Psychotherapists' experiences of telepsychotherapy during the COVID-19 pandemic in Argentina: impact on therapy setting, therapeutic relationship and burden.

In order to prevent the spread of the coronavirus in Argentina, quarantine and distancing measures were adopted. This has led to a large increase in the use of online psychotherapy. Several international studies have already examined the transition from face-to-face therapy to telepsychotherapy during the COVID-19 pandemic from a therapist perspective, but within these studies, the Latin American context is not represented. To fill this research gap, this qualitative study explored the Argentinean psychotherapists' experiences with online psychotherapy during the COVID-19 pandemic by means of in-depth interviews and content analysis. Based on the international literature, an interview guideline was created which covered three main topics: setting, therapeutic relationship, and burden among therapists. For the analysis of the therapists' answers, a detailed codebook was developed. Effects were identified in all three areas investigated. The nine interviewed psychotherapists described unfavorable therapy conditions which affected the therapeutic setting, the psychotherapeutic methods and contents. Positive effects in the therapeutic relationship included patients being more open, but also negative effects such as discontinuation of therapies were reported. Therapists experienced telepsychotherapy as more exhausting than in-person psychotherapy, but they considered it a valuable tool during the pandemic, and the transition an enriching experience. These results, which are partially consistent with international findings, have practical implications for the practice of telepsychotherapy in Argentina. Technical conditions should be improved and patients' privacy during the session should be ensured. Treatment techniques and diagnostics need to be adapted for their use in telepsychotherapy.

Space and Well-Being in High Security Environments.

Research into the spatial dimensions of deprivation of liberty and psychiatric hospitalization has a long and complex tradition. In this context, the increasing numbers of prisoners and patients in forensic hospitals have impressively shown how difficult it is to ensure security, therapy and rehabilitation when space is scarce or not well-suited. In this narrative review, we present the main findings of recent lines of research on spaces in prisons and forensic psychiatric wards, with particular attention to the links between overcrowding in prisons and secure forensic psychiatric hospitals and violence, the foundations of prison and hospital architecture, and on how the design of spaces in prisons and hospitals can influence well-being. We assess and discuss these findings in the context of the current debate on how well-being in secure spaces can support the achievement of rehabilitation goals even in overcrowded institutions.

External locus of control and cognitive ability independently distinguish men in prison from community living non-offending men.

BACKGROUND: The ability to cope with failure and subsequent feedback is crucial for prisoner rehabilitation. Impaired executive function in prisoners, high trait aggression and external locus of control can undermine the capacity to react to feedback in socially adaptive ways. AIM: To investigate the relationships between aggression, locus of control, and attribution in an experimental task involving feedback about failure and success. METHODS: Two groups were compared: 1. Imprisoned men, 2. Community living men without a history of incarceration. Aggression, locus of control and reasoning ability were assessed by means of psychometric instruments. An experimental task building on cognitive ability and providing performance-related feedback was carried out. Attributions of failure and success were measured using an ad hoc rating scale. RESULTS: Prisoners reported higher levels of aggression and generalised externality, but poorer reasoning ability than the comparison group. Aggression was associated with external locus of control. In the experimental task, the community group showed higher success rates; higher scores on the task were correlated with less external attribution of own performance. Higher external locus of control and lower reasoning ability were independently associated with being a prisoner in a logistic regression model. CONCLUSIONS AND IMPLICATIONS: Men in prison were characterised by greater social and fatalistic externality paired with lower reasoning ability than never incarcerated community men. In-prison rehabilitation strategies should pay early attention to improving reasoning ability and enabling men to recognise likely overuse of externally attributing their difficulties to fate, then helping them to become more realistic in their attributions and make use of realistic feedback.

Rising inpatient numbers in forensic security hospitals of German federal state of Baden-Württemberg: Background and explanatory approaches.

In this article, we describe critical epidemiological trends in forensic psychiatric care in the German federal state of Baden-Württemberg. For some years, there has been a marked increase in the number of patients with psychoses and with a migration background in the high-security hospitals of Baden-Württemberg. We present a number of studies exploring hypotheses as to why this is the case. Taking into account a set of person-related and non-person (forensic system)-related variables, we suggest that rising treatment figures may be understood in terms of system variables rather than individual patient characteristics. Findings regarding predictors of treatment length and legal outcome, as well as characteristics of migrant patients and patients assigned to forensic aftercare, are discussed.

Well-Being as a Precursor and Consequence of Micro-Processes in a Group Psychotherapy With Forensic Patients.

