Life Is About Change: A Professional Memoir.

Receiving my doctorate in 1961 just as John F. Kennedy was inaugurated president of the United States, I was inspired by his sentiment that any person can make a difference, and every person should try. In this memoir I review my professional journey of trying to make a difference in researching, teaching, supervising, and practicing clinical psychology and psychotherapy. I began my career by working on an evidence base for projective techniques. Upon joining the Stony Brook faculty, I shifted my efforts to research on and practice of behavior therapy, and then to the incorporation of cognition in developing cognitive behavioral therapy. Further work on integration consisted of closing the gap between research and practice, lowering the barriers that existed across schools of therapy, and incorporating lesbian, gay, bisexual, and transgender issues into mainstream psychology.

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.

Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder.

Homework assignments, or specific tasks patients are asked to engage in or complete between sessions, are a controversial topic among psychoanalysts. While many argue these interventions contradict psychoanalytic principles, others believe they can help address problems and promote coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient's experience and that homework may be an important component of treating personality disorders (PD). We present the case of a man diagnosed with narcissistic PD. He often felt superior to and reported that he despised others, though the core self-image was of fragile. He embraced the role of the omnipotent caregiver, which came with boredom and anger and lack of satisfaction in his social life. The patient tried to control therapy, asserting that he could psychoanalyze himself. As a result, therapy was stalled and progress was limited. At this point, the therapist asked him to complete homework assignments that encouraged him to refrain from his compulsive caregiving to better understand what motivated this behavior. Through this process, the patient came to realize he acted out of avoidance, as he did not want to disclose his own vulnerabilities and flaws. At that point he was able to experience relationships while adopting different stances and finding new meanings. We argue that homework can be fully integrated into the relational psychoanalytic repertoire to improve self-reflection and foster change in patients with PD.

When one tool is not enough: An integrative psychotherapeutic approach to treating complex PTSD.

Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter-personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter-personal relationships. Self-harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains.

The heart of healing: Echoes of Sándor Ferenczi's legacy in Jeremy Safran's relational commitments.

In this duet of two voices honoring Jeremy Safran's legacy, the authors celebrate some points of resonance between Sándor Ferenczi's groundbreaking relational interventions and Safran's approach to the therapeutic relationship as the heart of healing. Karen Starr first highlights Ferenczi's now well-known creative experimentation with technique and his emphasis on and care for the relational dimension of psychoanalytic treatment. Jill Bresler then links Safran's career-long dedication to the therapeutic alliance to Starr's introductory remarks, honoring Safran and Ferenczi's shared dedication to expanding options in clinical practice through focus on the relationship. Recalling Safran's naming Ferenczi as a key figure in psychotherapy integration's origin story, Bresler reflects on her own learning from Safran's groundbreaking transtheoretical research into the mutative aspects of psychotherapy and his translating a psychoanalytic focus on the therapeutic relationship to CBT researchers and practitioners.

Remembering Jeremy Safran: continuing the conversation.

This introduction provides an overview to this special issue honoring the work and legacy of Jeremy D. Safran. Born of the Jeremy Safran Memorial Conference, held on April 2nd, 2023, this issue features a wide range of contributions from leaders in the field, former students, and early career professionals whose work engages and develops central ideas from Safran's work and reflects on his impact on their own clinical work and scholarship. Themes center around the three domains of Safran's major contributions: pedagogy; psychotherapy integration; and Buddhism, spirituality, and psychoanalysis. We observe among the contributions an experiential reconnecting with the deeply relational commitments of our friend and colleague.

How Personality Disorders Change in Psychotherapy: a Concise Review of Process.

PURPOSE OF REVIEW: The present review summarizes the current state of the art in psychotherapy processes during treatments for clients with personality disorders. We outline some methodological challenges in the discipline of process research, give a brief historical account on process research, and then focus on specific processes studied from an empirical perspective. RECENT FINDINGS: The current review acknowledges the centrality of the therapeutic relationship, in particular the therapeutic alliance, therapist empathy, and responsiveness in explaining outcome across treatment modalities for personality disorders. The review describes evidence from three overall and overlapping lines of inquiry that have garnered scientific interest in the past years. For emotional change (regulation, awareness, and transformation), socio-cognitive change (mentalizing, meta-cognition, and interpersonal patterns), and increase in insight and change in defense mechanisms, evidence is moderate to strong for these processes to contribute to healthy change in treatments for personality disorders, in particular borderline personality disorder. Avenues of future studies are outlined.

Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP)-An integrative, transdiagnostic approach.

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion-focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short-term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded-off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.

