Beyond Mentalizing: Epistemic Trust and the Transmission of Culture.

We explore the interpersonal origins of human culture, arguing that culture emerges as a necessary consequence of our helplessness in infancy, which in turn requires a greater degree of collaboration and social organization than is necessary for other mammals. We propose a model of cultural transmission that depends on a dyadic interpersonal process whose vicissitudes can have a lifelong impact. We explore the role played by imagining subjectively experienced psychological states and processes in others, which we have defined as mentalizing, in the process of cultural transmission, and propose that mentalizing is key to the establishment of epistemic trust-that is to say, an experience of trust that enables the individual to absorb and use the knowledge they are being offered. We suggest that psychoanalysis can be viewed as a paradigmatic example of a process of transferring knowledge from one human being (the teacher, the caregiver, the analyst) to another (the learner, the young person, the patient) and argue that the mechanisms of psychic change in analysis cannot be fully understood without appreciating this aspect of the biological/evolutionary origins of our essential humanity. Finally, we discuss the clinical implications of the model we are proposing for the psychoanalytic process.

The cultural change narrative as a core component of therapeutic change.

Introduction: Research indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment. Methods: The study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD. Results: The main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead. Discussion: The participants' stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT.

Activación de Recursos durante la primera sesión de psicoterapia y su relación con el cambio terapéutico temprano / Resource Activation during the first psychotherapy session and its relation with early therapeutic change

Resumen Objetivo: determinar diferencias en el grado en que los terapeutas enfocan sus intervenciones en activar recursos de los consultantes durante la primera sesión en procesos de psicoterapia con y sin resultados terapéuticos tempranos (RT), y caracterizar dichas intervenciones. Método: se utilizó una muestra de 32 procesos de psicoterapia con pacientes ambulatorios, realizados en contextos de prestación rutinaria de servicios y conducidos por terapeutas de distintas orientaciones teóricas. Estos procesos se agruparon según la presencia o ausencia de RT, evaluada a partir de la diferencia de puntajes en el reporte de bienestar de los consultantes entre la primera y la cuarta sesión, a través del Cuestionario de Autoreporte de Resultados (Outcome Questionnaire -OQ-45.2.-). Y el grado en que la actividad de los terapeutas se enfocó en la Activación de Recursos (AR) se evaluó mediante el Wirkfaktoren-K (WIFA-K. Factores de Efectividad de Klaus Grawe) para jueces independientes. Posteriormente, se realizó una prueba t de varianzas desiguales de Welch, a partir de los promedios de puntajes de la AR en ambos grupos. Resultados: se encontraron diferencias significativas entre ambos grupos; específicamente, los terapeutas del grupo Con RT dedicaron tres veces más tiempo de la sesión a trabajar en la AR que los del grupo Sin RT. Adicionalmente, se ofrece evidencia detallada respecto de la variación del foco en la AR a lo largo de la sesión y la proporción en que distintos contenidos relacionados con la AR son abordados en ambos grupos.

Abstract Objective: the objective of this paper is to determine the differences in the degree to which therapists focus their interventions on activating clients' resources during the first session of psychotherapy processes with and without Early Therapeutic Outcomes (ETO), and to characterize these interventions. Method: a sample of 32 outpatient psychotherapy processes was collected, carried out in routine service delivery contexts and conducted by therapists with different theoretical orientations. The therapies were grouped according to the presence or absence of ETO, evaluated from the difference in well-being reported by clients between the first and fourth session, through the Outcome Questionnaire (OQ-45.2; Lambert et al.,1996). To assess the extent to which the therapists' activity focused on RA in both groups, the Wirkfaktoren-K (Klaus Grawe Effectiveness Factors; von Consbruch et al., 2013) instrument was used by independent judges. Subsequently, a Welch's t-test of unequal variances was performed, based on the averages of AR scores, between both groups. Results: significant differences were found between both groups. Specifically, therapists in the "With ETO" group spent 3 times more minutes working on RA than those in the "Without ETO" group. In addition, detailed evidence is provided on the variation of the focus on RA throughout the session and the proportion in which different RA-related content is addressed in both groups.

