This study is the first report examining the relationship between pretreatment expectancy and treatment outcome in Osage Native Americans receiving mental health services. Results reveal that in Native American participants, high expectations for advice and approval in therapy may lead to poor treatment outcomes. Conversely, low expectancies may be risk factors for poor outcomes among White American individuals. Therefore, practitioners should consider client race during assessment and appropriately address problematic pretreatment expectancies to prevent poor treatment outcome. Given the differences in direction of effects between races, it may be best to increase advice and approval of therapeutic roles when working with Native American clients; whereas, it may be best to increase pretreatment expectancies with White American clients. Results are particularly notable given that Native American clients are pervasively under-researched and under-served.
Empirical evidence on whether patients' mental health and functioning will be more improved after long-term than short-term therapy is scarce. We addressed this question in a clinical trial with a long follow-up.
In the Helsinki Psychotherapy Study, 326 out-patients with mood or anxiety disorder were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT) and were followed for 10 years. The outcome measures were psychiatric symptoms, work ability, personality and social functioning, need for treatment, and remission.
At the end of the follow-up, altogether 74% of the patients were free from clinically elevated psychiatric symptoms. Compared with SPP, LPP showed greater reductions in symptoms, greater improvement in work ability and higher remission rates. A similar difference in symptoms and work ability was observed in comparison with SFT after adjustment for violations of treatment standards. No notable differences in effectiveness between SFT and SPP were observed. The prevalence of auxiliary treatment was relatively high, 47% in SFT, 58% in SPP and 33% in LPP, and, accordingly, the remission rates for general symptoms were 55, 45 and 62%, respectively.
After 10 years of follow-up, the benefits of LPP in comparison with the short-term therapies are rather small, though significant in symptoms and work ability, possibly due to more frequent use of auxiliary therapy in the short-term therapy groups. Further studies should focus on the choice of optimal length of therapy and the selection of factors predicting outcome of short- v. long-term therapy.
Although the efficacy of clinical hypnosis is well documented, its implementation in clinical practice is far from completed and there are few reports of systematic, professional training. This article gives a historical overview and description of a 1-year training program in clinical hypnosis which started in Norway in 2008 and has been held yearly since then. We describe the present education course with respect to aims, conceptual framework, structure, target groups, teaching themes, and experiences. The following factors have been considered of importance for the success of this program: The extent and duration of the course, the focus on demonstrations, experiential skill-building and exercises, and that the education is rooted in acknowledged clinical, academic, and educational environments. The participants' evaluations tell stories of mastery and positive experiences with hypnosis as a therapeutic tool in their clinical practice. However, many struggle to understand the various concepts of hypnosis, trance, and suggestions. Some find it hard to get started and challenging to integrate hypnosis in their clinical practice. Finally, some report scarce opportunities to apply their newly acquired skills at their work places and limited support by their leaders. The development of systematic, professional training programs as described in this article may be of importance for further implementation. However, this will also require that clinicians and leaders in universities and professional environments, and policymakers at higher levels, recognize clinical hypnosis as a valid and efficient choice of treatment. This must be reflected in dedicated efforts to ensure successful implementation in practice.
Negotiations about problem definitions are a crucial part of psychotherapeutic and counselling work. In a conversation with a psychotherapist or a counsellor, the client's initial description of his or her trouble is transformed into an expert-informed problem formulation. This study aims to explicate how reasoning about troubles and life difficulties in a dialogue with a psychotherapist may be grounded in cultural knowledge about ageing.
We draw upon ethnomethodology, and particularly on conversation analysis and membership categorisation analysis, to describe how age identities can be invoked in reasoning about explanations and solutions of psychological problems. The data consist of telephone conversations between a psychotherapist and people seeking help for their life difficulties on a Swedish radio programme.
Our analysis shows how references to callers' age were used to position the callers as members of stage-of-life categories, in order to invoke expectations tied to the categories. The callers' positions in the life course served as an interpretative resource for negotiating understanding of the callers' troubles, and suggesting a normative description of their life situations.
This study explicates in interactional detail the interpretative use of cultural common-sense knowledge about the life course in the context of the specific institutional tasks of radio counselling.
Online therapies are partly automated therapies, in which psychotherapeutic contents have been complemented with computer-aided presentational and educational contents, with a therapist giving support to the progress of the patient. As methods, these therapeutic programs incorporate therapeutic methods that have proven effective, such as remodeling of thoughts, activation of behavior and exposure, empathy, strengthening of cooperative relationship and motivation, and general support for self-reflection. For instance, online therapies already constitute part of the Finnish treatment guidelines on depression. Online therapies are available throughout Finland for the essential psychiatric illnesses.
Little research has been done on therapeutic alliance in group psychotherapy, especially the impact of treatment duration and therapist professional characteristics.