Developing Emotion-Based Case Formulations: A Research-Informed Method.

OBJECTIVES: New research-informed methods for case conceptualization that cut across traditional therapy approaches are increasingly popular. This paper presents a trans-theoretical approach to case formulation based on the research observations of emotion. METHODS: The sequential model of emotional processing (Pascual-Leone & Greenberg, 2007) is a process research model that provides concrete markers for therapists to observe the emerging emotional development of their clients. We illustrate how this model can be used by clinicians to track change and provides a 'clinical map,' by which therapist may orient themselves in-session and plan treatment interventions. RESULTS: Emotional processing offers as a trans-theoretical framework for therapists who wish to conduct emotion-based case formulations. First, we present criteria for why this research model translates well into practice. Second, two contrasting case studies are presented to demonstrate the method. CONCLUSIONS: The model bridges research with practice by using client emotion as an axis of integration. Key Practitioner Message Process research on emotion can offer a template for therapists to make case formulations while using a range of treatment approaches. The sequential model of emotional processing provides a 'process map' of concrete markers for therapists to (1) observe the emerging emotional development of their clients, and (2) help therapists develop a treatment plan. Copyright © 2016 John Wiley & Sons, Ltd.

Predicting Psychotherapy Dropouts: A Multilevel Approach.

UNLABELLED: The role of therapeutic processes in predicting premature termination of psychotherapy has been a particular focus of recent research. The purpose of this study was to contrast outpatients who completed therapy and those who dropped out with respect to their self-reported in-session experiences of self-esteem, mastery, clarification and the therapeutic alliance. The 296 patients with mixed disorders were treated with an integrative form of cognitive-behavioural therapy without pre-determined time limit (M = 20.2 sessions). Multilevel analyses indicated that patients who did not completetreatment reported, on average, lower levels of self-esteem, mastery and clarification and lower ratings of their therapeutic alliance in treatment in contrast to patients who completed therapy. Patient-reported change in self-esteem experiences over the course of treatment turned out to be the strongest predictor of dropout from psychotherapy or successful completion. When dropout occurred before the average treatment length was reached, patients reported fewer clarifying experiences as early as the first session and their ratings of the therapeutic alliance were characterized by an absence of positive development. Both of these aspects seem to be involved in patients' decisions to leave treatment early. The findings underscore the importance of the therapeutic process in understanding the mechanisms behind treatment dropout. KEY PRACTITIONER MESSAGE: Analyses data from 296 patients at a private outpatient clinic in a routine practice setting (CBT). Completer/dropout definition: presence or absence of measurement battery at post-assessment. Focuses on change in therapy processes by investigating post-session reports. Finds that positive changes in self-esteem experiences is the most robust predictor of dropout, followed by ratings of clarification experiences and the global alliance. In line with recent dropout research, these process indicators might help to detect therapeutic situations that are connected with psychotherapy dropouts.

Research on psychotherapy integration: building on the past, looking to the future.

Integration has become an important and influential movement within psychotherapy practice, reflected by the fact that many treatment providers now identify as integrative. However, integration has not had as great an influence on psychotherapy research. The goal of this paper is to highlight the growing body of research on psychotherapy integration, and to identify future directions for research that may strengthen the integration movement as well as the field of psychotherapy as a whole. We first summarize the past 25 years of research on integration, with a focus on four approaches to integration: theoretical integration, technical eclectic, common factors, and assimilative integration. Next, we identify directions of research within these four areas that could strengthen and support integrative practice. We then propose ways in which the perspective of integrationists could contribute to psychotherapy research in the critical areas of harmful effects, therapist effects, practice-oriented research, and training. We end this paper by suggesting that a greater collaboration between integrationists and psychotherapy researchers will help to create a unified landscape of knowledge and action that will benefit all participants and advance the field.

Narrative and emotion process in psychotherapy: an empirical test of the Narrative-Emotion Process Coding System (NEPCS).

OBJECTIVE: While the individual contributions of narrative and emotion processes to psychotherapy outcome have been the focus of recent interest in psychotherapy research literature, the empirical analysis of narrative and emotion integration has rarely been addressed. The Narrative-Emotion Processes Coding System (NEPCS) was developed to provide researchers with a systematic method for identifying specific narrative and emotion process markers, for application to therapy session videos. METHOD: The present study examined the relationship between NEPCS-derived problem markers (same old storytelling, empty storytelling, unstoried emotion, abstract storytelling) and change markers (competing plotlines storytelling, inchoate storytelling, unexpected outcome storytelling, and discovery storytelling), and treatment outcome (recovered versus unchanged at therapy termination) and stage of therapy (early, middle, late) in brief emotion-focused (EFT), client-centred (CCT), and cognitive (CT) therapies for depression. RESULTS: Hierarchical linear modelling analyses demonstrated a significant Outcome effect for inchoate storytelling (p = .037) and discovery storytelling (p = .002), a Stage × Outcome effect for abstract storytelling (p = .05), and a Stage × Outcome × Treatment effect for competing plotlines storytelling (p = .001). There was also a significant Stage × Outcome effect for NEPCS problem markers (p = .007) and change markers (p = .03). CONCLUSION: The results provide preliminary support for the importance of assessing the contribution of narrative-emotion processes to efficacious treatment outcomes in EFT, CCT, and CT treatments of depression.