Cambio y estancamiento terapéutico en pacientes con intento suicida desde dos metodologías de análisis de discurso / Therapeutic change and stagnation in patients with suicide attempt from two methodologies of discourse analysis

La presente investigación tiene como objetivo analizar desde dos métodos de análisis de discurso (Indicadores de Cambio Genérico y el Algoritmo David Liberman-AH) los momentos de cambio y estancamiento en extractos de entrevista de una persona con intento suicida que acudió a un proceso de psicoterapia. Se analizaron en los fragmentos los intercambios entre paciente y terapeuta. El primer fragmento corresponde a un episodio de cambio terapéutico y el segundo a uno de estancamiento. En los resultados se muestra la calificación de los fragmentos mediante los dos métodos y se destacan semejanzas en cuanto a los criterios para delimitar el cambio y el estancamiento. En la discusión se precisa la importancia del uso de ambos métodos para una detección detallada de procesos de pensamiento, sensopercepción y afecto relacionados con el intento suicida, así como sobre el surgimiento y sostenimiento de sentimientos de bienestar en los episodios de cambio, además se valora la diferencia que ofrece el ADL, dado que proporciona la detección de defensas(AU)

Two fragments of a psychotherapy process with a patient with a suicide attempt were analyzed from two discourse analysis methodologies. The first corresponds to an episode of therapeutic change and the second to one of stagnation. Similarities were observed in both methods in terms of the criteria for delimiting change and stagnation, as well as the importance of using both methods for a detailed detection of thought processes, sensory perception and affect related to the suicide attempt, as well as the emergence and maintenance of feelings of well-being in episodes of change;in addition, the difference offered by the ADL is valued, since it provides the detection of defenses(AU)

A Dynamic Autocatalytic Network Model of Therapeutic Change.

Psychotherapy involves the modification of a client's worldview to reduce distress and enhance well-being. We take a human dynamical systems approach to modeling this process, using Reflexively Autocatalytic foodset-derived (RAF) networks. RAFs have been used to model the self-organization of adaptive networks associated with the origin and early evolution of both biological life, as well as the evolution and development of the kind of cognitive structure necessary for cultural evolution. The RAF approach is applicable in these seemingly disparate cases because it provides a theoretical framework for formally describing under what conditions systems composed of elements that interact and 'catalyze' the formation of new elements collectively become integrated wholes. In our application, the elements are mental representations, and the whole is a conceptual network. The initial components-referred to as foodset items-are mental representations that are innate, or were acquired through social learning or individual learning (of pre-existing information). The new elements-referred to as foodset-derived items-are mental representations that result from creative thought (resulting in new information). In clinical psychology, a client's distress may be due to, or exacerbated by, one or more beliefs that diminish self-esteem. Such beliefs may be formed and sustained through distorted thinking, and the tendency to interpret ambiguous events as confirmation of these beliefs. We view psychotherapy as a creative collaborative process between therapist and client, in which the output is not an artwork or invention but a more well-adapted worldview and approach to life on the part of the client. In this paper, we model a hypothetical albeit representative example of the formation and dissolution of such beliefs over the course of a therapist-client interaction using RAF networks. We show how the therapist is able to elicit this worldview from the client and create a conceptualization of the client's concerns. We then formally demonstrate four distinct ways in which the therapist is able to facilitate change in the client's worldview: (1) challenging the client's negative interpretations of events, (2) providing direct evidence that runs contrary to and counteracts the client's distressing beliefs, (3) using self-disclosure to provide examples of strategies one can use to diffuse a negative conclusion, and (4) reinforcing the client's attempts to assimilate such strategies into their own ways of thinking. We then discuss the implications of such an approach to expanding our knowledge of the development of mental health concerns and the trajectory of the therapeutic change.

Treatment and Therapeutic Change of Individuals Imprisoned for Child Abuse in the Barcelona Study on Sex Offenders.

The sexual abuse of children is a serious social problem that must be prevented through distinct measures. Among them is the application of treatments to those who have already committed sex crimes in order to prevent them from committing a new one. To assess the efficacy of sexual offense treatment, the most common method has been to compare the recidivism rates of treated and untreated groups. Several meta-analyses in this regard-as well as some specific studies in Spain-have shown that the application of treatment is associated with lower recidivism rates. However, the analysis of the subjects' recidivism alone does not reveal the therapeutic changes that the treatment may elicit in them. Some international studies have evaluated the therapeutic improvements resulting from the application of treatments to men who had sexually abused children. In this context, this study explores the therapeutic changes experienced by a sample of subjects imprisoned for child abuse (N = 145), after participating in the treatment program applied in the Spanish prison system. Nine therapeutic variables were assessed (such as anxiety, cognitive distortions, impulsivity, and social self-esteem), before and after treatment, using an instrument named the Psychological Assessment Scale for Sex Offenders (PASSO). The obtained results show that most of the assessed therapeutic variables improved after treatment, with strong correlations between them. The implications of the results for treatment practice are discussed, as well as the main methodological limitations of this research.

