The family alliance as a facilitator of therapeutic change in systemic relational psychotherapy for borderline personality disorder: A case study.

Managing the Therapeutic Alliance is often complex when it comes to the treatment of borderline personality disorder (BPD), but the alliance is crucial for the success of the therapy. Combined individual and family interventions have been shown to be very useful in treating of these cases. This study has two objectives. First, to describe how the family therapeutic alliance facilitates therapeutic change through family psychotherapy for families with a member diagnosed with BPD. Second, to analyze how the therapeutic change achieved through combined individual and family systemic relational psychotherapy affects the individual functioning of the patient with BPD. This single case study used the System of Observation of Family Therapy Alliances (SOFTA-o) to analyze the therapeutic alliance, along with two semi-structured clinical interviews, one at the beginning and one at the end of therapy. Results show a dynamic and positive evolution of the therapeutic alliance throughout the therapeutic process and how this alliance facilitated therapeutic change, both reducing the symptomatology of the patient with BPD and improving family communication and functioning. Results contribute to highlighting the importance of including family therapy as an intervention unit in protocols for patients with BPD.

Evaluation of male-specific psychoeducation for major depressive disorder compared to cognitive behavioral therapy psychoeducation: A randomized controlled investigation in mentally distressed men.

Background: Research suggests that male-specific psychotherapy approaches for major depressive disorder (MDD) that consider traditional masculinity ideologies (TMI) may achieve improved treatment efficacy and reduced therapy dropout. However, studies examining male-specific psychotherapy for MDD or specific therapy aspects remain lacking. Methods: An anonymous online study on men's mental health examined 152 self-reporting mentally distressed cisgender men (Mage = 25.5 ± 9.1) from German-speaking countries of Europe. After completing baseline assessments (T1) of state self-esteem, state shame, positive/negative affect, depressive symptoms, and TMI, men were randomly assigned to read either a male-specific (MSP) or a cognitive behavioral therapy-oriented (CBT) psychoeducation text for MDD. Immediately afterwards, participants rated its usefulness and completed follow-up assessments (T2). Results: Men in the MSP condition showed a stronger decrease in shame and negative affect as compared to men in the CBT-psychoeducation condition. Furthermore, in the MSP condition, prototypical depression symptoms tended to increase as compared to the CBT-psychoeducation, whereas male-typical externalizing depression symptoms tended to decrease. Conclusion: MSP for MDD may help depressed men feel less ashamed about their MDD and experience less negative affect about their condition than CBT-psychoeducation. Furthermore, MSP for MDD may elicit a shift from male-typical externalizing depression symptoms to prototypical depression symptoms.

Telehealth-delivered recovery-orientated well-being plan group program for bipolar disorder: a pilot randomised feasibility and acceptability study.

BACKGROUND: Psychological interventions may assist in the management of bipolar disorder, but few studies have assessed the use of group therapy programs using telehealth. AIMS: The present study aimed to assess the feasibility and acceptability of a well-being group program for people living with bipolar disorder designed to be delivered via telehealth (Zoom platform) using a randomised controlled pilot design. METHOD: Participants were randomly assigned to either the 8-week well-being plan treatment condition or the wait-list control condition. They were administered a structured diagnostic instrument to confirm bipolar disorder diagnosis followed by a set of self-report questionnaires relating to mood, quality of life, personal recovery, and stigma. RESULTS: A total of 32 participants (16 treatment; 16 control) were randomised with 12 participants completing the intervention, and 13 the control condition. The program appeared acceptable and feasible (75% retention rate) with a mean attendance being reported of 7.25 sessions attended out of a possible 8 sessions. Participants reported high levels of satisfaction overall with the intervention, with a mean score of 9.18 out of 10. DISCUSSION: Preliminary evidence suggests that delivery of the group program online is feasible and acceptable for participants living with bipolar disorder. As the program was designed to prevent relapse over time, further research is needed to determine if the program may be helpful in improving symptom outcomes over a longer follow-up period.

