Reawakening Reflective Capacity in the Psychotherapy of Schizophrenia: A Case Study

Disturbed sense of self has long been identified as a common experience among people suffering with schizophrenia. More recently, metacognitive deficits have been found to be a stable and independent feature of schizophrenia that contributes to disturbed self‐experience and impedes recovery. Individual psychotherapy designed to target poor metacognition has been shown to promote a more coherent sense of self and enhanced recovery in people with schizophrenia. We provide a report of a 2‐year individual psychotherapy with a patient suffering with chronic schizophrenia. Progress was assessed over the course of treatment using the Metacognition Assessment Scale and the Brief Psychiatric Rating Scale. The patient experienced improved metacognitive capacity and reduced symptom severity over the course of therapy. Implications for clinical practice are discussed.     

Integrative Psychotherapy for Schizophrenia: Its Potential for a Central Role in Recovery Oriented Treatment

Research has affirmed that recovery from serious mental illnesses (SMI), such as schizophrenia, is a common outcome and often involves subjective changes in the experience of self, one's identity, and one's sense of agency in the world. Although many different interventions have been developed and validated, efforts to consider how those interventions should be integrated to assist people to direct their own recovery have been limited. This article considers the 5 case reports of psychotherapy presented in this special issue that have sought to integrate scientifically valid approaches within a recovery frame work. Exploring shared themes, this article suggests that a common set of processes exists between these examples of integrative work. These include therapist acceptance of a vulnerable stance in the face of uncertainty, which rejects stigma and remains open to knowing the person. This ultimately allows the kinds of meaning to be made jointly between the therapist and client that promote recovery.     

An Integrative Psychotherapy Approach to Foster Community Engagement and Rehabilitation in Schizophrenia: A Case Study Illustration

This case study illustrates the use of a long‐term integrative psychotherapy approach with a middle‐ aged man with chronic schizophrenia and a mood disorder. The case of “Holst” describes a man with a history of insecure attachment and trauma who later went on to contract a serious chronic illness, precipitating the onset of psychotic symptoms, depression, and chronic suicidal ideation, resulting in multiple hospitalizations. Combining metacognition‐oriented therapy with elements of cognitive behavioral therapy and psychiatric rehabilitation, this approach fostered significantly improved community functioning and attainment of personal goals over time. Through the journey of therapy, the patient also developed a more coherent narrative about his life, established a stable sense of self, and became an active agent in the world. This case illustration demonstrates that these three different approaches can be used in a sequential and complementary fashion to foster recovery in the midst of serious physical and mental illness.     

Interpersonal Psychotherapy for Depression: Overview, Clinical Efficacy, and Future Directions

In this report we review the history of the development of interpersonal psychotherapy (IPT) and the content of this intervention in both its acute and maintenance treatment forms. We trace its theoretical bases to the therapeutic traditions established by Adolf Meyer and Harry Stack Sullivan, as well as to the attachment theory of Bowlby. We examine its empirical foundation in studies linking change in the social environment to the onset and maintenance of major depression. We describe two acute treatment studies of IPT, each of which suggests that short-term IPT is equivalent in efficacy to well-controlled pharmacotherapy. Two of the prophylactic studies suggest that IPT Is superior to a no-treatment or medication clinic and placebo approach in the prevention of new episodes. In examining flow IPT exerts its affect, we first consider studies of process and then studies of process as it relates to outcome. Finally, we make suggestions for future directions in research on IPT of depression.     

The Role of the Allegiance Effect in Psychotherapy Research: Controlling and Accounting for It

The allegiance effect is by now a well-established phenomenon in psychotherapy research. It is of interest both because of its potential for contaminating between-group comparisons and because no definitive explanation for it has been generally accepted by the field. This commentary underscores the need to control for allegiance effects but also speculates on ways to account for it. Because of difficulties in eliminating the allegiance effect, we might consider it a phenomenon worthy of study in its own right, so we can at least understand it.     

The ongoing rewriting of the therapeutic contract in Metacognitive Interpersonal Therapy for narcissistic personality disorder: The case of Mark

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.     

集体心理治疗对缓解期精神分裂症患者认知功能的影响

目的探讨集体心理治疗对缓解期精神分裂症患者认知功能改善的作用。方法将60例经急性期治疗后的精神分裂症患者随机分为研究组及对照组,对照组实行常规治疗,包括药物治疗及一般工娱疗。研究组在此基础上辅以集体心理治疗。治疗前后分别应用韦氏成人智力量表(WAIS)、威斯康星卡片法分类测验(WCST)及临床记忆量表评分。结果治疗后两组WAIS、WCST及临床记忆量表评分较治疗前有明显改善(t=2.861～4.953,P<0.05或P<0.01)。其中以联合集体心理治疗的联想学习、记忆商数、WCST正确百分数和随机错误数成绩较常规治疗为好(t=3.651～5.214,P<0.01)。结论集体心理治疗对精神分裂症患者认知功能的改善有积极意义。     

团体心理治疗对缓解期精神分裂症认知功能的作用

目的 探讨团体心理治疗对缓解期精神分裂症认知功能改善的作用.方法 将60例经急性期治疗后的精神分裂症患者随机分为研究组和对照组,对照组实行常规治疗,包括药物治疗及一般工娱治疗.研究组在此基础上辅以团体心理治疗.治疗前后分别应用韦氏成人智力量表(WAIS)、威斯康星卡分类测验(WCST)及临床记忆量表评分.结果 治疗后两组WAIS、WCST及临床记忆量表评分较治疗前有明显改善(t=3.20,P＜0.05).其中以联合团体心理治疗的联想学习、记忆商数、WCST正确百分数和随机错误数成绩较常规治疗为好.结论 团体心理治疗对精神分裂症认知功能的改善有积极作用.     

