The association between patient-therapist MATRIX congruence and treatment outcome.

Objective: The present study aimed to examine the association between patient-therapist micro-level congruence/incongruence ratio and psychotherapeutic outcome. Method: Nine good- and nine poor-outcome psychodynamic treatments (segregated by comparing pre- and post-treatment BDI-II) were analyzed (N = 18) moment by moment using the MATRIX (total number of MATRIX codes analyzed = 11,125). MATRIX congruence was defined as similar adjacent MATRIX codes. Results: the congruence/incongruence ratio tended to increase as the treatment progressed only in good-outcome treatments. Conclusion: Progression of MATRIX codes' congruence/incongruence ratio is associated with good outcome of psychotherapy.

On the Logic of the Unconscious Conception of Causation Part I: The Oedipal Meta-Wish and the Sexualization of Asymmetric Time.

The direction of time is often defined by describing asymmetries between past and future events, referred to as "time-arrows." Two important time-arrows are the mutability time-arrow, which specifies that the past is unalterable, while the future is not; and the causal time-arrow, which stipulates that past events may cause future events, but not vice versa. The author argues that the unconscious conception of causation expressed in both the oedipal myth and certain oedipal wishes negates the mutability and causal time-arrows. The author suggests, therefore, distinguishing between oedipal phantasies that undermine the ordinary conceptions of causation and time (such as the wish of being one's own parent), and classical content that is in line with our time perception (such as sexual and aggressive wishes toward parents). Analyzing clinical examples suggests that some patients' oedipal phantasies are combined with unconscious sexual satisfaction from the asymmetric conception of time. When this sexual satisfaction is analyzed, they might expose the oedipal phantasies founded on the symmetric conception of time.

On the logic of unconscious objects.

The aim of this paper is to distinguish between conscious and unconscious conceptions of objects. I will argue that we consciously ascribe different properties to the same object based on their coexistence in time and space. For example, the colour and flavour of an apple are ascribed to the same object as they relate to the same spatiotemporal location. However, since there is no reference to time in unconscious thinking, we cannot ascribe properties unconsciously to objects based on spatiotemporality. Instead, I hypothesize, properties are unconsciously ascribed to the same object based on the drive they satisfy. This hypothesis accounts for substantial unconscious processes such as condensation, displacement, splitting and certain linguistic features of unconscious thinking. Moreover, it enables the identification of a type of suppression of unconscious content-logical suppression-used to classify levels of personality organization. The clinical merit of this hypothesis will be presented through various case reports.

Patient-therapist congruent exchanges engaged with the potential-to-experience is associated with better outcome of psychotherapy.

BACKGROUND: The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. However, as this assumption has never been empirically tested, the relationship between such interventions and treatment outcome is unclear. The aim of this pilot study is to explore the relationship between patient-therapist congruence of potential-to-experience engaged statements and the outcome of psychodynamic treatments. METHODS: Transcripts of 90 sessions from good- and poor-outcome treatments (N = 18) were encoded using the MATRIX - a novel content analysis tool of psychodynamic psychotherapy. Based on fixed algorithms, this observer-coding system is designed to identify different types of clinical interventions, including those which focus on the potential-to-experience. Total number of MATRIX codes analysed was 11,125. We compared the total congruence/incongruence ratio of such statements in good and poor treatments. The importance of the congruence/incongruence ratio of the potential-to-experience statements was measured by applying general linear models to classify treatment outcome. RESULTS: The congruence/incongruence ratio of the potential-to-experience engaged statements was significantly higher in good treatments. In the best model for classifying treatment outcome based on the congruence/incongruence ratios of several parameters, the congruence/incongruence ratio of the potential-to-experience engaged statements was the single most important predictor. DISCUSSION: Maintaining the congruence of potential-to-experience engaged statements within the therapeutic session is associated with better clinical outcome. This provides an initial empirical indication to the importance of the potential-to-experience discourse in psychotherapy praxis. PRACTITIONER POINTS: The concept of potential-to-experience is a major component in psychodynamic theory and assumed to be an important component of psychotherapeutic technique. The current results suggest that the ability of both patient and therapist to maintain the congruence of potential-to-experience statements within the session may improve clinical outcomes. These findings suggest a practical approach for a better management of the therapeutic process. Mainly, it recommends therapists to implement a very careful, active listening to potential-to-experience-related content throughout the session, while highlighting the patient's associations for their potential to become new modus operandi. Moreover, the current study presents an integrative, micro-level tool that enables the translation of complex theoretical concepts in psychotherapy into measurable constructs, aiming at the creation of a bridge between clinical theory and evidence-based practice.

