The role of stigma during the course of inpatient psychotherapeutic treatment in a German sample

A, Deres; Bürkner, Paul‐Christian; Klauke, Benedikt; Buhlmann, Ulrike

doi:10.1002/cpp.2423

Cited by 7 publications

(5 citation statements)

References 37 publications

(59 reference statements)

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“…Our findings replicate and extend prior research (Deres et al, 2020; Owen et al, 2013; Wade et al, 2011) by demonstrating that the self-stigma associated with seeking psychological help is related to worsened perceptions of the therapist–client working alliance. However, they are inconsistent with those reported by Kendra et al (2014), who found that within-person increases in self-stigma were associated with a stronger working alliance.…”

Section: Discussionsupporting

confidence: 87%

“…This self-stigma is positively associated with the self-stigma of seeking help, but also a distinct construct and less prominent barrier to care (Tucker et al, 2013). In one study, Deres et al (2020) found that self-stigma predicted a worse working alliance at the subsequent session among 60 inpatient clients. Although data were longitudinal, analyses did not disaggregate the predictor variable (i.e., self-stigma) into between- and within-person effects, thus confounding the appropriate interpretation of study findings; doing so enables researchers to ask for whom (i.e., between person, time-invariant) and under what conditions (i.e., within person, session-by-session changes) self-stigma predicts alliance ratings (Curran & Bauer, 2011; Hoffman, 2015).…”

Section: Overview Of the Present Studymentioning

confidence: 99%

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Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

Seidman¹,

Vogel²,

Lannin³

2023

Psychotherapy

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The self-stigma (i.e., shame) associated with psychotherapy is a prominent barrier to seeking psychological help, but less is known about its effects after treatment begins. Evidence suggests that self-stigma may interfere with the formation of the therapeutic alliance, but no studies have examined this throughout the course of psychotherapy. Self-stigma's erosion of the alliance may be most pronounced when clients experience heightened psychological distress, but this also has not been examined. Therefore, the present study addresses these omissions among 37 clients who completed at least three therapy sessions for research credit. Participants completed measures of self-stigma and past-week symptoms of distress before each session and ratings of the working alliance after. Predictor variables were disaggregated into betweenperson (time-invariant or average levels) and within-person (time-variant or session-by-session changes) components to enable investigation of for whom (and under what conditions) self-stigma was associated with the therapeutic alliance. Results indicated that higher levels of self-stigma (between and within persons) predicted a worse alliance. When examined as an interaction effect alongside distress in a multilevel moderation model, higher between-person ratings of self-stigma predicted a weaker therapistclient alliance across levels (M ± 1 SD) of within-person distress. Notably, its effects became more pronounced as symptoms of distress increased, indicating a period in which clients are simultaneously most likely to need help yet least likely to feel allied with their therapist. Findings highlight the importance for therapists to simultaneously monitor and consider both average and session-by-session fluctuations in selfstigma and distress to develop and maintain the working alliance. Clinical Impact StatementQuestion: (a) Does the self-stigma of seeking psychotherapy, when considered at between-(i.e., timeinvariant, or average levels) and within-person levels (i.e., time-variant, or session-by-session fluctuations), interfere with the therapy process by damaging the therapist-client working alliance? (b) Is this relationship moderated by fluctuations in past-week symptoms of psychological distress? Findings: (a) Heightened self-stigma (between and within persons) predicts lower ratings of the alliance. (b) There is a cross-level moderation effect: higher between-person ratings of self-stigma predict a weaker alliance across levels (M ± 1 SD) of within-person distress; its adverse effects are exacerbated as, session-by-session, clients experience heightened symptomatology. Meaning: The effects of self-stigma interfere with the working alliance and do not disappear "at the therapy door." To develop and maintain the alliance, it appears important for therapists to consider self-stigma and distress as both trait-and state-like components. Next Steps: Future research is needed to examine the interactional effects between self-stigma and psychological distress among diverse clinical population...