Four Versions of Transtheoretical Stances, and the Bernese View.

A brief characterization of transtheoretical stances to which existing approaches can be allocated is followed by a description of the "Bernese view", that is, what Klaus Grawe and his colleagues, including the authors of this article have developed: the origins, a model of the multiple constraint satisfaction construction of therapist action, a discussion of psychotherapy integration, the crucial role of supervisors in an integrative multiple constraint satisfaction approach, and a discussion of when and how trainees should be introduced to a transtheoretical stance.

Responding to Key Process Markers as a Focus of Psychotherapy Training and Practice.

Historically, evidence-based psychotherapy training has favored the standardized application of discrete treatment packages, with key outcomes being the therapist's adherence to and competent delivery of theory-prescribed ingredients. However, this model often fails to align with the priorities and values of clinicians, and research casts doubt on the notion that a therapist's faithful application of treatment protocols is a valid index of clinical expertise. Considering this, training and practice models that emphasize evidence-based clinician flexibility and patient-centered tailoring of interventions are receiving increased attention. In this article, we outline one such model informed by the context-responsive psychotherapy integration (CRPI) framework. Consistent with CRPI principles, we describe several "if this/then try that" marker-response sequences that could become a centerpiece of a more nuanced, clinically representative, and evidence-based psychotherapy training paradigm. Finally, we offer several recommendations for future work on CRPI.

Needs, Modes, and Stances: Three Cardinal Questions for Psychotherapy Practice and Training.

Background: Advances in motivational science (Dweck, 2017), personality dynamics (Lazarus & Rafaeli, 2023), and process-based psychotherapy (Hofmann & Hayes, 2019) converge into a pragmatic, integrative, and transtheoretical model of practice and training. Method: The model comprises three elements: a formulation centered on clients' psychological needs which provides guidance regarding the goals and processes most profitable to pursue; a recognition that such pursuit frequently requires contending with a multiplicity of clients' internal self-states (i.e., modes); and an enumeration of pragmatic therapeutic stances likely to help address clients' need-related goals in light of their modes. Results: We distill these elements into three cardinal questions: What needs does this client have that are not currently met, and what are the most profitable ways of remedying that frustration? What mode or modes does this client manifest - both generally and at this very moment? and What stance should I adopt in response to the client's current mode? We suggest that clinicians should be trained to continually pose these questions and seek to answer them collaboratively with their clients. Conclusion: This model - illustrated here using schema therapy terms - offers a process-based approach which serves as a theoretically integrative starting point but is general enough to provide an assimilative integration roadmap for therapists anchored in most primary orientations. Integrative or assimilative therapists trained to attend to needs, modes, and stances are likely to be (and be perceived as) particularly responsive, and thus, to enact "common factor" practices known to be conducive to therapeutic alliance and gains.

The Functions of Safety in Psychotherapy: An Integrative Theoretical Perspective Across Therapeutic Schools.

Objective: There is a certain consensus in the psychotherapeutic literature that safety plays a central role in human development and psychotherapy and that lack of safety undermines mental health. However, the role of safety in psychotherapy has not yet been thoroughly examined. In this article, we identify and integrate the diferent functions of safety in psychotherapy on a theoretical basis. Method: We made a panoramic overview of the concept of safety across some of the main psychotherapeutic schools that represent major paradigms in contemporary psychotherapy (psychodynamic, cognitive-behavioral, humanistic). We then analyzed, compared, and synthetized the findings to identify the common functions that safety plays both in ontogenesis and in clinical practice across different therapeutic orientations. Results: Our analysis showed that safety is indeed rightly prioritized across psychotherapy schools because of its developmental value in promoting change and adaptation both in ontogenesis and clinical settings. The findings suggest that the main functions of safety are to secure survival, facilitate restoration, promote exploration, sustain risk-taking, and enable integration, with these functions being complementary and dependent on the context. However, safety seems to be in a dialectical and paradoxical relationship to psychotherapy and human development. Adequate ontogenetic development and treatment progress do not appear to require continuous maintenance of maximum possible safety. Rather, they seem to require enough safety, adequately and timely modulated according to developmental needs and treatment phases. Conclusions: Although safety provides the necessary basis that enables restoration, fuels exploration, and facilitates treatment progress, safety's misdosage (e.g., lack, excess), misconstruction (e.g., misattunement, misinterpretation), or misuse (exploitation, idealization) may hinder the healthy development of attachment, identity, autonomy, self/co-regulation as well as the ability to tolerate and cope with dangers, risks, insecurities, or frustrations. Future research is suggested to further explore the role of safety in psychotherapy.

