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1.
Psychotherapy (Chic) ; 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31448934

RESUMO

This is an evidence-based case study examining the process and outcome of 22 prenatal sessions and 1 postpartum follow-up session of psychodynamic therapy for a woman pregnant after a history of repeated pregnancy losses. Self-report measures of depression, anxiety, pregnancy-specific anxiety, prenatal attachment, trauma, and perinatal grief were completed prior to each session. A session quality item was completed after each session and a therapy outcome measure at termination and follow-up. The therapist and the patient completed an exit interview on the therapy relationship, which focused on moments of tension or misunderstanding, over the course of treatment. All sessions were transcribed and scored by certified raters for reflective functioning. Results suggest that the patient experienced reliable and clinically significant change on all pregnancy-specific measures, with most change happening in the early phase of treatment. However, general symptoms of depression and anxiety were variable and highly volatile over time. Exit interviews suggest that therapist empathy and validation were helpful in promoting change on pregnancy-specific symptoms, whereas problems or ruptures in the alliance may have been associated with a lack of change on general psychiatric symptoms. The patient showed little change on reflective functioning, perhaps contributing to ruptures in psychotherapy and lack of change on general psychiatric symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

2.
Psychotherapy (Chic) ; 55(4): 434-444, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30335456

RESUMO

Although writing about the real relationship has existed from the beginnings of the "talking cure," it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable. In this article, a meta-analysis is presented on the association between the strength of the real relationship and the outcome of psychotherapy. Summed across 16 studies, this meta-analysis revealed a moderate association with outcome (r = .38, 95% confidence interval [.30, .44], p < .001, d = 0.80, N = 1.502). This real relationship-outcome association was independent of the type of outcome studied (treatment outcome, treatment progress, and session outcome) and of the source of the measure (whether the client or the therapist rated the real relationship and/or treatment outcome). We also present commonly used measures of the real relationship, limitations of the research, and patient contributions. The article concludes with diversity considerations and practice recommendations for developing and strengthening the real relationship. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

3.
Psychotherapy (Chic) ; 55(3): 275-288, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30179034

RESUMO

Pregnancies after loss are often characterized by feelings of depression, anxiety, trauma-like symptoms, and problems bonding to the fetus. Difficulties bonding to the unborn baby during pregnancy are of clinical importance because they are predictive of problems in the mother-infant attachment relationship, perhaps explaining why some studies show a higher risk of insecure attachment for babies born after loss. O'Leary (2004) has proposed that problems in prenatal bonding during pregnancies after loss are the result of the challenge these mothers face of having to grieve the loss of one baby while bonding to another. This article argues that the theory of mentalization helps to explain why some parents successfully resolve this central challenge during pregnancies after loss and go on to develop a secure attachment to the next infant, whereas others continue to experience long-term attachment problems. Specifically, pregnancies after loss are conceptualized as a potentially traumatic experience in which mentalization may decrease and, at the same time, serve as a protective factor against attachment problems with infants born after loss due to unresolved trauma and grief. Several aspects of mentalization, including the capacity to mentalize: (a) affect associated with trauma and loss, (b) attachment relationships as distinct, (c) multiple and conflicting mental states, and (d) early inadequate attachment experiences related to trauma and loss, are proposed to help mothers pregnant after loss to mourn the loss of one baby while attaching to another, ameliorating potential attachment problems postpartum. Clinical interventions for facilitating these mentalizing capacities are suggested. (PsycINFO Database Record

4.
Psychotherapy (Chic) ; 55(1): 20-26, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29565619

RESUMO

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record


Assuntos
Atitude Frente a Morte , Pesar , Pais/psicologia , Morte Perinatal , Psicoterapia/métodos , Tabu/psicologia , Adaptação Psicológica , Adulto , Cultura , Feminino , Humanos , Recém-Nascido , Gravidez
5.
Psychotherapy (Chic) ; 54(4): 367-372, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29251956

RESUMO

This introduction article to the special section on psychotherapy for pregnancy loss reviews important societal and psychological issues, key clinical processes and recommendations, and future research directions. Differences and similarities among the articles in the special section are discussed along with each article's contribution to the higher order goal of viewing pregnancy loss through a psychological rather than solely medical lens. Each article in this section reviews different therapeutic modalities, interventions, and key clinical process issues when working with patients who have suffered the loss of a pregnancy. The important role that psychotherapy can play in helping parents to mourn the loss of a pregnancy is explored in this introductory article and throughout the special section. (PsycINFO Database Record