The potential of arts therapies in Parkinson's disease rehabilitation: A comprehensive review.

Background and purpose: Parkinson's disease (PD) causes a decline in motor function, cognitive decline, and impacts the mental health of patients. Due to the high cost and side effects of conventional treatments, the medical community has begun to explore safer and more cost-effective alternative therapies. In this context, arts therapies have gained increasing attention as innovative treatments. This review plans to explore the role and potential of various arts therapies in the rehabilitation of PD patients by analyzing existing literature and case studies. Methods: This review comprehensively searched the literature in several databases, including PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure, to assess the effectiveness of different arts therapies in the rehabilitation of patients with PD. Results: From 3440 articles screened, 16 met the inclusion criteria. These studies included a variety of therapies, including music, meditation, yoga, art, dance, theatre, video games and play therapy. These different types of arts therapies had a positive impact on the motor, psychological and cognitive rehabilitation of PD patients, respectively. Conclusion: The existing literature highlights the great potential of arts therapies in the rehabilitation of people with PD, further confirming the efficacy of arts therapies in enhancing the motor, psychological and cognitive rehabilitation process of people with PD. In addition, this review identifies research gaps in the use of color therapy in PD rehabilitation and highlights the need for further exploration of various arts therapies modalities.

[The care team, from roots to new challenges]. / L'équipe soignante, des racines aux nouveaux défis.

The team is a fundamental and structuring dimension of care, founded on the principles of complementarity, interdependence, and shared objectives and responsibilities towards the patient. As a result of the pandemic and the rationalization of public hospitals, teams are faced with changes in the role of supervisors and the arrival of new figures such as advanced practice nurses. While these changes can bring new dynamism and questioning of practices, they can also be destabilizing. The institution must preserve the role of the team and its members.

[Adolescents with Gender Incongruence - Special Case Constellations]. / Jugendliche mit Geschlechtsinkongruenz ­ besondere Fallkonstellationen.

Adolescents with Gender Incongruence - Special Case Constellations Abstract: Adolescents with gender incongruence and gender identity variants have a high rate of accompanying mental disorders, such as depression, autism spectrum disorders, or eating disorders. Yet, the interaction between gender incongruence, gender dysphoric distress, and accompanying mental disorders is complex and varies considerably from case to case. We need an individualized approach and careful professional assessment to help those affected and their guardians make informed decisions regarding possible treatment steps in complex case constellations. Maintaining careful process support and planning of the treatment steps can help to resolve blocked development processes in adolescents with gender incongruence and accompanying psychological disorders or in young people with unstable gender identity development.

'Like walking with someone as opposed to trying to catch up to them'-Dynamics at play when clinicians and young people formulate together.

OBJECTIVE: The aim of the present study was to explore the social process of formulation in talk therapy between young people and clinicians. DESIGN: Qualitative semi-structured interview study. METHOD: Ten young people (male = 6, female = 4, age range = 16-23 years) and nine clinicians from various disciplines within a youth mental health service were interviewed. Constructivist grounded theory was used for the analysis. RESULTS: Four themes were constructed from the data; a 'level playing field' between young person and clinician enables formulation, formulating is a constant process of getting it right and getting it wrong, emotional expression and attunement get us closer to each other and to understanding, and 'formulation versus diagnosis' can create tension in the therapy room. The constructivist grounded theory devised demonstrated how the dynamics of power, collaboration, openness, and the therapeutic relationship are constantly in flux during the process of formulation. CONCLUSION: The paper presents a constructivist grounded theory which incorporates dynamics relating to power, collaboration, and openness. The importance of the therapeutic relationship is also emphasised. The theory encourages continuous and recursive personal reflection by the therapist as to how they can be optimally attuned to the dynamics of power, collaboration, and openness with young people.

Formulation-based cognitive behavioral therapy compared to an active control and a waitlist in adult inmates with ADHD: study protocol for a randomized controlled trial.

