A training outline for conducting psychotherapy process ratings: An example using therapist technique

Stein, Michelle B.; Pesale, Frank P.; Slavin, Jenelle M.; Hilsenroth, Mark J.

doi:10.1080/14733140903229457

Cited by 28 publications

(35 citation statements)

References 34 publications

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“…The reliability and clinical validity of the CPPS has been well established (Hilsenroth, Ackerman, & Blagys, 2001 & Cromer, 2007;Hilsenroth et al, 2006;Thompson-Brenner & Westen, 2005;Westen, Novotny, & Thompson-Brenner, 2004). We have previously reported (Hilsenroth et al, 2005;Stein, Pesale, Slavin, & Hilsenroth, 2010) on the excellent inter-rater reliability and internal consistency of the CPPS, as well as significant results on several separate reliability and validity analyses conducted across several different contexts and samples. The CPPS data we utilized in the current study were derived from these reports, have followed procedures detailed there and were rated by trained external raters who have demonstrated the ability to reliably rate these individual techniques in a good (ICC 0.60-0.74;Fleiss, 1981) to excellent range (ICC 0.75;Fleiss, 1981).…”

Section: Social Cognition and Object Relations Scalementioning

confidence: 86%

Relationship Between Patient Pre‐treatment Object Relations Functioning and Psychodynamic Techniques Early in Treatment

Mullin

Hilsenroth

2012

Clin Psychology and Psychoth

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Consider more frequent use of psychodynamic techniques early in treatment with patients expressing more pathological object representations, particularly when these deficits are in the affective and identity domains. Lower patient object relations functioning may necessitate an in session focus on issues that are avoided or uncomfortable early in treatment. Lower patient object relations functioning may necessitate the need to address and explore labile affective expressions in session as they occur early in treatment. When patients are able to more adaptively express or manage aggressive impulses early within psychodynamic psychotherapy consider the integration of problem solving, goal oriented, future focused (i.e., CB) techniques.

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Section: Social Cognition and Object Relations Scalementioning

confidence: 86%

Relationship Between Patient Pre‐treatment Object Relations Functioning and Psychodynamic Techniques Early in Treatment

Mullin

Hilsenroth

2012

Clin Psychology and Psychoth

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“…Regular reliability meetings were held during the coding process to prevent rater drift (for a more detailed description of this rater training process, see Stein et al, 2010). Immediately after viewing a videotaped session, the judges independently completed the CPPS.…”

Section: Treatment Fidelity: Cppsmentioning

confidence: 99%

Psychodynamic Techniques Related to Outcome for Anxiety Disorder Patients at Different Points in Treatment

Pitman

Slavin-Mulford

Hilsenroth

2014

Journal of Nervous &Amp; Mental Disease

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Although psychodynamic therapy has a well-articulated model of therapeutic change for anxiety, few empirical studies have examined specific treatment interventions related to symptom improvement. We examined the degree of adherence to a psychodynamic model of therapy (Blagys and Hilsenroth [Clin Psychol 7:167-188, 2000) related to changes in anxiety symptoms across early treatment process. Secondary analyses also examined the use of specific psychodynamic techniques across early treatment process in relation to symptom change. The current study sought to extend the findings of , who found a relationship between the use of psychodynamic techniques in the third session (independent clinical ratings) and reduction in anxiety symptoms at posttreatment (r = 0.46, p = 0.04). Using the same sample of anxiety disorder patients (N = 20), we found a significant relationship between psychodynamic technique and posttreatment change in anxiety symptoms at the ninth session (r = 0.49, p = 0.03) and the mean levels of psychodynamic technique across both third and ninth sessions (r = 0.53, p = 0.02). In addition, specific psychodynamic techniques demonstrated significant relationships or moderate to large effects with posttreatment changes in anxiety symptoms at the third and ninth sessions as well as mean ratings across early treatment (third and ninth sessions). These findings indicate that therapist focus on cyclical intrapersonal patterns in patient actions, feelings, or experience as well as suggestions of alternative ways to understand these experiences or events not previously recognized by the patient (i.e., interpretation) in the early treatment process were particularly helpful in reducing posttreatment anxiety symptoms. Clinical implications and areas for future research will be discussed.

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“…82,83 Inter-rater reliability is reported as rating from good to excellent [intraclass correlation coefficient (ICC) 0.60-0.75]. 83,84 In the current study, the CPPS was used to assess treatment fidelity for the CBT and STPP arms of the study and to assess treatment differentiation between all three treatment modalities used in IMPACT. Overall, a CBT session was judged to be 'adherent' if the total mean score for items on the cognitive-behavioural subscale of the CPPS was ≥ 2, for which a mean score of 2 indicates that the use of cognitive-behavioural techniques was 'somewhat characteristic' of a session.…”

Section: Instruments Comparative Psychotherapy Process Scale -Externamentioning

confidence: 99%

Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

Goodyer

Reynolds

Barrett

et al. 2017

Health Technol Assess

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BackgroundAlthough there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years.ObjectiveTo determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment.DesignObserver-blind, parallel-group, pragmatic superiority randomised controlled trial.SettingA total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London.ParticipantsAdolescents aged 11–17 years withDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses.InterventionsIn total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up.Main outcome measuresMean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation.ResultsThere were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104;p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126;p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome.ConclusionsThe three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings.LimitationsNeither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data.Trial registrationCurrent Controlled Trials ISRCTN83033550.FundingThis project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit toThe Lancet.

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A training outline for conducting psychotherapy process ratings: An example using therapist technique

Cited by 28 publications

References 34 publications

Relationship Between Patient Pre‐treatment Object Relations Functioning and Psychodynamic Techniques Early in Treatment

Relationship Between Patient Pre‐treatment Object Relations Functioning and Psychodynamic Techniques Early in Treatment

Psychodynamic Techniques Related to Outcome for Anxiety Disorder Patients at Different Points in Treatment

Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

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