Questionary research on individual psychotherapy of borderline personality disorder (BPD)]

The authors researched individual psychotherapy of borderline personality disorder (BPD) in Japan using a questionnaire given to expert therapists. To select the expert therapists, a database search for the keywords "borderline personality disorder" and "border-line case" was carried out in the Japanese literature on psychiatry and clinical psychology. Thus, 280 expert therapists, who were authors of articles related to the psychotherapy of BPD, were selected. Qestionnaires on individual psychotherapy of BPD were sent to them, and 128 responses were obtained. About 60% of these therapists were performing structured individual psychotherapy. This was about half of the psychiatrists and almost all of the clinical psychologists. Most of the structured psychotherapy was performed once a week, with 50 minute sessions. But there also were biweekly, 30-39 minute, 40-49 minute, and 20-29 minute sessions. The basic therapeutic methodology was psychoanalytic psychotherapy, supportive psychotherapy, and eclectic therapy, with each of them constituting about one third of the total, in this order of percentage. In the case of structured individual psychotherapy, what the majority of the therapists performed is as follows. They talked about therapeutic goals. When talking about therapeutic goals, the focus was on realistic issues such as improving social adaptation, controlling impulsive behavior or reducing the symptoms. In the face of self-harm behavior, they talked about the meaning and the utility of self-harm behavior, listened to the progression of the episodes, or said it was definitely not a good thing to do. If the self-harm behaviors were repeated, they told the patients that it was necessary for them to be confined to the closed-ward, or told them that the continuation of psychotherapy might become difficult. When there was intense anger toward the therapists, they validated the rightful parts of it. Concerning the anger and depression of the therapists, they restrained their feelings and considered them later, talked about it with their colleagues and experts, or communicated to the patients their honest feelings. In the case of frequent telephone calls, they told their patients to reduce their calls as much as possible, but when the calls came, talked with them briefly. Or they allotted the times the patients could make a call. Disclosure of the private information of the therapists was not done at all, or was done sometimes according to the situation. They actively talked about the limitations of the therapists and the patient-therapist relationship. They appreciated and praised the achievements of the patients. They talked about the termination of the psychotherapy. When they happened to meet the patients outside of the therapy, they responded to the patients only when they were addressed, or they addressed the patients by themselves but just briefly. The clinical situation of the BPD individual psychotherapy in Japan was not made clear so far. Our research clarified the situation, though there was the methodological limitation of the questionnaire research.     

Patients' preferences in the treatment of depressive disorder in primary care

Patients' preferences in the treatment of depression are important in clinical practice and in research. Antidepressant medication is often prescribed, but adherence is low. This may be caused by patients preferring psychotherapy, which is often not available in primary care. In randomized clinical trials, patients' preferences may affect the external validity. The aim of this article is to study patients' preferences regarding psychotherapy and antidepressant medication and the impact of these preferences on treatment outcome. A systematic review of the literature was performed. The majority of patients preferred psychotherapy in all available studies. Antidepressants were often regarded as addictive and psychotherapy was assumed to solve the cause of depression. Discussing and supporting preferences as part of a quality improvement program of depression care, resulted in more patients receiving the treatment that was most suitable to them. In two patient-preference trials, preferences did not influence treatment outcome. It can be concluded that a substantial percentage of well-informed patients prefer psychotherapy. Patients with strong preferences, mostly for psychotherapy, are likely not to enter antidepressant treatment or randomized clinical trials if their preferences are not supported.     

The different kinds of group psychotherapy with patients with different diagnoses

Group psychotherapy is a treatment method in which in addition to the therapist(s) the participating individuals are, autocentrically, active in attaining a therapeutic effect. The different kinds of group psychotherapy are described: 1) activity group psychotherapy, 2) analytic group psychotherapy, 3) directive-suggestive-group psychotherapy, 4) psychodrama, 5) accelerating/focal methods of group psychotherapy. Group psychotherapeutic techniques with patients of different diagnoses are discussed, e.g. group psychotherapy with drug dependants and alcoholics, in which it is not possible to use a pure analytic method of group psychotherapy. Their oral tendencies and narcissistic desires of undergoing a fusion with the therapist have to a certain degree to be fulfilled. Schizophrenics should encounter in group psychotherapy an unconditioned emotional response from the therapist. These patients on the one hand expect to be understood in their psychotic experience, but on the other hand they seem to be glad when the measures of the outside reality are maintained in the group. The relatives of schizophrenics wanting to co-operate are taken in a parallel group. Depressives, especially endogenous depressives, need a longer time to be integrated in a therapeutic group than other patients, but if they can be integrated, it helps them to tolerate their sufferings. To the neurotics, group psychotherapy offers insight and a chance to “translate” this insight into a new social behaviour. Analytic self-experience groups with staff members give them an opportunity to recognise from their own experience the conflicts and the behaviour patterns from which their patients suffer.     

