Testing of the therapist to reduce maladaptive interactional patterns: Categorizing patients' tests.

OBJECTIVE: This empirical study undertakes a categorization of the core concept of Control Mastery Theory: mostly unconscious testing of pathogenic beliefs that patients exhibit in relating to their therapist to work on their problems. The focus lays on latent meanings of manifest tests. METHOD: We qualitatively analyze transcripts of 172 psychotherapy sessions with 23 patients for sequences in which significant patient-therapist interactions occur, and systematize identified tests into thematic categories based on what tests intent to achieve (ICC = .68). Guided by theory, the analysis is attending to complexity, individuality, and the unconscious. RESULTS: Tests circle around striving for independence, deserving/self-worth, acceptance, and entitlement. Individual tests have various underlying meanings, are interrelated, and may be multidimensional. CONCLUSION: Meanings of tests must be confirmed within the psychotherapeutic process. Incorporating the treating clinician thus seems important.

Can we differentiate between psychoanalytic and psychodynamic psychotherapy? - An empirical investigation of therapists' self-reports.

Therapy differentiation is a crucial component of psychotherapy research. It refers to whether inspected treatments differ from one another. In the history of psychoanalysis, the differentiation between psychodynamic and analytic psychotherapy was often discussed but seldom inspected empirically. In this study, we propose a set of items which should in theory offer the possibility to differentiate between psychodynamic and analytic psychotherapy on session level. We inspect these items using therapists' self-reports concerning N = 295 cases of different psychodynamic and analytic therapies. Results of an exploratory factor analysis and subsequent inspections of the psychodynamic and analytic items in different forms of therapies strengthen the usability of these items for differentiating between psychodynamic and analytic therapy. However, further studies using different perspectives (e. g., observer ratings) are essential. The presented items are a promising step towards the development of an instrument for treatment differentiation which could later be used in treatment comparison studies.

Passing patients' tests-But how? An analysis of therapists' helping skills in response to patient testing.

According to control mastery theory, patients in psychotherapy try to master their problems by disconfirming their pathogenic beliefs. This can be done by testing the therapist. So far, there is hardly any evidence on what concrete interventions or statements of therapists are specifically helpful in passing those tests. In our study, we analyzed the verbal utterances of therapists in test situations to determine whether there is a difference in statements used for passing or failing tests. A total of 168 session transcripts of 21 patients were selected from a total of six therapists, two each in psychoanalytic therapy, psychodynamic therapy, and cognitive behavioral therapy. Test situations were identified, and therapist responses were coded using the helping skills system. There were significant differences in the therapists' reactions to test situations. In particular, closed questions, approval, interpretation, and reflection of the patients' feelings by therapists were associated with a high probability of passing tests. These findings can especially support therapists-in-training to obtain an orientation on how to deal with their patients' test situations that may be perceived as challenging and are important for therapy success while respecting the individuality of their patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

[Can Psychoanalytic and Psychodynamic Psychotherapy be Reliably Discriminated? - Developement of the "Adherence of Psychoanalytic and Psychodynamic Therapy Scale" (APP Scale)]. / Können analytische und tiefenpsychologisch fundierte Psychotherapie reliabel voneinander getrennt werden?

The study aims at the development of an adherence scale (APP) for psychoanalytic therapy (PA) and psychodynamic therapy (PD) with high discriminant ability to differentiate between these 2 treatments. The development of the APP scale comprises 6 steps. Nine trainees underwent an intensive rater training. After reaching an interrater reliability of ICC [2.1]>0.60, seven trainees participated as raters in the psychometric study. The reliability of the APP Scale was ICC [1.1]=0.58 and ICC [1.3]=0.81 (PA subscale), and ICC [1.1]=0.67 and ICC [1.3]=0.86 (PD subscale) indicating sufficient to excellent reliability. The discriminant ability of the APP Scale based on audiotaped PD- and PA-sessions was d=1.04 (PA subscale) and d=1.48 (PD subscale) indicating large effect sizes, respectively. Thus, the APP scale applied by trained psychology students and postgraduates, discriminates reliably the conceptually overlapping treatments, provided that the raters were trained intensively by experts in PA and PD.

Outcome trajectories and mediation in psychotherapeutic treatments of major depression.