Psychotherapy is an important approach for the treatment of psychiatric disorders. Apart from treating disorders as such, psychotherapy aims at increasing patients' well-being. The Therapeutic Cycles Model (TCM) is a process-oriented theoretical model that makes predictions about the psychotherapeutic progress based on verbatim content. The model helps to identify therapeutic factors on a language level. The present study aims at analyzing transcripts of group therapy sessions with forensic psychiatric patients using the rationale of the TCM. Furthermore, the relationship between linguistic features of psychotherapy sessions and patients' well-being before and after therapy are investigated. In order to identify therapeutic factors, a group psychotherapy with nine drug addicted forensic psychiatric patients was videotaped and transcripts of N = 16 sessions were analyzed. Process-oriented measures were rated by the patients, their therapists, and an external observer. Patients' self-reported well-being before therapy was negatively related to Connecting (indicating emotional insight), and the frequency of therapeutic cycles, which are both thought of as key moments in therapy. Well-being of forensic patients is not necessarily a helpful precursor for insightful and productive events in therapy to occur. The findings help to better understand psychotherapeutic micro-processes throughout forensic therapies, and their relationship with patients' well-being. Implications for research and the forensic practice are discussed.

Aggression, attributional style, and locus of control among imprisoned migrants from the former Soviet Union.

BACKGROUND: In the 1990s, over two million migrants from the former Soviet Union with German ancestry came to Germany, a small number of whom committed offences. AIM: The aim of this study is to investigate aggression, locus of control, and attributional style in these (male) migrants imprisoned in Germany. METHODS: Three groups of men with German ancestry were compared: 1.36 prisoners migrating into Germany from the former Soviet Union (migrant-P), 2.31 migrating into Germany from the former Soviet Union without a history of offending (community sample; C), and 3.40 German prisoners with no migration experience (native-P). RESULTS: Aggression was high among all prisoners relative to nonoffending migrants. Prisoners tended to be under-achievers educationally compared with community living migrants. Imprisoned migrants had scores on locus of control and on attribution scales of feeling more influenced by fate and other external factors than had the community migrants, but in a regression model with aggression as the dependent variable and locus of control and attributional style measures as the independent variables, only external attributional style with respect to failure was significantly related to aggression. IMPLICATIONS: External attributional style appears to be linked to the probability of aggressive behaviours, leading to unlawful acts and imprisonment. Regardless of whether a person has a migration history or not, as attribution of failure among these relatively low-achieving prisoners was associated with aggression, loosening these attributional tendencies in therapy might help to reduce aggression. Migration per se was not problematic in these respects in this sample.

La Psicoterapia Psicoanalítica de Grupos Paralelos de Padres e Hijos: interrelaciones de la perspectiva clínica con la investigación empírica de proceso terapéutico / The psychodynamic Parent-Child Parallel Group Intervention: Relationships between the clinical perspective and the analysis of the therapeutic process

El presente artículo presenta el abordaje denominado Psicoterapia Psicoanalítica de Grupos Paralelos de Padres e Hijos. Se describen diferentes fases y aspectos de la trayectoria clínica y de investigación (2002-2014), incluyendo las perspectivas epidemiológica, diagnóstica y terapéutica de la consulta. Se describen los estudios centrados en el análisis del proceso terapéutico de un grupo de madres, cuyo objeto de investigación fueron la Interacción Grupal, el Foco Terapéutico, los patrones verbales de emoción-abstracción y los factores terapéuticos comunes en la terapia grupal (basados sobre Yalom, 1985). Estos estudios mostraron que en la fase inicial del grupo dominan las racionalizaciones y la disociación de los afectos respecto de las situaciones traumáticas, y especialmente de la problemática del niño. La experiencia del grupo como base segura (factor terapéutico Cohesión Grupal) posibilita el proceso de crecimiento en el grupo en la fase media. En la fase final del grupo se manifiestan nuevas modalidades de afrontar la frustración o las amenazas de un medio circundante poco propicio.