BACKGROUND: Recent literature suggests that ADHD is a risk factor for the development of antisocial behavior that is more severe and persistent than in community and other psychiatric populations. The combination of stimulant medication and psychotherapy (particularly cognitive behavioral therapy, CBT) is considered an evidence-based intervention for adults with ADHD. In contrast, few studies have evaluated the efficacy of medication in adult prisoners with ADHD, and the literature on the efficacy of psychotherapy is virtually nonexistent. Therefore, this article presents the protocol of a trial that will assess the efficacy of a formulation-based CBT program for inmates with ADHD. METHODS: The study has a multicenter randomized controlled trial design. After screening and recruitment, participants will be randomly assigned to the CBT intervention, a general offender treatment program, or a waitlist. Pre- and post-treatment self-report and clinician-report assessments, as well as 6- and 12-month follow-up assessments will be conducted. These will include both clinical (e.g., ADHD symptoms, depression and anxiety symptoms, self-esteem, alcohol/drug abuse, treatment adherence, quality of life) and criminological (e.g., recidivism and risk of recidivism) measures. Linear mixed models will be used to assess differences between groups. DISCUSSION: This study may be the first to evaluate the efficacy of a psychotherapy intervention in adult inmates with ADHD. It is expected that addressing the specific needs of ADHD would not only result in the previously reported clinical improvements (e.g., reduction in ADHD and comorbidity symptoms), but also reduce the risk and rate of recidivism compared to the general intervention or no intervention. However, the design may be limited by the difficulties inherent in the prison setting and in following up the sample after release. TRIAL REGISTRATION: ClinicalTrials.gov NCT06080373. Registered on October 12, 2023.

The development of the therapeutic alliance during the first five hypnotherapy sessions.

The therapeutic alliance is a principal element that allows the dynamics and effects of psychotherapy to be analyzed. In the past half-century, many studies have explored various psychotherapeutic approaches, including psychoanalytic, cognitive-behavioral and systemic psychotherapy, but hypnotherapy has not been addressed. This article presents the first analysis using current methods of verifying and understanding the dynamics of change in hypnotherapy, regarding to the therapeutic alliance. Luborsky et al.'s (1996) revised Helping Alliance Questionnaire (HAq-II) was administered to 59 patients in treatment with psychologists and psychiatrists using Ericksonian hypnosis. Our results suggest that the dynamics of the alliance in the first sessions of hypnotherapy involve factors related more to the therapist's adjustment to the patient than to the progress the patient makes in these initial sessions.

Halifax somatic symptom disorder trial: A pilot randomized controlled trial of intensive short-term dynamic psychotherapy in the emergency department.

BACKGROUND: Patients commonly present at hospital Emergency Departments (ED) with distress that meet criteria for a Somatic Symptom and Related Disorder (SSRD). Without access to effective treatment, risk of ongoing patient disability and further ED visits is high. METHOD: This pilot trial used a randomized parallel group design to test the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP). ED patients who met criteria for SSRD were recruited. The effects of ISTDP plus medical care as usual (MCAU) were judged through comparison against 8 weeks of MCAU plus wait-list symptom monitoring (WL-SM). The primary outcome was somatic symptom at 8 weeks. Patients allocated to WL-SM could cross-over to receive ISTDP and 6-month follow-up data was collected. Baseline measures of patient attachment style and alexithymia were collected to examine vulnerabilities to somatic symptoms. CLINICALTRIALS: gov: NCT02076867. RESULTS: Thirty-seven patients were randomized to 2 groups (ISTDP = 19 and WL-SM = 18). Multi-level modelling showed that change over time on somatic symptoms was significantly greater in the ISTDP group. Between-group differences were large at 8 weeks (Cohen's d = 0.94) and increased by end of treatment (Cohen's d = 1.54). Observed differences in symptoms of depression and illness anxiety were also large, favoring ISTDP, and effects were maintained at follow-up. Patients receiving ISTDP had reduced ED service utilization at 2-year follow-up. CONCLUSIONS: ISTDP appears an efficacious treatment for SSRD and a larger randomized trial is justified.