Assuntos
Aborto Espontâneo/psicologia , Psicoterapia/métodos , Feminino , Pesar , Humanos , Gravidez
6.
Psychotherapy (Chic) ; 53(3): 347-53, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27631865

RESUMO

In this article, clinical errors in the treatment of perinatal grief after a miscarriage are discussed, including (a) minimizing or avoiding painful affects related to the miscarriage, (b) assuming grief is resolved upon a subsequent healthy pregnancy, and (c) neglecting early unresolved losses that are reawakened by the loss of the pregnancy. It is argued that these unintentional errors, frequently committed by significant others in the patient's life, are similarly made by well-intentioned clinicians due to a lack of knowledge about the psychological impact of miscarriage and, moreover, an unconscious avoidance of such a common yet distressing loss. Background information relevant to each clinical error is briefly reviewed, followed by recommendations for a better approach to the situation and verbatim clinical exchanges. The author suggests that, in general, a better approach to treatment is based on the assumptions that: (a) miscarriage is often a traumatic loss in a woman's life, and (b) the traumatic affect associated with the event should be approached, rather than avoided, within a safe affect regulating relationship with the therapist. (PsycINFO Database Record


Assuntos
Aborto Espontâneo/psicologia , Adaptação Psicológica , Erros Médicos , Psicoterapia , Adulto , Mecanismos de Defesa , Feminino , Pesar , Humanos , Acontecimentos que Mudam a Vida , Masculino , Terapia Conjugal , Gravidez
7.
J Couns Psychol ; 62(2): 314-20, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24660688

RESUMO

The relationship between treatment progress (as rated by both clients and therapists) and real relationship (also rated by both clients and therapists) was decomposed into between-therapist and within-therapist (between-client) effects and analyzed using the actor-partner interdependence model. We reanalyzed a subset of the data, 12 therapists and 32 clients, from Gelso et al.'s (2012) study of brief, theoretically diverse outpatient treatment. Consistent with and extending previous research, clients whose therapists provided higher average levels of client-perceived real relationship across the clients treated by a given therapist had better progress ratings from both themselves and their therapists. Within each therapist's caseload, differences between clients in client- or therapist-rated real relationship were unrelated to either client- or therapist-rated outcome. Clients whose therapists provided higher average levels of therapist-perceived real relationship, across the clients treated by the therapist, had worse progress ratings from the therapists. The results provide additional evidence for the importance of between-therapist differences in therapeutic relationship qualities, both client and therapist rated.


Assuntos
Pessoal de Saúde , Relações Profissional-Paciente , Feminino , Humanos , Masculino , Modelos Psicológicos , Percepção , Resultado do Tratamento
8.
Psychotherapy (Chic) ; 51(3): 327-33, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25068190

RESUMO

The goal of this special section is to work toward establishing a common identity for relationally inclined clinicians across proscribed theoretical orientations, facilitating a shared identity among diverse psychotherapists while placing a spotlight on relationship research. This article discusses the need for a more coherent and less polarizing professional identity for psychotherapists and why a more universal relational orientation to psychotherapy is timely given the current state of psychotherapy practice and research. Lastly, common relational themes that run throughout the diverse treatment paradigms presented in this special section are discussed, framing what it means to be a relational psychotherapist while hopefully providing some direction for future research and clinical training.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Transtornos Mentais/terapia , Papel Profissional/psicologia , Relações Profissional-Paciente , Psicoterapia/métodos , Humanos
9.
Psychotherapy (Chic) ; 51(3): 413-23, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24773091

RESUMO

This study used the Actor Partner Interdependence Model (APIM; Kenny & Cook, 1999) to examine the associations of client- and therapist-rated real relationship (RR) and session quality over time. Eighty-seven clients and their therapists (n = 25) completed RR and session quality measures after every session of brief therapy. Therapists' current session quality ratings were significantly related to all of the following: session number (b = .04), their session quality rating of the previous session (b = .24), their RR in the previous session (b = 1.091), their client's RR in the previous session (b = .17), and interactions between their own and their clients' RR and session number (b = -.16 and ß = -.04, respectively). Clients' ratings of current session quality were significantly related to only their own RR in the previous session (b = .47). Implications for future research and practice are discussed.