Sintomatología depresiva y función reflexiva en la psicoterapia psicodinámica con pacientes distímicas: comparación de tres casos / Depressive symptoms and reflective function of dysthymic patients in a psychodynamic psychotherapy: a comparison of three single cases

El estudio examina empíricamente la relación entre el estado de ánimo depresivo y la mentalización en el curso de la terapia. Las preguntas de investigación fueron: ¿Pueden observarse cambios en el estado de ánimo depresivo y / o en la mentalización en el curso de la terapia? ¿Puede observarse una relación entre el síntoma depresivo cardinal y la mentalización? Método: La muestra se compuso de tres casos únicos homogéneos en cuanto a sexo, edad, diagnóstico y resultado del tratamiento. La terapia incluyó como mínimo 50 sesiones. Los instrumentos utilizados fueron Profile of Mood States (POMS) para medir la Depresión y Reflective Functioning Scale para medir la Función Reflexiva (Reflective Function, RF). Para el análisis estadístico se utilizó la correlación de rangos de Spearman. Resultados: En los tres casos se observó una tendencia descendente para la variable Depresión. La RF disminuyó en un caso, y en dos casos no se modificó. Sólo en un caso se halló una correlación (negativa) entre Depresión y RF. Conclusiones: En estudios futuros deberá investigarse una muestra más amplia y homogénea. Se recomienda la utilización de un diseño de investigación y de métodos estadísticos más complejos, así como la inclusión de diversas variables de proceso.(AU)

Sintomatología depresiva y función reflexiva en la psicoterapia psicodinámica con pacientes distímicas: comparación de tres casos / Depressive symptoms and reflective function of dysthymic patients in a psychodynamic psychotherapy: a comparison of three single cases

El estudio examina empíricamente la relación entre el estado de ánimo depresivo y la mentalización en el curso de la terapia. Las preguntas de investigación fueron: ¿Pueden observarse cambios en el estado de ánimo depresivo y / o en la mentalización en el curso de la terapia? ¿Puede observarse una relación entre el síntoma depresivo cardinal y la mentalización? Método: La muestra se compuso de tres casos únicos homogéneos en cuanto a sexo, edad, diagnóstico y resultado del tratamiento. La terapia incluyó como mínimo 50 sesiones. Los instrumentos utilizados fueron Profile of Mood States (POMS) para medir la Depresión y Reflective Functioning Scale para medir la Función Reflexiva (Reflective Function, RF). Para el análisis estadístico se utilizó la correlación de rangos de Spearman. Resultados: En los tres casos se observó una tendencia descendente para la variable Depresión. La RF disminuyó en un caso, y en dos casos no se modificó. Sólo en un caso se halló una correlación (negativa) entre Depresión y RF. Conclusiones: En estudios futuros deberá investigarse una muestra más amplia y homogénea. Se recomienda la utilización de un diseño de investigación y de métodos estadísticos más complejos, así como la inclusión de diversas variables de proceso.

Predicting discharge in forensic psychiatry: the legal and psychosocial factors associated with long and short stays in forensic psychiatric hospitals.

In Germany, both the number of patients treated in forensic psychiatric hospitals and the average inpatient treatment period have been increasing for over thirty years. Biographical and clinical factors, e.g., the number of prior offences, type of offence, and psychiatric diagnosis, count among the factors that influence the treatment duration and the likelihood of discharge. The aims of the current study were threefold: (1) to provide an estimate of the German forensic psychiatric patient population with a low likelihood of discharge, (2) to replicate a set of personal variables that predict a relatively high, as opposed to a low, likelihood of discharge from forensic psychiatric hospitals, and (3) to describe a group of other factors that are likely to add to the existing body of knowledge. Based on a sample of 899 patients, we applied a battery of primarily biographical and other personal variables to two subgroups of patients. The first subgroup of patients had been treated in a forensic psychiatric hospital according to section 63 of the German legal code for at least ten years (long-stay patients, n=137), whereas the second subgroup had been released after a maximum treatment period of four years (short-stay patients, n=67). The resulting logistic regression model had a high goodness of fit, with more than 85% of the patients correctly classified into the groups. In accordance with earlier studies, we found a series of personal variables, including age at first admission and type of offence, to be predictive of a short or long-stay. Other findings, such as the high number of immigrants among the short-stay patients and the significance of a patient's work time before admission to a forensic psychiatric hospital, are more clearly represented than has been observed in previous research.

Assessing reliability, validity, and clinical utility of the BEST-Index in measuring living skills among forensic inpatients.

The assessment of behavioral change as a result of inpatient treatment in forensic psychiatry is an important precondition for violence risk prediction in forensic psychiatry. In relation to a multitude of diagnostically based risk assessment instruments, there is a shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments that are behaviorally based and therefore appropriate for use within varied psychiatric contexts. There is also a need for instruments which will offer assessors the opportunity to examine possible relationships between criteria of social risk and criteria of more general aspects of social functioning. Tapping the issues pointed out above, the authors present an overview of a normatively based social profiling instrument (the BEST-Index), and discuss evidence for its validity, reliability, and aspects of clinical utility.

