Clinical Psychology and Psychotherapy
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Emotion‐focused therapy (EFT) has increasingly made use of case conceptualization. The current paper presents a development in the case conceptualization approach of EFT. It takes inspiration from recent research on emotion transformation in EFT. The case conceptualization presented here can guide the therapist in listening to the client's narrative and in observing the client's emotional presentation in sessions. Through observing regularities, the therapist can tentatively determine core emotion schemes' organizations, triggers that bring about the emotional pain, the client's self‐treatment that contributes to the pain, the fear of emotional pain that drives avoidance and emotional interruption strategies. The framework recognizes global distress, into which the client falls, as a result of his or her inability to process the underlying pain, the underlying core pain and the unmet needs embedded in it. This conceptual framework then informs therapists as to which self‐organizations (compassion and protective anger based) have to be facilitated to respond to the pain and unmet needs, so that they might transform it. The conceptual framework can guide the therapist's thinking/perceptions and actions in the session. Copyright © 2014 John Wiley & Sons, Ltd.
Therapists can better facilitate emotional transformation when they understand the dynamics involved in the client's distress. Emotion transformation is facilitated by first helping the client to access the core underlying painful feelings and unmet needs embedded in them and then by helping the client to generate adaptive emotional responses to those unmet needs.
Compassionate mind training (CMT) was developed for people with high shame and self‐criticism, whose problems tend to be chronic, and who find self‐warmth and self‐acceptance difficult and/or frightening. This paper offers a short overview of the role of shame and self‐criticism in psychological difficulties, the importance of considering different types of affect system (activating versus soothing) and the theory and therapy process of CMT. The paper explores patient acceptability, understanding, abilities to utilize and practice compassion focused processes and the effectiveness of CMT from an uncontrolled trial. Six patients attending a cognitive–behavioural‐based day centre for chronic difficulties completed 12 two‐hour sessions in compassionate mind training. They were advised that this was part of a research programme to look at the process and effectiveness of CMT and to become active collaborators, advising the researchers on what was helpful and what was not. Results showed significant reductions in depression, anxiety, self‐criticism, shame, inferiority and submissive behaviour. There was also a significant increase in the participants' ability to be self‐soothing and focus on feelings of warmth and reassurance for the self. Compassionate mind training may be a useful addition for some patients with chronic difficulties, especially those from traumatic backgrounds, who may lack a sense of inner warmth or abilities to be self‐soothing. Copyright © 2006 John Wiley & Sons, Ltd.
The objective of this research was to study the relation between the processing and recall of information in major depressive disorder. An autobiographical memory task was applied to 42 subjects with a diagnosis of major depressive disorder, 28 subjects with a diagnosis of panic disorder and 51 subjects without any psychological disorder. We used clinical scales for the evaluation of depression and anxiety. The results of the three groups, and both assessment periods of depressed subjects, were compared. The results indicate the existence, in severely depressed subjects, of a bias in processing and recalling negative information. We associate this situation to the existence of negative contents in self‐schemas and processing and recall of information consistent with these schema contents. Based on the obtained results, we consider that the onset and maintenance of depression is more related to the information encoding and recall processes, controlled by the self's negative schemas, than with negative thoughts. Copyright © 2011 John Wiley & Sons, Ltd.
The fact that depressed individuals predominantly recall categorical memories should alert therapists to their presence and the difficulties associated with eliciting specific memories. The importance of insisting upon a greater memory specificity as a means to interrupt the depressive bias and the importance of categorical memories as a possible diagnostic tool of severity of depression should be taken into consideration. A greater focus upon positive memories should be beneficial in therapy. An evaluation of the recall characteristics of autobiographical memories in depressed and panic patients allows for their use in the therapeutic process, in terms of the activation of such memories and the associations that can be fostered by the therapist. The relation between early maladaptive schemas and autobiographical memories allows for a clarification of such schemas in therapy by means of the autobiographical memories recalled. In a therapeutic setting, a relation can be established between autobiographical memories, attachment styles and interpersonal relations patterns, concerning panic and depressed patients.
This qualitative study explored the process of help‐seeking and therapy among clients with religious or spiritual beliefs. Ten clients who were currently in, or had recently finished, therapy were interviewed. Participants reported using their religious or spiritual beliefs to cope with their psychological problems before and during therapy. Prior to therapy, they were worried that secular‐based help might weaken their faith. However, the experience of having psychological distress and the process of receiving therapy were both perceived as strengthening to faith and ultimately part of a spiritual journey. Contrary to expectations, a match between the spirituality or religious affiliation of the therapist and client was not considered important. This implies that the ‘religiosity gap’ between secular therapists and clients with religious/spiritual beliefs is bridgeable. Copyright © 2007 John Wiley & Sons, Ltd.