Trajectories and mediators of change were investigated in a process-outcome study. Patients were allocated at random to psychoanalytic therapy (PA) or psychodynamic therapy (PD), and later to cognitive-behavioral therapy (CBT). Measurement points were at pre-treatment, during ongoing treatment, at post-treatment, and during a three-year follow-up. Outcome trajectories were assessed using the Beck Depression Inventory (BDI; Hautzinger et al. 1994), the Symptom Checklist 90 Revised Version (SCL-90-R; Franke 1995), and the Inventory of Interpersonal Problems (IIP; Horowitz, Strauss, and Kordy 2000). Therapeutic alliance and introject were tested as mediators, assessed using the Helping Alliance Questionnaire (HAQ; Bassler, Potratz, and Krauthauser 1995) and INTREX, introject surface (Tress 1993). Multilevel modeling was applied to estimate outcome trajectories and to test for mediation. Symptoms decreased in early and ongoing treatment in all treatment groups. After the end of treatment, depressive and general psychiatric symptoms continued to decrease in significantly greater degree in the PA group than in the PD and CBT cohorts. During early treatment, interpersonal problems decreased significantly more in those allocated to PD than in the PA and CBT groups. During ongoing treatment, improvement in interpersonal problems was significantly higher in the PA group than in the others and, compared to CBT, continued to increase significantly after termination. Mediational analyses revealed that neither introject affiliation nor therapeutic alliance mediated differential treatment effects.

Oxytocin-induced coping with stressful life events in old age depends on attachment: findings from the cross-sectional KORA Age study.

BACKGROUND: Whether oxytocin functions as a stress hormone in older age is unknown. We investigated oxytocin levels and the perceived stress of an adverse life event in an older population-representative sample and considered the effect of a secure/insecure attachment style on this association. METHODS: Non-fasting plasma oxytocin was measured from 952 participants (65-90 years) of the cross sectional KORA-Age study. The psychological impact of an adverse life event was assessed based on the Psychosocial Stress Questionnaire. Attachment style was determined by the Relationship-Specific Attachment Scales for Adults. Linear regression models of oxytocin, stratified for attachment style, were controlled for age, sex, and further for alcohol, smoking, and physical activity. Adjusted least squares means of oxytocin were calculated. RESULTS: Oxytocin levels did not differ between men and women (mean, 95% confidence interval (CI), 321 (277-365) and 309 (272-345)pg/ml, respectively). Oxytocin levels were positively associated with the experience of an adverse event (n=273, 29%) versus no event (n=679, 71%), in securely attached (ß estimate=0.17, standard error (SE)=0.08, P value=0.03) but not in insecure participants (-0.10, 0.09), P=0.28). Oxytocin was positively associated with diminished stress among securely attached participant (event with little suffering: ß=0.35. SE=0.12, great suffering: ß=0.15. SE=0.14, severe suffering: ß=0.03. SE=0.12). Among participants who reported minimal suffering, insecure individuals had lower oxytocin (adjusted mean, 95%CI: 172, 127-216 pg/ml) than securely attached individuals (279, 222-352 pg/ml, P=0.006). CONCLUSIONS: These epidemiologic data support the hypothesis that oxytocin may have an attenuating effect on perceived stress due to adverse life events in old age. The conditional role of attachment style in stress-induced endogenous oxytocin production is highlighted.

Is It All about the Higher Dose? Why Psychoanalytic Therapy Is an Effective Treatment for Major Depression.

UNLABELLED: Empirical evidence for the effectiveness of long-term psychodynamic psychotherapy (LTPP) in patients with mood disorders is growing. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/psychoanalytic techniques or to a higher number of sessions. We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) and cognitive-behavioural therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy and 24 receiving CBT. Depressive symptoms, interpersonal problems and introject affiliation were assessed prior to treatment, after treatment and at the 1-, 2- and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT. Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques on changes in introject affiliation during follow-up. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression. KEY PRACTITIONER MESSAGE: Psychoanalytic therapy is an effective treatment for major depression, especially in the long run. The differential effectiveness of psychoanalytic therapy cannot be fully explained by its higher dose. Distinctive features of psychoanalytic technique (e.g., focusing on patients' dreams, fantasies, sexual experiences or childhood memories) may play an important role in establishing sustained therapeutic change.

[Utilization and utility of psycho-oncologic support of patients with mamma-carcinoma]. / Nutzung und Nutzen psychoonkologischer Versorgung bei Patientinnen mit Mamma-Karzinom.

OBJECTIVES: This study explores patients' utilization of psycho-oncologic support and the effectiveness thereof. METHODS: At the hospital in Munich-Harlaching, 51 patients were recruited following their first admission to the breast centre, 27 of whom utilized the psycho-oncologic service. They were compared to 24 decliners of the service. All patients completed self-rating questionnaires (Distress-Thermometer and Patient Health Questionnaire) at admission and at release. Group differences were calculated statistically by chi-square- and t-tests. RESULTS: We found no significant differences between users and decliners concerning socio-demographic and somatic data, but there were significant group differences in mental health. Users reported more mental distress and more depressive and anxiety symptoms. Psycho-oncologic interventions showed small to large effect sizes. CONCLUSIONS: Although this study corresponded more to external than to internal validity standards, it did yield provisional empirical evidence that psycho-oncologic interventions are effective in the treatment of the mental symptoms of breast cancer patients.