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 relationship of self-regulation and aggression: an empirical test of personality systems interaction theory.

On the basis of personality systems interaction (PSI) theory, the authors examine self-regulation, conflict behaviour, behavioural resources, and personality disorders in a sample of 83 male offenders and explore the role self-regulatory variables play with respect to aggressive behaviour. Although substantial correlations between self-regulatory functions and aggressive behaviour were found, these variables did not predict aggression in a subsequent regression analysis with measures of self-regulation, conflict behaviour, and personality disorders as independent variables. Antisocial behaviour, behavioural self-control, and affect were among the strongest predictors of aggression. Specific predictions based on PSI theory could not be confirmed. Theoretical implications of the findings are discussed and put into relation with treatment issues of offenders.

El BEST-Index: un instrumento para la valoración de la peligrosidad y las habilidades prácticas en pacientes psiquiátricos / BEST-Index: an instrument for evaluating the dangerousness and practic ability in psychiatry patients

El objeto de este estudio fue ampliar la base empírica de un instrumento para la valoración de la peligrosidad y las habilidades sociales (Behavioural Status índex [BEST-Index]) y explorar su utilidad en la práctica psiquiátrica. La muestra se compuso de N = 86 pacientes internados en unidades psiquiátricas forenses. Los pacientes fueron evaluados en tres oportunidades en intervalos de nueve meses con el BEST-Index, la Escala de Calificación de la Psicopatía Revisada (Psychopathy Check List Revised [PCL-R]) y la escala HCR-20 (Historical-Clinical-Risk Management-20). Resultados: El BEST-Index posee una confiabilidad interjueces adecuada; las escalas del BEST-Index exhiben correlaciones significativas con los instrumentos estadísticos PCL-R y HCR-20. Además, el BEST-Index permite valorar cambios conductuales relevantes en el curso del tratamiento

The aim of this study was to introduce a unified approach to assessment of social risk and related social behaviours in offender groups using the Behavioural Status Index (BEST-Index); and to explore its clinical utility for the forensic psychiatric field. Using an initial sample of N=86 forensic psychiatric patients, the BEST-Index, the Psychopathy Checklist Revised [PCL-R] and the scale HCR-20 (Historical-Clinical-Risk Management-20) were applied three times in intervals of nine months. Results: The BEST-Index has satisfactory inter rater reliability; the data suggest good convergent validity of the BEST-Index scales and the actuarial instruments (HCR-20, PCL-R); the BEST-Index also allows for monitoring behavioural change over the treatment period

Aggressive behavior in male offenders: preliminary analyses of self-regulatory functions in a sample of criminals.

The functional role of self-regulation in aggressive and violent behavior continues to be an important problem in the forensic field. Theoretically, self-regulatory functions should influence other dimensions known to be related to aggressive behavior, but as of yet there is no empirical test of this assumption. Emotional self-regulation, conflict behavior, behavioral resources, and personality disorders were examined in a sample of 70 offenders with respect to the role that self-regulatory variables play in aggressive behavior. Although substantial correlations between self-regulator functions and aggressive behavior were found, these variables did not predict aggression in a subsequent regression analysis. Implications of the findings are discussed and put into relation with treatment issues of aggressive offenders.

Self-regulation in violent and non-violent offenders: a preliminary report.

BACKGROUND: The functional role of self-regulation in violent behaviour is not yet fully understood. AIM: To test the hypothesis that violent offenders have more deficits in self-regulation and self-control than non-violent offenders. METHODS: Self-regulation and personality disorders were evaluated in a sample of 70 violent and non-violent incarcerated offenders using the Volitional Components Questionnaire (VCQ) and the SCID-II for DSM-IV. RESULTS: The self-report data indicate that violent offenders were no different from non-violent offenders on either facilitatory or inhibitory modes of self-regulation and self-control. Compared with a sample of normal, healthy men, differences were found in all tested self-regulation variables but not in self-control. Except for antisocial personality, the groups were similar in personality features. CONCLUSIONS: The proposed hypothesis was not sustained on this measure of self-regulation. With regard to self-regulation and self-control, violent and non-violent offenders were similar and treatment interventions to improve capacity in these respects are probably useful for both groups.

