB model post intervention, and this effect remained 5 years later.

Using interpersonal reconstructive therapy to address comorbid problems organized by attachment-based learning: The case of Don.

Feature heterogeneity and diagnostic overlap occur regularly among patients in clinical settings. In interpersonal reconstructive therapy (IRT), a case formulation focused on patterns learned in close attachment relationships guides intervention choices. This study illustrates how IRT formulation and treatment proceed, and how it may also fail when there is not close adherence to underlying principles. Don is a music professor in his 40's with a significant trauma history and complex diagnostic profile that includes many hospitalizations and suicide attempts. He qualified for several diagnostic and statistical manual of mental disorders personality disorders via formal diagnostic interviews (obsessive-compulsive, avoidant, passive-aggressive, narcissistic), as well as major depression, generalized anxiety, and substance abuse. Don's formulation demonstrates how self-destruction can function as a "gift of love" to internalized representations of important caregivers. Data from work with patients like Don confirm the usefulness of Benjamin's IRT lens for navigating comorbidity, as well as the importance of underlying principles of change.

Moment-by-moment interpersonal behaviors in poor vs. good psychodynamic psychotherapy outcomes: Does complementarity say it all?

Can patient-therapist moment-by-moment transactions uncover contrary treatment outcomes? The current study answers this question by analyzing the transcripts from eight therapy sessions of 20 patients each, for a total of 160 sessions and nearly 30,000 units of analysis. Patients were matched into ten pairs, each having the same diagnosis and the same clinician but with opposite treatment results: Ten patients were classified as responders (i.e., good-outcome patients) and as many as nonresponders (i.e., poor-outcome patients). Patient and therapist behaviors were coded using the Structural Analysis of Social Behavior (SASB) model. Overall, patients and therapists engaged in complementary relational patterns: Good-outcome patients tended to adopt loving and protecting interaction styles, similarly, therapists treating good-outcome cases employed protection and self-disclosure behaviors. In contrast, poor-outcome patients tried to interpersonally separate from the therapist, and both-patients and therapists alike-exhibited attacking and recoiling behaviors. However, when taking a closer look, i) separation appeared to be disruptive per se, that is, beyond any evidenced interpersonal asymmetry; ii) self-disclosure on the therapist side turned out to be supportive of therapeutic complementarity; iii) when facing failure, highly experienced therapists seemed to indulge into noncomplementary or even hostile behaviors. Findings confirm that the target of the patient- therapist transferential transactions should be distinguished from transactions regarding other people or other life circumstances in order to avoid misleading interpretation of data and, consequently, conducting therapy based on misleading grounds.

Therapeutic Atmosphere in Psychotherapy Sessions.

There is uncertainty concerning what the active ingredients in psychotherapy are. The First Experimental Study of Transference interpretations (FEST) was a randomized controlled trial of the effects of transference work (TW) in psychodynamic psychotherapy. Women with low quality of object relations (QOR) showed a large positive effect of transference work, while men with high QOR showed a slight negative effect. The present study aimed to expand the knowledge from the FEST by investigating the therapeutic atmosphere with Structural Analysis of Social Behavior (SASB). Two-way ANOVAs were conducted to investigate differences between SASB cluster scores between subgroups. The therapeutic atmosphere was characterized by Protect-Trust, Affirm-Disclose and Control-Submit. Multilevel modeling was used to assess the relationship between a therapist variable and outcomes for men and women. Contrary to expectations, no significant differences in therapeutic atmosphere between subgroups (with or without TW in women with low QOR and men with high QOR) were observed using the process measure SASB.

Changes in depressed patients' self-statements.

Objective: Individuals' use of self-statements reflecting self-criticism, a sense of inadequacy, and low self-worth has been linked to the incidence, severity, and recurrence of major depressive disorder [de Graaf, L. E., Huibers, M. J. H., Cuijpers, P., & Arntz, A. (2010). Minor and major depression in the general population: Does dysfunctional thinking play a role? Comprehensive Psychiatry, 51(3), 266-274. doi:10.1016/j.comppsych.2009.08.006; Riso, L. P., du Toit, P. L., Blandino, J. A., Penna, S., Dacey, S., Duin, J. S., … Ulmer, C. S. (2003). Cognitive aspects of chronic depression. Journal of Abnormal Psychology, 112(1), 72-80. doi:10.1037/0021-843X.112.1.72]. The present study used an observer-rated measure, the Structural Analysis of Social Behavior [Benjamin, L. S. (1974). Structural Analysis of Social Behavior. Psychological Review, 81(5), 392-425. doi:10.1037/h0037024], to examine patients' self-directed communication over the course of psychotherapy.Method: Self-talk in early and late therapy sessions was examined using cases (N = 44) from the cognitive therapy arm of Jacobson and colleagues' component study of cognitive therapy for depression [Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295-304. doi:10.1037/0022-006x.64.2.295, Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (2000). A component analysis of cognitive-behavioral treatment for depression. Prevention & Treatment, 3(1). doi:10.1037/1522-3736.3.1.323a]. We identified changes at treatment termination, and used hierarchical multiple regression to examine whether improvements in patient self-talk influenced treatment outcome up to 24 months post-termination.Results: Trends indicate that patients used friendlier and less critical self-statements at the end of treatment. Decreased self-critical behaviour was associated with fewer symptoms at the end of treatment and up to one year later; increased self-acceptance was linked to symptom improvement a year and a half after termination.Conclusion: Consistent with cognitive theory, reduced self-criticism was associated with better treatment outcomes. Longer-term improvement was linked to the development of friendlier and more accepting self-referential behaviour.

Psychological symptoms and self-image of patients with complaints attributed to dental restorative materials.