Therapeutic alliance was rated by patients on the Working Alliance Inventory-Short Form at three time points (sessions 3, 10 and 17) in a randomized controlled trial of short-term and long-term psychodynamic group psychotherapy. As predictors we selected therapist clinical experience and length of didactic training, which have demonstrated ambiguous results in previous research. Linear latent variable growth curve models (structural equation modeling) were developed for the three Working Alliance Inventory-Short Form subscales bond, task and goal.
We found a significant variance in individual growth curves (intercepts and slopes) but no differential development due to group length. Longer therapist formal training had a negative impact on early values of subscale task in both treatments. There was an interaction between length of the therapists' clinical experience and group length on early bond, task and goal: therapists with longer clinical experience were rated lower on initial bond in the long-term group but less so in the short-term group. Longer clinical experience influenced initial task and goal positively in the short-term group but was unimportant for task or significantly negative for goal in the long-term group.
There was no mean development of alliance, and group length did not differentially impact the alliance during 6 months. Early ratings of the three Working Alliance Inventory-Short Form subscales partly reflected different preparations of patients in the two group formats, partly therapist characteristics, but more research is needed to see how these aspects impact alliance development and outcome. Therapists should pay attention to all three aspects of the alliance, when they prepare patients for group therapy.
In psychodynamic groups, length of therapy does not differentiate the overall level or the development of member-leader alliance. Within psychodynamic groups, each individual appear to have their unique perception of the member-leader alliance. Therapists with longer formal psychotherapy training may be less successful in establishing early agreement with patients on the tasks of psychodynamic group psychotherapy. Patients perceive a somewhat lower degree of early emotional bonding with the more clinically experienced therapists in long-term psychodynamics groups. Therapists with more clinical experience may contribute to a stronger degree of initial agreement with patients on the tasks and goals of short-term group psychotherapy.
The purpose of this study is to assess the relative effectiveness of Interpersonal Psychotherapy (IPT), Psychoeducative Group Therapy (PeGT), and treatment as usual (TAU) for patients with Major Depressive Disorder (MDD) in municipal psychiatric secondary care in one Finnish region.
All adult patients (N?=?1515) with MDD symptoms referred to secondary care in 2004-2006 were screened. Eligible, consenting patients were assigned randomly to 10-week IPT (N?=?46), PeGT (N?=?42), or TAU (N?=?46) treatment arms. Antidepressant pharmacotherapy among study participants was evaluated. The Hamilton Depression Rating scale (HAM-D) was the primary outcome measure. Assessment occurred at 1, 5, 3, 6, and 12 months. Actual amount of therapists' labor was also evaluated. All statistical analyses were performed with R software.
All three treatment cells showed marked improvement at 12-month follow-up. At 3 months, 42 % in IPT, 61 % in PeGT, and 42 % in TAU showed a mean =50 % in HAM-D improvement; after 12 months, these values were 61 %, 76 %, and 68 %. Concomitant medication and limited sample size minimized between-treatment differences. Statistically significant differences emerged only between PeGT and TAU favoring PeGT. Secondary outcome measures (CGI-s and SOFAS) showed parallel results.
All three treatments notably benefited highly comorbid MDD patients in a public sector secondary care unit.
ClinicalTrials.gov NCT02314767 (09.12.2014).
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This study investigated changes in trainees' self-rated experience as a therapist over the course of one practicum treatment case in basic psychotherapy education in Sweden. Undergraduate students (n = 76) provided longitudinal information on their healing involvement and stressful work involvement. The results of the Development of Psychotherapists Common Core Questionnaire (DPCCQ) demonstrated that trainees' basic relational skills, technical skills, perceived difficulties, and constructive coping strategies changed linearly, with an increasing slope. Technical expertise changed the most, and relational skills developed moderately. In-session feelings of anxiety and boredom did not change. The individualized reliable change scores show that the process during training is different for different students. Most students did not change at all, and some students even changed negatively. Investigation of how pedagogic variables affect therapists' development is necessary to support the professional growth of trainees in their involvement with different types of psychotherapy.
This is a short article on the history and training standards in the Institute of Group Analysis in Copenhagen (IGA-CPH). We describe theoretical orientations and influences in the long-term training program and new initiatives, like courses in mentalization-based group treatment and a dynamic short-term group therapy course, as well as research in group psychotherapy in Denmark. Some group analytic initiatives in relation to social issues and social welfare are presented, as well as initiatives concerning the school system and unemployment.
This article describes the development of group psychotherapy in Finland as a treatment in the 1950s, 1960s, and 1970s. Different theoretical preferences split the training programs into two; both are now trying to survive in a psychotherapeutically changing landscape. All training programs have been transferred to the universities, but a lack of interest in, and knowledge about, group psychotherapy has resulted in fewer students choosing this program. This may result, in the future, in even less knowledge of, and research in, group dynamics in Finland.