Therapists’ therapies: The relation between training therapy and patient change in long-term psychotherapy and psychoanalysis

Abstract

Patients’ development across stages in long-term psychodynamic psychotherapy or psychoanalysis was studied in relation to various parameters of their therapists’ training, or personal, therapies. The change variable was symptom distress, the General Symptom Index, according to the Symptom Checklist-90. A series of latent class regression analyses revealed that one class of therapists (16% of the sample) whose patients had the least change in treatment, and in fact had nonsignificant deterioration, was significantly overrepresented by psychotherapists with long psychoanalyses for their training therapies. Alternative interpretations of the findings are discussed.

Zusammenfassung

Die Therapien der Therapeuten: Die Beziehung zwischen Therapeutentraining und der Veränderungen der Patienten bei Langzeitpsychotherapie und Psychoanalyse

Entwicklung der Patienten in verschiedenen Stadien von Langzeittherapie oder Psychoanalyse wurde in Beziehung gesetzt zu verschiedenen Parametern der Ausbildung ihrer Therapeuten bzw. deren persönlicher Therapien. Die Veränderungsvariable war der Symptomstress entsprechend dem allgemeinen Symptomindex nach der Symptomcheckliste-90. Eine Reihe von Regression Analysen mit latenten Klassen zeigte eine Klasse von Therapeuten auf (16% der Stichprobe), deren Patienten die geringsten Veränderungen aber auch keine Verschlechterung aufwiesen. In dieser Klasse waren Psychotherapeuten mit langen Lehranalysen überrepräsentiert. Es werden auch alternative Interpretationen dieser Ergebnisse diskutiert.

Résumé

Les thérapies des thérapeutes?: la relation entre la thérapie didactique et le changement chez le patient dans la psychothérapie et psychanalyse de longue durée

Le développement des patients à travers les phases de psychothérapies psychodynamiques ou de psychanalyses de longue durée était étudié en relation à divers paramètres de la thérapie personnelle ou didactique de leurs thérapeutes. La variable de changement était la détresse symptomatique, le General Symptom Index selon la Symptom Checklist-90. Une série d'analyses par la régression par classe latente a révélé qu'une classe de thérapeutes (16% de l’échantillon) dont les patients avaient changé le moins voire se détérioraient de façon non significative était surreprésentée de façon significative par des psychothérapeutes ayant eu de longues psychanalyses comme thérapies didactiques. Des interprétations alternatives des résultats sont discutées.

Resumen

Terapia de terapeutas. La relación entre el tratamiento didáctico y el cambio del paciente en psicoterapia y psicoanálisis a largo plazo

Se estudió el desarrollo de los pacientes a través de etapas en psicoterapia psicodinámica o psicoanálisis a largo plazo, en relación con diversos parámetros del entrenamiento de sus terapeutas o terapias personales. La variable de cambio fue un síntoma de distrés, del ïndice General de Síntomas, de acuerdo con el Symptom Checklist-90. Una serie de análisis de regresión de clase latente reveló que una clase de terapeutas (16% de la muestra), cuyos pacientes habían experimentado el cambio menor en el tratamiento y que, de hecho, no tuvieron deterioro significativo, estuvo significativamente sobrerrepresentada por psicoterapias con psicoanálisis largos en sus terapias didácticas. Se debate sobre interpretaciones alternativas de los hallazgos.

Resumo

As terapias dos terapêutas: A relação entre terapia de treino e a mudança do paciente em psicoterapia de longo prazo e psicanálise

Foi estudada a relação entre o desenvolvimento dos pacientes ao longo dos estádios da psicoterapia psicodinâmica de longo prazo ou psicanálise e os vários parâmetros da terapia, de treino ou pessoal, dos seus terapeutas. A variável de mudança foi a sintomatologia psicopatológica, o Índice de Perturbação Geral da Lista de Sintomas de Derrogatis (SCL-90). Uma série de análises de regressão ( La Lent Class Regression) revelou que um grupo de terapeutas (16% da amostra), cujos pacientes tiveram as menores mudanças no tratamento e sem deterioração significativa, estava significativamente sobre-representados por psicoterapeutas com longa experiência de psicanálise para as suas terapias de treino. Serão discutidas interpretações alternativas para os resultados.

     

A 5-year retrospective study of survival of zirconia single crowns fitted in a private clinical setting

ObjectivesThe aim of this report was to evaluate the 5-year clinical performance and survival of zirconia (NobelProcera?) single crowns.MethodsAll patients treated with porcelain-veneered zirconia single crowns in a private practice during the period October 2004 to November 2005 were included. The records were scrutinized for clinical data. Information was available for 162 patients and 205 crowns.ResultsMost crowns (78%) were placed on premolars and molars. Out of the 143 crowns that were followed for 5 years, 126 (88%) did not have any complications. Of those with complications, the most common were: extraction of abutment tooth (7; 3%), loss of retention (15; 7%), need of endodontic treatment (9; 4%) and porcelain veneer fracture (6; 3%). No zirconia cores fractured. In total 19 restorations (9%) were recorded as failures: abutment tooth extraction (7), remake of crown due to lost retention (6), veneer fracture (4), persistent pain (1) and caries (1). The 5-year cumulative survival rate (CSR) was 88.8%.ConclusionsAccording to the present 5-year results zirconia crowns (NobelProcera?) are a promising prosthodontic alternative also in the premolar and molar regions. Out of the 143 crowns followed for 5 years, 126 (88%) did not have any complications. However, 9% of the restorations were judged as failures. Further studies are necessary to evaluate the long-term success.     