Dialectical Thinking: A Proposed Foundation for a Post-modern Psychology.

For the authors, the way from a modern to a post-modern psychology requires dialectical thinking. Dialectical thinking recognizes the importance of contradiction, change, and synthesis; it also includes recognition of the value as well as limits of modern epistemological approaches. The article describes foundations for both ongoing efforts to understand and research the ontogeny of dialectical thinking and for appreciating the scope of dialectical thinking and its relevance for establishing a bridge from modern to post-modern psychology.

Reformulated Object Relations Theory: A Bridge Between Clinical Psychoanalysis, Psychotherapy Integration, and the Understanding and Treatment of Suicidal Depression.

In contrast to the fruitful relationship between psychoanalysis/psychoanalysts and the humanities, institutionalized psychoanalysis has been largely resistant to the integration of psychoanalysis with other empirical branches of knowledge (infant observation, psychotherapy research, psychological and neurobiological sciences), as well as clinical ones [primarily cognitive-behavioral therapy (CBT)]. Drawing from two decades of theoretical and empirical work on psychopathology, psychotherapy, and psychoanalysis, the author aims to show how a reformulation of object relations theory (RORT) using (neuro-)psychological science may enhance a clinical-psychoanalytic understanding and treatment of suicidal depression, which constitutes one of the most formidable health challenges of our time. Specifically, he rewrote the notion of Melanie Klein positions-primarily the depressive position-using extant knowledge of structure of emotions, the centrality of mental representations of the future ("prospection") and the toxic nature of criticism-based emotions. This reformulation enables a dialog between clinical psychoanalysis and other therapeutic schools of thought and sheds light on the understanding and treatment of suicidal depression.

Integration versus conflict between schools of dream theory and dreamwork: integrating the psychological core qualities of dreams with the contemporary knowledge of the dreaming brain.

The various ways schools of psychotherapy relate to dreams have been marked by isolationism and mutual conflict rather than self-examination and then integrating the discoveries and methods of other schools. Jung's method was in opposition to Freud's psychoanalysis. Existential psychology was dismissive of Freud's and Jung's discoveries, while cognitive dream interpretation and cognitive therapy sought other roads entirely. In addition, scientific and neuropsychological dream research has been only insignificantly tied to the psychotherapeutic dream theories. These conflicts and the lack of a comprehensive dream theory has made it convenient for the current rationalist collective consciousness and treatment systems to reject the often times challenging knowledge about ourselves that dreams can provide. This paper describes how contemporary theories of complex cybernetic information networks can create an overriding, constructive framework for uncovering common traits within the above-mentioned branches of dream research and dreamwork. Within this framework, ten core qualities are delineated, supported by both therapeutic knowledge as well as scientific research: 1) Dreams deal with matters important to us; 2) Dreams symbolize; 3) Dreams personify; 4) Dreams are trial runs in a safe place; 5) Dreams are online to unconscious intelligence; 6) Dreams are pattern recognition; 7) Dreams are high level communication; 8) Dreams are condensed information; 9) Dreams are experiences of wholeness; 10) Dreams are psychological energy landscapes. For each core quality I describe short dreamwork sequences from my own practice and a schematic image of how I perceive the overriding interaction between systems in the dreaming brain. For each core quality recommendations for practical dreamwork are provided. Finally, I draw attention to dreams as a huge psychological resource for humankind.

