Empathic relational bonds and personal agency in psychotherapy: Implications for psychotherapy supervision, practice, and research

Although psychotherapy researchers have become increasingly interested in identifying common factors that contribute to effective therapeutic practices, across psycho-diagnostic categories and treatment approaches, relatively little attention to date has been focused on the impact of these research findings for psychotherapy supervision and training programs. To address this gap, in this article we describe key components of an integrative psychotherapy supervision and training program that focuses on the development of a strong therapeutic alliance as an empirically supported, common principle of change in psychotherapy. We review empirical research evidence that addresses the contributions of therapist empathic engagement for the development of secure, relational bonds, heightened client agency, and the development of strong therapeutic alliances, and we discuss the implications of these findings for therapy practice and supervision training. We conclude with specific recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

A personal computer-based spike detector and sorter: implementation and evaluation.

Many studies of neuronal activity require isolation of the extracellular wave form (spike) of a single neuron from the potentials generated by nearby cells. A variety of methods for spike sorting exists, but most are expensive and require specialized hardware and software. Moreover, there is no easy and objective way for evaluating and comparing the performance of spike sorting devices. We describe here a system for on-line spike sorting that is implemented on an IBM PC/AT computer using commercially available hardware and C-language software. Spikes are detected after crossing an amplitude threshold and are sorted or rejected by template matching. The templates are constructed in a learning phase, using a fast manual sorting of all detected spikes. Later, each detected spike is matched against all defined templates. A detected spike which does not match any template, or matches more than one, is rejected. A continuous display of the wave forms of the last 256 sorted, double-matched, and rejected spikes is used as the main tool for parameter adjustment and error detection. Also described is a new and highly versatile tool for generating appropriate wave forms for critical evaluation of sorter performance. Using the same hardware and software tools, a simulation program mimics the extra-cellular activity of several neurons by linear combination of two vectors and added random noise. The size, shape and the variability of the action potential, as well as its firing pattern, can be adjusted. Comparison of the sorter output with the known simulated activity is used to examine the sorter performance and limitations.     

An agency model for developing and coordinating psychiatric aftercare

The development of coordinated systems for delivery of aftercare services to psychiatric patients has lagged far behind the theoretical emphasis on community maintenance. From a collaboration of 29 treatment and rehabilitation facilities, an independent agency was established to improve aftercare services in Metropolitan Toronto. Known as Community Resources Consultants, the agency was designed to facilitate and rationalize the use of existing services, to identify gaps in service, to initiate or cooperate in the development of new services, and to involve hospital and community service personnel in raising the level of expertise in the provision of aftercare. Formal and informal assessments indicate that CRC has had a positive effect on the provision of aftercare services and on professionals' level of awareness of aftercare priorities.     

Cueing an unresolved personal goal causes persistent ruminative self-focus: An experimental evaluation of control theories of rumination

Background and ObjectivesControl theory predicts that the detection of goal discrepancies initiates ruminative self-focus (Martin & Tesser, 1996). Despite the breadth of applications and interest in control theory, there is a lack of experimental evidence evaluating this prediction. The present study provided the first experimental test of this prediction.MethodsWe examined uninstructed state rumination in response to the cueing of resolved and unresolved goals in a non-clinical population using a novel measure of online rumination.ResultsConsistent with control theory, cueing an unresolved goal resulted in significantly greater recurrent intrusive ruminative thoughts than cueing a resolved goal. Individual differences in trait rumination moderated the impact of the goal cueing task on the extent of state rumination: individuals who had a stronger tendency to habitually ruminate were more susceptible to the effects of cueing goal discrepancies.LimitationsThe findings await replication in a clinically depressed sample where there is greater variability and higher levels of trait rumination.ConclusionsThese results indicate that control theories of goal pursuit provide a valuable framework for understanding the circumstances that trigger state rumination. Additionally, our measure of uninstructed online state rumination was found to be a valid and sensitive index of the extent and temporal course of state rumination, indicating its value for further investigating the proximal causes of state rumination.     

Community mental health care: clients' perceptions of services and an evaluation of a voluntary agency support scheme

A questionnaire assessment of mental health and of perceptions of formal care was conducted with a sample of clients before they received a voluntary agency mental health intervention in addition to normal community psychiatric and social services. The assessment was repeated three months later. A matched control group who received only the normal services were also assessed twice over a period of three months. Both groups improved significantly on the mental health measure over the three months and there was little difference between the treatment and control group. Clients in the voluntary agency group were less satisfied with community psychiatric services and may have chosen the voluntary agency as an alternative source of help. Women in both groups showed less improvement in measured mental health than men. Community Psychiatric Nurses (CPNs) were seen more frequently than social workers, psychologists and psychiatrists. Contacts with CPNs and social workers were rate most favourably.     