Rapid Restoration of Vascularity and Oxygenation in Mouse and Human Islets Transplanted to Omentum May Contribute to Their Superior Function Compared to Intraportally Transplanted Islets

Transplantation of islets into the liver confers several site‐specific challenges, including a delayed vascularization and prevailing hypoxia. The greater omentum has in several experimental studies been suggested as an alternative implantation site for clinical use, but there has been no direct functional comparison to the liver. In this experimental study in mice, we characterized the engraftment of mouse and human islets in the omentum and compared engraftment and functional outcome with those in the intraportal site. The vascularization and innervation of the islets transplanted into the omentum were restored within the first month by paralleled ingrowth of capillaries and nerves. The hypoxic conditions in the islets early posttransplantation were transient and restricted to the first days. Newly formed blood vessels were fully functional, and the blood perfusion and oxygenation of the islets became similar to that of endogenous islets. Furthermore, islet grafts in the omentum showed at 1 month posttransplantation functional superiority to intraportally transplanted grafts. We conclude that in contrast to the liver the omentum provides excellent engraftment conditions for transplanted islets. Future studies in humans will be of great interest to investigate the capability of this site to also harbor larger grafts without interfering with islet functionality.     

The presence of inhibitory RNA elements in the late 3'-untranslated region is a conserved property of human papillomaviruses

Here we have tested the inhibitory activity of the late untranslated region (UTR) of nine different human papillomavirus (HPV) types representing three different genera and six different species. These HPVs include both low-risk and high-risk types. We found that the late UTR of the various HPVs all displayed inhibitory activity, although they inhibited gene expression to various extent. The late UTR from the two distantly related HPV types 1 and 16, which are two different species that belong to different genera, each interacted with a 55 kDa protein. This protein cross-linked specifically to both HPV-1 and HPV-16 late UTR, although it bound more strongly to HPV-16 than to HPV-1, which correlated with the higher inhibitory activity of the HPV-16 late UTR. Mutagenesis experiments revealed that inactivation of two UGUUUGU motifs in the HPV-16 late UTR or two UAUUUAU motifs in the HPV-1 late UTR resulted in loss of binding of p55. In summary, these results demonstrate that the presence inhibitory elements encoding PuU(3-5)Pu-motifs in the HPV late UTR is a conserved property of different HPV types, species and genera, and suggest that these elements play an important role in the viral life cycle.     

Central concepts in the midwife-woman relationship

The relationship between the midwife and the woman is essential for a positive experience for woman during childbearing period, i.e. pregnancy, childbirth and the first postpartum phase. Thereby, the aim of this study was to delineate central concepts in the midwife-woman relationship, in normal as well as high-risk situations. A secondary analysis was performed on original texts from eight Swedish qualitative studies, all with a phenomenological or phenomenological-hermeneutic approach. Six pairs of concepts were elucidated; each one describing one aspect from the woman's perspective and one responsive aspect from the midwife. The pairs of concepts are: surrender-availability, trust-mediation of trust, participation-mutuality, loneliness-confirmation, differenceness-support uniqueness and creation of meaning-support meaningfulness. Disciplinary concepts about the midwife-woman relationship have evolved that are essential for care in both normal and high-risk contexts, and we suggest that they should be implemented as a guide for midwifery care.     

Soluble TNF Receptors and Kidney Dysfunction in the Elderly

The importance of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in the development of kidney disease is being unraveled. Yet, community-based data regarding the role of sTNFRs are lacking. We assessed serum sTNFRs and aspects of kidney damage cross-sectionally in two independent community-based cohorts of elderly participants: Prospective Investigation of the Vasculature in Uppsala Seniors (n=815; mean age, 75 years; 51% women) and Uppsala Longitudinal Study of Adult Men (n=778; mean age, 78 years). Serum sTNFR1 correlated substantially with different aspects of kidney pathology in the Uppsala Longitudinal Study of Adult Men cohort (R=−0.52 for estimated GFR, R=0.22 for urinary albumin-to-creatinine ratio, and R=0.17 for urinary kidney injury molecule-1; P<0.001 for all), with similar correlations in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort. These associations remained significant after adjustment for age, sex, inflammatory markers, and cardiovascular risk factors and were also evident in participants without diabetes. Serum sTNFR2 was associated with all three markers in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort (P<0.001 for all). Our findings from two independent community-based cohorts confirm and extend results of previous studies supporting circulating sTNFRs as relevant biomarkers for kidney damage and dysfunction in elderly individuals, even in the absence of diabetes.     

The Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS) Questionnaire: item reduction and further validation

Purpose

The Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS) Questionnaire is a patient and parent-completed disease-specific instrument used in Hunter syndrome (mucopolysaccharidosis II), a rare paediatric progressive multi-systemic lysosomal storage disease. The objective of this study was to shorten the number of items of the Questionnaire to reduce response burden while maintaining its content validity.

Methods

Data collected in a clinical trial were used. An iterative process helped identifying redundant or low performing items based on content validity and psychometric properties. Validation on the retained items was assessed using patients and parent’s responses in terms of reliability, validity and responsiveness.

Results

The HS-FOCUS was completed by 49 patients and 84 parents. Items were mainly removed owing to high floor effects, high inter-item correlations (>0.80) or inadequate content. The shortened patient and parent versions (18 and 21 items) each contained five function domains. Internal consistency and test–retest reliability were >0.70 for most domains, except Breathing and School/work. Concurrent validity was demonstrated by significant correlations (>0.30) with similar concepts of previously validated measures. Significant differences were found in all domain scores across levels of disability.

Conclusions

The shortened HS-FOCUS is a reliable, valid and responsive measure, where burden in answering the Questionnaire was reduced without compromising its validity.