Assuntos
Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Relações Profissional-Paciente , Psicoterapia/métodos , Contratransferência (Psicologia) , Feminino , Humanos , Masculino , Satisfação do Paciente , Estudantes/psicologia , Transferência (Psicologia)
10.
Psychotherapy (Chic) ; 50(3): 360-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24000852

RESUMO

In recent years, the theory of mentalization has been applied to a number of clinically relevant areas including psychotherapy for patients with borderline personality disorder, therapy with adolescents and children, treatment of self-harm in young people, parent-infant early interventions, and even community outreach (see Midgley & Vrouvam, 2012. Minding the child: Mentalizing interventions with children, young people, and their families. London and New York: Routledge). Extending on this body of work, the present article applies the theory of mentalization to psychotherapies that aim to help first time expecting mothers psychologically adjust to and prepare for motherhood. Theory and research suggest that pregnancy represents an intermediate space in which, under ideal circumstances, the woman comes to represent herself as a mother, her unborn child as a separate and intentional being, and her emotional bond or attachment to the fetus. However, the expecting mother's own conflictual experiences being mothered are likely to influence her ability to mentalize her pregnancy, setting the stage for problems in the mother-infant dyad postpartum. This article explores how mentalizing techniques may be used in psychotherapy to help mothers-to-be to mentalize their emerging identity as a mother, their unborn child, and their developing relationship to the fetus.


Assuntos
Relações Materno-Fetais/psicologia , Mães/psicologia , Apego ao Objeto , Gravidez/psicologia , Processos Psicoterapêuticos , Psicoterapia/métodos , Teoria da Mente , Adulto , Maus-Tratos Infantis/psicologia , Emoções , Feminino , Humanos , Imaginação , Recém-Nascido , Acontecimentos que Mudam a Vida , Comportamento Materno/psicologia , Complicações na Gravidez/psicologia , Gravidez não Planejada/psicologia , Projeção
11.
J Couns Psychol ; 59(4): 495-506, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22946982

RESUMO

This study sought to assess the association of client- and therapist-rated real relationship with each other and with the outcome of brief psychotherapy. It also aimed to determine whether changes over time in perceptions of the real relationship and increasing convergence between clients' and therapists' ratings of the real relationship were associated with outcome. Forty-two clients and their therapists (n = 19) at 2 university counseling centers completed measures assessing the strength of their real relationship after every session of brief psychotherapy. They also completed an outcome measure at the end of treatment. Clients' ratings of the real relationship after the first session, first quarter of treatment, and after all sessions combined related to outcomes. Therapists' ratings of the real relationship at these time points did not relate to outcome. However, increases over time in therapists' ratings of real relationship strength, as well as increasing convergence with clients' ratings of the real relationship, did relate to outcome. Implications for future research and practice are discussed.


Assuntos
Relações Profissional-Paciente , Processos Psicoterapêuticos , Psicoterapia Breve , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Maryland , Modelos Psicológicos , Resultado do Tratamento , Virginia
12.
Psychotherapy (Chic) ; 47(1): 111-21, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22402005

RESUMO

Although clinical researchers have applied attachment theory to client conceptualization and treatment in individual therapy, few researchers have applied this theory to group therapy. The purpose of this article is to begin to apply theory and research on adult dyadic and group attachment styles to our understanding of group dynamics and processes in adult therapy groups. In particular, we set forth theoretical propositions on how group members' attachment styles affect relationships within the group. Specifically, this article offers some predictions on how identifying group member dyadic and group attachment styles could help leaders predict member transference within the therapy group. Implications of group member attachment for the selection and composition of a group and the different group stages are discussed. Recommendations for group clinicians and researchers are offered.


Assuntos
Transtornos Mentais/terapia , Apego ao Objeto , Teoria Psicológica , Psicoterapia de Grupo/métodos , Identificação Social , Transferência (Psicologia) , Humanos , Relações Interpessoais
13.
Psychotherapy (Chic) ; 44(3): 300-15, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22122257

RESUMO

The psychology literature at large considers rater bias to be a substantial source of error in observer ratings. Yet, it is typically ignored by psychotherapy researchers using participant (psychotherapist/client) ratings. In particular, interrater variability, or differences between raters' overall tendency to rate others favorably or unfavorably, has been a largely ignored source of error in studies that use psychotherapists and/or clients as raters. Ignoring rater bias can have serious consequences for statistical power and for interpretation of research findings. Rater bias may be a particular problem in psychotherapy research, as psychotherapists are often asked to rate subjective variables that require much rater inference. Consequently, we examined the extent to which rater bias is a factor in psychotherapist ratings of client transference and insight, by comparing psychotherapist variance from these ratings to psychotherapist variance in ratings of client-perceived emotional intelligence, using Hierarchical Linear Modeling. Results suggest that bias may be a substantial source of error in psychotherapist process and relationship ratings, accounting for, on average, 38% of the total variance in scores, and 30% after accounting for perceived emotional intelligence. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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