Mental health in the aged: prevalence, covariates and related neuroendocrine, cardiovascular and inflammatory factors of successful aging.

BACKGROUND: Although aging is accompanied by diminished functioning, many elderly individuals preserve a sense of well-being. While the concept of "successful aging" has been popular for many decades, little is known about its psycho-physiologic and endocrine underpinnings. KORA-Age is a population-based, longitudinal study designed to determine the prevalence of successfully aged men and women between 65 and 94 years old in the MONICA/KORA Augsburg cohort of randomly selected inhabitants. Specifically, we aim to identify predictors of successful aging and to elucidate bio-psychosocial mechanisms that maintain mental health and successful adaptation despite adverse experiences of life and aging. METHODS/DESIGN: Components of successful aging were assessed in a telephone survey of 4,127 participants (2008-2009) enrolled in the MONICA/KORA cohort, on average, 13 years earlier. Psychosocial, somatic and behavioural predictors are used to determine factors that contribute to successful aging. An age-stratified random sub-sample (n = 1,079) participated in a personal interview where further psychological mechanisms that may underlie successful adaptation (resilience, social support, attachment) were examined. The interactions among neuroendocrine systems in the aging process are investigated by studying the cortisol/dehydroepiandrosterone-sulfate ratio, the level of insulin-like growth factor I, and oxytocin. DISCUSSION: Longitudinal determinants of successful aging can be assessed based on a follow-up of an average of 13 years. A comprehensive analysis of biological as well as physio-psychological information provides a unique opportunity to investigate relevant outcomes such as resilience and frailty in the elderly population.

Patterns of interpersonal problems and their improvement in depressive and anxious patients treated with psychoanalytic therapy.

Interpersonal problems were studied in 121 patients treated with psychoanalytic therapy using the Inventory of Interpersonal Problems. Four characteristic subtypes were identified, which differed in the quality and flexibility of their interpersonal behavior. Independent of the predominant type of interpersonal problems, the psychotherapy treatment led to strong decreases in interpersonal distress and increases in interpersonal differentiation. Psychoanalytic therapy was highly effective for all identified interpersonal subtypes and seems to help patients achieve more satisfactory relationships.

[Effectiveness of inpatient psychodynamic psychotherapy: a follow-up study]. / Langzeit-Katamnese zur Effektivität einer stationären psychodynamischen Psychotherapie.

OBJECTIVES: This study investigates the stability of symptomatic and interpersonal changes after inpatient psychodynamic psychotherapy. METHODS: 437 patients were assessed 3 to 5 years after discharge with the Symptom Checklist (SCL-90-R), the Inventory of Interpersonal Problems (IIP), global assessment of effectiveness and utilization of posttreatment psychotherapy. The therapist's perspective was evaluated by the Impairment Severity Score (BSS), the Global Assessment of Functioning Scale (GAF), and the Clinical Global Impressions (CGI). RESULTS: Patients improved in all SCL-90-R scales significantly. The Global Severity Index (GSI) effect size was 0.81 posttreatment and 0.82 at follow-up. All IIP scales improved significantly; effect size of IIP total score was 0.40 at posttreatment and 0.60 at follow-up. There were substantial gains in BSS,GAF, and CGI. 84% of the patients were in psychotherapy after dismissal. DISCUSSION: Posttreatment results were in accordance with comparable studies. The results are stable on a symptomatic level and improve further on an interpersonal level.

Psychic structure: exploring an empirically still unknown territory.

The Scales of Psychological Capacities (SPC) were developed to gauge structural change, the mode-specific effect of psychoanalysis and psychoanalytic psychotherapies. In this study, as a first step, basic psychometric properties that assess psychic structure were examined. Construct validity was investigated as predictive validity in a known-groups approach. Two predictions were formulated: (1) there are differences in psychic structure between borderline patients, depressive patients, and healthy controls that are verified by the SPC, and (2) borderline patients show inconsistent and divergent self- and object representations most frequently, followed by depressive patients and, finally, by healthy controls, a fact reflected by the SPC. These scales were applied to a sample of 33 borderline patients, 36 depressed women, and 36 healthy controls. Both predictions were confirmed. Thus, empirical evidence is provided of the SPC being a valid measure for assessing psychic structure.