Mostly harmless? Clinical practice guidelines need further consideration of psychotherapy adverse effects.

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines on mood disorders recommend psychotherapy as foundational care for patients with acute depression with minimal discussion of any potential adverse effects. Randomised controlled trial evidence on psychotherapy adverse effects is limited. This is problematic because clinicians must balance the benefits of treatment against the harms, and clinical decisions become skewed without data on adverse effects. We suggest that clinical practice guidelines should be more guarded about recommending psychotherapy and add consensus statements on adverse effects for informed consent and clinical decision-making.

Addressing At-the-Moment Defenses against Painful Affects: A Core Mechanism of Change in Psychodynamic Treatment.

There is an ongoing tension in the psychodynamic field between interpreting the meaning of a patient's verbal productions or actions and addressing the defenses utilized by the patient. Some authors maintain that implicit interactions between analyst and patient may be more important than the verbal interventions by the analyst. This article stresses the importance of observing and appropriately addressing how patients manage painful affects in the sessions. Focusing the patients' attention on their at-the-moment defenses as they occur in the session is an experience-near intervention and minimizes interventions that address issues far from the patient's consciousness and that require a high level of conjecture by the therapist. This technique can be utilized at any point in treatment, regardless of its duration and intensity. Several vignettes are provided that suggest that addressing defenses against painful affect is a pantheoretical construct and may be a common factor in psychodynamic treatment. A successful randomized control trial utilizing this technique with children (regulation-focused psychotherapy) is described. There have been limited empirical studies of the impact of therapists addressing defenses in sessions, but the work of J. Christopher Perry and colleagues, particularly the development of the Psychodynamic Intervention Rating Scales, offers an opportunity to further study the impact of defense interpretations and other interventions.

Establishing a Method of Systematic and Reliable Analysis of Psychodynamic Process Notes.

Introduction: Process notes contain unique information concerning core elements of a psychodynamic treatment. These elements may be both conscious and unconscious for the author. One element for study is the tendency to which a therapist writes about providing either supportive or expressive interventions. This study sought to establish a method of systematically and reliably identifying the records of therapists' interventions as supportive or expressive. Methods: Three early-career clinicians were trained in the use of a process note intervention rating scale constructed specifically for this study. Quantitative statistical analyses assessed the scale's reliability and internal consistency. Results: Interrater reliability analysis determined at a p of 0.005 a Fleiss's kappa of 0.24 and an intraclass correlation coefficient of 0.264, suggesting a low but statistically significant reliability between the raters. A Cronbach's alpha of 0.67 and a McDonald's omega of 0.53 suggested questionable internal consistency. Discussion: Early-career clinicians can reliably code the manifestations of interventions in psychodynamic process notes as supportive or expressive. Future studies may improve the reliability and internal consistency of the scale, add measures of interpretation content, and evaluate these data in relation to other core elements of process notes, such as the author's emotional engagement as manifested in language measures and clinical outcome.

The Development of Psychodynamic Psychiatry in China.

The development of psychoanalysis and psychodynamic psychiatry in China is influenced by political, economic, cultural, and social ideology. The process of psychoanalysis entering China is also a reflection of Chinese history, mirroring China's transition from conservatism to openness, from focusing on tradition to embracing modernity, and from focusing on community and family to individualism. These changes align with the Chinese continuous exploration and pursuit of integration, adaptation, and individuation in the process of globalization, urbanization, and modernization. This article describes the continuous expansion and development of psychoanalysis and psychodynamics in China parallel to societal changes and how an increasing number of people have begun to engage in psychoanalysis or psychoanalytic practices and research. The author describes challenges to how psychoanalysis can better serve the Chinese people through clinical practice and in-depth research under the country's unique social, cultural, historical, and political background.