La manière dont les écoles de psychothérapie s'intéressent au rêve a été caractérisée par l'isolationnisme et les conflits plutôt que par l'introspection puis l'intégration des découvertes et des méthodes d'autres écoles. La méthode de Jung était en opposition avec la psychanalyse de Freud. La psychologie existentielle prenait de haut les découvertes de Freud et de Jung, pendant que l'interprétation cognitive du rêve et la thérapie cognitive cherchaient des voies complètement différentes. De plus, la recherche scientifique et neuropsychologique sur le rêve a été très peu liée aux théories psychothérapeutiques du rêve. Ces conflits, ainsi que l'absence d'une théorie globale sur le rêve, ont facilité le rejet par la conscience collective rationnelle actuelle et par le système de traitement de la connaissance sur nous souvent exigeante que nous apporte le rêve. Cet article décrit comment les théories contemporaines des réseaux d'information cybernétique complexe peuvent créer un cadre fondamental et constructif pour dévoiler les traits communs entre les branches de recherche sur le rêve et de travail sur le rêve mentionnées ci-dessus. Dans ce cadre, dix qualités essentielles sont définies selon la connaissance thérapeutique et la recherche scientifique: 1) Les rêves s'occupent des problèmes qui nous importent, 2) Les rêves symbolisent, 3) Les rêves personnifient, 4) Les rêves sont des essais effectués dans un espace sans danger, 5) Les rêves sont connectés à l'intelligence inconsciente, 6) Les rêves sont une reconnaissance des formes ou des schémas, 7) Les rêves sont des communications de haut niveau, 8) Les rêves sont de l'information condensée, 9) Les rêves sont des expériences de globalité, 10) Les rêves sont des paysages d'énergie psychologique. En tant qu'illustrations, je décris pour chaque qualité de courtes séquences de travail avec les rêves à partir de ma propre pratique, et une image schématique de comment je perçois l'interaction principale entre les systèmes du cerveau en train de rêver. Pour chacune des Qualités Essentielles des recommandations concernant le travail possible sur le rêve sont fournies. Finalement j'attire l'attention sur la ressource potentielle énorme que sont les rêves pour l'humanité dans sa totalité.

Los modos en los que las escuelas de psicoterapia se han referido a los sueños han estados marcados por el aislamiento y el conflicto mutuo en vez de por la autoevaluación y la integración posterior de los descubrimientos y los métodos de las otras escuelas. El método de Jung se oponía al psicoanálisis de Freud. La psicología Existencial desacreditó los descubrimientos de Freud y de Jung, mientras que la interpretación cognitiva de los sueños y la terapia cognitiva buscó enteramente otros caminos. Junto a todo lo anterior, la investigación científica y neuropsicológica de sueños ha estado ligada a las teorías psicológicas solo de manera insignificante. Estos conflictos y la ausencia de una teoría comprehensiva de los sueños, ha dado lugar a que la actual consciencia colectiva racionalista y los sistemas de tratamiento rechacen el - a menudo desafiante - conocimiento sobre nosotros mismos que los sueños pueden proveer. El artículo describe cómo las teorías contemporáneas de redes complejas de información cibernética puedan crear un marco de referencia constructivo para descubrir rasgos comunes dentro de las líneas de investigación de los sueños mencionadas anteriormente. Dentro de este marco de referencia, se describen diez cualidades centrales, sustentadas tanto por el conocimiento terapéutico como por la investigación científica. 1) Los sueños dan cuenta de cuestiones que nos son importantes; 2) Los sueños simbolizan; 3) Los sueños personifican; 4) Los sueños son ensayos en un lugar seguro; 5) Los sueños son vías a una inteligencia inconsciente; 6) Los sueños son patrones de reconocimiento; 7) Los sueños son comunicaciones de alto nivel; 8) Los sueños son información condensada;9) Los sueños son experiencias de totalidad; 10) Los sueños son paisajes de energía psicológica. Como ilustraciones educativas, describo, para cada cualidad central, secuencias cortas de trabajo de sueños de mi propia práctica y una imagen esquemática de como percibo la interacción entre los diferentes sistemas en el cerebro soñante. Para cada Cualidad Central se proveen recomendaciones prácticas para el trabajo de sueños. Finalmente, llamo la atención hacia los sueños como un inmenso recurso psicológico para la humanidad en su totalidad.

Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions.

The study aimed to test whether countertransference reactions contain valid information about the patient. The authors examined whether a significant part of the variance in emotional, cognitive, and motivational responses to recorded therapy sessions is attributable to the patient. Six student raters listened to 605 audiotaped sessions of 81 patients with major depression treated by 19 therapists and indicated their reactions using a modified version of the Countertransference Questionnaire. The relative amount of variance in countertransference reactions due to differences between patients, ranging from 2% to 16%, was significant for most of the countertransference dimensions. Reactions were influenced by type of treatment and severity of depression but not by comorbid personality disorder or interpersonal problems. The relative amount of variance due to differences between raters was large, averaging at 23%. The authors conclude that-albeit having a relatively low "signal-to-noise ratio"in raters without psychotherapy training-countertransference reactions contain valid clinical information.