Self-determined,but not non-self-determined,motivation predicts activations in the anterior insular cortex: an fMRI study of personal agency

Neuroscientific studies on agency focus rather exclusively on the notion of who initiates and regulates actions, not on the notion of why the person does. The present study focused on the latter to investigate two different reasons underlying personal agency. Using event-related functional magnetic resonance imaging, we scanned 16 healthy human subjects while they imagined the enactment of volitional, agentic behavior on the same task but either for a self-determined and intrinsically motivated reason or for a non-self-determined and extrinsically motivated reason. Results showed that the anterior insular cortex (AIC), known to be related to the sense of agency, was more activated during self-determined behavior while the angular gyrus, known to be related to the sense of loss of agency, was more activated during non-self-determined behavior. Furthermore, AIC activities during self-determined behavior correlated highly with participants’ self-reported intrinsic satisfactions. We conclude that self-determined behavior is more agentic than is non-self-determined behavior and that personal agency arises only during self-determined, intrinsically motivated action.     

Confidentiality and therapy: an agency perspective

The present paper discusses the current interpretations of confidentiality restrictions and indicates the limitations of these for certain specialized treatment programs such as those for sex offenders. The interpretation of confidentiality regulations are usually based on weighing the benefits of maintaining a therapeutic relationship versus the risk to society that accrues when a therapist does not report a potentially dangerous person. The paper will point out that this limited view of confidentiality does not take into account the effect of such limitations on an agency's ability both to monitor patient progress and to reach a substantial number of patients. These issues are developed, based on a specific case encountered by an outpatient sex-offender treatment program.     

Ostensible agency: another malpractice hazard

Under the tort doctrine of ostensible (apparent) agency, a psychiatrist was named as a codefendant in a psychiatric malpractice suit against a nonmedical psychotherapist employed in his medical group, who had treated the plaintiff in her private practice in the same offices. The psychiatrist was later dismissed as a defendant, but to avoid being sued in such a case, a psychiatrist contemplating an association with another professional should 1) check the professional's record with the appropriate licensing agency, 2) require proof of licensure and malpractice insurance, 3) require that the professional's private patients sign disclosure statements, and 4) assure that names on written materials are kept separate.     

Facilitated communication: An experimental evaluation

Nineteen participants in a day treatment program for the developmentally disabled participated in this validation study of facilitated communication (FC). Subjects and facilitators had been involved in FC and judged competent by supervisors of the FC project at the facility. An information-passing design was used requiring short-term recall of one randomly selected stimulus card at a time. Cards varied by the shape, the color of that shape, and the number of that shape used on each card. Results failed to validate facilitated communication for the group as a whole, any individual facilitator, or any of the subjects. The closeness of the results to chance expectations from an experiment designed to validate only the most elemental claims of FC suggests that extraordinary caution be accorded any claims of communication that are the sole product of FC.The authors acknowledge Philip Levy, Kevin Travers, and the staff of the Young Adult Institute Day Treatment Program in Tanytown, New York, for their cooperation and support in the completion of this research.     

Taking risks for personal gain: An investigation of self-construal and testosterone responses to competition

Recent research on testosterone and risk-taking behavior is beginning to focus on the role of context-dependent changes in testosterone. Extending this research, our study investigated the association between testosterone reactivity to competitive outcomes and risk-taking in the context of a video game based competition. The study also examined whether self-construal moderated this relationship. Results indicated that a rise in testosterone during competition did not predict subsequent risk-taking behavior. However, a rise in testosterone during competition predicted subsequent risk-taking behaviors within winners with independent self-construals. Nevertheless, results did not reveal an association between basal testosterone and risk-taking, nor did competitive outcomes modulate a differential testosterone response. Overall, we treat these findings as preliminary, as there were multiple analyses conducted and effect sizes were relatively small. We discuss these results in the context of recent animal findings that testosterone facilitates success at future competitions after winning a competition, as well as recent research suggesting self-construal moderates associations between testosterone and aggression.     

The Autism Survey: An evaluation of reliability and validity

Psychometric properties of the Autism Survey, an instrument designed to assess respondents' knowledge about autism, were evaluated. Subjects completed the survey at a training conference and again 1 month later. Confirmatory factor analysis indicated that the survey measures one factor. With respect to reliability, the Autism Survey proved to be stable across time, and the total score was internally consistent. A few rogue items were recommended for deletion. Further analyses support the validity of the instrument.     

Radioautographic investigation of monoaminergic neurons: An evaluation

This review outlines the most relevant contributions currently available on the detection and ultrastructural characterization of monoaminergic neurons by radioautography after administration of radiolabeled monoamines. It includes methodological considerations and then a critical analysis of the diagnostic value of the radioautographic method for catecholaminergic and serotoninergic neurons, emphasizing in particular its recent applications to the visualization of dopaminergic axon terminals. An attempt is then made to evaluate the method in terms of specificity, sensitivity and resolution and its possibilities with regard to quantitative analysis. Lastly, its value for approaching the dynamic and metabolic properties of monoaminergic neurons is stressed.