Despite the prevalence of mental health problems in later life, older people markedly underutilize mental health services. A greater awareness of factors influencing older peoples' attitudes to mental illness may therefore improve awareness and treatment of mental disorders in this population. A mixed methodology approach was used to explore and compare older peoples' attitudes to mental illness in a sample of clinical and non‐clinical participants. Results indicated that, similar to younger people, older people endorsed a range of positive and negative attitudes to mental illness. However, when attitudes to mental illness were considered within the context of ageing and experience a more complex pattern of results emerged. Although negative attitudes to mental illness were associated with negative attitudes to ageing across the entire sample, clinical participants (and those with prior experience of mental illness) reported more positive attitudes to mental illness and more negative attitudes to ageing than non‐clinical participants, for whom the reverse was true. Attitudes were also differentially related to health behaviour outcomes. Results suggest that attitudes to mental illness and ageing may be linked and mediated by personal experience and capacity for psychological self‐regulation in the face of age‐associated adversity. Copyright © 2009 John Wiley & Sons, Ltd.
The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive–behavioural treatment (CBT) manual were tested.
Thirty‐eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24‐session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV and the structured clinical interview for DSM‐IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory—short form.
The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence.
Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd.
Patients' behavioural resistance to therapy may make it more difficult for cognitive–behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult, although whether this is true varies across therapists. Therapists' adherence to a structured protocol and borrowing from outside of the CBT model do not appear to be affected by disorder severity or Axis I comorbidity.
The objective of the present study was to construct and validate a short‐form version of the Self‐Compassion Scale (SCS). Two Dutch samples were used to construct and cross‐validate the factorial structure of a 12‐item Self‐Compassion Scale–Short Form (SCS–SF). The SCS‐SF was then validated in a third, English sample. The SCS–SF demonstrated adequate internal consistency (Cronbach's alpha ≥ 0.86 in all samples) and a near‐perfect correlation with the long form SCS (
• The 12‐item Self‐Compassion Scale–Short Form (SCS–SF) in Dutch and English offers an economical alternative to the long Self‐Compassion Scale (SCS) to measure self‐compassion. Although the original long form of the SCS is reduced to half, the SCS–SF is reliable and has the same factorial structure as the original scale.
The objective of the study was to assess the reliability and validity of a retrospective self‐report measure of potential traumatic experiences among psychiatric outpatients. The range of evaluated experiences includes emotional neglect and abuse. Participants completed the Traumatic Experiences Checklist (TEC) (
Psychotherapy patients who experience large, stable symptomatic improvement between sessions are more likely than those without such sudden gains to benefit from treatment. However, there is limited empirical basis for the definition of sudden gains, and it is unclear how they may affect symptomatic change at other points in treatment.
In a psychotherapy training clinic, 149 adults completed a distress measure at each session. For each criterion in the definition of sudden gains, we evaluated the prediction of outcome, possible moderating variables, local score instability, and multisession change before and after score shifts.
Large intersession improvement did not lead to increased rate of change later in treatment, but it did predict outcome, regardless of whether nearby session scores were stable. Early improvement during the first five treatment sessions was an independent predictor of outcome. Large intersession improvement generally occurred in the context of local score instability.
Sudden gains appear to predict outcome because of improvement inherent in the gains themselves. Early overall improvement predicts outcome almost as effectively as do sudden gains. There may be advantages to redefining sudden gains as large intersession improvement, regardless of local score stability.
We examined the role of baseline patient characteristics as predictors of outcome (end‐state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio‐demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self‐esteem, shame, interpersonal problems and attachment style) were analysed.
Data came from the CT arm of a multicentre RCT with
Up to 37% of the post‐treatment variance (LSAS) could be explained by all pre‐treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end‐state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end‐state functioning and response, but not with remission. Self‐esteem was positively associated with higher end‐state functioning and more shame with better response. Attrition could not be significantly predicted.
The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical‐based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level.
Personality, self‐esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively. Beyond these two factors, most patients share a similar likelihood of treatment success when treated according to the manual by Clark and Wells.
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