Therapist Affect Focus and Patient Outcomes in Psychodynamic Psychotherapy: A Meta-Analysis

Diener, Marc J.; Hilsenroth, Mark J.; Weinberger, Joel

doi:10.1176/ajp.2007.164.6.936

Cited by 177 publications

(137 citation statements)

References 37 publications

(36 reference statements)

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“…Neurosciences significantly highlighted how relational our mind is [150] and that human beings are wired to be social [151]. Initial findings showed that shared emotions can synchronize brain activity [152]: from a meta-analytic studies of dynamic psychotherapies we now know that they are effective in several mental disorders [153] and that the more they consider affective and emotional aspects the more effective they are [154]. …”

Section: Discussionmentioning

confidence: 99%

Resistance to treatment and change in anorexia nervosa: a clinical overview

et al. 2013

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BackgroundCurrent literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN – with an in-depth investigation of resistance-related psychological factors.A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered.DiscussionThe selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists’ countertransference.SummaryRemarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.

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Section: Discussionmentioning

confidence: 99%

Resistance to treatment and change in anorexia nervosa: a clinical overview

et al. 2013

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“…In‐session emotional arousal and processing may be a key mechanism of change across therapy models and disorders (Greenberg & Pascual‐leone, ; Solbakken, Hansen, & Monsen, ; Whelton, ). For example, a number of process‐outcome studies have indicated that the degree of in‐session emotional activation is related to outcome in psychodynamic therapies (e.g., Diener, Hilsenroth, & Weinberger, ; Fisher, Atzil‐slonim, Bar‐Kalifa, Rafaeli, & Peri, ; Town, Lomax, Abbass, & Hardy, ; Town, Salvadori, Falkenstrom, Bradley, & Hardy, in press), as well as in emotion‐focused therapy (Goldman, Greenberg, & Pos, ; Pos, Greenberg, Goldman, & Korman, ). Previous research on ISTDP has also indicated that a high degree of MUCE in treatment (i.e., an “unlocking of the unconscious”) is associated with better outcome in mixed patient samples (Johansson, Town, & Abbass, ; Town, Abbass, & Bernier, ).…”

Section: Introductionmentioning

confidence: 99%

Intensive Short‐Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process‐outcome study

Lilliengren

Town

Kisely

et al. 2017

Clin Psychology and Psychoth

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The objective of this study was to evaluate the clinical- and cost-effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for generalized anxiety disorder (GAD). We further aimed to examine if a key clinical process within the ISTDP framework, termed the level of mobilization of unprocessed complex emotions (MUCE), was related to outcome. The sample consisted of 215 adult patients (60.9% female) with GAD and comorbid conditions treated in a tertiary mental health outpatient setting. The patients were provided an average of 8.3 sessions of ISTDP delivered by 38 therapists. The level of MUCE in treatment was assessed from videotaped sessions by a rater blind to treatment outcome. Year-by-year healthcare costs were derived independently from government databases. Multilevel growth models indicated significant decreases in psychiatric symptoms and interpersonal problems during treatment. These gains were corroborated by reductions in healthcare costs that continued for 4 years post-treatment reaching normal population means. Further, we found that the in-treatment level of MUCE was associated with larger treatment effects, underlining the significance of emotional experiencing and processing in the treatment of GAD. We conclude that ISTDP appears to reduce symptoms and costs associated with GAD and that the ISTDP framework may be useful for understanding key therapeutic processes in this challenging clinical population. Controlled studies of ISTDP for GAD are warranted.

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“…Individuals with higher QOR may enter treatment with expectations of being responded to in a reasonable manner, thus deriving less of a corrective relational experience and perhaps utilizing other aspects of the program-such as insight (Jennissen, Huber, Ehrenthal, Schauenburg, & Dinger, 2018), affect (Diener, Hilsenroth, & Weinberger, 2007), or social rehabilitation activities (Korostiy, Kozhyna, & Zelenskaya, 2013) to foster more adaptive self-appraisals. These patients, whose lifelong relational patterns were relatively more coherent and stable, fared just as well as low-QOR patients in self-esteem improvement over the course of treatment.…”

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confidence: 99%

Improving self‐esteem through integrative group therapy for personality dysfunction: Investigating the role of the therapeutic alliance and quality of object relations

et al. 2019

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Objective We aimed to investigate change in self‐esteem through intensive group treatment for personality dysfunction, by exploring: (a) the relationship between patients’ experience of therapeutic alliance and improvement in self‐esteem during treatment, including patients’ quality of object‐relations (QOR) as a possible moderator; and (b) the association between improvement in self‐esteem during treatment, and depressive symptoms 9 months later. Method Eighty patients with personality dysfunction, consecutively enrolled in a group‐oriented treatment program, were assessed at pretreatment, posttreatment, and 9 months follow‐up. Results Especially for patients with lower QOR, alliance predicted self‐esteem change during treatment. In addition, change in self‐esteem during treatment predicted follow‐up depression severity, even when controlling for within‐treatment symptom change. Conclusions Patients with impoverished inner relational representations may benefit more from a secure alliance in terms of improving their self‐esteem. Change in self‐esteem may also be important in preventing relapse of depressive symptoms in people with personality dysfunction.

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Therapist Affect Focus and Patient Outcomes in Psychodynamic Psychotherapy: A Meta-Analysis

Cited by 177 publications

References 37 publications

Resistance to treatment and change in anorexia nervosa: a clinical overview

Resistance to treatment and change in anorexia nervosa: a clinical overview

Intensive Short‐Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process‐outcome study

Improving self‐esteem through integrative group therapy for personality dysfunction: Investigating the role of the therapeutic alliance and quality of object relations

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