Existential loneliness: a review of the concept, its psychosocial precipitants and psychotherapeutic implications for HIV-infected women.

While many of the most urgent psychological issues that women with HIV infection are forced to deal with are existential in nature, and therefore shared by humankind, the assault on their physical and psychological being may trigger these issues in large amounts and may overwhelm their defensive structure. Existential loneliness may be an important existential issue that arises for these women and needs to be given equal consideration alongside other forms of loneliness. In this paper, we review the concept of existential loneliness, discuss methods to measure the concept, delineate some central psychosocial precipitants of existential loneliness among HIV-infected women, and discuss psychotherapeutic implications. We conclude that incorporating an existential philosophical perspective into one's particular therapeutic stance may be especially appropriate with this population.

Therapist competence: its temporal course, temporal stability, and determinants in short-term anxiety-provoking psychotherapy.

Using hierarchical linear models procedures (Bryk & Raudenbush, 1992), growth curve analyses were performed to examine the temporal course, rate of change over time, and determinants of therapist competence in short-term anxiety-provoking psychotherapy (STAPP) (Sifneos, 1992). Treatments were 20 sessions long, were manualized, and therapists were experienced clinicians receiving manual-guided supervision. Patients (N= 13) had mostly anxiety diagnoses. Results indicated that, on average, therapist competence ratings followed a flat-line course over time. Estimated mean rate of change was close to zero and varied very little across therapists. Also, therapists who, in an initial session, were more competent in performing STAPP also intervened more frequently in a helping and protecting manner. One possible implication of the findings is that one initial evaluation may be an unbiased estimator of a therapist's general level of competence across sessions.

The effects of common and specific factors in short-term anxiety-provoking psychotherapy: a pilot process-outcome study.

This study attempted to identify the necessary and sufficient change factors in short-term anxiety-provoking psychotherapy (STAPP). Twenty patients were randomly assigned to either STAPP or a form of nondirective therapy almost devoid of psychodynamic elements but with common factors of psychotherapy intact. Both treatments were 20 sessions long, were manualized, and therapists in both conditions were experienced clinicians receiving manual-guided supervision. Most patients had a diagnosis of anxiety. Results showed that patients in both treatments improved greatly symptomatically and that no further gains were made after termination. Treatments were equally effective. The therapeutic alliance was a strong predictor of symptom improvement. The findings underscore the importance of common factors pertaining to the therapeutic relationship, and they may open to question, to some degree, the therapeutic effectiveness of psychodynamic technique factors in STAPP. The way in which specific and common factors can be brought together under the umbrella of the concept of affect attunement is discussed.

Is IPT time-limited psychodynamic psychotherapy?

Interpersonal psychotherapy (IPT) has sometimes but not always been considered a psychodynamic psychotherapy. The authors discuss similarities and differences between IPT and short-term psychodynamic psychotherapy (STPP), comparing eight aspects: 1) time limit, 2) medical model, 3) dual goals of solving interpersonal problems and syndromal remission, 4) interpersonal focus on the patient solving current life problems, 5) specific techniques, 6) termination, 7) therapeutic stance, and 8) empirical support. The authors then apply both approaches to a case example of depression. They conclude that despite overlaps and similarities, IPT is distinct from STPP.

Evidence that therapy works in clinically representative conditions.

This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysis provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results.

The manifestation and management of staff countertransference on a pediatric AIDS team.

The authors discuss the countertransference reactions that arise in staff who work in a hospital outpatient clinic with children with HIV and AIDS. Countertransference feelings such as guilt, anger, and helplessness can be easily aroused when working with a young, impoverished, dying population. Factors that precipitate these feelings and their manifestations are discussed, as well as the antitherapeutic effects of acting on one's countertransference. Psychodynamic explanations are offered for some of the more salient countertransference reactions. Finally, suggestions are made for management of countertransference, such as strong team leadership, ongoing support groups, and redefinition of therapeutic objectives.

Symptom improvement and its temporal course in short-term dynamic psychotherapy. A growth curve analysis.

Using hierarchical linear model procedures, growth curve analyses were performed to examine the course, rate, and correlates of symptom improvement during short-term anxiety-provoking psychotherapy (STAPP) and a 2-year posttermination period. The Symptom Check-list-90 was used to measure general symptomatology. The sample consisted of 15 patients who were found suitable for STAPP. Most had a diagnosis of anxiety. Therapists were in postgraduate manual-guided STAPP training. Results showed that three of four patients made a reliable and clinically significant symptom improvement over the course of treatment. Patients improved at a steady rate during treatment as well as after treatment. Average improvement was large and significant during treatment, while small and marginally significant after treatment. Improvement rates varied significantly over the course of treatment and were faster for patients less rigid in their personality functioning.

[Sexual contacts between psychotherapists and patients. A review of recent American literature]. / Seksuell kontakt mellom psykoterapeuter og pasienter. En gjennomgåelse av nyere amerikansk litteratur.

According to research in the USA, most psychotherapists reported sexual attraction to one or more of their patients during their career. Only a small minority, however, engaged in sex with their patients. There is a subgroup among offenders (i.e. repeaters) whose views on therapist-patient sex are distorted and grossly at variance with standard professional ethics. Nine of ten patients who have been involved in sex with their therapists are harmed by it. The clinical problems they present resemble those of incest and rape victims. In terms of prevention it seems worthwhile to train students and psychotherapist trainees in ethics and in how to handle sexual feelings. Efforts to rehabilitate offenders have met with little success so far. Prevalence of doctor-patient sex does not seem to differ across most clinical medical specialties.

Predicting patient change from therapist competence and patient-therapist complementarity in short-term anxiety-provoking psychotherapy: a pilot study.

In this pilot study, therapist competence and patient-therapist complementarity measured by the Structural Analysis of Social Behavior system (SASB; Benjamin, 1974) were examined as to their interrelation and their unique, collective, and interactive contributions to patient change in 20 sessions of short-term anxiety-provoking psychotherapy (STAPP; Sifneos, 1979). Patients were 15 highly educated outpatients, mean age 30 years, with mainly anxiety diagnoses. Therapists were in postgraduate manual-guided STAPP training. Results show that competence in an early session did not relate to patient change. In contrast, patient-therapist complementarity ratings predicted patient change both alone and over and above competence. Predictions were strongest for changes in general distress and dysfunctional attitudes and for shorter term change rather than for longer term change.

Comparative effects of short-term psychodynamic psychotherapy: a meta-analysis.

In a review of 19 clinically relevant comparative outcome studies published 1978-1988, short-term psychodynamic psychotherapy (STPP) was evaluated as to overall effects, differential effects, and moderating effects vis-à-vis no-treatment controls (NT) and alternative psychotherapies (AP), respectively. Overall, STPP was superior to NT at posttreatment, inferior to AP at posttreatment, and even more so at 1-year follow-up. STPP was inferior to AP in treating depression and, in particular, to cognitive-behavioral therapy for major depression. STPP was equally successful with mixed neurotics. As research quality increased, STPP grew less superior to NT. Furthermore, STPP decreased its overall superiority over NT and increased its overall inferiority to AT on a series of clinically relevant variables. Improvement in research quality from 1978 to 1988 was noted. Evidence, although limited, supported the view that STPP approaches do seem to differ along a few major dimensions.