Fluctuation in the assimilation of problematic experiences: A comparison of two contrasting cases of Emotion Focused Therapy.

The assimilation model suggests that therapeutic change occurs through a gradual assimilation of problematic experiences. Previous case studies have suggested that both good- and poor-outcome cases exhibit a fluctuating pattern of assimilation progress, characterized by advances and setbacks. Our study examined more closely how this fluctuating pattern is related to symptom change across therapy. We analyzed the longitudinal relations among assimilation ratings, instability (fluctuation) in assimilation ratings, and clinical symptom intensity in two contrasting cases of emotion-focused therapy for depression, one good and one poor outcome. We used the assimilation of problematic experiences scales (APES) to measure assimilation and the outcome- questionnaire (OQ-10) to measure clinical symptom intensity. To assess assimilation instability, we used a fluctuation measure that calculated the amplitude and the frequency of changes in assimilation levels. The results showed that in the good-outcome case, assimilation levels and instability tended to increase and symptom intensity tended to decrease, particularly in the final phase of treatment. In the poor-outcome case, assimilation levels and instability did not change much across sessions.

"When my children see their father is sober, they are happy": A qualitative exploration of family system impacts following men's engagement in an alcohol misuse intervention in peri-urban Kenya.

Background: Men's alcohol misuse does not occur in a vacuum but has a cascade of consequences for families and children, with ties to violence, poor parenting, and poor partner and child mental health. Despite the intersection of individual and interpersonal problems associated with men's alcohol use, studies exploring the impact of men's completion of alcohol misuse treatment on family and family member outcomes are scarce. Here we begin to explore this question. Methods: We conducted qualitative interviews (N = 13) with female partners and children (8-17 years) of men with problem drinking who completed individual treatment targeting alcohol misuse, depressed mood, and family-focused efforts in Eldoret, Kenya. Interviews and thematic content analysis were guided by ecological-transactional systems theory. Results: Findings highlighted positive perceived changes for men, families, women and children that interacted together in a bi-directional pathway. Partners and children described men's reduced drinking, reduced spending, increased family-focused effort (e.g., coming home early), as well as increased emotion regulation, and openness to and communication with family. These changes were tied to perceived improvements in the couple and father-child relationship, including improved trust and time together, which were tied to improvements in women and children's emotional well-being (e.g., hope). Concurrently, reports noted men's increased effort to share money earned with the family which alleviated financial stress and helped ensure basic needs were met. Results aligned with the ecological transactional systems frame, with individuals in the family, family relationships, and economic climate each dynamically shaping each other. Conclusions: Although larger studies are needed, results provide promising signals regarding the potential downstream effects of individual treatment on family systems and members, which may in turn help maintain men's changes in drinking.

Analysis of the Emails From the Dutch Web-Based Intervention "Alcohol de Baas": Assessment of Early Indications of Drop-Out in an Online Alcohol Abuse Intervention.

Nowadays, traditional forms of psychotherapy are increasingly complemented by online interactions between client and counselor. In (some) web-based psychotherapeutic interventions, meetings are exclusively online through asynchronous messages. As the active ingredients of therapy are included in the exchange of several emails, this verbal exchange contains a wealth of information about the psychotherapeutic change process. Unfortunately, drop-out-related issues are exacerbated online. We employed several machine learning models to find (early) signs of drop-out in the email data from the "Alcohol de Baas" intervention by Tactus. Our analyses indicate that the email texts contain information about drop-out, but as drop-out is a multidimensional construct, it remains a complex task to accurately predict who will drop out. Nevertheless, by taking this approach, we present insight into the possibilities of working with email data and present some preliminary findings (which stress the importance of a good working alliance between client and counselor, distinguish between formal and informal language, and highlight the importance of Tactus' internet forum).