Metacognitive Reflective and Insight Therapy for People in Early Phase of a Schizophrenia Spectrum Disorder

Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal‐directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges.     

集体心理治疗对精神分裂症缓解期记忆功能的影响

目的探讨集体心理治疗对缓解期精神分裂症记忆功能改善的作用。方法将60例经急性期治疗后的精神分裂症患者随机分为研究组及对照组,对照组实行常规治疗,包括药物治疗及一般工娱疗;研究组在此基础上辅以集体心理治疗。治疗前后分别应用W A IS、W CST及临床记忆量表评分。结果治疗后两组W A IS、W CST及临床记忆量表评分较治疗前有明显改善(t=2.563～4.256,P<0.05)。其中以联合集体心理治疗的联想学习、记忆商数、W CST正确百分数和随机错误数成绩较常规治疗为好。结论集体心理治疗对精神分裂症记忆功能的改善有积极意义。     

团体心理治疗对康复期精神分裂症患者临床效果的影响

目的 探讨团体心理治疗对康复期精神分裂症患者的应用效果。方法 选择我院精神科2016年7月~2018年7月收治的90例康复期精神分裂症患者,随机为对照组与心理组,各45例。给予对照组患者常规心理干预,心理组患者给予团体心理治疗干预,比较两组患者简明精神病量表（BPRS）与住院精神病人康复疗效评定量表（IPROS）评分。结果 干预后,心理组的BPRS评分为（11.34±1.18）分,低于对照组的（18.26±2.26）分,差异有统计学意义（P＜0.05）;心理组IPROS评分为（25.57±1.58）分,低于对照组的（32.39±2.76）分,差异有统计学意义（P＜0.05）。结论 团体心理治疗可有效缓解康复期精神分裂症患者的精神症状,提高其社会功能,临床应用效果较好。     

人际心理治疗与认知行为治疗对广泛性焦虑障碍治疗效果的对照研究

目的:探讨人际心理治疗与认知行为治疗对广泛性焦虑障碍的疗效。方法:将90例广泛性焦虑障碍患者随机分为人际心理治疗组(IPT)和认知行为治疗组(CBT)各45例,疗程为12周,分别于治疗前后采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评定临床疗效。结果:治疗后,两组的HAMA、HAMD评分都明显低于治疗前(如HAMAt=9.97,11.41;P均0.01);治疗后CBT组的睡眠障碍因子分差值低于IPT组(t=2.34,P0.05),两组间其余因子分差值无显著性差异(如HAMAt=-0.51,P0.05)。结论:人际心理治疗与认知行为治疗对广泛性焦虑障碍均有疗效,认知行为治疗在改善睡眠障碍方面要优于人际心理治疗。     

The Training Value of the Psychodynamic Psychotherapy Long Case: A Psychiatry Trainee's Perspective

In order to fully satisfy eligibility criteria for membership of the Royal College of Psychiatrists, trainees must demonstrate satisfactory attainment of competencies in psychotherapy. Evidence required includes a Psychotherapy ‘ACE’ (assessment of clinical expertise) and completion of two psychotherapy cases in two modalities. With training posts in the Yorkshire deanery becoming European Working Time Directive compliant, a trainee gains less experience in their actual clinical post. Therefore, what benefit could a trainee derive from further time away from their posts in order to gain experience in a subspecialty that very few of us will pursue long‐term? I have conducted a 40‐week period of psychodynamic psychotherapy. I also received weekly supervision sessions with an experienced therapist. I will reflect on my positive experiences completing a psychodynamic long case and describe how the skills I have developed are transferable to most aspects of practice. The role of the psychiatrist within the NHS is continually being redefined. The Department of Health's New Ways of Working initiative may result in fleeting patient contact, which may not be conducive to in‐depth psychodynamic work. I would suggest that, at this uncertain time, psychiatrists might wish to push for further involvement with psychotherapy. The first step in this process is to ensure that all psychiatric trainees are adequately trained in psychotherapy. Efforts should be made to ensure that, as working hours become more unpredictable, psychiatric trainees are afforded protected time slots in order to complete psychotherapy training.     

Emotion and Emotion Regulation: A Map for Psychotherapy Researchers

Never before has the pace of research on emotion and emotion regulation been as vigorous as it is today. This news is welcomed by researchers who study psychological therapies and who believe that emotion and emotion regulation processes are fundamental to normal and abnormal functioning. However, one unwelcome consequence of this otherwise happy state of affairs is that therapy researchers now face an array of bewildering decisions about what to measure and why. What is needed is a map that will help researchers make wise decisions in this domain. In this spirit, we locate Sloan and Kring's (2007) important review of available emotion and emotion regulation measures within the wider field of affective constructs and the broader problem space of psychotherapy research. Where appropriate, we illustrate our points with examples from our own work, and highlight the payoffs and challenges of integrating affective and clinical science.     

The Efficacy of Group Psychotherapy for Depression: A Meta-analysis and Review of the Empirical Research

We conducted a meta-analysis of 48 research reports on the efficacy of group therapy for depression. In 15 studies in which treated participants were compared to untreated controls, the average effect size was 1.03, suggesting that the average treated participant was better off than about 85% of the untreated participants. Analyses of clinically significant change suggested that treated participants improved substantially. However, even after treatment, participants still had pronounced depressive symptomatology relative to normative levels of depressive symptoms seen in non-depressed individuals. We conclude that group therapy is an efficacious treatment for depressed patients. However, numerous questions remain unanswered. For example, little empirical work has investigated what advantages group therapy might have over individual therapy. We conclude by making recommendations for future research in this area.