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Section: Discussionsupporting

confidence: 87%

Section: Overview Of the Present Studymentioning

confidence: 99%

Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

Seidman¹,

Vogel²,

Lannin³

2023

Psychotherapy

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“…Fourth, the EFA (Study 2) extracted factors aligned with a priori theoretical assumptions and replicated empirical findings of psychotherapy effects and outcomes (e.g. Deres et al 2020;Flückiger et al 2018;Norcross and Lambert 2018), lending credibility to their content.…”

Section: Discussionmentioning

confidence: 63%

“…Deres et al. 2020; Flückiger et al. 2018; Norcross and Lambert 2018), lending credibility to their content.…”

Section: Discussionmentioning

confidence: 90%

A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences

Dandachi‐FitzGerald,

Houben,

Broers

et al. 2024

Clin Psychology and Psychoth

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BackgroundClients' adverse experiences during psychotherapy are rarely monitored in clinical practice or research trials. One obstacle here is the lack of a measure to gauge both positive and negative experiences during psychotherapy. We developed and evaluated a new instrument for measuring such experiences.MethodThe Positive and Negative Experiences of Psychotherapy (PNEP) questionnaire was developed based on pilot data, a literature review, and two existing scales for measuring primarily adverse experiences during psychotherapy. Mental healthcare clients (N = 200) anonymously completed and evaluated the PNEP. Subsequently, a sample of professionals (N = 34) who underwent psychotherapy in the context of their training filled in the PNEP twice, with a 2‐week interval in between.ResultsThe positive and negative experiences subscales of the PNEP were found to possess excellent internal consistencies (αs ≥ 0.90). The PNEP test–retest reliability was 0.93 for the positive experiences subscale and 0.78 for the negative experiences subscale. For the positive subscale, four factors were extracted: symptom reduction and positive well‐being, high quality of therapy and therapeutic relation, personal growth and acceptance and interpersonal functioning. For the negative subscale, exploratory factor analysis suggested a three‐factor solution: escalation of symptoms and emotional distress, low quality of therapy and therapeutic relation and (self‐)stigmatization and dependency. Participants related a median of 13 positive and six negative therapy experiences to their most recent treatment. The most frequently endorsed negative experiences were having more negative thoughts and memories, feeling emotionally overwhelmed and an increase in stress due to the therapy. A minority of participants (10.5%) reported no negative treatment experiences.ConclusionsIn the field of psychotherapy, the evaluation of risks and benefits is crucial for assessing safety and effectiveness. The PNEP could be a promising instrument for achieving this objective, although further research is needed to replicate and expand upon the current findings.

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“…If research does support this as a fruitful avenue for positive help-seeking behavior, mental health providers might be able to assist patients who are hospitalized to deal with public stigma by preparing them for discrimination from others (e.g., people disassociating from them, employment difficulties) and finding people or groups who are supportive, regardless of the hospitalization. We also note a continued need for self-stigma reduction interventions, as self-stigma remains a prevalent concern (e.g., Mathison, 2019) and interferes with inpatient treatment process and outcome (Deres et al, 2020; Ociskova et al, 2018).…”

Section: Discussionmentioning

confidence: 95%

A heavier burden of stigma? Comparing outpatient and inpatient help-seeking stigma.

Mathison¹,

Seidman²,

Brenner³

et al. 2024

Stigma and Health

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Although research on the stigma associated with mental health care has grown substantially in the last decade, most of this work focuses on outpatient treatment; recent research on the stigma associated with inpatient treatment is strikingly absent. In this study, we examined the stigma of seeking professional psychological help from outpatient and inpatient treatment settings. College students (N = 350) at a large, Midwestern university completed three commonly used mental health stigma scales which we modified to reflect either outpatient stigma or inpatient stigma. Overall, participants’ ratings on inpatient and outpatient stigma were significantly different (partial η2 = .39). Compared to outpatient treatment, participants reported significantly greater public stigma and self-stigma associated with inpatient treatment (partial η2 = .14 and .16, respectively) as well as poorer attitudes about inpatient treatment (partial η2 = .36). Path analysis with bias-corrected bootstrapping indicated that the relationships between inpatient and outpatient public stigma with their respective attitudes toward seeking treatment were partially mediated by their respective self-stigmas. This differs slightly from previous findings demonstrating support for full mediation. Research and clinical implications are discussed.

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The role of stigma during the course of inpatient psychotherapeutic treatment in a German sample

Cited by 7 publications

References 37 publications

Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

Examining between- and within-person effects of the self-stigma of seeking psychological help on the therapeutic working alliance: The moderating role of psychological distress.

A Scale for Measuring Positive and Negative Experiences of Psychotherapy (PNEP): First Psychometric Findings of a New Instrument for Monitoring Clients' Experiences

A heavier burden of stigma? Comparing outpatient and inpatient help-seeking stigma.

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