Interpersonal Psychotherapy: A Review of Theory, History, and Evidence of Efficacy.

Interpersonal psychotherapy (IPT) is an empirically validated treatment for mood disorders, anxiety disorders, eating disorders, and trauma. IPT is based on the concept of "relational frame"-that an individual's experience of psychological distress impacts those around them, and that their social support network impacts the distressed individual. This concept, along with the specific techniques and tools that flow from it and the theoretical bases of IPT (attachment and interpersonal theory) make IPT unique. In this article we review the theoretical bases of IPT (attachment and communication) and provide a brief history of IPT, as well as the evidence supporting its use for a variety of disorders. We also describe its application to groups, adolescents, and other diverse populations. Future directions for research and treatment development are proposed, particularly research in the area of combining IPT with other psychotherapeutic modalities.

Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy for Depressive Disorders: Enhancing Access and Tailoring Interventions in Diverse Settings.

Depressive disorders are an enormous societal burden given their high prevalence and impact on all facets of being human (e.g., relationships, emotions, motivation). There is a variety of evidence-based psychological treatments, with cognitive behavioral therapy (CBT) being the gold standard for major depression. Research has shown that mindfulness-based interventions (MBIs) such as mindfulness-based cognitive therapy (MBCT) are an effective relapse prevention and treatment for depression and that MBIs can be integrated in individual therapy. Furthermore, various delivery modes (e.g., digital-delivered therapy) and settings are offered to best meet different needs and improve accessibility: Evidence suggests that therapist-guided digital CBT, blended therapy, and, to some degree, digitalized MBIs may be an efficacious supplement to traditional face-to-face therapy. This chapter provides an overview of the principles and evidence base for CBT and MBCT as well as different delivery modes for depressive disorders in adults. Finally, chances and challenges of integration are discussed as implications for practice, as well as recommendations and ideas for future research.

The Importance of Psychotherapy for Treatment-Resistant Depression.

Many clinicians choose psychoanalytic psychotherapy or supportive psychotherapy as the primary method of treating depression with or without antidepressant medications. Despite new antidepressants, 20% or more patients showed inadequate responses to the medications, and remained in chronic courses, known as "treatment-resistant depression (TRD)."In this chapter, we described (1) the reasons for psychotherapy in treating TRD from the perspectives of the hazard of polypharmacy, resistance, and neural mechanisms. (2) Next, we focused on the importance of assessment with two clinical vignettes and the original modality of psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy in brief. (3) Finally, we described specific considerations in undertaking psychotherapy for TRD patients in terms of transference, countertransference, and resistance. In addition, the efficacy of psychoanalytic psychotherapy in childhood, adolescent, and late-life depression has been depicted in this paper.

Well-Being Therapy for Depression.

Well-being therapy (WBT) is a short-term psychotherapeutic strategy, based on the technique of self-observation via the use of a structured diary and the guide of a therapist, with the goal of increasing psychological well-being, thus reaching euthymia and a balance among psychic forces. WBT showed to be suitable for application in residual symptoms of unipolar and bipolar depression, since the sequential combination with cognitive-behavioural therapy (CBT) led to a decrease in the relapse rate of recurrent depression. WBT also showed clinical utility in the treatment of cyclothymia, which represents one of the stages of bipolar disorder. Further, WBT seems to have efficacy in treatment-resistant depression and in case of withdrawal syndromes (in particular the so-called persistent post-withdrawal disorder) following antidepressant decrease, switch or discontinuation. In brief, WBT is a rather new but promising therapeutic strategy in the management of unipolar and bipolar depression. This chapter offers an overview of WBT possible applications.

Toward Tailoring Just-in-Time Adaptive Intervention Systems for Workplace Stress Reduction: Exploratory Analysis of Intervention Implementation.