Activación de Recursos en Psicoterapia. ¿Cómo se ha estudiado y qué sabemos?: Una revisión sistemática / Resource Activation in Psychotherapy. How has it been studied and what do we know?:A Systematic Review

Resumen A partir de los primeros metaanálisis sobre efectividad en psicoterapia, Grawe (1997) abstrae teóricamente cuatro mecanismos transteóricos relacionados con el cambio, siendo el principal de ellos Activación de Recursos. Este mecanismo es entendido como el uso de las capacidades y disposición motivacional del paciente al servicio de un objetivo terapéutico, así como el ajuste de las intervenciones terapéuticas a dichos aspectos. Basado en una revisión sistemática de la literatura en inglés y español, el presente artículo discute resultados de distintos estudios empíricos, con el objetivo de esclarecer qué sabemos sobre la relación entre Activación de Recursos y el cambio en psicoterapia. La búsqueda de artículos no se restringió por año de publicación ni diseño metodológico, en tanto en el estudio reportado se hubiera evaluado el mecanismo Activación de Recursos y se aportara evidencia de su relación con una segunda variable. Los 14 estudios incluidos ofrecen evidencia mayoritariamente a favor de la relación entre Activación de Recursos y resultados terapéuticos, pero con dudas respecto de cómo y cuándo este mecanismo favorece, o incluso pudiera entorpecer el cambio. Estas dudas son discutidas a partir de la relación entre Activación de Recursos y distintas variables de proceso, así como de aspectos metodológicos de los estudios. La principal limitación de esta revisión guarda relación con la heterogeneidad metodológica de los estudios incluidos, sumado a la homogeneidad geográfico-cultural donde fueron desarrollados, lo que sugiere interpretar con cautela tanto la integración de la evidencia como su generalización, a la espera de nuevos estudios en distintos contextos.

Abstract From the first meta-analyzes on effectiveness in psychotherapy, Grawe (1997) theoretically abstracts four trans-theoretical mechanisms related to change, the main one being Resource Activation. This is understood as the use of the patient skills and motivational readiness in the service of a therapeutic objective, as well as the adjustment of therapeutic interventions to these aspects. Based on a systematic review of English and Spanish literature, this article discusses the results of different empirical studies, with the aim of clarifying what we know about the relationship between resource activation and change in psychotherapy. For this review, the search was not restricted by year of publication or methodological design, as long as the Resource Activation mechanism was evaluated and evidence of its relationship with a second variable was provided. The 14 included studies offer evidence mostly in favor of the relationship between Resource Activation and therapeutic results, but with doubts about how and when this mechanism favors or could even hinder change. These doubts are discussed based on the relationship between Resource Activation and different process variables, as well as methodological aspects of the studies. The main limitation of this review is related to the methodological heterogeneity of the included studies, added to the geographical-cultural homogeneity where they were developed, which suggests interpreting with caution both the integration of the evidence and its generalization, pending new studies in different contexts.

Empirical evidence of disease activity thresholds used to indicate need for major therapeutic change in US veterans with rheumatoid arthritis.

BACKGROUND: A previous analysis of the Veterans Affairs Rheumatoid Arthritis (VARA) registry showed that more than half of the patients with rheumatoid arthritis (RA) did not receive a major therapeutic change (MTC) despite moderate or severe disease activity. We aimed to empirically determine disease activity thresholds associated with a decision by rheumatologists and nurse practitioners to institute a MTC in patients with RA and to report the impact of that change on RA disease activity. METHODS: We analyzed data from the VARA registry between January 1, 2006, and September 30, 2017. Eligible patients had a visit with 3 disease activity measures (DAMs) recorded: Disease Activity Score for 28 joints (DAS28), Clinical Disease Activity Index (CDAI), and Routine Assessment of Patient Index Data 3 (RAPID3). The Youden Index was used to identify disease activity thresholds that best discriminated rheumatologist/nurse practitioner decision to initiate MTC. Clinical outcome was 20% improvement in the American College of Rheumatology criteria (ACR20 response). The effect of MTC on ACR20 response was presented as crude descriptive statistics and evaluated using G-computation for marginal and conditional effects with established disease activity level combined with an empirical threshold from Youden analysis. RESULTS: The study population comprised 1776 patients (12,094 visits: 3077 with MTC, 9017 without MTC). Empirical thresholds (95% bootstrap confidence interval with 1000 replications) for MTC were 4.03 (3.70-4.36) for DAS28, 12.9 (10.4-15.4) for CDAI, and 3.81 (3.32-4.30) for RAPID3. Visits with MTC had increased likelihood of ACR20 response: risk ratios for ACR20 response for visits with MTC vs without MTC ranged 1.2-2.6 across DAMs; risk differences ranged 0.2-14.5%. CONCLUSIONS: MTC was associated with clinical improvement across all DAMs with the greatest change in patients with RA disease activity above the Youden threshold identified in this work. TRIAL REGISTRATION: VARA Registry, https://www.hsrd. RESEARCH: va.gov/research/abstracts.cfm?Project_ID=2141698764.