[Results of psychoanalytic long-term therapy in specific diagnostic groups: improvement in symptoms and interpersonal relationships]. / Ergebnisse analytischer Langzeitpsychotherapien bei spezifischen psychischen Störungen: Verbesserungen in der Symptomatik und in interpersonellen Beziehungen.

OBJECTIVES: In the present paper, data from four German studies on the efficacy of outpatient psychoanalytic long-term psychotherapy were examined for symptom reduction (SCL-90-R) and reduction of interpersonal problems (IIP-D). Specifically, the research question addressed the efficacy of long-term therapy in specific diagnostic groups and was was compared with that of a parallel group who underwent shorter-term psychodynamic therapy. METHODS: Data from four German studies addressing the efficacy of outpatient psychoanalytic long-term therapy were collected. Evaluation of these data was carried for specific diagnostic groups allowing for comorbid diagnoses. The effects of psychoanalytic therapy were assessed by pre-post and pre-follow-up comparisons using paired t-tests. Additionally, effect sizes were calculated. Psychoanalytic long-term psychotherapy and shorter-term psychodynamic therapy were compared by using a repeated measure ANOVA: Pretreatment vs. posttreatment/follow-up (two-levels) with the between subject factor "therapy conditions" (two levels). RESULTS: The results showed that in terms of improvement of symptoms and interpersonal problems, psychoanalytic long-term therapy was at least as effective as shorter term psychodynamic therapy with regard to the following ICD-10 diagnostic groups: affective disorders (F3), anxiety disorders (F40; F41; F42), personality disorders (F60; F61; F62), and a group of mixed neurotic disorders (F43; F50; F51; F1; F55). Effect sizes were large and remained stable at follow-up. CONCLUSIONS: The authors emphasize the clinical relevance of the examined diagnostic groups and relatively large effects achieved by the psychoanalytic treatment. Furthermore, the occurrence of comorbid diagnoses and their consequences are discussed. The authors stress that the specific effects of psychoanalytic therapy can only be very insufficiently tapped by the outcome measures referring to symptoms and interpersonal problems.

[How do community-based mental health staff in Austria perceive their job? -- a qualitative study]. / Wie erleben Professionelle der gemeindepsychiatrischen Versorgung in Osterreich ihre Tätigkeit? -- Eine inhaltsanalytische Studie.

OBJECTIVE: The aim of this study was to explore, using a simple qualitative design, how community mental health staff in Austria perceive their job. METHOD: 195 community-based mental health professionals answered seven open questions on how they perceive their job. The main areas covered were the most important tasks of the job, skills necessary to perform these tasks, as well as positive and negative aspects of the job. Answers were subjected to thematic content analysis. RESULTS: For most professionals, contact with clients and team colleagues were the major rewards of the job. Aspects experienced as stressful were the clients' illness, role ambiguity, team conflicts and lack of time. Necessary skills many respondents did not feel competent in were specialised knowledge and psychosocial skills. CONCLUSIONS: It might be useful to revise existing forms of collaboration within multiprofessional teams. The responsibility for difficult patients may be shared by several members of the team, who should contribute their specific knowledge. Training should be tailored towards the needs of the different professional groups and focus on those skills that are required in community mental health care.

[Job satisfaction and burnout in professionals in austrian mental health services]. / Jobzufriedenheit und Burn-out bei Professionellen der gemeindepsychiatrischen Versorgung in Osterreich.

OBJECTIVE: The aim of this study was to explore job satisfaction, professional role and burnout among community mental health staff in Austria. METHODS: The Minnesota Job Satisfaction Questionnaire, the GHQ-12, the Maslach Burnout Inventory and a questionnaire exploring staff's professional role and team identity were administered to 195 community-based mental health professionals in two Austrian regions. Staff's job perception was assessed in open questions. Predictors of burnout scores were identified in multivariate analyses. RESULTS: While the mental health professionals had elevated scores on the GHQ-12, their levels on the three burnout subscales were low. Social workers and psychologists showed the lowest job satisfaction, social workers also had low role identity scores. Being in the current job for a short time and disposing of psychosocial skills were predictors of high job satisfaction. High burnout scores were predicted by the lack of basic psychosocial competence and a lack of general knowledge in mental health care. The effect of caseload on psychological well-being was positive as well as negative. CONCLUSIONS: Even if the mental health professionals in our study show high levels of general stress, they seem to have less emotional problems resulting from extensively dealing with troubled individuals. Improving basic psychosocial competence and general expertise in mental health care might have a protective effect against developing a burnout syndrome.