BACKGROUND: Integrating stress-reduction interventions into the workplace may improve the health and well-being of employees, and there is an opportunity to leverage ubiquitous everyday work technologies to understand dynamic work contexts and facilitate stress reduction wherever work happens. Sensing-powered just-in-time adaptive intervention (JITAI) systems have the potential to adapt and deliver tailored interventions, but such adaptation requires a comprehensive analysis of contextual and individual-level variables that may influence intervention outcomes and be leveraged to drive the system's decision-making. OBJECTIVE: This study aims to identify key tailoring variables that influence momentary engagement in digital stress reduction microinterventions to inform the design of similar JITAI systems. METHODS: To inform the design of such dynamic adaptation, we analyzed data from the implementation and deployment of a system that incorporates passively sensed data across everyday work devices to send just-in-time stress reduction microinterventions in the workplace to 43 participants during a 4-week deployment. We evaluated 27 trait-based factors (ie, individual characteristics), state-based factors (ie, workplace contextual and behavioral signals and momentary stress), and intervention-related factors (ie, location and function) across 1585 system-initiated interventions. We built logistical regression models to identify the factors contributing to momentary engagement, the choice of interventions, the engagement given an intervention choice, the user rating of interventions engaged, and the stress reduction from the engagement. RESULTS: We found that women (odds ratio [OR] 0.41, 95% CI 0.21-0.77; P=.03), those with higher neuroticism (OR 0.57, 95% CI 0.39-0.81; P=.01), those with higher cognitive reappraisal skills (OR 0.69, 95% CI 0.52-0.91; P=.04), and those that chose calm interventions (OR 0.43, 95% CI 0.23-0.78; P=.03) were significantly less likely to experience stress reduction, while those with higher agreeableness (OR 1.73, 95% CI 1.10-2.76; P=.06) and those that chose prompt-based (OR 6.65, 95% CI 1.53-36.45; P=.06) or video-based (OR 5.62, 95% CI 1.12-34.10; P=.12) interventions were substantially more likely to experience stress reduction. We also found that work-related contextual signals such as higher meeting counts (OR 0.62, 95% CI 0.49-0.78; P<.001) and higher engagement skewness (OR 0.64, 95% CI 0.51-0.79; P<.001) were associated with a lower likelihood of engagement, indicating that state-based contextual factors such as being in a meeting or the time of the day may matter more for engagement than efficacy. In addition, a just-in-time intervention that was explicitly rescheduled to a later time was more likely to be engaged with (OR 1.77, 95% CI 1.32-2.38; P<.001). CONCLUSIONS: JITAI systems have the potential to integrate timely support into the workplace. On the basis of our findings, we recommend that individual, contextual, and content-based factors be incorporated into the system for tailoring as well as for monitoring ineffective engagements across subgroups and contexts.

Qualitative focus group study of interprofessional healthcare providers to inform the development of a virtual psychoeducational training program for the treatment of childhood interpersonal trauma.

The shortage of adequately trained healthcare providers (HCPs) able to treat adults who have experienced childhood interpersonal trauma (CIT) is a pressing concern. This study explored HCPs' training needs for a trauma-focused psychoeducational group intervention and the potential barriers and facilitators to accessing such training. Three 1-hour focus group sessions were conducted with HCPs (n = 17) from two urban and one rural community healthcare organization serving diverse populations in Ontario, Canada, including under-housed people, women struggling with mental health and addiction, and LGBTQ+ populations. On average, participants had 2.4 years in their current role and 18.1 years of mental health field experience. Thematic analysis revealed key findings: a strong clinical need for trauma services, accessible training programs, and broadly applicable interventions relevant for diverse populations. Notably, participants emphasized the clinical advantages and increased accessibility of a virtual training programs focused on psychoeducational treatment interventions, particularly within community-based healthcare settings. This study highlights the potential of a virtual psychoeducational training programs for HCPs to address this critical gap in healthcare provision for individual with CIT. It also underscores the need to move beyond training program development and focus on implementation and sustainability of interventions in clinical practice.