Explaining Symptoms in Systemic Therapy. Does Triadic Thinking Come Into Play?

The main aim of this study is to explore the breadth of the inference field and the type of etiopathogenetic contents of symptom explanations provided by the client and therapist in the first two psychotherapy sessions conducted using a systemic approach. Does the therapist use triadic explanations of psychopathology as suggested by her approach? And do clients resort almost exclusively to monadic and dyadic explanations as did the university students in our previous study? What kind of explanations do they propose? The coding system "1 to 3: from the monad to the triad" was applied to the transcripts of 25 individual systemic therapies conducted by the same therapist. This manual allows coding of the inference field of symptom explanations according to three categories: monadic, dyadic, and triadic. These three broad categories are also used to analyze the etiopathogenetic content of each explanation: traumatic, intrapersonal, and interpersonal. Our findings showed that clients and their therapist actually used different inference fields: clients resorted almost exclusively to monadic and dyadic explanations, whereas their therapist included the triadic explanatory level. Moreover, the therapist provided more interpersonal explanations than her clients. Hence, the dissonance between client and therapist about the inference fields - a crucial premise of one of the most accepted ideas of therapeutic change according to systemic therapies - is proven, at least among our participants. Thanks to this dissonance, clients and therapists can create a new story, potentially able to change clients' feelings, without disconfirming their emotions.

A conversation analysis of communicative changes in a time-limited psychotherapy group for mothers with post-natal depression.

Objective: To examine qualitatively changes occurring in discussions within a time-limited psychotherapy group for mothers with post-natal depression. Method: Discussions occurring in a group that comprised five mothers and a therapist were recorded over the course of six one-hour therapeutic sessions. Participants had been referred or had self-referred to the group on the basis of having post-natal depression. The recorded discussions were transcribed and then analysed in accordance with principles of conversation analysis. Results: Analysis of early and later group discussions showed changes in group members' alignment with the topics that were introduced, in turn-allocation and turn-taking, and in the co-construction of accounts of experience. In contrast to early discussions, in later discussions participants aligned with topics relating to personal emotions, self-selected as next speakers in the discussions, and collaboratively worked up accounts that made sense of their experiences of childbirth and of being diagnosed as having post-natal depression. Conclusions: Interactional changes over the duration of the group point to the benefits for mothers with post-natal depression of participating in a time-limited psychotherapy group. Fine-grained analysis of group discussions potentially offers a way of examining changes over time in psychotherapeutic groups more generally.

What sticks? Patients' perspectives on treatment three years after psychotherapy: A mixed-methods approach.

Objective: In the present study, a patient-focused, mixed-methods approach was applied to relate patients' personal experiences of change processes during therapy to their long-term psychometric treatment outcomes. Method: Comprehensive follow-up quantitative assessments and qualitative interviews were conducted with n = 30 patients who had completed an integrative CBT treatment three years prior. Qualitative content analysis by two independent coders was used to categorize patients' subjective explanations of therapeutic change. Correlations were applied to relate the frequency and diversity of change factors to clinically significant change of symptom distress at post-treatment and 36-month follow-up. Cluster analysis was performed to identify clusters of patients with similar patterns of change factors. Results: Qualitative content analysis with good interrater reliability revealed five main categories: (1) Therapeutic relationship (2) Activating resources (3) Motivational clarification and insight (4) Action-oriented coping strategies (5) Healing therapeutic setting. Higher levels of change factors were associated with greater relief of symptoms at post-treatment and 36-month follow-up. Cluster analysis revealed three different groups of patients. Conclusions: The analysis provides insight into therapeutic change factors from the patient's perspective. Some categories are consistent with theoretically driven models of common factors. Results may help tailor psychotherapy to patients' individual needs.

Mechanisms of change in dialectical behaviour therapy and cognitive behaviour therapy for borderline personality disorder: a critical review of the literature.