Treatment of depressive patients in private practice--empirical results, health political and social conditions and recommendations

Although depression and symptoms of depression belong to the most common disorders in private practice, affected patients are not always diagnosed as early as possible in Germany and often not sufficiently treated. In order to improve the care for persons with depression it is necessary that family doctors are prepared to guide these patients with empathy, treat them adequately pharmacologically both in respect to the depression and to all other somatic aspects and to refer them in time to specialists for psychiatry, psychosomatic medicine or psychotherapy. Political and social conditions that have pathogenic effects should be changed and the shortage of psychotherapy needs to be overcome. In future, the integrated care in ambulant and clinical settings will probably be successful, first trials and test setups have shown good results.     

Predicting Psychotherapy Utilization for Patients With Borderline Personality Disorder

The purpose of this study was to create hypotheses that would serve as predicting variables in the planning of psychotherapeutic treatment for patients with borderline personality disorder (BPD). Twenty psychiatric inpatients were treated with psychoanalytically oriented psychotherapy for 6 weeks with the aim of clarifying, planning, and preparing them for outpatient psychotherapy. The authors investigated anxiety, aggression, interpersonal problems, and self-concept before and after inpatient treatment. Nine patients engaged in further outpatient psychotherapy. Significant predictors for engaging in further treatment were female gender, strong subjective perception of interpersonal problems, and generalized negative self-concept of own capacities. High reactive readiness for aggression and thorough conviction of self-efficacy had predictive value for nonengagement in further psychotherapy. Correlations between aggression and increased capability of one's self and severe interpersonal problems were found only in psychotherapy nonusers. Results emphasize the importance of acknowledging mechanisms of destruction, attachment, and mentalization in initial psychotherapy planning.     

Inter-session-processes

We do not know much about how patients internalize, remember or use psychotherapeutic experiences between psychotherapy sessions and how they use them for change. What happens with in-session-experiences after a session ("inter-session-process") is of main importance for outcome. The inter-session-process describes the work on psychotherapy between sessions. Although inter-session-processes are a central element connecting psychotherapy process and outcome, they remain a neglected area of research. Previous studies examined individual outpatient settings only. This paper gives an overview over theory, instruments for measurement, previous studies and relevance of inter-session-processes for the field of psychotherapy research.     

Geburt, Tod und Wiedergeburt des Dodo-Vogels: Mythen der Psychotherapie und Psychotherapieforschung

Many of the psychotherapy schools' theoretical assumptions haved turned out to be myths because psychotherapy research has not been able to confirm them. However, research has also established clear evidence for the efficacy of psychotherapy. Thus, research is not questioning the relevance of psychotherapy but rather the widespread assumptions about the mode of its functioning. The validity of the so-called dodo-bird verdict is controversial. According to the dodo-bird verdict, the most important psychotherapy schools have a similar efficacy. Many of the current research results suggest that a medical model is not appropriate to explain psychotherapy's mode of functioning. According to this model, psychotherapy is effective as a result of a specific therapeutic procedure which is matched to the patient's mental problems. In contrast, a model is indicated in which psychotherapy is conceived as a process of social influencing.     

Effectiveness of Different Psychotherapy Approaches in the Treatment of Borderline Personality Disorder

Recent clinical trials support the conclusion that patients with borderline personality disorder are best treated with structured and specifically designed forms of psychotherapy. The strongest evidence from clinical trials favors dialectical behavior therapy and mentalization-based treatment. These methods, which have several similarities, could be shortened to make them more accessible. Successful psychotherapy in individuals with borderline personality disorder should not resemble treatment as usual but should offer a predictable structure and methods to promote emotion regulation and problem solving in current life.     

And if that doesn't work, what next ...? A study of treatment failures in schizophrenia.

A systematic study of schizophrenic patients who did not respond satisfactorily to one of five different forms of treatment given under controlled conditions showed that almost all of them responded satisfactorily to subsequent treatment with the combination of ataraxic drugs and group psychotherapy. Whatever the original form of treatment, and despite subsequent retreatment with drugs and group psychotherapy, there was a treatment-resistant core--a few patients who either responded very slowly or who improved relatively little.     