[The evaluation of living skills in forensic-psychiatric patients]. / Die Beurteilung von lebenspraktischen Fertigkeiten forensisch-psychiatrischer Patienten mit dem BEST-Index.

The role of daily living skills in forensic psychiatric patients in relation to psychotherapeutic progress and the potential reduction of dangerous behaviour has been neglected in the scientific discussion about clinical instruments for the evaluation of dangerousness and recidivism. This is mainly due to the lack of adequate observationally based instruments allowing for valid and reliable therapeutic assessments. Therefore, a new means of assessment focusing on daily living skills and social risk (the BEST-Index [Behavioural Status Index] was applied to n = 86 German forensic psychiatric patients. Two widely known actuarial instruments tapping violence risk were administered for cross validation (Psychopathy Checklist Revised [PCL-R], HCR-20). Within intervals of nine months, all instruments were applied three times. Sufficient inter rater reliability and good convergent validity of the sub-scales in relation to the actuarial instruments (HCR-20, PCL-R) could be demonstrated; supported by empirical data, clinicians working with the BEST-Index may use it to monitor behavioural change over long treatment periods. It is suggested that treatment planning and evaluation of mentally ill offenders might profit from its use.

El concepto de insight en la psicoterapia de grupo: Aporte a su clarificación mediante el uso de métodos de análisis de texto computarizado y un modelo de la actividad verbal en los procesos terapéuticos / The conept of Insight in group Psychotherapy: Contribution to its clarificaction through the Use of Computer Assisted Text Analysis and a Model of Speech Activity in Therapeutic Processes

Objetivos. El objeto del estudio fue la indagación de las relaciones entre factores terapéuticos en la psicoterapia grupal y características formales de la conversación grupal. Además se investigó la aplicabilidad de los postulados del modelo de Ciclo Terapéutico (TCM; Mergenthaler, 1996, 1998) a los procesos psicoterapéuticos grupales. Método. El material se compuso de 42 protocolos textuales de sesiones de una psicoterapia grupal para pacientes con trastornos alimentarios registrada en banda magnetofónica y transcripta en su totalidad. Por medio de métodos de análisis de texto asistidos por computadora se identificaron los denominados Patrones de Emoción Abstracción en la conversación grupal. Factores Terapéuticos Grupales fueron evaluados por un observador externo mediante una escala para la medición de procesos grupales. Resultados. Se encontraron relaciones positivas significantes entre el factor terapéutico Insight y el patrón verbal Connecting, así como entre Catarsis y Experiencing. Además se comprobó una relación positiva entre el factor Proceso Terapéutico y una secuencia específica de patrones y variables verbales llamada el Ciclo Terapéutico. Discusión. En este estudio de caso único se observó que el método de los Patrones de Emoción Abstracción realiza aportes diferenciales a la clarificación de los microprocesos grupales.

El concepto de insight en la psicoterapia de grupo: Aporte a su clarificación mediante el uso de métodos de análisis de texto computarizado y un modelo de la actividad verbal en los procesos terapéuticos / The conept of Insight in group Psychotherapy: Contribution to its clarificaction through the Use of Computer Assisted Text Analysis and a Model of Speech Activity in Therapeutic Processes

Objetivos. El objeto del estudio fue la indagación de las relaciones entre factores terapéuticos en la psicoterapia grupal y características formales de la conversación grupal. Además se investigó la aplicabilidad de los postulados del modelo de Ciclo Terapéutico (TCM; Mergenthaler, 1996, 1998) a los procesos psicoterapéuticos grupales. Método. El material se compuso de 42 protocolos textuales de sesiones de una psicoterapia grupal para pacientes con trastornos alimentarios registrada en banda magnetofónica y transcripta en su totalidad. Por medio de métodos de análisis de texto asistidos por computadora se identificaron los denominados Patrones de Emoción Abstracción en la conversación grupal. Factores Terapéuticos Grupales fueron evaluados por un observador externo mediante una escala para la medición de procesos grupales. Resultados. Se encontraron relaciones positivas significantes entre el factor terapéutico Insight y el patrón verbal Connecting, así como entre Catarsis y Experiencing. Además se comprobó una relación positiva entre el factor Proceso Terapéutico y una secuencia específica de patrones y variables verbales llamada el Ciclo Terapéutico. Discusión. En este estudio de caso único se observó que el método de los Patrones de Emoción Abstracción realiza aportes diferenciales a la clarificación de los microprocesos grupales.(AU)