Background: Little is known about the "active ingredients" of psychological therapy for Borderline Personality Disorder (BPD) despite a growing evidence base documenting its clinical effectiveness. This information can be used by clinicians to inform service planning and care pathways.Aims: The aim of this study was to review published empirical research investigating the potential mechanisms underlying therapeutic change in Dialectical Behaviour Therapy (DBT) and Cognitive Behaviour Therapy (CBT) for BPD.Method: A thorough search of the PsychInfo, CINAHL Plus, PubMed, MEDLINE and EMBASE databases revealed research into potential mechanisms of change.Results: A total of 52 abstracts were reviewed. After a full text screen of the most relevant studies, 14 met inclusion criteria. Twelve examined DBT and two CBT. Mechanisms of change identified broadly fell into three categories: emotion regulation/self-control, skills use and therapeutic alliance/investment in treatment. Outcomes measured included general mental health diagnoses (e.g. anxiety, depression) and BPD-specific symptoms (e.g. self-harm/suicidality, impulsivity, substance misuse, anger).Conclusion: Further empirically robust research is required to test hypotheses about the influence of the proposed mechanisms on therapeutic change in psychological therapies for BPD.

Understanding Therapeutic Change Process Research Through Multilevel Modeling and Text Mining.

Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied, and multi-layered processes? We advocate the use text mining and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. We (re-)used the data from Lamers et al. (2015) because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analyzed through MLMs. We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-leveled TCPR outcomes (using a MLM). Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR.

How do adolescents with depression experience improvement in psychodynamic psychotherapy? A qualitative study.

BACKGROUND: There is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents' experiences of factors promoting improvement in psychodynamic therapy. METHODS: Eight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work - In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semi-structured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation. RESULTS: The analysis revealed four main themes. 'Exploring oneself' comprises autonomy and acknowledgment, openness, insight and acceptance of oneself. 'Therapist relation and characteristics' includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. 'Focusing on everyday life' includes learning and practical orientation. 'Time factors' refers to duration and frequency. CONCLUSIONS: Together with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one's place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life. TRIAL REGISTRATION: ClinicalTrials.gov . Id: NCT01531101. Date of registry: 8 February 2012, retrospectively registered.

The role of the individual in the coming era of process-based therapy.

For decades the development of evidence-based therapy has been based on experimental tests of protocols designed to impact psychiatric syndromes. As this paradigm weakens, a more process-based therapy approach is rising in its place, focused on how to best target and change core biopsychosocial processes in specific situations for given goals with given clients. This is an inherently more idiographic question than has normally been at issue in evidence-based therapy over the last few decades. In this article we explore methods of assessment and analysis that can integrate idiographic and nomothetic approaches in a process-based era.

Phenomenological-narrative contributions to understand the narrative strategies that shape the autobiographical account throughout different moments of the therapeutic process.

Different studies suggest that the strategies and narrative styles that people use to construct their autobiographical accounts have repercussions on their self-organization, as well as on their identity experience and their conception of the world. Empirical evidence supports changes in different aspects related to process, structure, and content in the narrative of clients during the course of the therapeutic process; these, in turn, seem to condition the course and the results of the process. In this paper we will seek to show, based on a case study and through the application of a method of phenomenological-narrative analysis, what are the predominant narrative strategies that a client uses in order to shape her autobiographical narrative in the initial and final moments of her psychotherapeutic process. Our data suggest that the narrative strategies at the beginning and end of the therapy are qualitatively differentiable. Changes are observed in the plot of the respective accounts, as well as a differentiated mode in the use of narrative functions. More specifically toward the end of psychotherapy, the client makes a deeper characterization of herself and others, based on predicates of a subjectivating, interpretive, and evaluative-reflective kind. She also predominantly uses proconcluding metacomments, which could facilitate the integration of problematic experiences. In summary, our data suggest that after a successful therapeutic process the client uses more complex and integrated narrative strategies for the construction of her autobiographical account.

The Conceptual Framework of Thematic Mapping in Case Conceptualization.

This article, the 3rd in a series of 5, introduces the conceptual framework for thematic mapping, a novel approach to case conceptualization. The framework is transtheoretical in that it is not constrained by the tenets or concepts of any one therapeutic orientation and transdiagnostic in that it conceptualizes clients outside the constraints of diagnostic criteria. Thematic mapping comprises 4 components: a definition, foundational principles, defining features, and core concepts. These components of the framework, deemed building blocks, are explained in this article. Like the foundation of any structure, the heuristic value of the method requires that the building blocks have integrity, coherence, and sound anchoring. We assert that the conceptual framework provides a solid foundation, making thematic mapping a potential asset in mental health treatment.