On the logic of the unconscious.

Freud argues that the laws of classical logic do not hold true with regard to the unconscious. The aim of this paper is to provide an alternative logic that is consistent with Freud's conception of the unconscious. This aim is achieved in two steps. First, I argue that most Freudian features of the unconscious are consequences of the fact that unconscious thoughts in the Freudian sense are negationless. Then I suggest a formal logical system that lacks the negation symbol, and is known as negationless-logic, with which to formulate the logic of the unconscious. I demonstrate that this suggestion provides a better understanding of various psychological phenomena, such as projection, reaction-formation, delusion and the misconstrual of the empty set in childhood. Finally, I argue that negationless-logic provides solutions to certain shortcomings in Matte-Blanco's formulation of the logic of the unconscious.

Getting more out of meta-analyses: a new approach to meta-analysis in light of unexplained heterogeneity.

BACKGROUND AND OBJECTIVES: Meta-analyses sometimes summarize results in the presence of substantial unexplained between-study heterogeneity. As GRADE criteria highlight, unexplained heterogeneity reduces certainty in the evidence, resulting in limited confidence in average effect estimates. The aim of this paper is to provide a new clinically useful approach to estimating an intervention effect in light of unexplained heterogeneity. METHODS: We used a random-effects model to estimate the distribution of an intervention-effect across various groups of patients given data derived from meta-analysis. The model provides a distribution of the probabilities of various possible effects in a new group of patients. We examined how our method influenced the conclusions of two meta-analyses. RESULTS: In one example, our method illustrated that evidence from a meta-analysis did not support authors' highly publicized conclusion that hypericum is as effective as other antidepressants. In the second example, our method provided insight into a subgroup analysis of the effect of ribavirin in hepatitis C, demonstrating clear important benefit in one subgroup but not in others. CONCLUSION: Analysing the distribution of an intervention-effect in random-effects models may enable clinicians to improve their understanding of the probability of particular-intervention effects in a new population.

Processes in Psychotherapy and the MATRIX: The Case of Projective Identification.

The MATRIX is a tool designed to analyze psychoanalytic sessions. It is composed of two axes: focus (patient, therapist, and dyad) and dimension (space, content, and order). The MATRIX was found to be a reliable tool, and valid for identifying the therapist's theoretical inclinations in psychoanalytic-oriented psychotherapy sessions. In the present study, we suggest that the MATRIX can identify different (Kleinian, Bionian, and relational) approaches to projective identification, thus providing therapists and supervisors an easy-to-use tool for monitoring, and better managing, projective identifications during psychoanalytically oriented psychotherapy.

The MATRIX, a novel tool exploring dynamic psychotherapy: Preliminary psychometric properties.

Most measures in the field of psychodynamic psychotherapy are bound to a specific theory, and usually focus only on patient processes or therapist interventions. The MATRIX is a newly developed research tool that focuses on events within both the patient and the therapist individually, as well as on dyadic events, and provides the simple and meaningful coding of content for therapy session transcripts in psychotherapy. The present study describes the inter-rater reliability and construct validity of the MATRIX. Reliability of the MATRIX was assessed by applying it to 805 fragments of psychodynamic-oriented psychotherapy sessions. Three independent experts coded fragments, and the tool was examined for reliability. Validity in identifying the theoretical inclinations was assessed by applying the MATRIX to 30 segments (containing 1309 fragments) of sessions that reflect different theoretical orientations. Findings evinced high inter-rater reliability for all dimensions. The MATRIX was found to have high degree of validity for differentiating the theoretical inclinations of segments of sessions. The MATRIX is a reliable and valid measure that may enable moment-to-moment, quantitative, analysis of psychodynamic psychotherapy.

Assessment of the Risk of Fractures Because of Service on Diesel Submarines: A Retrospective Cohort Study.