Brief Psychotherapy of a Grief Reaction*

A patient suffering from a grief reaction treated by brief psychotherapy is described. Several factors contributed to her grief, among them termination with her former psychotherapist without sufficient working through of this separation. The nature of the brief psychotherapy is outlined as well as a follow-up interview by an independent observer.     

Religious psychotherapy as management of bereavement

This study was aimed at determining the effect of psychotherapy in patients in bereavement. Fifteen patients in a control group were given brief psychotherapy and 15 study group patients received psychotherapy with a religious perspective. The patients in the study group showed consistently significant improvements as compared with the control group at the end of 6 months. The results indicate that highly religious patients with grief and bereavement tend to improve faster when a religious psychotherapy is added to a cognitive-behaviour approach.     

A Common Factors Approach to Psychotherapy With Chronically Suicidal Patients: Wrestling With the Angel of Death

Objective: Conducting psychotherapy with chronically suicidal patients challenges clinical decision making and emotional self-management in both trainees and seasoned practitioners. Educators and trainees have noted the need for additional teaching materials in these areas. This article is intended to address these needs. Methods: We review the literature on evidence-based, suicide-oriented psychotherapies; consider commonalities among them; and integrate these findings with observations and suggestions from older professional literature and anecdotal clinical wisdom. Results: Based on these sources, we describe a common factors–based approach for clinicians undertaking the ongoing psychotherapy of chronically suicidal patients, to be practiced within a comprehensive treatment framework that addresses safety planning as well as multimodal interventions including psychosocial and biological approaches. We discuss initial considerations; a checklist of motivations, coping styles, defenses, existential, spiritual, and religious issues, attachments and relationships to be explored in delineating directions to be undertaken in psychotherapy; technical issues for ongoing psychotherapy; perspectives that have been helpful for patients; and coping strategies for countertransference management. Conclusions: Patients are best served by clinicians who focus on the alliance, actively engage chronically suicidal patients and their families, directly confront warning signs, routinely address the many psychological issues mentioned, and carefully attend to their own countertransference reactions and capacities for emotional regulation. Using these strategies, techniques, and tactics, clinicians are better equipped to help chronically suicidal patients reduce suicide-related ideations, plans, and attempts, and, perhaps, completed suicides.     

Psychotherapy clients as human phenomena

In this article, clients of psychotherapy are viewed as human phenomena. Viewing them as such reestablishes the true subject matter of psychotherapy. The psychotherapy project includes understanding as opposed to explanation, as one of its essential components. As psychotherapists engage in understanding their clients, they find themselves focusing on subjectivity and interiority, both their clients' and their own. Viewing psychotherapy clients as human phenomena to be understood, in contrast to viewing them as cases to be explained, shifts the therapist's focus to a more complex and interpersonally engaged process, which includes the therapist's interior life as well as the client's. Phenomenology provides the means for articulating the true subject matter of psychotherapy, and shifts the focus from a medical model approach to a human science approach.     

Psychotherapy of the psychosomatic patient.

The role of psychotherapy for psychosomatic patients is reviewed. Barriers to treatment, including special characteristics of these patients that make them poor candidates for traditional psychodynamic interventions, are discussed with implications for practice. Clinical recommendations encompass two broad preparatory phases: I, the health alliance, and II, the life alliance.     

Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression

The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only.     

Review of Self-disclosure in psychotherapy

Reviews the book, Self-disclosure in psychotherapy by Barry A. Farber (see record 2006-11792-000). At one point or another, most therapists have wondered how much their patients are telling them and wrestled with how much they should reveal themselves to their patients. This book aims to provide an integrative and up-to-date review of the literature that has addressed these kinds of questions. By looking at patient, therapist, supervisee, and supervisor self-disclosure, Farber attempts to show both common and unique aspects of self-disclosure across the different parties involved in psychotherapy. Work from historical, clinical, research, and cultural perspectives comes together to provide readers with a multifaceted view of self-disclosure in psychotherapy. This book will be of interest to therapists, researchers, psychotherapy supervisors, and therapists-in-training. Farber's discussion of self-disclosure offers a nuanced perspective on the dilemmas involved in the psychotherapy process. By highlighting the features of self-disclosure across patients, therapists, supervisees, and supervisors, Farber enriches understanding of the phenomenon and encourages empathy for the perspectives of those in other psychotherapy roles. We believe that Farber has successfully synthesized work from various perspectives to create an illuminating review of self-disclosure in psychotherapy. The book condenses a broad range of literature into clearly organized and digestible chapters. The integration of research and theory with clinical vignettes, quotations from books and movies, and popular song lyrics make this work an unusually engaging and accessible read. (PsycINFO Database Record (c) 2010 APA, all rights reserved).