OBJECTIVES: The aim was to study self-image and the level of psychological symptoms in patients with symptoms attributed to their dental restorative materials. MATERIALS AND METHODS: A questionnaire containing questions regarding dental and medical history was answered by 257 participants, one group with local oral symptoms only (LSO), and one group with multi-symptoms (M-S). A reference group was randomly selected from a research database at the Department of Psychology, Umeå University, Sweden. The self-image was assessed using the Structural Analysis of Social Behavior (SASB). Psychological symptoms such as somatization, depression, and anxiety were assessed using the Symptom Check List 90 (SCL-90) and the Global Severity Index (GSI) was used to determine the level of psychological symptoms. RESULTS: SASB showed that the M-S group and the LSO-group scored significantly higher on the "spontaneous" and "positive self-image" than the reference group. In the SCL-90, the M-S group scored significantly higher than the LSO-group and the references on the somatization subscales. On depression, anxiety, and the GSI scale, the M-S group scored significantly higher than the reference group. CONCLUSIONS: The two subgroups scored significantly higher on the SASB Spontaneous and Positive clusters which indicates that these patients have an excessively positive self-image, are very spontaneous and have an overconfidence in themselves compared to the reference group. In the M-S group there was a clear tendency to somatization, depression, and anxiety and they were more psychologically stressed than the reference group. CLINICAL RELEVANCE: Among the patients with illness attributed to their dental materials, the M-S-patients had a significantly higher level of general psychological distress and somatization than the control group which may lead to mental stress.

Does interpersonal behavior of psychotherapy trainees differ in private and professional relationships?

AIM: The present study aimed to evaluate the effect of trainees' interpersonal behavior on work involvement (WI) and compared their social behavior within professional and private relationships as well as between different psychotherapeutic orientations. METHODS: The interpersonal scales of the Intrex short-form questionnaire and the Work Involvement Scale (WIS) were used to evaluate two samples of German psychotherapy trainees in psychoanalytic, psychodynamic, and cognitive behavioral therapy training. Trainees from Sample 1 (N = 184) were asked to describe their interpersonal behavior in relation to their patients when filling out the Intrex, whereas trainees from Sample 2 (N = 135) were asked to describe the private relationship with a significant other. RESULTS: Interpersonal affiliation in professional relationships significantly predicted the level of healing involvement, while stress involvement was predicted by interpersonal affiliation and interdependence in trainees' relationships with their patients. Social behavior within professional relationships provided higher correlations with WI than private interpersonal behavior. Significant differences were found between private and professional relation settings in trainees' interpersonal behavior with higher levels of affiliation and interdependence with significant others. Differences between therapeutic orientation and social behavior could only be found when comparing trainees' level of interdependence with the particular relationship setting. CONCLUSION: Trainees' interpersonal level of affiliation in professional relationships is a predictor for a successful psychotherapeutic development. Vice versa, controlling behavior in professional settings can be understood as a risk factor against psychotherapeutic growth. Both results strengthen an evidence-based approach for competence development during psychotherapy training.

Self-image and eating disorder symptoms in normal and clinical adolescents.

Eating disorders (ED) are psychiatric disorders of multifactorial origin, predominantly appearing in adolescence. Negative self-image is identified as risk factor, but the association between self-image and ED in adolescents or sex differences regarding such associations remains unclear. The study aimed to investigate the relationship between specific self-image aspects and ED symptoms in normal and clinical adolescents, including sex differences. Participants included 855 ED patients (girls=813, boys=42) and 482 normal adolescents (girls=238, boys=244), 13-15 years. Stepwise regression demonstrated strong associations between self-image and ED in normal adolescents (girls: R(2)=.31, boys: R(2)=.08), and stronger associations in patients (girls: R(2)=.64, boys: R(2)=.69). Qualitative sex differences were observed in patients. Connections between specific self-image aspects and ED have implications for clinical management of ED. The strong link between self-image variables and ED symptoms in normal girls, but not boys, is discussed in terms of the continuity-discontinuity hypothesis.

Differentiation, self-other representations, and rupture-repair processes: predicting child maltreatment-risk.

This set of studies was designed to examine the relational underpinnings of child abuse potential in a sample of 51 urban families. In Study 1, lower maternal differentiation of self-most notably, greater emotional reactivity and greater emotional cutoff-along with self-attacking introjects, together distinguished mothers at higher risk (vs. lower risk) for child maltreatment (CM). In Study 2, patterns of interactive rupture and repair were examined in a subsample of n = 15 families and found to vary as a function of risk for CM. Specifically, SASB coding (Benjamin, 1996, 2003) of mother-children interactions during two moderately stressful lab tasks revealed higher rates of interactive mismatch and mother-initiated ruptures, and fewer successful repairs in families at higher-risk-for-CM, relative to families at lower-risk. Implications for counseling and directions for further translational research are discussed.

[Not Available]. / Differente Perspektiven auf den Prozeß in stationärer Psychotherapie/ Different perspectives on the process ofinpatient psychotherapy.

Inpatient psychotherapy is characterized by a combination of different therapeutic approaches. Research on psychotherapeutic processes in inpatient psychotherapy uses often only a single observer's perspective, based on the assumption that there exists a unitary process underlying the total process of inpatient psychotherapy. This assumption is investigated in the present study of two single psychotherapy cases. The process is documented by means of Intrex-questionnaire of both therapist and patient, and by the SASB-coded videotaped and transcribed interactions. The results show a marked incongruence of the process as seen from the perspective of independent raters and from the questionnaire based self-report of therapist and patient. These findings put the commonly described process models of inpatient psychotherapy into question.