INTRODUCTION: Submariners are known to have decreased bone mass following periods of long submersion. We examined whether this produces a higher predilection to fractures. METHODS: This is a retrospective cohort study. Data were collected from the computerized medical records of 457 consecutive submariners (serving 1091.42 man-years). The control group included 3,219 consecutive sailors, (serving 5845.04 man-years). Groups were stratified according to age at induction, body mass index, place of birth, and status of service (i.e., compulsory versus professional). Analysis of fracture incidence and comparison of proportions between the groups was conducted using χ(2) tests and Fisher's exact test. The hazard ratio for fractures was performed using a survival analysis regression model for each group (Cox Proportional Hazard Model). RESULTS: Nineteen submariners (4.2%) and 94 sailors (2.9%) were shown to have fractures during their service (RR = 1.42, p = 0.15). A Cox proportional hazard model was employed. No statistically significant difference was found between the 2 groups (HR = 1.037, p = 0.89). No correlation was found between length of service and risk of fracture. Most fractures suffered by submariners occurred outside their work environment. CONCLUSIONS: Submariners are repeatedly exposed to prolonged submersions that are deleterious to bone strength. However, no statistically significant difference in the incidence of fractures was found between submariners and surface sailors. This is an important finding for the bone and occupational health of submariners in general.

Cell-free DNA as a marker for prediction of brain damage in traumatic brain injury in rats.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, and early predictors of neurological outcomes are of great clinical importance. Cell free DNA (CFD), a biomarker used for the diagnosis and monitoring of several diseases, has been implicated as a possible prognostic indicator after TBI. The purpose of this study was to determine the pattern and timing of CFD levels after TBI, and whether a relationship exists between the level of CFD and brain edema and neurological outcomes. Thirty-nine Sprague-Dawley rats were randomly assigned to two groups: rats in group 1 (sham group) were anesthetized and had a scalp incision without TBI, and rats in group 2 were anesthetized and had a scalp incision with TBI, which was induced by using a weight drop model that causes diffuse brain injury. A neurological severity score (NSS) was assessed at 1, 24, and 48 h after TBI. CFD was measured via blood samples drawn at t=0 (baseline), 12, 24, 48, 72, and 120 h after TBI. At 48 h after TBI, brain edema was determined in a subgroup of 11 rats by calculating the difference between rats' wet and dry brain weight. The significance of comparisons between and within groups (CFD levels, brain water content, and NSS) were determined using the Kruskal-Wallis, Mann-Whitney and Student t test. The correlation between CFD levels and the NSS, as well as between CFD levels and the extent of brain edema, was calculated using the Spearman and Pearson tests, respectively. Compared with baseline levels, the CFD levels in rats subjected to TBI were significantly increased at 24 and 48 h after TBI (p<0.01 and p<0.05, respectively). A positive correlation was demonstrated between CFD levels 24 h following TBI and the extent of brain edema (r=0.63, p<0.05), as well as between CFD levels and the NSS (r=0.79, p<0.005). In this study, we demonstrated an increase in CFD levels after TBI, as well as a correlation between CFD levels and brain edema and NSS. CFD levels may provide a quick, reliable, and simple prognostic indicator of neurological outcome in animals after TBI. Its role in humans has not been clearly elucidated, but has potentially significant clinical implications.

The effects of hemodialysis on blood glutamate levels in chronic renal failure: implementation for neuroprotection.

PURPOSE: The purpose of the present study is to investigate whether hemodialysis (HD) is effective in lowering blood glutamate levels. In addition, we examined the effect of HD on glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT) levels in the blood and described the rate and pattern of blood glutamate clearance during HD. MATERIALS AND METHODS: Blood samples were taken from 45 patients with stage V chronic kidney disease immediately after initiation of HD and hourly, for a total of 5 blood samples. Samples were sent for determination of glutamate, glucose, GOT, GPT, hemoglobin, hematocrit, urea, and creatinine levels. A blood sample from 25 healthy volunteers without chronic renal failure was used as a control for the determination of baseline blood levels of glutamate, GOT, and GPT. RESULTS: Glutamate and GPT levels in patients on HD were higher at baseline compared with healthy controls (P < .001). In the first 3 hours after HD, there was a decrease in blood glutamate levels compared with baseline levels (P < .00001). At the fourth hour, there was an increase in blood glutamate levels compared with the third hour (P < .05). CONCLUSIONS: Hemodialysis may be a promising method of reducing blood glutamate levels.